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CEN > Medical Emergencies and Communicable Diseases > Flashcards

Medical Emergencies and Communicable Diseases Flashcards

1. Describe concepts related to the assessment of an emergency department patient experiencing a medical emergency or communicable disease. 2. Describe various patient presentations related to medical emergencies and communicable diseases. 3. List interventions necessary for a patient presenting with medical emergencies and communicable diseases.

1
Q

define hypersensitivity

A

antibodies released that seek out and destroy a perceived intruder to protect the body from infection from viruses and bacteria

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2
Q

how are hypersensitivity rxns classified?

A

into 4 categories by Gell-Coombs classification

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3
Q

Gell-Coombs classification for hypersensitivity

A

I: immediate hypersensitivity
II: antibody-dependent cytotoxic hypersensitivity
III: immune complex disease
IV: delayed hypersensitivity

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4
Q

allergic rxn pathway

A

sensitized: exposed to allergen, IgE antibodies produced

repeat exposure: IgE reacts to allergen, releases chemical mediators

reaction: histamine, leukotriene; vasodilation, mucous secretions, edema, rashes

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5
Q

sx of histamine release in allergic rxn

A 
inflammation
mucus production
skin rxns, urticaria, hives
itchy, water eyes
sneezing, wheezing, coughing
runny nose
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6
Q

define anaphylaxis

A

acute, potentially fatal systemic reaction involving multiple organs that can be rapidly progressive

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7
Q

define pollycythemia

A

too many cells in the blood

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8
Q

secondary polycythemia

A

production of erythropoietin increases appropriately

aka physiologic physiologic polycythemia usually 2/2 high altitudes

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9
Q

common causes of polycythemia

A

living/visiting high altitudes

prolonged physical activity associated with hypoxia

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10
Q

sx polycythemia

A

fatigue
bruising
sensation of warmth in limbs

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11
Q

intervene polycythemia

A

supportive therapy

treat underlying cause

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12
Q

define polycythemia vera

A

overactive bone marrow that results in high RBCs, WBCs, and platelets that can be rapidly progressive

elevated hematocrit 55%

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13
Q

sx polycythemia vera

A 
often asymptomatic
elevated blood counts
HF, hypoxia
HA, vertigo
hepatosplenomegaly
high BP, blood clots
weakness, LH, fatigue
visual disturbances
pruritus after hot bath
red face
engorged retinal veins
red, warm, painful palms, feet
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14
Q

primary familial polycythemia

A

primarily affects middle-aged Jewish men

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15
Q

intervene polycythemia

A

phlebotomy to remove whole blood and replace with normal saline

aspirin for clotting risk

hydroxyurea for for myeloproliferative suppression (RBC reduction)

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16
Q

define anemia

A

decrease in concentration of RBCs or Hg in blood

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17
Q

intervene for iron deficiency

A

oral iron therapy

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18
Q

side effects of oral iron therapy

A

caustic to GI tract
green/dark stools
constipation
take with acidic substance

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19
Q

intervene for B12 deficiency

A

subQ B12 to compensate for lack of intestinal enzyme needed for absorption

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20
Q

intervene folic acid deficiency

A

fresh fruits, vegetables, folic acid supplements

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21
Q

intervene for anemia

A

maximize oxygenation of tissue via oxygen administration

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22
Q

define sickle cell disease

A

congenital hemolytic anemia causing RBCs to assume sickled shape

several types based on abnormality of Hg molecule

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23
Q

in whom does sickle cell disease primarily occur?

A

those of W. African descent

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24
Q

hemoglobin SS

A

classic sickle cell disease
gene from both parens
most common and severe

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25
Q

factors that precipitate SCC

A 
low O2 concentrations
infection
acidosis
dehydration
exposure to cold
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26
Q

sx SCC

A

sudden, explosive pain
abd, chest, back, joints
splenic ischemia, increase infection risk
heart ischemia increases coronary syndrome
priapism
ulcers of extremities

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27
Q

only cure for SCC

A

hematopoietic stem cell transplant

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28
Q

define neutropenia

A

decreased neutrophils

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29
Q

define neutrophil

A

WBC responsible for much of body’s protection against infection

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30
Q

risk of infection with neutropenia

A

risk increases as absolute neutrophil count (ANC) falls to severely neutropenic range (less than 500/uL)

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31
Q

calculate ANC

A

WBC x total neutrophils x 10

normal ANC is > 1,000/ul

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32
Q

common causes of neutropenia

A 
immunosuppressive therapy/disease
nutritional deficits
various infections
radiation
chemo
leukemia
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33
Q

sx neutropenia

A 
low grade fevers
recurrent infections
atypical, severe infections
sore mouth, oral ulcers
gingivitis
pneumonia
rectal abscess
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34
Q

intervene neutropenia

A 
protective isolation
avoid invasive procedures
dilute IV meds
slow IV push
cultures
abx, antipyretics
myeloid growth factors
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35
Q

what to avoid in neutropenia

A 
raw, undercooked meat
well water
unwashed produce
soft cheese
deli meat
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36
Q

define HIV

A

retrovirus spread via direct contact with infected blood or body secretions

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37
Q

characteristics of HIV

A

RNA, not DNA

retroviral RNA makes DNA that integrates into host’s chromosomal DNA and is expressed there

progresses to AIDS in 10 years if untreated

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38
Q

sx HIV

A 
nonspecific
swollen lymph nodes
fever
fatigue
diarrhea
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39
Q

define AIDS

A

HIV +
CD4+ count < 200/uL
% of CD4+ T cells < 14% of all lymphocytes
AIDS-related condition

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40
Q

sx AIDS

A 
weight loss
AMS
wasting, volume depletion, weakness
anemia, lymphopenia, thrombocytopenia
infections
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41
Q

intervene HIV/AIDS

A

antiretroviral meds
prophylaxis
treat infections
vaccinations

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42
Q

define leukemia

A

bone marrow starts manufacturing leukemic (abnormal) WBCs

excessive production of immature WBCs that do not function properly or provide adequate protection from inection

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43
Q

sx leukemia

A 
fatigue
fever
weight loss
bone pain
elevated uric acid
lymphadenopathy
hepatosplenomegaly
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44
Q

major types of leukemia

A

acute lymphoblastic leukemia
acute myeloid leukemia
chronic lymphocytic leukemia
chronic myeloid leukemia

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45
Q

ALL

A

85% of all cases affect B lymphocytes

high cure rate in children and adults

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46
Q

AML

A

affects cells not fully developed - can’t carry out normal functions

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47
Q

CLL

A

most common in adults

doesn’t completely interfere with development of mature red cells, white cells, and platelets

less severe than acute

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48
Q

CML

A

doesn’t completely interfere with development of mature red cells, white cells, and platelets

can be differentiated into chronic phase (most diagnoses), or accelerated phase and a blast phase

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49
Q

define idiopathic thrombocytopenia purpura

A

autoimmune disorder leading to isolated low platelet count with normal bone marrow and absence of other causes

usually after viral infection or immunization

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50
Q

characteristics of idiopathic thrombocytopenia purpura

A

most common in children 2-4 yo

antibodies often detectable against several platelet surface antigens

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51
Q

clinical syndromes of idiopathic thrombocytopenia purpura

A

acute in children
- often follows infection and resolves spontaneously w/in 2 mo

chronic in adults
-longer than 6 mo

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52
Q

sx idiopathic thrombocytopenia purpura

A 
bruising, petechiae
purpura
epistaxis
bleeding gums, nostrils
GI bleed
hematuria
menorrhagia
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53
Q

complications of idiopathic thrombocytopenia purpura

A

bleeding more common if platelets < 20,000

if < 10,000 spontaneous formation of hematomas in mouth

if < 5,000 fatal complications such as subarachnoid or intracerebral hemorrhage, lower GI bleed

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54
Q

intervene idiopathic thrombocytopenia purpura

A

observation

severe cases
-glucocorticoids, immune globulins

thrombopoietin receptor agonists to stimulate platelet production in bone marrow

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55
Q

define thrombocytosis

A

abnormally elevated platelet count that leads to increased risk of spontaneous clot formation

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56
Q

types of thrombocytosis

A

primary (aka essential) is d/t myeloproliferative disease

secondary (aka reactive)

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57
Q

sx thrombocytosis

A

asymptomatic
predispose thrombosis
erythromelalgia

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58
Q

define erythromelalgia

A

burning sensation and redness of extremities that resolves with cooling and/or aspirin

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59
Q

intervene thrombocytosis

A 
aspirin
hydroxyurea
anagrelide
interferon alfa
monitor complications
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60
Q

complications of thrombocytosis

A

PE
MI
DVT
stroke

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61
Q

define disseminated intravascular coagulation

A

abnormal activation of body’s clotting system that signals severe underlying problems that involves both abnormal clotting and bleeding

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62
Q

pathway of DIC

A

release/expression of tissue factor

systemic activation of coagulation (thrombin production overwhelms physiologic inhibitors)

intravascular fibrin deposition /
depletion of platelets & coag factors

thrombosis of small & mid vessels with organ failure / bleeding

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63
Q

causes of DIC

A 
sepsis, infection
trauma
organ destruction
malignancy
transfusion rxn
obstetric complications
retained dead fetus syndrome
vascular abnormalities
hepatic failure
toxic reactions
heat stroke
hyperthermia
venom bites
frostbites
GSW
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64
Q

sx DIC

A

abnormal clotting:

  • metabolic acidosis
  • mottling
  • necrosis
  • end organ failure

abnormal bleeding:

  • bruising, petechiae
  • purpura
  • epistaxis, bleeding gums
  • GI bleed, hematuria
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65
Q

intervene DIC

A

treat cause
control bleeding
pharm
blood products

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66
Q

pharm control of DIC

A

heparin

antifibrinolytic agents

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67
Q

laboratory findings in DIC

A 
platelets - decreased
fibrinogen - decreased
prothrombin time - longer
partial thromboplastin time - longer
d-dimer - elevated
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68
Q

define hemophilia

A

group of hereditary genetic disorders that impair the body’s ability to control blood clotting

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69
Q

hemophilia A

A

aka classic hemophlilia
recessive sex-linked
deficiency of factor VIII
most common

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70
Q

hemophilia B

A

aka Christmas disease
recessive sex-linked
deficiency of factor IX

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71
Q

hemophilia C

A 
aka Rosenthal's syndrome
deficiency of factor XI
much rarer than A or B
either sex
most common in Ashkenazi Jews
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72
Q

Von Willebrand disease

A

most common bleeding disorder
carried on chromosome 12
both men and women
missing/defective von Willebrand factor

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73
Q

sx hemophilia

A

bleeding of soft tissues, muscles, or weight-bearing joints

bleeding into oral/nasal mucosa, urinary tract GI tract, CNS

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74
Q

concerns with hemophilia

A

hemarthrosis or hematoma
lacerations
venipuncture
no IM injections

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75
Q

intervene hematoma in hemophilia

A

ice
compression dressing
immobilization
elevation

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76
Q

intervene lacerations in hemophilia

A

topical thrombin

observe for 4 hours post suture

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77
Q

intervene venipuncture in hemophilia

A

pressure for at least 5 min

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78
Q

dc teaching in hemophilia

A 
safety precautions
avoid aspirin NSAIDs
medic alert
young children protections
physically active
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79
Q

define isotonic dehydration

A

proportionate loss of water and sodium

most common

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80
Q

lab values in isotonic dehydration

A

osmolality: normal
sodium: 135-145

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81
Q

causes of isotonic dehydration

A

excessive sweating
not drinking enough
repeat vomiting, diarrhea
severe bleeding

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82
Q

define hypertonic (hypernatremic) dehydration

A

more water lost than sodium

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83
Q

physiology of hypertonic dehydration

A

increased extracellular sodium

fluid pulled out of intracellular space leading to cell shrinkage

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84
Q

lab values in hypertonic dehydration

A

osmolality: elevated
sodium: elevated
BUN: elevated

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85
Q

causes of hypertonic dehydration

A 
diarrhea, water deprivation
excessive sweating
poorly treated DM
diabetes insipidus
heat stroke
ESRD
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86
Q

define hypotonic (hyponatremic) dehydration

A

more sodium lost than water

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87
Q

physiology of hypotonic dehydration

A

sodium lost from extracellular space

higher intracellular sodium levels pull water from extracellular space into cell via osmosis

cellular swelling

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88
Q

causes of hypotonic dehydration

A 
overly dilute baby formula
SIADH
lung CA
heat stroke
burns, trauma
pancreatitis
diuretics
chronic malnutrition

rehydrating young children with fluids w/o salt

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89
Q

lab values in hypotonic dehydration

A

low osmolality

decreased sodium

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90
Q

intervene dehydration

A

fluid resuscitation based on severity
oral fluids and electrolytes
IV crystalloids if severe

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91
Q

causes of hypernatremia

A 
water loss
excessive sodium intake
diabetes insipidus
diuretics
Cushing syndrome
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92
Q

sx hypernatremia

A 
AMS
weakness
muscle twitch
thirst
dry membranes
low grade fever
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93
Q

intervene hypernatremia

A 
treat cause
isotonic fluids
replace gradually
0.45 NS
restrict sodium intake
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94
Q

causes of hyponatremia

A 
inadequate Na intake
excessive water gain
HF
cirrhosis
SIADH
laxatives
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95
Q

sx hyponatremia

A 
abd cramps
N/V
HA
AMS
anorexia
muscle twitch
tremors
seizures
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96
Q

intervene hyponatremia

A

hypervolemia: fluid restriction, oral Na
hypovolemia: isotonic fluids, high-sodium fluids

if severe (< 125) hypertonic saline

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97
Q

sodium ion overview

A

the primarily positively charged extracellular ion in the body

does not freely cross from interstitial space into cell

water moves to compensate Na levels

normal 135-145

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98
Q

causes of hyperkalemia

A 
sodium depletion
acidosis
trauma, burns, crush injuries
ACE inhibitors, beta blockers
digoxin, NSAIDs
Addison disease
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99
Q

sx hyperkalemia

A 
paresthesia
irritability
weakness, paralysis
decreased tendon reflex
N/D
bradycardia, hypotension
tall peaked T wave
flat P wave
BBB
depressed ST
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100
Q

intervene hyperkalemia

A

loop diuretics

severe: Ca gluconate, insulin, glucose, kayexalate, dialysis

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101
Q

causes of hypokalemia

A 
V/D
K depleting diuretics
insulin
excessive laxatives
acute alcoholism
HF
leukemia
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102
Q

sx hypokalemia

A 
leg cramps
decreased tendon reflex
constipation
digoxin toxicity
tachycardia, tachypnea
rhabdo
flatted/inverted T wave
U wave
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103
Q

intervene hypokalemia

A

correct cause
IV replacement
K sparing diuretic

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104
Q

potassium ion overview

A

intracellular cation with 98% found inside cells, other 2% in extracellular fluid

normal 3.5-5

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105
Q

function of K ion in cells

A

maintenance of cell membrane potential

homeostasis of cell volume

transmission of action potential in nerve cells

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106
Q

causes of hypercalcemia

A 
malignancy
hyperparathyroidism
ACE inhibitors
hyperthyroidism
fractures
acidosis
K sparing diuretics
excessive vit D
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107
Q

sx hypercalcemia

A 
N/V, weight loss
abd pain, constipation
HTN
kidney stones
confusion, lethargy, AMS
AV block
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108
Q

intervene hypercalcemia

A 
hydration
loop diuretics
corticosteroids
sodium bicarb
dialysis
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109
Q

causes hypocalcemia

A 
hypoparathyroidism
malabsorption
insufficient Vit D
inadequate Ca intake
hypoalbuminemia
hyperphosphatemia
diuretics
diarrhea
bone cancer
alkalosis
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110
Q

sx hypocalcemia

A 
muscle cramps
hyperreflexia
tetany
paresthesia
Chvostek, Trousseau signs
anxiety, confusion, irritable
arrhythmias
111
Q

intervene hypocalcemia

A

IV Ca gluconate
vit D
replace mag and phos

112
Q

calcium ion overview

A

blocks Na channels and inhibits depolarization of nerve and muscle fiver

increased Ca raises threshold for depolarization

normal 9-10.5

113
Q

causes of hyermagnesemia

A

renal failure
untreated DKA
Addison disease
HD

114
Q

sx hypermagnesemia

A 
decreased muscle/nerve activity
hypoactive tendon reflex
weakness
drowsiness, lethargy
diaphoresis
CNS depression
N/V
hypotension, vasodilation
arrhythmias
bradycardia
coma
115
Q

intervene hypermagnesemia

A

oral/IV fluids

emergency: Ca gluconate

avoiding Ma products

116
Q

causes hypomagnesemia

A 
loop and thiazide diuretics
malabsorption
excessive GI fluid loss
acute alcoholism
preeclampsia
pregnancy
117
Q

sx hypomagnesemia

A 
muscle weakness
AMS
agitation, confusion
SZs
tetany, ataxia
Chvostek, Trousseau signs
tachycardia, HTN
vent arrhythmias
hyperactive tendon reflex
depressed ST
prolonged QT
118
Q

intervene hypomagnesemia

A

emergency: IV mag 1-2 G over 1-2 min
nonemergency: IV mag 1-2 g over 2 hours

increase dietary Mg intake

119
Q

magnesium ion overview

A

needed for muscle, nerve, enzyme fxn

helps body use energy and is needed to move other electrolytes (K, Na) into and out of cell

normal 1.7-2.3

120
Q

define adrenal emergency

A

lack of excess of adrenaline aka epinephrine

121
Q

where is adrenaline produced?

A

adrenal glands

some in neurons

122
Q

adrenaline overview

A

aka epi

primary hormone for fight/flight response

123
Q

define Cushing syndrome

A

prolonged exposure to elevated levels of glucocorticoids or cortisol

124
Q

sx Cushing syndrome

A 
moon face
buffalo hump
fat above clavicles
excess sweating
capillary dilation
thin skin, easy bruising
proximal muscle weakness
hirsutism
baldness
dry/brittle hair
hypocalcemia (rare)
insomnia
impotence in men
amenorrhea, infertility
125
Q

prevent Cushing syndrome

A

taper medications

126
Q

define acute adrenal insufficiency

A

low levels of cortisol and aldosterone

medical emergency, potentially life threatening

127
Q

causes of acute adrenal insufficiency

A 
sudden discontinuation of glucocorticoids
Addison disease
congenital adrenal hyperplasia
infection
trauma, surgery, burns
hemorrhage
pregnancy
128
Q

sx acute adrenal insufficiency

A 
dehydration d/t urine loss
hypoNa, hyperK
hypoglycemia
weakness, fatigue
hypotension
anorexia, weight loss
N/V, abd pain, D/C
129
Q

assessing acute adrenal insufficiency

A

BMP
cortisol
adrenocorticotropic levels

130
Q

intervene acute adrenal insufficiency

A

immediate replacement of glucocorticoids and mineralocorticoids

tx shock ia IV fluids

reverse electrolyte abnormalities

131
Q

effect of hydrocortisone tx in acute adrenal emergency

A

replace glucocorticoids

132
Q

effect of dexamethasone tx in acute adrenal emergency

A

replace mineralocorticoids

133
Q

effect of IV insulin/dextorse or kayexalate in acute adrenal emergency

A

reduce serum K

134
Q

effect of dextrose 50% in acute adrenal emergency

A

reverse hypoglycemia

135
Q

effect of vasopressors in acute adrenal emergency

A

treat hypotension 2/2 hypovolemia

136
Q

effect of O2 in acute adrenal emergency

A

meet increased O2 demands d/t increased HR 2/2 hypovolemia

137
Q

effect of IV crystalloids in acute adrenal emergency

A

treat hypovolemia

138
Q

why cardiac monitoring in acute adrenal emergency?

A

high risk for arrhythmia

139
Q

primary function of ADH

A

retention of water - regulates retention by increasing water reabsorption in kidney

vasoconstriction

140
Q

causes of neurogenic diabetes insipidus

A 
tumors (hypothalamus, pituitary)
head injury
cerebral aneurysm
meningitis, encephalitis
phenytoin, lithium
141
Q

causes of nephrogenic diabetes insipidus

A 
polycystic kidney disease
pyelonephritis
SCC
sarcoidosis
familial genetic disorders
142
Q

sx diabetes insipidus

A 
polydipsia
decreased urine specific gravity
decreased urine osmolality
increased serum osmolality
increased serum sodium
143
Q

central diabetes insipidus

A

deficiency of arginine vasopressin (AVP) aka ADH

144
Q

nephrogenic diabetes insipidus

A

due to kidney or nephron dysfunction caused by insensitivity of kidneys or nephrons to ADH

145
Q

intervene for diabetes insipidus

A

fluid replacement (oral or hypotonic)

monitor for cerebral edema

replace ADH

146
Q

causes of SIADH

A 
head trauma
infections
CNS disorders, stroke, aneurysm
malignancy
adrenal insufficiency
pain, stress
meds
147
Q

sx SIADH

A 
decreased urine output
increased urine spec. gravity
increased urine osmolality
decreased serum osmolality
decreased serum sodium
148
Q

intervene SIADH

A

water restriction
IV NS or hypertonic saline
furosemide
monitor I/O and neuro status

149
Q

define SIADH

A

hyponatremia and hypo-osmolality d/t inappropriate, continued secretion or action of ADH despite normal/increased plasma volume

hyponatremia is due to excess of water, NOT deficiency of Na

150
Q

define hypoglycemia

A

blood glucose < 60 in adults, < 40 in infants

151
Q

sx hypoglycemia

A 
cool, diaphoretic
tachycardia, palpitations
shallow respirations
dilated pupils
AMS, slurred speech
disorientation, SZs
coma, brain damage
152
Q

intervene hypoglycemia

A

oral glucose if conscious

IV dextrose
D5W
glucagon IM

153
Q

pathophysiology of DKA

A

absolute/near absolute insulin deficiency

  • severe hypoglycemia
  • ketone body production
  • systemic acidosis

hours to 1-2 days
usually in T1DM

154
Q

sx DKA

A 
tachycardia, hypotension
volume depletion
fatigue
acute AMS
acetone on breath
Kussmaul respirations
abd pain
dehydration
155
Q

labs in DKA

A

blood glucose < 600
elevated BUN
glucose, ketones in urine
acidosis

156
Q

intervene DKA

A 
IV fluids
IV insulin bolus, infusion
replace electrolytes
K, phos
sodium bicarb for acidosis
157
Q

pathophysiology of hyperosmolar hyperglycemia syndrome (HHS)

A

severe relative insulin deficiency

  • profound hyperglycemia
  • profound hyperosmolality
  • no ketone production or acidosis

days to weeks
usually T2DM or unrecognized diabetes

158
Q

sx HHS

A 
weakness
polyuria, polydipsia
significant volume depletion
anorexia, N/V
acute AMS
seizures
dehydration
159
Q

labs in HHS

A

BG > 600
elevated BUN
no glucose or ketones in urine

160
Q

intervene HHS

A

IV fluids
insulin with D50.45
replace electrolytes
K if low

161
Q

thyroid overview

A

regulates body’s metabolic rate via hypothalmic-pituitary-thyroid counter-regulatory system

162
Q

thyroid storm overview

A

aka thyrotoxic crisis

rare but severe and life threatening complication of hyperthyroidism

163
Q

sx thyroid storm

A 
hyperthermia (38.7-40C)
CNS dysfxn
cardiovascular dysfxn
-sinus tach, a.fib, angina
GI dysfxn (N/V/D)
164
Q

intervene thyroid storm

A 
treat cause
treat hyperthermia w/ acetaminophen
increase fluids, calories
antithyroid drugs
-propylthiouracil
-methimazole
-iodine
-glucocorticoids
165
Q

sx myxedema coma

A 
hypothermia (below 35.5) w/o shivering
bradycardia, hypotension
hypoventilation
coma, seizures
myxedema madness (psychosis)
166
Q

risk factors for myxedema coma

A

> 60 yo
women
winter months

167
Q

intervene myxedema coma

A 
treat cause
passive warming
rehydration, Na replacement
intubate, ventilate
IV thyroid replacement
levothyroxine, thyroxine
glucocorticoids
168
Q

define acute renal failure

A

kidneys fail to adequately filter waste products from blood

acute or chronic

169
Q

function of renal system

A

filter blood and regulate BP, electrolyte balance, RBC production

170
Q

define acute renal failure

A

rapidly progressive loss of renal function

171
Q

parameters of acute renal failure

A

oliguria (< 400 ml/day in adults)
< 0.5 ml/kg/hr in children
< 1 ml/kg/hr in infants

+fluid and electrolyte balance

172
Q

3 types of acute renal failure

A

prerenal
intrinsic
postrenal

173
Q

prerenal failure

A

before kidney/renal blood flow

d/t transient renal hypoperfusion

174
Q

causes of prerenal failure

A

hypotension
decreased cardiac output
decreased effective arterial blood volume

175
Q

intrinsic/intrarenal failure

A

3 categories:
acute glomerulonephritis
acute interstitial nephritis
acute tubular necrosis

176
Q

acute glomerulonephritis

A

inflammation and damage to glomerular membrane

177
Q

acute interstitial nephritis

A

allergic rxn to meds or response to infectious process

178
Q

acute tubular necrosis

A

nephrotoxic agents or renal hypoperfusion

179
Q

postrenal failure

A

post kidneys

180
Q

causes of postrenal failure

A

urinary tract obstructions
including renal calculi
benign prostatic hyperplasia
obstructed urinary catheter

181
Q

toxins causing acute renal failure

A 
NSAIDs, ACE inhibitors
acyclovir, cephalosporins
tetracyclines, vanc
cimetidine
amphetamines, heroin
bacterial toxins
chemo, immunosuppressants
HIV protease inhibitors
heavy metals
industrial chemicals
organic solvents
radiation
snake/insect venom
182
Q

intervene for acute renal failure

A 
stop nephrotoxic drugs
IV crystalloids
increase urinary output
remove obstruction
correct electrolyte imbalances
183
Q

define chronic kidney disease

A

sustained kidney damage indicated by presence of structural or functional abnormalities and/or GFR below 60 ml/min for a least 3 months

184
Q

stage 1 CKD

A

early damage with normal function

GFR > 90

185
Q

stage 2 CKD

A

worse damage with reduced function

GFR 60-80

186
Q

stage 3 CKD

A

even worse damage with less function

GFT 30-59

187
Q

stage 4 CKD

A

severe damage, barely able to sustain life

GFR 15-29

188
Q

stage 5 CKD

A

ESRD, severe impaired function, not adequate to sustain life

GFR < 15

189
Q

sx CKD

A

HTN
fluid, electrolyte imbalances
oliguria, anuria
uremic syndrome

190
Q

fluid and electrolyte imbalances in CKD

A

volume overload
hyperkalemia
metabolic acidosis
hyperphosphatemia

191
Q

hormonal imbalances in CKD

A

anemia
hyperparathyroidism
bone disease

192
Q

uremic syndrome in CKD

A 
neuropathy
anorexia
nausea
vomiting
fatigue
malnutrition
193
Q

functions of kidneys

A

hematopoiesis
filtration
fluid and electrolyte balance

194
Q

integumentary sx of CKD

A 
bruises
pruritus
dry skin
skin color changes
dry hair/nails
195
Q

cardiovascular sx of CKD

A 
HTN
tachycardia
dysrhythmias
EKG changes
abnormal heart sounds
retinopathy
fluid retention
pulm edema
196
Q

resp sx of CKD

A

increased RR
Kussmaul respirations
crackles
decreased PO2

197
Q

renal sx of CKD

A 
decreased urine output
azotemia
proteinuria
hematuria
hyperuricemia
198
Q

GI sx of CKD

A 
anorexia
N/V
nalitosis
metallic taste
GI bleed
199
Q

neuro sx CKD

A 
peripheral neuropathy
restless legs
AMS, LOC
lethargy, confusion
encephalopathy
200
Q

hematological sx of CKD

A 
anemia
weakness, fatigue
pallor
lethargy
bleeding d/t impaired platelet aggregation
201
Q

musculoskeletal sx of CKD

A 
renal osteodystrophy
decreased calcium
vitamin D impairment
hyperparathyroidism
pathological fractures
202
Q

immune sx of CKD

A

increased risk of infection

203
Q

intervene for CKD

A 
correct electrolyte, fluid imbalance
treat arrhythmias, HTN, pulm edema
vent support
treat infections
HD
204
Q

sepsis bundle to be completed w/in 3 hours

A

lactate
blood cultures
abx
30 ml/kg crystalloid

205
Q

sepsis bundle to be completed within 6 hours

A

vasopressors for MAP > 65
CVP and ScvO2 for septic shock
remeasure lactate if it was elevated

206
Q

adult endpoints of sepsis resuscitation

A

CVP 8-12 mmHg
MAP > 65
ScvO2 70% of SVO2
urine 0.5 ml/kg/hr

207
Q

pediatric endpoints of sepsis resuscitation

A

normal HR
cap refill < 2 sec
central, peripheral pulses
urine output > 1 ml/kg/hr

208
Q

diseases requiring airborne precautions

A 
TB
measles
chickenpox until crusted
immunocompromised
disseminated herpes
209
Q

diseases requiring droplet precautions

A 
resp viruses
influenza
parainfluenza
adenovirus
RSV
pertussis
nisseria meningitis
group A strep
210
Q

diseases requiring contact precautions

A 
stool incontinence
norovirus
rotovirus
c.diff
draining wounds
uncontrolled secretions
pressure ulcers
ostomy tubes
bag draining bodily fluids
generalized fluids
211
Q

characteristics of rubeola/measles

A

highly contagious
incubation 8-12 days

transmission:

  • 4 days after exposure to 4 days after rash appears
  • nasal or resp secretions
212
Q

sx rubeola/measles

A 
fever
3 C's
-conjunctivitis
-coryza
-cough (dry)
eyelid edema, photophobia
malaise, irritability
rash
-Koplik spots
-maculopapular rash
213
Q

Koplik spots

A 
in measles
small red specks
blue white center
buccal mucosa near molars
2 days before rash
disappears 48 hours after rash
214
Q

maculopapular rash in measles

A

head to trunk to lower extremities
14 days after exposure

immunocompromised patients don’t always have rash

215
Q

intervene measles

A

airborne
immunize
supportive care
antipyretics

216
Q

complications of measles

A

fetuses exposed during 1st trimester at risk for heart defects, developmental delays, deafness, stunted growth

217
Q

define mumps

A

paramyxovirus that causes grandular enlargement of salivary, parotid glands

active in spring

218
Q

transmission of mumps

A

resp droplets, saliva

most contagious 1-2 days before appearance of parotitis

infectious up to 5 days after onset of glandular enlargement

219
Q

sx mumps

A

parotitis
fever
URI sx

220
Q

intervene mumps

A 
droplet
immunize
supportive care
analgesics
antipyretics
oral steroids for severe orchitis
221
Q

pertussis overview

A

aka whooping cough

gram-negative bordetella pertussis

attaches to resp tract ciliated epithelium

produces toxin that limits ability to clear secretions

222
Q

incubation/transmission of pertussis

A

incubates 7-10 days

transmission vai resp droplets

223
Q

stages of pertussies

A

Stage I: catarrhal stage (1-2 weeks

Stage II: paroxysmal stage (1-6 weeks)

Stage III: convalescent stage (weeks-months)

224
Q

catarrhal stage of pertussis

A

corzya
sneezing
low grade fever
occasional cough that worsens

225
Q

paroxysmal stage of pertussis

A

cough worsens

unremitting paroxymals bursts of coughing (whoop)

coughing more at night

cough may lead to petechial rash above nipple line

226
Q

convalescent stage of pertussis

A

gradual recovery as cough becomes less severe/frequent

superinfections can occur d/t trapped secretions

227
Q

assessing pertussis

A

dacron swab in posterior nasopharynx

228
Q

intervene pertussis

A 
droplet
supportive care
macrolide abx
antitussives
antipyretics
229
Q

dc teaching for pertussis

A

vaccination

household members tx with abx regardless of vaccination status

230
Q

transmission of chickenox

A

resp droplets, skin contact
infectious 48 hours before rash

contagious until all sin lesions crusted over and no new lesions formed

231
Q

sx chickenpox

A 
purulent vesicular rash
fever
HA
anorexia
lymphadenopathy
malaise
pruritus
urticaria
232
Q

intervene chickenpox

A 
airborne, contact isolation
sympomatic
antiviral
antihistamines
antipyretics, analgesics
varicella immunoglubulin if pregnant
systemic abx if 2ndary infection
NO aspirin in children
233
Q

define shingles

A

reactivation of varicella virus that has lain dormant in dorsal ganglia following chickenpox

lesions follow path of nerve dermatomes

234
Q

sx shingles

A

pain followed by vesicular lesions w/in 48 hours

painful, localized, unilateral pain

vesicular lesions along nerve dermatome

does not cross midline

235
Q

intervene shingles

A 
airborne, contact
antivirals
cover lesions
supportive care
comfort measures
varicella zoster vaccine
236
Q

define diphtheria

A

infection of mucous membranes by corynebacterium diphtheriae

237
Q

incubation/transmission of diphtheria

A

incubates 1-8 days

transmission via resp droplets

238
Q

sx diphtheria

A 
low grade fever
sore throat
thick gray membrane on tonsils, pharynx
weakness
sore throat
fever
swollen neck glands
239
Q

pseudomembrane in diphtheria

A

thick, gray membranous covering on tonsils, pharynx

forms w/in 2-3 days of infection

interferes with respiration

sticks to tissue below, cannot be manually removed d/t risk of bleeding

240
Q

complications of diphtheria

A

toxins absorbed into blood stream and damage heart, kidneys, nerves

myocarditis
neuritis
airway obstruction

241
Q

assessing diphtheria

A

throat culture for gram stain, culture, sensitivity

toxin analysis specimen

polymerase chain reaction

242
Q

intervene diphtheria

A

droplet
vaccine
diphtheria antitoxin
abx immediately (erythromycin)

243
Q

define mononucleosis

A

acute viral illness d/t Epstein-Barr

244
Q

incubation/transmission of mono

A

body fluids, esp saliva

sx occur 4-6 weeks after infection

245
Q

prodrome syndrome of mono

A 
fatigue
anorexia, N/V
chills, diaphoresis
HA
myalgia
246
Q

illness syndrome of mono

A 
low grade fever
sore throat
HA, body aches
lymphadenopathy
rash
diarrhea
earache
red throat
enlarged tonsils
petechiae on palate
247
Q

complications of mono

A 
hepatosplenomegaly
thrombocytopenia
PNA
meningitis, encephalitis
hepatitis
pericarditis
splenic rupture
airway obstruction
death (rare)
248
Q

assessing mono

A

monospot
Epstein-Barr virus antigen test
CBC
LFTs

249
Q

intervene mono

A

sx control
analgesics (no aspirin)
corticosteroids
salivary precautions

250
Q

dc teaching for mono

A

avoid strenuous activities and contact sports x 4 weeks

warm salt water gargles

avoid alcohol 1 mo

do not donate blood 6 mo

sx of intraabdominal bleeding

251
Q

define c.diff

A

caused by clostridium difficile, gram + anaerobic spore forming bacillus

gives rise to abx associated diarrhea

252
Q

sx c.diff

A 
profuse, frequent diarrhea
abd cramping, pain
fever
nausea, loss of appetite
weight loss
dehydration, hypovolemia
kidney failure
253
Q

intervene c.diff

A 
contact precautions
stop abx
IV fluids
antiemetics
metronidazole, vanc, fidazomicin
stool transplant
254
Q

MDRO

A

microbes resistant to multiple antimicrobials aka superbugs

255
Q

types of MDROs

A 
MRSA
vancomycin RSA
extended spectrum beta-lactamase
VRE
multi drug resistant a.bawnannii
256
Q

define MRSA

A

s.aureus resistant to penicillins, cephalosporins

257
Q

prevelance of MRSA

A

most common in skin and soft tissue, hair follicle abscesses

258
Q

MRSA transmission

A

direct contact w/ infection

259
Q

sx MRSA

A

purulent with yellow or white center, central point (head), draining pus, possible aspirate pus

“spider bite”

260
Q

intervene MRSA

A 
I&amp;D
culture
sensitivities
clindamycin
tetracyclines
rifampin
linezolid
261
Q

define VRE

A

vanc resistant enterococcus

262
Q

prevalence of VRE

A

long-term abx
surgical patients
invasive devices

263
Q

transmission of VRE

A

direct contact w/ infection

264
Q

sx VRE

A 
sepsis
UTI
meningitis
endocarditis
infected wounds
265
Q

intervene VRE

A

remove source of infection
culture, sensitivities
combo abx therapy long term

266
Q

TB overview

A 
mot latent
1/10 progress to active
pulm system affected in 0% of cases
15-20% of active cases infection spreads outside lungs
airborne
267
Q

latent TB

A

contained by immune system
asymptomatic, noncontagious
isoniazid monotherapy

268
Q

active TB

A

symptomatic, highly contagious

269
Q

sx TB

A

chronic cough > 2-3 weeks
night sweats, fever, chills
weight loss, anorexia
fatigue

270
Q

assessing TB

A

CXR
sputum culture
labs

271
Q

intervene TB

A

airborne

multidrug therapy

272
Q

TB dc teaching

A

med compliance
containing resp secretions
dispose of contaminated materials
avoid close contact

273
Q

BCG

A

TB vaccine
90% of people worldwide
not in N.America
causes false skin positive

CEN (12 decks)

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