Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Clin Med IV: Geriatrics and Hospital Medicine > Medications, Consultations & Prevention of Inpatient Complications > Flashcards

Medications, Consultations & Prevention of Inpatient Complications Flashcards

1
Q

What are the approaches to fluid management?

4Rs

A

Routine Maintenance
Replacement
Redistribution
Resuscitation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What do intravascularly dry patients look like?

A

Decreased urine output
CVP
IVC
Hypotension
Tachycardia
Decreased weight

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the goal of fluids

A

maintain hemodynamic stability, euvolemic state

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the daily fluid requirements

A

25-30ml/kg/day of water (total fluid)
*rarely more than 3L per day

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

When should enteral nutrition be considered

A

if NPO > 3days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

how should fluids be dosed for obese patients

A

weight based dosing should be off ideal body weight, not actual body weight

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

who are fluid requirements lower for

A

elderly
CKD
CHF
malnourished patients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What does tonicity define

A

the cell

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is hypertonic fluid

A

tonicity higher than that of the blood
for TBI, fluid shifts, hyponatremia

3% NACL, 7% NACL, D10W and higher concentrations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are Colloids

A

high molecular weight, will stay in intravascular space longer

albumin (16hrs intravasc vs 30min NS), hetastarch

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is Isotonic

A

denoting or relating to a solution having the same osmotic pressure as some other solution, especially one in a cell or a body fluid

NS, LR, D5W, plasmalyte

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what is Hypotonic fluid

A

tonicity is lower thant hat of the blood, used for hypernatremia

.45% NACL (1/2NS), D2.5W

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is Crystalloids

A

isotonic but hypo-oncotic lack the large proteins that keep fluid intravascularly

NS, LR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are balanced crystalloids

A

include lactate or acetate, they are buffered, low Cl-

LR, Plasmalyte

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What does 0.45% hypotonic saline increase the risk of

A

cerebral edema

rarely used

used in patients with hypovolemia in setting of hypernatremia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

when do we use 3% hypertonic saline

A

symptomatic hyponatremia
elevated ICP (d/t TBI, bleed, concern for herniation)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What can occur with innapropriate 3% hypertonic saline administration

A

osmotic demyelination syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the pH of LR

A

6.5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is within LR

(components)

A

Ca2+, K+, Cl-, Na+

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Will patients who recieve LR get lactic acidosis

A

NO

may cause increase lactate but not lactic acid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

what is contraindicated in newonates with LR

A

Ceftriaxone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are the CONS of NS

A

intracellular potassium depletion
Hypercholremic metabolic acidosis
neutrophil activation
pH 5.5
(high volume can cause hypercholremic metabolic acidosis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is Plasmalyte

A

balanced crystalloid fluid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is D5W

A

dextrose 5% in free water
used in hypoglycemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

what makes up 50% of all plasma proteins

A

albumin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

If a trauma patient is hypotensive, what fluids should they NOT recieve

A

crystalloid fluids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

in a trauma if a patient looses 1L of blood how much fluid and what type will they need

A

3L (ish) of crystalloid to maintain normovolemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

how much of fluids will remain as intravascular volume

A

30%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What is the preferred method of nutrition management

A

enteral nutrition
requires working GI tract

30
Q

what are the risk with enteral nutrition

A

not meeting nutritional requirements
aspiration (NG)
GI distress
wound infection if surgically placed

31
Q

what are the indications for parenteral nutrition

A

if requirements not met via enteral
if Gi tract issues

32
Q

what are the risks of parenteral nutrition

A

systemic infection
occlusion of line
thrombosis

33
Q

what are IV opioid options

A

Morphine
Hydromorphone (Dilaudid)
Fentanyl

34
Q

what is the PK of fentanyl

A

RAPID onset < 1 minute, only lasts about 1 hour

35
Q

What does MME stand for

A

Morphile Miligram Equivalents (MME)

36
Q

what is the MME that are at higher risk of OD

A

Over 50 MME/Day

37
Q

What is pyshiologic decline exacerbated by inactivity/immobility

A

deconditioning

38
Q

How are pressure ulcers managed

A

consult wound care early
document
dibridement and clean
dressings
monitor for infection

39
Q

What is Virchows Triad

A

stasis
endothelial injury
hypercoagulable state

40
Q

What are provoking facotrs for VTE

A

estrogen/BC
smoking
immobility
trauma

41
Q

What is the treatment of VTE

A

anticoagulation
(LMWH, DOACs)

42
Q

What are the Ws of post-op fever

A

wind
water
walk
wound
wounder about drugs

43
Q

What are Risk factors with Hospital acquired infections (HAIs)

A

hospital associated
immunosuppression, older age, increased LOS, medical comorbidites, frequent hospitalization, etc

44
Q

What are common hospital acquired infections

A

c. diff
CLABSI
CAUTI (e.coli, pseduomonas)
SSI (s. aureus)
HAP/VAP

45
Q

What is CLABSI

A

central-line associated blood stream infections

46
Q

What is CAUTI

A

catheter-associated UTIs

46
Q

What is a VAP

A

ventilator associated pneumonia

47
Q

what is HAP

A

hospital acquired pneumonia

48
Q

what is a SSI

A

surgical site infection

49
Q

What is a CDI

A

c.diff infection

50
Q

What is the management of HAI

A

removal/replacement of offending agent if possible
site +/- Blood cultures
lab workup for sepsis
empiric abx
fluid resuscitation if needed
monitor for deterioration

51
Q

What is the #1 HAI

what are the pathogen associated with this

A

CAUTI

cath is the m/c indwelling device

E.coli, Pseudomonas, klebsiella, proteus, enterococcus, staph

52
Q

what is the presentation of a CAUTI

A

often fever w/o urinary symptoms
hematuria, suprapubic pain, flank pain, CVA tenderness
bacteremia + positive urine culure and no other source
pyuria

53
Q

how is a CAUTI diagnosed

A

dx of exclusion
Urine culture (from foley bag)
blood cultures

54
Q

What is the treatment of CAUTI

A

change foley (biofilm)
debatable when abx should be started
abx (pipercillin-tazo, ceftazidime, aztronam)

55
Q

What are contraindications for IO

A

osteoporosis
osteogenesis imperfecta
bone fracture
recent placement of IO
cellultitis, infection, burn over insertion site

56
Q

what are the inerstion sites for IO’s

A

proximal tibia (m/c)
humerus

57
Q

what are the risks of IO

A

infection
skin necrosis (extravasation)
compartment syndrome (if through bone completely)
epiphyseal injury
fat embolism
pain

58
Q

What are the indications for central lines

A

cant get peripheral access
need access for procedures
measure central venous pressure
administer certain meds

59
Q

What meds often need a central line

A

pressors, calcium chloride, potassium

60
Q

What are complications of central line

A

hematoma/pain
extravasation of fluids
phelbitis
cellulitis
neurovascular injury
bacteremia/sepsis
DVT
tissue necrosis

61
Q

What is the most common procedure for central lines

A

seldinger technique

needly used to intoduce guidewire, batheter is then placed over the guidewire

62
Q

What is a paracentesis

A

removes ascited for fluid analysis and/or assistance with symptoms management associated with large ascites volume

therapeutic and diagnostic

62
Q

what is a thoracenesis used for

A

pleural effusion

d/t CHF, pneumonia, cancer, PE< cirrhosis

63
Q

what are the contraindications for thoracentesis

A

loculations (need special US guided drainage)
infection to overlying skin
coagulation abnormalities

64
Q

how is a patient positioned for a thoracentesis

A

sitting upright and bending forward

65
Q

What are the compliations of thoracentesis

A

pneumothorax, bleeding, hemothorax, puncture of spleen or liver

66
Q

Where is CSF made

A

ventricles
produced by choroid plexus

67
Q

What are the inidcation of LP

A

Meningitis (CNS Infection)
MS
Aneurysms
unexplainedd seizures
instil chemo/contrast
assess or elevated ICP

68
Q

what are contraindications of LP

A

overlying infection
space occupying lesion
increased ICP
coagulopathy
lumbar fusion/laminectomy

69
Q

What is BIPAP

A

Bilevel Positive Pressure
senses when pt inhails and provides expiratory PEEP

Clin Med IV: Geriatrics and Hospital Medicine (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions