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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
factors that precipitate SCC
``` low O2 concentrations infection acidosis dehydration exposure to cold ```
26
sx SCC
sudden, explosive pain abd, chest, back, joints splenic ischemia, increase infection risk heart ischemia increases coronary syndrome priapism ulcers of extremities
27
only cure for SCC
hematopoietic stem cell transplant
28
define neutropenia
decreased neutrophils
29
define neutrophil
WBC responsible for much of body's protection against infection
30
risk of infection with neutropenia
risk increases as absolute neutrophil count (ANC) falls to severely neutropenic range (less than 500/uL)
31
calculate ANC
WBC x total neutrophils x 10 normal ANC is > 1,000/ul
32
common causes of neutropenia
``` immunosuppressive therapy/disease nutritional deficits various infections radiation chemo leukemia ```
33
sx neutropenia
``` low grade fevers recurrent infections atypical, severe infections sore mouth, oral ulcers gingivitis pneumonia rectal abscess ```
34
intervene neutropenia
``` protective isolation avoid invasive procedures dilute IV meds slow IV push cultures abx, antipyretics myeloid growth factors ```
35
what to avoid in neutropenia
``` raw, undercooked meat well water unwashed produce soft cheese deli meat ```
36
define HIV
retrovirus spread via direct contact with infected blood or body secretions
37
characteristics of HIV
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
38
sx HIV
``` nonspecific swollen lymph nodes fever fatigue diarrhea ```
39
define AIDS
HIV + CD4+ count < 200/uL % of CD4+ T cells < 14% of all lymphocytes AIDS-related condition
40
sx AIDS
``` weight loss AMS wasting, volume depletion, weakness anemia, lymphopenia, thrombocytopenia infections ```
41
intervene HIV/AIDS
antiretroviral meds prophylaxis treat infections vaccinations
42
define leukemia
bone marrow starts manufacturing leukemic (abnormal) WBCs excessive production of immature WBCs that do not function properly or provide adequate protection from inection
43
sx leukemia
``` fatigue fever weight loss bone pain elevated uric acid lymphadenopathy hepatosplenomegaly ```
44
major types of leukemia
acute lymphoblastic leukemia acute myeloid leukemia chronic lymphocytic leukemia chronic myeloid leukemia
45
ALL
85% of all cases affect B lymphocytes high cure rate in children and adults
46
AML
affects cells not fully developed - can't carry out normal functions
47
CLL
most common in adults doesn't completely interfere with development of mature red cells, white cells, and platelets less severe than acute
48
CML
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
49
define idiopathic thrombocytopenia purpura
autoimmune disorder leading to isolated low platelet count with normal bone marrow and absence of other causes usually after viral infection or immunization
50
characteristics of idiopathic thrombocytopenia purpura
most common in children 2-4 yo antibodies often detectable against several platelet surface antigens
51
clinical syndromes of idiopathic thrombocytopenia purpura
acute in children - often follows infection and resolves spontaneously w/in 2 mo chronic in adults -longer than 6 mo
52
sx idiopathic thrombocytopenia purpura
``` bruising, petechiae purpura epistaxis bleeding gums, nostrils GI bleed hematuria menorrhagia ```
53
complications of idiopathic thrombocytopenia purpura
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
54
intervene idiopathic thrombocytopenia purpura
observation severe cases -glucocorticoids, immune globulins thrombopoietin receptor agonists to stimulate platelet production in bone marrow
55
define thrombocytosis
abnormally elevated platelet count that leads to increased risk of spontaneous clot formation
56
types of thrombocytosis
primary (aka essential) is d/t myeloproliferative disease secondary (aka reactive)
57
sx thrombocytosis
asymptomatic predispose thrombosis erythromelalgia
58
define erythromelalgia
burning sensation and redness of extremities that resolves with cooling and/or aspirin
59
intervene thrombocytosis
``` aspirin hydroxyurea anagrelide interferon alfa monitor complications ```
60
complications of thrombocytosis
PE MI DVT stroke
61
define disseminated intravascular coagulation
abnormal activation of body's clotting system that signals severe underlying problems that involves both abnormal clotting and bleeding
62
pathway of DIC
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
63
causes of DIC
``` 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 ```
64
sx DIC
abnormal clotting: - metabolic acidosis - mottling - necrosis - end organ failure abnormal bleeding: - bruising, petechiae - purpura - epistaxis, bleeding gums - GI bleed, hematuria
65
intervene DIC
treat cause control bleeding pharm blood products
66
pharm control of DIC
heparin | antifibrinolytic agents
67
laboratory findings in DIC
``` platelets - decreased fibrinogen - decreased prothrombin time - longer partial thromboplastin time - longer d-dimer - elevated ```
68
define hemophilia
group of hereditary genetic disorders that impair the body's ability to control blood clotting
69
hemophilia A
aka classic hemophlilia recessive sex-linked deficiency of factor VIII most common
70
hemophilia B
aka Christmas disease recessive sex-linked deficiency of factor IX
71
hemophilia C
``` aka Rosenthal's syndrome deficiency of factor XI much rarer than A or B either sex most common in Ashkenazi Jews ```
72
Von Willebrand disease
most common bleeding disorder carried on chromosome 12 both men and women missing/defective von Willebrand factor
73
sx hemophilia
bleeding of soft tissues, muscles, or weight-bearing joints bleeding into oral/nasal mucosa, urinary tract GI tract, CNS
74
concerns with hemophilia
hemarthrosis or hematoma lacerations venipuncture no IM injections
75
intervene hematoma in hemophilia
ice compression dressing immobilization elevation
76
intervene lacerations in hemophilia
topical thrombin | observe for 4 hours post suture
77
intervene venipuncture in hemophilia
pressure for at least 5 min
78
dc teaching in hemophilia
``` safety precautions avoid aspirin NSAIDs medic alert young children protections physically active ```
79
define isotonic dehydration
proportionate loss of water and sodium most common
80
lab values in isotonic dehydration
osmolality: normal sodium: 135-145
81
causes of isotonic dehydration
excessive sweating not drinking enough repeat vomiting, diarrhea severe bleeding
82
define hypertonic (hypernatremic) dehydration
more water lost than sodium
83
physiology of hypertonic dehydration
increased extracellular sodium fluid pulled out of intracellular space leading to cell shrinkage
84
lab values in hypertonic dehydration
osmolality: elevated sodium: elevated BUN: elevated
85
causes of hypertonic dehydration
``` diarrhea, water deprivation excessive sweating poorly treated DM diabetes insipidus heat stroke ESRD ```
86
define hypotonic (hyponatremic) dehydration
more sodium lost than water
87
physiology of hypotonic dehydration
sodium lost from extracellular space higher intracellular sodium levels pull water from extracellular space into cell via osmosis cellular swelling
88
causes of hypotonic dehydration
``` overly dilute baby formula SIADH lung CA heat stroke burns, trauma pancreatitis diuretics chronic malnutrition ``` rehydrating young children with fluids w/o salt
89
lab values in hypotonic dehydration
low osmolality | decreased sodium
90
intervene dehydration
fluid resuscitation based on severity oral fluids and electrolytes IV crystalloids if severe
91
causes of hypernatremia
``` water loss excessive sodium intake diabetes insipidus diuretics Cushing syndrome ```
92
sx hypernatremia
``` AMS weakness muscle twitch thirst dry membranes low grade fever ```
93
intervene hypernatremia
``` treat cause isotonic fluids replace gradually 0.45 NS restrict sodium intake ```
94
causes of hyponatremia
``` inadequate Na intake excessive water gain HF cirrhosis SIADH laxatives ```
95
sx hyponatremia
``` abd cramps N/V HA AMS anorexia muscle twitch tremors seizures ```
96
intervene hyponatremia
hypervolemia: fluid restriction, oral Na hypovolemia: isotonic fluids, high-sodium fluids if severe (< 125) hypertonic saline
97
sodium ion overview
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
98
causes of hyperkalemia
``` sodium depletion acidosis trauma, burns, crush injuries ACE inhibitors, beta blockers digoxin, NSAIDs Addison disease ```
99
sx hyperkalemia
``` paresthesia irritability weakness, paralysis decreased tendon reflex N/D bradycardia, hypotension tall peaked T wave flat P wave BBB depressed ST ```
100
intervene hyperkalemia
loop diuretics severe: Ca gluconate, insulin, glucose, kayexalate, dialysis
101
causes of hypokalemia
``` V/D K depleting diuretics insulin excessive laxatives acute alcoholism HF leukemia ```
102
sx hypokalemia
``` leg cramps decreased tendon reflex constipation digoxin toxicity tachycardia, tachypnea rhabdo flatted/inverted T wave U wave ```
103
intervene hypokalemia
correct cause IV replacement K sparing diuretic
104
potassium ion overview
intracellular cation with 98% found inside cells, other 2% in extracellular fluid normal 3.5-5
105
function of K ion in cells
maintenance of cell membrane potential homeostasis of cell volume transmission of action potential in nerve cells
106
causes of hypercalcemia
``` malignancy hyperparathyroidism ACE inhibitors hyperthyroidism fractures acidosis K sparing diuretics excessive vit D ```
107
sx hypercalcemia
``` N/V, weight loss abd pain, constipation HTN kidney stones confusion, lethargy, AMS AV block ```
108
intervene hypercalcemia
``` hydration loop diuretics corticosteroids sodium bicarb dialysis ```
109
causes hypocalcemia
``` hypoparathyroidism malabsorption insufficient Vit D inadequate Ca intake hypoalbuminemia hyperphosphatemia diuretics diarrhea bone cancer alkalosis ```
110
sx hypocalcemia
``` muscle cramps hyperreflexia tetany paresthesia Chvostek, Trousseau signs anxiety, confusion, irritable arrhythmias ```
111
intervene hypocalcemia
IV Ca gluconate vit D replace mag and phos
112
calcium ion overview
blocks Na channels and inhibits depolarization of nerve and muscle fiver increased Ca raises threshold for depolarization normal 9-10.5
113
causes of hyermagnesemia
renal failure untreated DKA Addison disease HD
114
sx hypermagnesemia
``` decreased muscle/nerve activity hypoactive tendon reflex weakness drowsiness, lethargy diaphoresis CNS depression N/V hypotension, vasodilation arrhythmias bradycardia coma ```
115
intervene hypermagnesemia
oral/IV fluids emergency: Ca gluconate avoiding Ma products
116
causes hypomagnesemia
``` loop and thiazide diuretics malabsorption excessive GI fluid loss acute alcoholism preeclampsia pregnancy ```
117
sx hypomagnesemia
``` muscle weakness AMS agitation, confusion SZs tetany, ataxia Chvostek, Trousseau signs tachycardia, HTN vent arrhythmias hyperactive tendon reflex depressed ST prolonged QT ```
118
intervene hypomagnesemia
emergency: IV mag 1-2 G over 1-2 min nonemergency: IV mag 1-2 g over 2 hours increase dietary Mg intake
119
magnesium ion overview
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
define adrenal emergency
lack of excess of adrenaline aka epinephrine
121
where is adrenaline produced?
adrenal glands some in neurons
122
adrenaline overview
aka epi | primary hormone for fight/flight response
123
define Cushing syndrome
prolonged exposure to elevated levels of glucocorticoids or cortisol
124
sx Cushing syndrome
``` 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
prevent Cushing syndrome
taper medications
126
define acute adrenal insufficiency
low levels of cortisol and aldosterone medical emergency, potentially life threatening
127
causes of acute adrenal insufficiency
``` sudden discontinuation of glucocorticoids Addison disease congenital adrenal hyperplasia infection trauma, surgery, burns hemorrhage pregnancy ```
128
sx acute adrenal insufficiency
``` dehydration d/t urine loss hypoNa, hyperK hypoglycemia weakness, fatigue hypotension anorexia, weight loss N/V, abd pain, D/C ```
129
assessing acute adrenal insufficiency
BMP cortisol adrenocorticotropic levels
130
intervene acute adrenal insufficiency
immediate replacement of glucocorticoids and mineralocorticoids tx shock ia IV fluids reverse electrolyte abnormalities
131
effect of hydrocortisone tx in acute adrenal emergency
replace glucocorticoids
132
effect of dexamethasone tx in acute adrenal emergency
replace mineralocorticoids
133
effect of IV insulin/dextorse or kayexalate in acute adrenal emergency
reduce serum K
134
effect of dextrose 50% in acute adrenal emergency
reverse hypoglycemia
135
effect of vasopressors in acute adrenal emergency
treat hypotension 2/2 hypovolemia
136
effect of O2 in acute adrenal emergency
meet increased O2 demands d/t increased HR 2/2 hypovolemia
137
effect of IV crystalloids in acute adrenal emergency
treat hypovolemia
138
why cardiac monitoring in acute adrenal emergency?
high risk for arrhythmia
139
primary function of ADH
retention of water - regulates retention by increasing water reabsorption in kidney vasoconstriction
140
causes of neurogenic diabetes insipidus
``` tumors (hypothalamus, pituitary) head injury cerebral aneurysm meningitis, encephalitis phenytoin, lithium ```
141
causes of nephrogenic diabetes insipidus
``` polycystic kidney disease pyelonephritis SCC sarcoidosis familial genetic disorders ```
142
sx diabetes insipidus
``` polydipsia decreased urine specific gravity decreased urine osmolality increased serum osmolality increased serum sodium ```
143
central diabetes insipidus
deficiency of arginine vasopressin (AVP) aka ADH
144
nephrogenic diabetes insipidus
due to kidney or nephron dysfunction caused by insensitivity of kidneys or nephrons to ADH
145
intervene for diabetes insipidus
fluid replacement (oral or hypotonic) monitor for cerebral edema replace ADH
146
causes of SIADH
``` head trauma infections CNS disorders, stroke, aneurysm malignancy adrenal insufficiency pain, stress meds ```
147
sx SIADH
``` decreased urine output increased urine spec. gravity increased urine osmolality decreased serum osmolality decreased serum sodium ```
148
intervene SIADH
water restriction IV NS or hypertonic saline furosemide monitor I/O and neuro status
149
define SIADH
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
define hypoglycemia
blood glucose < 60 in adults, < 40 in infants
151
sx hypoglycemia
``` cool, diaphoretic tachycardia, palpitations shallow respirations dilated pupils AMS, slurred speech disorientation, SZs coma, brain damage ```
152
intervene hypoglycemia
oral glucose if conscious IV dextrose D5W glucagon IM
153
pathophysiology of DKA
absolute/near absolute insulin deficiency - severe hypoglycemia - ketone body production - systemic acidosis hours to 1-2 days usually in T1DM
154
sx DKA
``` tachycardia, hypotension volume depletion fatigue acute AMS acetone on breath Kussmaul respirations abd pain dehydration ```
155
labs in DKA
blood glucose < 600 elevated BUN glucose, ketones in urine acidosis
156
intervene DKA
``` IV fluids IV insulin bolus, infusion replace electrolytes K, phos sodium bicarb for acidosis ```
157
pathophysiology of hyperosmolar hyperglycemia syndrome (HHS)
severe relative insulin deficiency - profound hyperglycemia - profound hyperosmolality - no ketone production or acidosis days to weeks usually T2DM or unrecognized diabetes
158
sx HHS
``` weakness polyuria, polydipsia significant volume depletion anorexia, N/V acute AMS seizures dehydration ```
159
labs in HHS
BG > 600 elevated BUN no glucose or ketones in urine
160
intervene HHS
IV fluids insulin with D50.45 replace electrolytes K if low
161
thyroid overview
regulates body's metabolic rate via hypothalmic-pituitary-thyroid counter-regulatory system
162
thyroid storm overview
aka thyrotoxic crisis rare but severe and life threatening complication of hyperthyroidism
163
sx thyroid storm
``` hyperthermia (38.7-40C) CNS dysfxn cardiovascular dysfxn -sinus tach, a.fib, angina GI dysfxn (N/V/D) ```
164
intervene thyroid storm
``` treat cause treat hyperthermia w/ acetaminophen increase fluids, calories antithyroid drugs -propylthiouracil -methimazole -iodine -glucocorticoids ```
165
sx myxedema coma
``` hypothermia (below 35.5) w/o shivering bradycardia, hypotension hypoventilation coma, seizures myxedema madness (psychosis) ```
166
risk factors for myxedema coma
> 60 yo women winter months
167
intervene myxedema coma
``` treat cause passive warming rehydration, Na replacement intubate, ventilate IV thyroid replacement levothyroxine, thyroxine glucocorticoids ```
168
define acute renal failure
kidneys fail to adequately filter waste products from blood acute or chronic
169
function of renal system
filter blood and regulate BP, electrolyte balance, RBC production
170
define acute renal failure
rapidly progressive loss of renal function
171
parameters of acute renal failure
oliguria (< 400 ml/day in adults) < 0.5 ml/kg/hr in children < 1 ml/kg/hr in infants +fluid and electrolyte balance
172
3 types of acute renal failure
prerenal intrinsic postrenal
173
prerenal failure
before kidney/renal blood flow d/t transient renal hypoperfusion
174
causes of prerenal failure
hypotension decreased cardiac output decreased effective arterial blood volume
175
intrinsic/intrarenal failure
3 categories: acute glomerulonephritis acute interstitial nephritis acute tubular necrosis
176
acute glomerulonephritis
inflammation and damage to glomerular membrane
177
acute interstitial nephritis
allergic rxn to meds or response to infectious process
178
acute tubular necrosis
nephrotoxic agents or renal hypoperfusion
179
postrenal failure
post kidneys
180
causes of postrenal failure
urinary tract obstructions including renal calculi benign prostatic hyperplasia obstructed urinary catheter
181
toxins causing acute renal failure
``` 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
intervene for acute renal failure
``` stop nephrotoxic drugs IV crystalloids increase urinary output remove obstruction correct electrolyte imbalances ```
183
define chronic kidney disease
sustained kidney damage indicated by presence of structural or functional abnormalities and/or GFR below 60 ml/min for a least 3 months
184
stage 1 CKD
early damage with normal function GFR > 90
185
stage 2 CKD
worse damage with reduced function GFR 60-80
186
stage 3 CKD
even worse damage with less function GFT 30-59
187
stage 4 CKD
severe damage, barely able to sustain life GFR 15-29
188
stage 5 CKD
ESRD, severe impaired function, not adequate to sustain life GFR < 15
189
sx CKD
HTN fluid, electrolyte imbalances oliguria, anuria uremic syndrome
190
fluid and electrolyte imbalances in CKD
volume overload hyperkalemia metabolic acidosis hyperphosphatemia
191
hormonal imbalances in CKD
anemia hyperparathyroidism bone disease
192
uremic syndrome in CKD
``` neuropathy anorexia nausea vomiting fatigue malnutrition ```
193
functions of kidneys
hematopoiesis filtration fluid and electrolyte balance
194
integumentary sx of CKD
``` bruises pruritus dry skin skin color changes dry hair/nails ```
195
cardiovascular sx of CKD
``` HTN tachycardia dysrhythmias EKG changes abnormal heart sounds retinopathy fluid retention pulm edema ```
196
resp sx of CKD
increased RR Kussmaul respirations crackles decreased PO2
197
renal sx of CKD
``` decreased urine output azotemia proteinuria hematuria hyperuricemia ```
198
GI sx of CKD
``` anorexia N/V nalitosis metallic taste GI bleed ```
199
neuro sx CKD
``` peripheral neuropathy restless legs AMS, LOC lethargy, confusion encephalopathy ```
200
hematological sx of CKD
``` anemia weakness, fatigue pallor lethargy bleeding d/t impaired platelet aggregation ```
201
musculoskeletal sx of CKD
``` renal osteodystrophy decreased calcium vitamin D impairment hyperparathyroidism pathological fractures ```
202
immune sx of CKD
increased risk of infection
203
intervene for CKD
``` correct electrolyte, fluid imbalance treat arrhythmias, HTN, pulm edema vent support treat infections HD ```
204
sepsis bundle to be completed w/in 3 hours
lactate blood cultures abx 30 ml/kg crystalloid
205
sepsis bundle to be completed within 6 hours
vasopressors for MAP > 65 CVP and ScvO2 for septic shock remeasure lactate if it was elevated
206
adult endpoints of sepsis resuscitation
CVP 8-12 mmHg MAP > 65 ScvO2 70% of SVO2 urine 0.5 ml/kg/hr
207
pediatric endpoints of sepsis resuscitation
normal HR cap refill < 2 sec central, peripheral pulses urine output > 1 ml/kg/hr
208
diseases requiring airborne precautions
``` TB measles chickenpox until crusted immunocompromised disseminated herpes ```
209
diseases requiring droplet precautions
``` resp viruses influenza parainfluenza adenovirus RSV pertussis nisseria meningitis group A strep ```
210
diseases requiring contact precautions
``` stool incontinence norovirus rotovirus c.diff draining wounds uncontrolled secretions pressure ulcers ostomy tubes bag draining bodily fluids generalized fluids ```
211
characteristics of rubeola/measles
highly contagious incubation 8-12 days transmission: - 4 days after exposure to 4 days after rash appears - nasal or resp secretions
212
sx rubeola/measles
``` fever 3 C's -conjunctivitis -coryza -cough (dry) eyelid edema, photophobia malaise, irritability rash -Koplik spots -maculopapular rash ```
213
Koplik spots
``` in measles small red specks blue white center buccal mucosa near molars 2 days before rash disappears 48 hours after rash ```
214
maculopapular rash in measles
head to trunk to lower extremities 14 days after exposure immunocompromised patients don't always have rash
215
intervene measles
airborne immunize supportive care antipyretics
216
complications of measles
fetuses exposed during 1st trimester at risk for heart defects, developmental delays, deafness, stunted growth
217
define mumps
paramyxovirus that causes grandular enlargement of salivary, parotid glands active in spring
218
transmission of mumps
resp droplets, saliva most contagious 1-2 days before appearance of parotitis infectious up to 5 days after onset of glandular enlargement
219
sx mumps
parotitis fever URI sx
220
intervene mumps
``` droplet immunize supportive care analgesics antipyretics oral steroids for severe orchitis ```
221
pertussis overview
aka whooping cough gram-negative bordetella pertussis attaches to resp tract ciliated epithelium produces toxin that limits ability to clear secretions
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incubation/transmission of pertussis
incubates 7-10 days transmission vai resp droplets
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stages of pertussies
Stage I: catarrhal stage (1-2 weeks Stage II: paroxysmal stage (1-6 weeks) Stage III: convalescent stage (weeks-months)
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catarrhal stage of pertussis
corzya sneezing low grade fever occasional cough that worsens
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paroxysmal stage of pertussis
cough worsens unremitting paroxymals bursts of coughing (whoop) coughing more at night cough may lead to petechial rash above nipple line
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convalescent stage of pertussis
gradual recovery as cough becomes less severe/frequent superinfections can occur d/t trapped secretions
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assessing pertussis
dacron swab in posterior nasopharynx
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intervene pertussis
``` droplet supportive care macrolide abx antitussives antipyretics ```
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dc teaching for pertussis
vaccination | household members tx with abx regardless of vaccination status
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transmission of chickenox
resp droplets, skin contact infectious 48 hours before rash contagious until all sin lesions crusted over and no new lesions formed
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sx chickenpox
``` purulent vesicular rash fever HA anorexia lymphadenopathy malaise pruritus urticaria ```
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intervene chickenpox
``` airborne, contact isolation sympomatic antiviral antihistamines antipyretics, analgesics varicella immunoglubulin if pregnant systemic abx if 2ndary infection NO aspirin in children ```
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define shingles
reactivation of varicella virus that has lain dormant in dorsal ganglia following chickenpox lesions follow path of nerve dermatomes
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sx shingles
pain followed by vesicular lesions w/in 48 hours painful, localized, unilateral pain vesicular lesions along nerve dermatome does not cross midline
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intervene shingles
``` airborne, contact antivirals cover lesions supportive care comfort measures varicella zoster vaccine ```
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define diphtheria
infection of mucous membranes by corynebacterium diphtheriae
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incubation/transmission of diphtheria
incubates 1-8 days transmission via resp droplets
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sx diphtheria
``` low grade fever sore throat thick gray membrane on tonsils, pharynx weakness sore throat fever swollen neck glands ```
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pseudomembrane in diphtheria
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
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complications of diphtheria
toxins absorbed into blood stream and damage heart, kidneys, nerves myocarditis neuritis airway obstruction
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assessing diphtheria
throat culture for gram stain, culture, sensitivity toxin analysis specimen polymerase chain reaction
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intervene diphtheria
droplet vaccine diphtheria antitoxin abx immediately (erythromycin)
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define mononucleosis
acute viral illness d/t Epstein-Barr
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incubation/transmission of mono
body fluids, esp saliva sx occur 4-6 weeks after infection
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prodrome syndrome of mono
``` fatigue anorexia, N/V chills, diaphoresis HA myalgia ```
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illness syndrome of mono
``` low grade fever sore throat HA, body aches lymphadenopathy rash diarrhea earache red throat enlarged tonsils petechiae on palate ```
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complications of mono
``` hepatosplenomegaly thrombocytopenia PNA meningitis, encephalitis hepatitis pericarditis splenic rupture airway obstruction death (rare) ```
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assessing mono
monospot Epstein-Barr virus antigen test CBC LFTs
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intervene mono
sx control analgesics (no aspirin) corticosteroids salivary precautions
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dc teaching for mono
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
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define c.diff
caused by clostridium difficile, gram + anaerobic spore forming bacillus gives rise to abx associated diarrhea
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sx c.diff
``` profuse, frequent diarrhea abd cramping, pain fever nausea, loss of appetite weight loss dehydration, hypovolemia kidney failure ```
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intervene c.diff
``` contact precautions stop abx IV fluids antiemetics metronidazole, vanc, fidazomicin stool transplant ```
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MDRO
microbes resistant to multiple antimicrobials aka superbugs
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types of MDROs
``` MRSA vancomycin RSA extended spectrum beta-lactamase VRE multi drug resistant a.bawnannii ```
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define MRSA
s.aureus resistant to penicillins, cephalosporins
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prevelance of MRSA
most common in skin and soft tissue, hair follicle abscesses
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MRSA transmission
direct contact w/ infection
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sx MRSA
purulent with yellow or white center, central point (head), draining pus, possible aspirate pus "spider bite"
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intervene MRSA
``` I&D culture sensitivities clindamycin tetracyclines rifampin linezolid ```
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define VRE
vanc resistant enterococcus
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prevalence of VRE
long-term abx surgical patients invasive devices
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transmission of VRE
direct contact w/ infection
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sx VRE
``` sepsis UTI meningitis endocarditis infected wounds ```
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intervene VRE
remove source of infection culture, sensitivities combo abx therapy long term
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TB overview
``` mot latent 1/10 progress to active pulm system affected in 0% of cases 15-20% of active cases infection spreads outside lungs airborne ```
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latent TB
contained by immune system asymptomatic, noncontagious isoniazid monotherapy
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active TB
symptomatic, highly contagious
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sx TB
chronic cough > 2-3 weeks night sweats, fever, chills weight loss, anorexia fatigue
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assessing TB
CXR sputum culture labs
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intervene TB
airborne | multidrug therapy
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TB dc teaching
med compliance containing resp secretions dispose of contaminated materials avoid close contact
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BCG
TB vaccine 90% of people worldwide not in N.America causes false skin positive

CEN (12 decks)

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