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CEN Review > Medical Emergencies & Communicable Diseases > Flashcards

Medical Emergencies & Communicable Diseases Flashcards

1
Q

A patient with an open-ended double lumen peripherally inserted central catheter (PICC) is admitted to the emergency department for treatment of intractable nausea and vomiting. Which of the following statements is true about these catheters?

A. They can tolerate flow rates up to 300 psi.
B. A 5 ml or smaller syringe should be used when flushing the line.
C. Turbulent flushes should be avoided.
D. Asking the patient to raise his arm above his head may remove a mechanical obstruction.

A

D. Asking the patient to raise his arm above his head may remove a mechanical obstruction.

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2
Q

What is a fever

A

100.4F or 38C

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3
Q

Occur 5 months - 5 yrs, peaks 8 - 20 months due to an immature nervous system. Treat with Tylenol and Ibuprofen. No Aspirin in children!

A

Febrile seizure

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4
Q

A sign/symptom of hyponatremia is:

A. Hypertension
B. Hyperactivity
C. Seizure activity
D. Neck vein distention

A

C. Seizure activity

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5
Q

Which acid-base imbalance is often associated with hyperkalemia?

A. Respiratory acidosis
B. Metabolic acidosis
C. Respiratory alkalosis
D. Metabolic alkalosis

A

B. Metabolic acidosis

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6
Q

When assessing a patient for hypocalcemia, the nurse attempts to elicits Chvostek’s sign by:

A. Applying a BP cuff to the upper arm, inflating the cuff and observing for carpopedal spasm
B. Tapping a finger on the skin above the supramandibular portion of the parotid gland and observing for twitching of the upper lip on the side opposite the stimulation
C. Tapping a finger on the skin above the supramandibular portion of the parotid gland and observing for twitching of the upper lip on the same side as the stimulation
D. Having the patient hyperventilate to produce
carpopedal spasm caused by respiratory alkalosis

A

C. Tapping a finger on the skin above the supramandibular portion of the parotid gland and observing for twitching of the upper lip on the same side as the stimulation

C=calcium, C=cheek, C=chvostek’s

A. Applying a BP cuff to the upper arm, inflating the cuff and observing for carpopedal spasm = Trousseaus sign

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7
Q

Causes of hyponatremia <135 mEq/L (6)

A

-Excess water intake
* Freshwater drowning
* Excessive ADH secretion (SIADH)
* Diuretics
* GI losses
* Diaphoresis

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8
Q

Causes of hypernatremia >145 mEq/L (7)

A

-Sweating
* Hyperventilation
* Diarrhea
* Diabetes insipidus
* Fever
* Hyperaldosteronism (Cushing’s syndrome)
* Corticosteroid use

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9
Q

Symptoms of

Hyponatremia (8)

Hypernatremia (7)

A

Hyponatremia:
* Lethargy/fatigue/ muscle cramps
* Postural hypotension
* Tachycardia
* Tremors, Seizures
* Altered mental status
* Poor skin turgor
* Diminished DTR’s
* Headache

Hypernatremia:
* Lethargy/fatigue/ muscle cramps
* Thirst, dry mucus membranes
* Headache
* Altered mental status
* Hypotension & tachycardia
* Poor skin turgor
* Hyperactive DTR’s

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10
Q

Treatment for

Hyponatremia (6)

Hypernatremia (8)

A

Hyponatremia:
* Maintain ABC’s
* Fluid replacement with NS
* Hypertonic (3%) in severe cases (No more than 250ml)
* Free water restriction
* Seizure precautions
* Pt education re: diuretics, dietary intake, free water intake

Hypernatremia:
* Maintain ABC’s
* Fluid resuscitation
* Initially with NS
* Follow with ½ NS
* Diuretics to prevent fluid overload
* Seizure precautions
* Na+ restrictions
* Pt education: diet, fluid replacement after exercise

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11
Q

Causes of hypokalemia <3.5 (6)

A
  • NPO status
  • GI losses (N/V/D, suction, fistulas)
  • Diuretics
  • Metabolic alkalosis
  • β2-agonists
  • Hyperaldosteronism (Cushing’s syndrome)
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12
Q

Causes of hyperkalemia >5 (6)

A
  • Renal failure
  • Early stage of burns
  • Massive crush injury
  • Metabolic acidosis – i.e. DKA
  • Hypoaldosteronism (Addison’s disease)
  • Medications
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13
Q

Symptoms of

Hypokalemia (9)

Hyperkalemia (10)

A

Hypokalemia:
* Shallow respirations
* Muscle weakness -> paralysis
* Muscle cramps and paresthesias
* Anorexia
* Ileus
* ST depression
* T wave inversion or flattening
* U waves
* PVC’s (especially if on digoxin)

Hyperkalemia:
* Nausea, vomiting
* Muscle twitching
* Seizures
* Acidosis
* Peaked T waves
* ST depression
* PR interval prolongation
* Widening QRS
* Complete heart block
* Ventricular fibrillation

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14
Q

Treatment for

Hypokalemia (5)

Hyperkalemia (8)

A

Hypokalemia:
* Replace K+ (PO or IV)
* May need Mg++
* Pt education
* Potential for dig toxicity
* Dietary supplements

Hyperkalemia:
* Calcium chloride or gluconate
* Albuterol
* D50 and insulin
* NaHCO3
* Loop diuretic
* Resin exchange
* Dialysis
* Continuous cardiac monitoring

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15
Q

Causes of hypocalcemia <8.5 (8)

A
  • Poor absorption
  • Malabsorption Conditions
    *Decreased Vit D
    *Renal failure
    *Hypoparathyroidism
    *Calcium channel blocker overdose
    *Alkalosis
    *Massive transfusion
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16
Q

Causes of hypercalcemia >10.5 (6)

A
  • Renal failure
  • Use of thiazide diuretics
  • Hyperthyroidism/hyperparathyroidism
  • Steroid use
  • Malignancy
  • Prolonged Immobility
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17
Q

Symptoms of

Hypocalcemia (12)

Hypercalcemia (12)

A

Hypocalcemia:
*Paresthesias of fingers, toes, lips, nose
*Muscle cramping
* + Chvostek’s sign
* + Trousseau’s sign
*Hyperactive DTR’s
*Anxiousness, irritability
* Laryngospasms
* Seizures
-Mg++ and PO4 3- decreased
*Alkalosis
*Prolonged QT and ST intervals
* T-wave inversion

Hypercalcemia:
* Nausea/vomiting
* Abdominal distention
* Headache
* Lethargic, confused
* Fatigue & profound muscle weakness
* Depressed DTR’s
* Electrolyte abnormalities (Hyponatremia, Hypokalemia, Low Phosphate)
* Elevated BUN/Cr
* Low serum albumin
* Shortened QT interval
* Widened PR (>15mg/dl)
* Bradycardia, heart blocks, BBB (>20mg/dl)

18
Q

Treatment for

Hypocalcemia (6)

Hypercalcemia (7)

A

Hypocalcemia:
* ABC’s
* Cardiac monitoring
* Seizure precautions
* Stop hyperventilation
* Calcium gluconate
* Calcium chloride

Hypercalcemia:
* Treat the underlying cause
* Cardiac monitoring
* Aggressive fluid administration (NS)
* Loop diuretics
* Calcitonin
* Bisphosphonates
* Dialysis

19
Q

Type of hemophilia: Classic hemophilia, variant of factor VIII

A

Hemophilia A

20
Q

Type of hemophilia: Christmas disease, absence or deficient factor IX

A

Hemophilia B

21
Q

Type of hemophilia: Rosenthal’s syndrome, deficiency in factor XI

A

Hemophilia C

22
Q

Type of hemophilia: Defective platelet adherence and decreased levels of factor VIII

A

von Willebrand disease (angiohemophilia)

23
Q

9 symptoms of hemophilia

A

-Painful, edematous joints, decreased ROM
*Hemarthrosis
*Prolonged bleeding after procedures
* PTT prolonged (intrinsic pathway)
* PT normal (extrinsic pathway)
* Platelet count normal
* Factor VIII decreased (A and von Willebrand)
* Factor IX decreased (B)
* Factor XI decreased (C)

24
Q

Coags for patients with hemophilia:

PTT?
PT?
Platelets?

A
  • PTT prolonged (intrinsic pathway)
  • PT normal (extrinsic pathway)
  • Platelet count normal
25
Q

Management for hemophilia (9)

A
  • No IM injections
  • Ice, immobilize, elevate, compressive dressing for hemarthrosis
  • Desmopressin
  • Cryoprecipitate
  • FFP
  • Factor VIII or IX
  • Avoid ASA and NSAIDS
  • Topical thrombin
  • Observe for 4 hrs after laceration repair
26
Q

Abnormal decrease in the absolute number, premature destruction, abnormal functioning of platelets, congenital or acquired

A

Thrombocytopenia

27
Q

18 drugs that can cause thrombocytopenia

A
  • Chemotherapeutic agents
  • Alcohol
  • Anticonvulsants
  • Thiazide diuretics
  • Solvents
  • Insecticides
  • Radiation
  • Heparin (HIT)
  • NSAIDS
  • PLAVIX
  • ASA
  • Prednisone
  • Penicillins
  • Quinidine
  • Rifampin
  • Chloramphenicol
  • Lasix
  • Tetracycline
28
Q

Acute cases occur in children 2-6 years old after viral illness, self-limiting, rarely reoccurs; chronic cases occur in adults 20-40 years old, gradual onset, has remissions & exacerbations

A

ITP

29
Q

Labs for thrombocytopenia:

-Platelet count?

-PT?

-PTT?

-Bleeding time?

A
  • Platelet count <150,000
  • PT/PTT normal
  • Bleeding time prolonged
30
Q

Symptoms of thrombocytopenia (5)

A
  • Bruising, petechia
  • Epistaxis, bleeding gums
  • GI bleeding
  • Hematuria
  • Retinal hemorrhage
31
Q

Management of thrombocytopenia patients (7)

A
  • ABC’s
  • Handle pt gently
  • Avoid IM injections
  • Closely monitor venipuncture sites
  • Platelet transfusions
  • IV immune globulin
  • Splenectomy (severe)
32
Q

12 symptoms of sickle cell

A
  • Pain in joints, chest, abdomen, & back
  • Impaired growth
  • Tachycardia
  • Tachypnea
  • Cardiomegaly
  • Jaundice
  • Priapism
  • High risk for infection
    *Low Hgb (hemolytic anemia)
    *Elevated reticulocytes
    *Low PaO2
    *Elevated bilirubin
33
Q

3 ways we treat sickle cell crisis

A

-oxygen
-IV hydration
-analgesia

34
Q

Inherited, genetic disorder seen in people of African, Mediterranean, Indian, Middle Eastern decent. Occurs due to an abnormal Hgb S present on RBC’s. Pain occurs with hypoxia, dehydration, cold, infection or acidosis. Clumping of RBC’s causes microcirculatory obstruction, leads to tissue ischemia and infarction. Causes intermittent episodes of acute and chronic pain.

A

Sickle Cell Disease

35
Q

What things causes sickling in a sickle cell crisis?

A

hypoxia, dehydration, cold, infection or acidosis

36
Q

What is the cause of sickle cell?

A

Occurs due to an abnormal Hgb S present on RBC’s

37
Q

9 causes of DIC

A
  • Trauma (Burns, Brain injury, Multiple injuries, Fat emboli)
  • Obstetric (Amniotic fluid embolus, Retained dead fetus, Abruptio placenta, Eclampsia)
  • Infections (Viral, Bacterial, Fungal, Hemolytic)
  • Transfusion reaction
  • Massive transfusion
  • ITP
  • Aneurysms
  • Hypothermia
  • ASA toxicity
38
Q

Underlying disease or condition -> Stimulation of coagulation cascade. This leads to fibrin clot formation and activation of fibrinolysis. This causes microvascular thrombus and activation of fibrinolysis.

A

Disseminated Intravascular Coagulation

39
Q

9 symptoms of DIC

A
  • Bleeding from multiple sites
  • Petechia, ecchymosis, hematomas
  • Altered mental status
  • Dyspnea, tachypnea, hemoptysis
  • Signs of shock
  • Platelet, H&H, fibrinogen levels decreased
  • PT and PTT prolonged
    *Increased FDP’s
    *D-Dimer increased
40
Q

Treatment for DIC (5)

A

*ABC’s
*Treat the underlying cause
*Replace coagulation factors and RBC’s
*FFP/Platelets/Cryoprecipitate
*Heparin—continuous low-dose infusion (contraindicated in some conditions, controversial)

41
Q

Insufficiency of cortisol, aldosterone and androgen, hormones produced by the adrenal cortex. Occurs primarily in middle-aged females. Results in hyperpigmentation of skin, hypoglycemia, loss of libido, hair loss to legs, axilla and pubic area.

A

Addison’s Disease

CEN Review (6 decks)

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