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Med Surg 1 > MED surg1 > Flashcards

MED surg1 Flashcards

1
Q

Acute pain responses

A

Increased HR, Increased BP, Increased RR, dilated pupils, sweating

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2
Q

Assessing pain approach. (PQRSTU)

A

Precipitating or palliative, Quality or quantity, region or radiation, severity scale, timing, understudying

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3
Q

Caused by damage to somatic or visceral tissue, activating peripheral —–; GENERALLY responsive to NSAIDs and opioids

A

Nociceptive Pain

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4
Q

Type of pain; deep, aching, throbbing, well localized; arises from bone, joint, muscle, skin, or CT

A

Somatic Pain

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5
Q

Type of pain; from stimuli such as tumor involvement or obstruction; arises from internal organs

A

Visceral Pain

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6
Q

Type of pain; caused by damage to peripheral nerves or CNS, results in abnormal processing of stimuli; burning, numbing, shooting, stabbing, or itchy sensation

A

Neuropathic Pain

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7
Q

What are the 3 drug groups?

A

Non-opioids, opioids, adjuvants

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8
Q

Used for mild pain; acetaminophen, aspirin, NSAIDs; lack of ability to produce tolerance or dependence, available without prescription

A

Non-Opioids

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9
Q

Common side effects of NSAIDs

A

Bleeding tendencies, GI ulcers and bleeding, renal and CNS dysfunction

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10
Q

Strongest analgesics, inhibit transmission of nociceptive input from periphery to CNS; pure agonists; morphine (MS contin), oxycodone (Oxycontin), methadone, codeine. Used for mod-severe pain

A

Opioids

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11
Q

Common side effects of Opioids

A

sedation, respiratory depression, constipation, nausea, vomiting, pruritus

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12
Q

used for antidepressants, anticonvulsants, alpha-adrenergic agonists, corticosteriods (neuropathic pain)

A

Adjuvants

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13
Q

Level 1 (1-3)

A

Use non-opioids

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14
Q

Level 2 (4-6)

A

Use weak opioids alone or with adjuvant

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15
Q

Level 3 (7-10)

A

Use strong opioids

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16
Q

4,500-11,000/mm3

A

Leukocytes (WBCs)

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17
Q

3 Granulocytes

A

Neutrophils, Eosinophils, Basophils

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18
Q

3 Agranulocytes

A

Lymphocytes, Monocytes, Bands or stabs

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19
Q

Positively charged CATIONS from ECF (3)

A

Sodium, calcium, magnesium

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20
Q

Negatively charged ANIONS from ECF (2)

A

Chloride, Bicarbonate

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21
Q

135-145 mEq/L

A

Sodium

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22
Q

3.5-5.5 mEq/L

A

Potassium

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23
Q

8.5-10.5 mg/dL

A

Calcium

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24
Q

3-4.5mg/dL

A

Phosphorus

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25
Q

1.6-2.6mg/dL

A

Magnesium

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26
Q

Helps regulate osmolarity, maintains concentration and volume of ECF, generation and transmission of nerve impulses, acid-base balance, regulates water balance (water follows this)

A

Sodium

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27
Q

Hyponatremia is less than? caused by? watch for?

A

Less than 135
Causes: Increased loss of sodium, too much water
Watch: mental status changes and seizures (below 125); do not correct too quickly (brain damage)

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28
Q

Hypernatremia is more than? causes? give what?

A

Above 145
Causes: diabetes insipidus, low water intake or excessive loss of water
Give: hypotonic fluids, oral care important (dry mouth)

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29
Q

Transmission and conduction of nerve impulses, normal cardiac rhythms, skeletal and smooth muscle contraction, metabolic functions, acid-base balance

A

Potassium

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30
Q

Hypokalemia is less than? results in? watch for? treatment?

RESPIRATORY ALKALOSIS via hyperventilation

A

less than 3.5
Results: severe vomiting, diarrhea, arrhthmias, tachy, thready pulse
Watch: ECG changes
Tx: IV (MUST DILUTE)

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31
Q

Hyperkalemia is more than? causes? tx?

A

Above 5.5
Causes: Kidney impairment, METABOLIC ACIDOSIS, muscle twitching, low BP, dysrhythmias, abdominal cramping, diarrhea
Tx: Kayexalate (secreted in stool), IV insulin, dialysis if high

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32
Q

Transmission of nerve impulses, myocardial contractions, blood clotting, forming teeth and bone, muscle contractions- most found in skeletal system

A

Calcium

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33
Q

give patients their own blood through preoperative donation; typically coordinated in setting of a pre-arranged, elective surgery, when physician anticipates a need for post-operative blood transfusion

A

Autologous Blood

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34
Q

“donor directed”; blood source is from an individual designated by a patient or a patient’s family, who is interested in donating blood for the patient
-Bank blood: donated by general public

A

Donor Specific Blood

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35
Q

Used in a hemorrhage situation to replanish both the volume and the oxygen-carrying capacity of the circulatory system; treats decreased hemoglobin and hematocrit levels with hypovolemia

A

Whole blood

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36
Q

Given when decreased hemoglobin and hematocrit levels accompany a normal blood volume.

A

Packed red blood cells

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37
Q

For patients previously sensitized to transfusions. Blood is rinsed with a special solution that removes white blood cells and plasma proteins, thus decreasing the chance of a transfusion reaction. Typically contains approximately 250 mL of volume.

A

Washed packed red blood cells

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38
Q

Similar to PRBCs combined with the removal of approximately 95- 99% of the leukocytes. The removal of leukocytes helps to prevent a febrile reaction from leukocyte antibodies. Typically contains approximately 200 mL of volume.

A

Leukocyte-poor red blood cells

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39
Q

Universal Donor

A

O negative

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40
Q

Universal recipient

A

AB positive

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41
Q

Classic triad of chills, flank pain, and blood stained urine

A

Acute Hemolytic Reaction

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42
Q

Mild fever, jaundice and decreased post transfusion hematocrit

A

Delayed Hemolytic Reaction

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43
Q

Fever, chills, flushing, nausea most common type

A

Febrile non-hemolytic reaction

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44
Q

lack of fever, urticaria, dyspnea, chest tightness and hypotension, decreased oxygen saturation

A

Anaphylactic reaction

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45
Q

Fever or hypothermia, chills or rigors, abdominal pain, nausea

A

Bacterial Infection

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46
Q

concentrates intravascular space- water moves from inside to outside of cell (cell shrinks)

A

Hypertonic

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47
Q

dilutes intravascular space- water moves from outside to inside of cell (cell swells)
Isotonic: same osmotic pressure as plasma- no fluid shift

A

Hypotonic

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48
Q

Most physiologically adaptable fluid, no calories
To replace fluids in those who need electrolyte replacements- burn, surgery, and trauma patients, GI tract fluid losses, fistula drainage, metabolic acidosis

A

Lactated Ringer’s

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49
Q

volume expanders, longer duration than crystalloids (typically several days)
Treat hypoproteinemia and malnourished states

A

Colloids

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50
Q

Expensive
Contraindicated in severe anemia, heart failure, sensitivity
Withhold ACE inhibitors for 24 hours before administering

A

Albumin

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51
Q

nutritional support with glucose, protein, vitamins, electrolytes, elements, and sometimes fat

A

TPN: Total parenteral nutrition

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52
Q

Common symptoms of respiratory

A

dyspnea, cough, wheeze, chest pain

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53
Q

most important symptoms of respiratory insufficiency

A

Dyspnea

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54
Q

Chest pain- if respiratory

A

DOES NOT radiate, tenderness on palpation

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55
Q

Earliest sign of hypoxia

A

Mental status changes

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56
Q

Respiratory assessment

A

IPPA

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57
Q

7.35-7.45

A

pH

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58
Q

80-100

A

PaO2

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59
Q

35-45

A

PaCO2

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60
Q

22-26

A

HCO3

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61
Q

Low pH

A

Acidic

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62
Q

High pH

A

Basic

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63
Q

CO2 Below 35=? Above 45=?

A

Below 35=alkalotic

Above 45=acidic

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64
Q

HCO3 Below 22=? Above 26=?

A

Below 22=acidic

Above 26=alkalotic

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65
Q

Hyperventilating is blowing off CO2=

A

Alkalosis (less acid available)

66
Q

respiratory alkalosis=?

A

hyperventilation

67
Q

COPD (retain CO2)=

A

acidosis

68
Q

respiratory acidosis=

A

hypoventilation

69
Q

Respiratory system can change in – to –; metabolic system takes – to – to compensate

A

15-30min

hours- days

70
Q

common cold: spread by droplets or direct hand contact
Irritation/ sneezing/ nasal secretions, obstruction/ elevated temp/ malaise/ headache
More common in winter

A

Acute viral rhinitis

71
Q

Management of what?: rest, fluids, antihistamine/decongestant, antipyretics, analgesics
Avoid crowds, wash hands frequently, avoid hand to face contact, intranasal decongestant no more than 3 days

A

Acute viral rhinitis

72
Q

inflammation or hypertrophy of mucosa, secretion build up
Sinus pain/ headaches/ nasal drainage, obstruction/ congestion/ fever/ malaise
Management: control allergies/asthma, increase fluids, nasal irrigation
Antibiotics to treat infection if it persists longer than 7 days without treatment
1st choice- amoxicillin (10-14 days)
2nd choice- bactrim or erythromycin
Oral or topical decongestants, nasal corticosteroids, antihistamines

A

Sinusitis

73
Q

70% is viral
Scratchy throat, pain while swallowing, red and edematous pharynx
Management: increase fluid intake
Strep- antibiotics; candida- mycostatin (swish and swallow

A

Acute Pharyngitis

74
Q

complication of acute pharyngitis or acute tonsillitis
Tonsils enlarged, high fever, leukocytosis, “hot potato voice,” chills
Management: emergency tonsillectomy

A

Peritonsillar Abscess

75
Q

inflammation of larynx
Hoarseness, S&S of upper respiratory tract infection
Antibiotics if bacterial infection, voice rest, increase intake of cool liquids, use humidifier

A

Laryngitis

76
Q

nosebleed
Sneeze with mouth open, monitor respiratory status
Avoid vigorous nose blowing, lifting, strenuous activity, aspirin, and NSAIDs
Posterior nasal bleeding= emergency

A

Epistaxis

77
Q

on vocal cords from vocal abuse or irritation
Hoarseness
Voice rest and adequate hydration

A

Laryngeal polyps

78
Q

Acute or chronic infection of one or both lungs

High risk: very young, very old, immunocompromised

A

Pneumonia

79
Q

How to assess for pneumonia

A

Assessment: fever, chills, sweats, cough (with or without sputum), pleuritic chest pain, dyspnea, RR>20, temp>37.8 (100.0), tachycardia, crackles

80
Q

Prevention of pneumonia

A

Prevention: handwashing, balanced diet, rest, exercise, avoid smoking, good oral care, vaccines + incentive spirometry, coughing and deep breathing, ambulate, oral hygiene, adequate hydration, elevate head of bed 30-45 degrees with enteral feedings

81
Q

Risk factor in 80-90% of cases= smoking
90% originate from epithelium of bronchus
Takes 8-10 years for tumor to reach 1cm (smallest lesion detectable on x-ray)
Non-small cell lung cancer- 20%; small cell lung caner- 80%
Goals: effective breathing pattern, adequate airway clearance, adequate oxygenation of tissues, minimal to no pain, realistic attitude toward treatment and prognosis

A

Lung Cancer

82
Q

most common injury from blunt trauma (ribs 5-10 most common)
Pain during inspiration and coughing- does not take deep breaths so risk for atelectasis and pneumonia
Treatment: NSAIDs, opioids, nerve block agents

A

Fractured Ribs

83
Q

fracture of 2 or more ribs in 2 or more locations
Chest wall doesn’t provide structural support- crepitus near rib fractures
Prevents adequate ventilation of lung and increases work of breathing
Treatment: airway management, adequate ventilation, oxygen, pain control, reexpand lung

A

Flail Chest

84
Q

accumulation of fluid in alveoli and interstitial spaces of lungs
Complication of heart and lung diseases; left sided heart failure= most common cause
Emergency

A

Pulmonary edema

85
Q

chronic dilation of bronchioles (acquired or congenital)

Increased mucus formation, dyspnea, crackles at bases of lungs, hypoxemia, hemoptysis

A

Bronchiolectasis

86
Q

cavity in lung parenchyma containing purulent material; formed by necrosis of lung tissue
Oral care important

A

Lung abscess

87
Q

inhalation of fungal spores; not transmitted person to person
S&S similar to pneumonia
Treatment: oral antifungals, amphotericin B, IV fluconazole

A

Pulmonary fungal infections

88
Q

Chronic inflammatory disorder of airways; not a progressive disease
Wheezing, expiration may be prolonged, difficulty breathing, chest tightness, cough, tachycardia, cyanosis, hyperexpansion of thorax

A

Asthma

89
Q

Medications for asthma

A

start with SABA as needed for symptoms
SABA: short acting beta2-agonists- quick relief, not long term control
LABA: long acting beta2-agonists- not for acute symptoms or exacerbations
ICS: inhaled corticosteroid- long term therapy, daily, rinse mouth and spit after use
Oral systemic corticosteroid- acute exacerbations, not long term control

90
Q

Autosomal recessive
Chronic, progressive disease- moves from small to larger airways and leads to lung destruction
Affects exocrine mucus-producing glands (median survival age= 31)
Purulent secretions (bronchial plugging), inflammation (bronchial wall thickening), mucus dehydrated (air trapping and hyperinflation of lungs), productive cough, wheezing, dyspnea, recurrent infections, bronchiectasis (dilation and destruction), infiltrates, scarring on chest x-ray
Promote clearance of secretions, control lung infections, and provide adequate nutrition
Treatment: mucomyst; lung transplant only for advanced disease

A

Cystic Fibrosis

91
Q

Droplet contact and inhalation of aerosolized particles
Pneumonia is common complication
Increase fluid intake, good nutrition/ hand hygiene/ analgesic and antipyretics/ bedrest

A

Influenza

92
Q

amount myocardial fibers are stretched before contraction- determined by amount of volume at end of diastole

A

Preload

93
Q

amount of pressure ventricle must generate to push its contents into circulation
Ejection fraction: % of blood emptied from ventricle (60-70% normal)

A

Afterload

94
Q

Less than 200 mg/dL

A

Cholesterol (total)

95
Q

less than 100 mg/dL

A

LDL

96
Q

greater than 60 mg/dL

A

HDL

97
Q

less than 150 mg/dL

A

Triglycerides

98
Q

Male: 40-54%; Female: 38-47%

A

Hematocrit

99
Q

Male: 14-18 g/dL; Female: 12-16 g/dL

A

Hemoglobin

100
Q

150,000-300,000/ mcg

A

Platelets

101
Q

5,000-10,000 mcg

A

WBCs

102
Q

10-13.4 sec

A

PT

103
Q

60-70 sec

A

PTT

104
Q

30-40 sec

A

aPTT

105
Q

less than 2 (if not on warfarin)

A

INR

106
Q

fatty streaks of arterial wall progress to hard fatty plaques that narrow lumen

A

Atherosclerosis

107
Q

CAD risk factors

A

hyperlipidemia, hypertension, smoking, DM, obesity, sedentary lifestyle, male

108
Q

: ischemia due to coronary artery spasms

A

Prinzmetal’s variant

109
Q

Medications to prevent angina

A

nitrates, beta-blockers, calium channel blockers

110
Q

medications to precent MI and death

A

antiplatelets, ACE inhibitors, lipid lowering agents, aspirin helps relieve pain and thrombus formation

111
Q

performed during heart cath, stent used to keep vessel open and prevent re-stenosis, usually on long-term aspirin

A

Percutaneous transluminal coronary angioplasty (PTCA)

112
Q

Ranges from unstable angina to acute MI

Disruption of atherosclerotic plaque and formation of thrombus→ severe or complete obstruction of artery

A

acute coronary syndrome

113
Q

NSTEMI, unstable angina

A

Partially occluded

114
Q

STEMI

A

fully occluded

115
Q

Greatest danger period for sudden cardiac death?

A

24 hours after MI

116
Q

Treatment for MI: MONA

A

Morphine, oxygen, nitrate, aspirin

117
Q

Infection of inner layer of heart
Subacute: preexisting valve disease, caused by enterococci
Acute: healthy valves, rapid onset
Fever occurs in 90% of patients
Splinter hemorrhages in nail beds, petechiae, Osler’s nodes (fingers and toes), Janeway’s lesions (palms or soles), Roth’s spots, murmur, dyspnea on exertion, dysrhythmias, tachycardia, diaphoresis, positive blood cultures, increased ESR and cardiac enzymes
Antibiotics; accurate identification of infecting organism is key to successful treatment

A

Infective endocarditis

118
Q

inflammation of pericardial sac; cause usually unknown
Progressive severe chest pain (pleuritic in nature), pericardial friction rub
ECG abnormalities in 90% of patients

A

Acute Pericarditis

119
Q

accumulation of excess fluid in pericardium

A

Pericardial effusion

120
Q

develops as pericardial effusion increases in volume, increasing pressure on heart- chest pain, anxious, confusion, restless, decreased cardiac output, muffled heart sounds, narrowed pulse pressure, JVD, pulsus paradoxus
Antibiotics for bacterial pericarditis; NSAIDs for pain and inflammation; corticosteroids

A

Cardiac Tamponade

121
Q

results from scarring with loss of elasticity of pericardial sac
Begins with acute pericarditis, characterized by fibrin deposition with undetected pericardial effusion
Dyspnea on exertion, peripheral edema, ascites, weight loss, JVD, pericardial knock on auscultation
Treatment of choice: pericardiectomy

A

Chronic constrictive pericarditis

122
Q

inflammation of myocardium; frequently associated with pericarditis
Infection of myocytes causes cellular damage and necrosis; results in cardiac dysfunction
Treatment: digoxin- improves myocardial contractility and reduces ventricular rate; ACE inhibitors and beta-blockers- if heart is enlarged or for HF; diuretics- reduce fluid volume and preload; anticoagulation therapy; immunosuppressive therapy; oxygen

A

Myocarditis

123
Q

acute, inflammatory disease of heart potentially involving all layers
Occurs 2-3 weeks after group A strep pharyngitis- affects heart, skin, joints, CNS

A

Rheumatic Fever

124
Q

chronic condition and complication resulting from rheumatic fever→ scarring and deformity of heart valves
Antibiotics- only get rid of any existing group A strep bacteria left; anti-inflammatory agents- NSAIDs, corticosteroids, salicylates
Early detection and treatment of group A strep→ penicillin

A

Rheumatic heart disease

125
Q

valve orifice restricted, forward blood flow impeded, pressure gradient created across open valve; type of valvular heart disease

A

Stenosis

126
Q

incomplete closure of valve leaflets, results in backward flow of blood
Occur in children and adolescents from congenital conditions and in adults from CV disease

A

Type of valvular heart disease; Regurgitation

127
Q

majority of adult cases from rheumatic heart disease

Scarring of valve leaflets and chordae tendineae

A

Mitral valve stenosis

128
Q

majority of cases attributed to MI (MI with left ventricular failure increases risk for rupture of chordae tendineae and acute MR)
Thready peripheral pulses, cool and clammy extremities, weakness, fatigue, palpitations, dyspnea, orthopnea, peripheral edema
Audible S3

A

Mitral valve regurgitation

129
Q

most common form of valvular heart disease in the U.S.
Unknown cause, most patients asymptomatic for life
Late or holosystolic murmur, dysrhythmias, palpitations, dizziness, light-headedness
B-adrenergic blockers to control palpitations and chest pain
Stay hydrated, exercise regularly, avoid caffeine

A

Mitral valve prolapse

130
Q

usually discovered in childhood, adolescence, or young adulthood; could result from rheumatic fever later in life
Left ventricular hypertrophy, decreased cardiac output, pulmonary hypertension
Angina, syncope, exertional dyspnea→ left ventricular failure
Nitroglycerin contraindicated because it reduces preload
Diminished or absent second heart sound

A

Aortic valve stenosis

131
Q

retrograde blood flow from ascending aorta to left ventricle → volume overload
Pulmonary hypertension, right ventricular failure, myocardial contractility declines, “water-hammer” pulse
Soft or absent S1, presence of S3 and S4, diastolic murmur

A

Aortic valve regurgitation

132
Q

associated with rheumatic mitral stenosis, IV drug abusers, dopamine agonists
Right atrial enlargement

A

Tricuspid valve stenosis

133
Q

backward flow of blood from right ventricle; congenital

Right ventricle hypertension and hypertrophy

A

Pulmonic valve stenosis

134
Q

Drug therapy to treat/control HF?

A

digitalis, vasodilators, diuretics, beta-blockers, anticoagulants, antidysrhythmics, low sodium diet

135
Q

3rd most common cause of death in U.S. and Canada

A

Stroke

136
Q

Transient ischemic attack: transient episode of neurologic dysfunction without acute infarction of the brain, symptoms last

A

Ischemic

137
Q

bleeding within brain caused by rupture of vessel, hypertension is most important cause, during periods of activity

A

Intracerebral hemorrhage

138
Q

more likely to result in memory problems related to language

A

Left-brain stroke

139
Q

more likely to cause problems in spatial-perceptual orientation

A

Right-brain stroke

140
Q

Difficulty in judging position, distance, and movement
Impulsive, impatient, and denying problems related to stroke
Respond best to directions given verbally
Which side stroke?

A

Pts with stroke on right side of brain

141
Q

Slower in organization and performance of tasks
Impaired spatial discrimination
Have fearful, anxious response to stroke
Respond well to nonverbal cues
Which side stroke?

A

Pts with stroke on left side of brain

142
Q

when a group of cells has the ability to generate electrical impulse spontaneously

A

Automaticity

143
Q

capacity of the cardiac cell to depolarize in response to electrical impulse

A

Excitability

144
Q

ability of cardiac cells to transmit an impulse

A

Conductivity

145
Q

ability of cardiac muscle in response to a stimulus to shorten to produce systole

A

Contractility

146
Q

primary pacemaker of the heart, 60-100 bpm

A

SA node

147
Q

to slow electrical impulse between atria and ventricles to give time for atria to contract and empty contents into ventricles, 40-60 bpm

A

AV node

148
Q

continuation of AV node that allows impulses to enter into ventricles, divides into left and right bundle branches (LBB divides into 2 fascicles, RBB contains 1)

A

Bundle of His

149
Q

P wave is what?

A

atrial depolarization

150
Q

estimate of the amount of time it takes the impulse to travel from the SA node through the AV nodes, the bundle of His, and the main part of the left bundle branch

A

PR interval

151
Q

ventricular depolarization
Amount of time it takes for the impulse to travel from the left bundle branch and traverse the rest of the ventricle through the remainder of the conduction system

A

QRS complex

152
Q

amount of time it takes for ventricular depolarization and repolarization

A

QT interval

153
Q

Progressing narrowing and degeneration of arteries of neck, abdomen, and extremities
Atherosclerosis= leading cause
Typically appears at ages 60s to 80s, largely undiagnosed

A

PAD

154
Q

Classic symptom of PAD

A

intermittent claudication

155
Q

numbness or tingling in toes or feet

A

Paresthesia

156
Q

Most serious complication of PAD

A

nonhealing arterial ulcers and gangrene

157
Q

1st tx goal with PAD

A

modify CVD risk factors regardless of severity of symptomsAntiplatelet agents: aspirin (81-325 mg/day), clopidrogel (plavix)
ACE inhibitors: increase peripheral blood flow, ABI, walking distance; decrease CV morbidity and mortality

158
Q

chronic ischemic rest pain lasting longer than 2 weeks, arterial leg ulcers, and/or gangrene of leg

A

Critical limb ischemia

159
Q

episodic vasospastic disorder of small cutaneous arteries (fingers and toes)
Mainly in young women, response to SNS stimulation
Prevention is key- keep warm, stress free
Calcium channel blockers

A

Raynaud’s Phenonmenon

160
Q

often asymptomatic

Most common manifestation: deep diffuse chest pain, pain may extend to interscapular area

A

Thoracic aortic aneurysms

Med Surg 1 (1 decks)

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