Midterm Flashcards

Question

Sympathetic innervation of the ureters

Answer 1

Upper: T10-11 Lower: T12 - L2

Answer 2

S2-4 Colon, rectum, repro organs, bladder, pelvis, lower ureter

Answer 3

Tachypnea, accessory muscle use, tripoding...visible signs of increased work of breathing

Answer 4

Secondary prevention: assess for other cv sx (claudication), screen for thyroid dysfunction, anemia, etc. (things that may increase cardiac work load and cause sx to recur Tertiary prevention: Cardiac rehab (increase exercise tolerance)!, smoking cessation, tx of lipid disorders

Answer 5

Anemia: Hb will be saturated but Hct will be low therefore a pt may have a 95% pulse Ox but still be hypoxic. Severe anemia can cause fatigue and dyspnea as well as cardiac sx of HF and angina. Physical findings include pallor, especially of the conjunctiva and bounding pulses. Obtain CBC to evaluate for anemia

Answer 6

End-stage COPD is associated with cachexia, weight loss, bitemporal wasting and diffuse loss of subcutaneous adipose tissue. Pts will qualify for hospice at this stage

Answer 7

Palpation of chest for tenderness and access lung expansion; Percuss to compare sides- in a ladder pattern; auscultate- also in a ladder pattern - 2 anterior and at least 4 posterior while pt takes deep breaths through an open mouth; special tests- tactile fremitus and transmitted voice sounds as well as rib motion. \*\*Additional assessment of the upper airway is also recommended

Answer 8

_Primary prevention_: annual flu vaccine, Pneumococcal Vaccine (PCV13) followed by PPSV23 at least 1 yr later, TDaP (Bordatella pertussis) _Secondary prevention_: avoidance of dust, fumes, industrial exposure by using respiratiors or masks _Tertiary prevention_- smoking cessation/abstenence, pulm rehab

Answer 9

Hx and PE plus walking PulseOx, peak flow assess. No DX, move to phase 1: Phase 1 - CXR, Spirometry, ECG, CBC, BMP. No DX, move to phase 2: Phase 2 - Chest CT, Lung Vol, DLCO, neuromuscular function testing, echocardiogram, stress testing. No DX, move to phase 3: Phase 3 - Consider Cardiopulm exercise test and subspecialty referral

Answer 10

Accelerated decline in FEV1 in a dose-dependent response Only 15% is explained by pack-years, suggesting environmental and genetic components

Answer 11

Pt education: provide written material as well as discuss diagnosis, smoking cessation/avoidance and idetify other triggers s/a season change, air quality, ect; when to seek medical attention Medications: inhaled and PO: short-acting inhaled bronchodilators for rescue-Beta agonists (albuterol) and anticholinergic muscarinic antags (ipratropium) to improve FEV1; long-acting bronchodilators if symptoms persist - B agonists (salmeterol), anticholinergic muscarinic antags (tiotropium), LAMA\>LABA for sx improvement OMT (5 models) Pulmonology referral for refractory or complicated cases

Answer 12

Barrel chest, limited rib motion, limited lung expansion with limited exhalation. Percussion may reveal **generalized hyperresonance** d/t hyperinflation. Decreased breath sounds, wheezing and prolonged expirations are common. Transmitted voice sounds and fremitus are _decreased_ d/t **hyperinflation**

Answer 13

On a treadmill stress test, ST Depressions identified during increased cardiac workload, may also reproduce sx of dyspnea

Answer 14

ASA: bleeding, bruising, avoid NSAIDS (GI bleed) Nitrates: HA, hypotension, syncope, reflex tachycardia B Blockers: fatigue, depression,, bradycardia, heart block, bronchospasm, postural hypotension Dihydropiridine: HA, LE edema, fatigue, flushing, reflex tach Non-dihydropiridine: bradycardia, heart conduction defect, low EF, constipation

Answer 15

Brief, generally ~ 5 min Provide enough info to tell audience how you came to your conclusion Must be in chronologic order Must follow SOAP note format Accurately review events that lead to Pt making the appt ID risk factors and/or other underlying medical conditions that may affect dx Generate an assessment and plan (commit!)

Answer 16

EVERYTHING you did regardless of outcome! Use correct grading/scales, clearly specify location/direction, document positive and negative findings

Answer 17

Prgression to unstable angina --\> ACS --\> MI CVA PVD

Answer 18

Heavy, squeezing, pressure, tightness or choking..rarely described as actual pain.

Answer 19

Overall sensitivity is ~75% A negative result does not exclude CAD, although it makes the likelyhood of three-vessel or left main CAD extremely unlikely Contraindications to cardiac stress testing includes unstable angina w/in 48 hours, unstable ECG rhythm, acute myocarditis, sever aortic stenosis, uncontrolled heart failure, severe pulmonary HTN, and active infective endocarditis

Answer 20

Generally begins on exertion Levine sign Discomfort, tight, squeezing, heavy pressure but rarely "pain" May radiate to neck, jaw, back, shoulder, ulnar surface of arm. Trapezius area is generally spared Stable angina gets better with rest and 1-2 Nitro

Answer 21

Upper: T2-7 Lower: T11- L2

Answer 22

Typically include flattening of the diaphragm, increased AP diameter which is best appreciated by increased space between sternum and mediastinum on a lateral film

Answer 23

Progressive hypoxia (supplemental O2) Exacerbations increase as FEV1 decreases, driven by increased airway inflammation (\>50% are bacterial, 30% viral) Respiratory failure during an exacerbation: tx with O2 or bipap, possibly intubation/mechanical vent

Answer 24

To outline an initial treatment plan for pts entering a medical facility for specialized care _as a means to communicate_

Answer 25

When a patient needs hospital care but expected to stay only on e night to observe progress. Can transition to an inpatient admission if pt meets criteria

Answer 26

Admit, Diagnosis, Condition Vitals, Activity, Nursing, Diet, Allergies, Labs and Diagnostics, IV fluids, Specalists/Consults, Medication, Monitoring

Answer 27

1. _Conditions for admission:_ admit, diagnosis, condition, allergies, meds 2. _Diagnostic procedures_: Vitals, activity, Nursing, Diet, Labs, IV fluids, Specalists/consults, Meds 3. _Safety_: Medications, Monitoring

Answer 28

1. The service 2. The attending 3. Particular Unit 4. Need for telemetry

Answer 29

1. Requiring, or likely to require, advanced respiratory support 2. Patients requiring support of two or more organ systems 3. Patients with chronic impairment of ONE or more orgen systemswho also require support for an acute, reversable failure of another organ 4. When the PT needs care that cannot be addressed on another unit d/t medication intensity, need for close monitoring, high risk of declinen in condition

Answer 30

List the primary DX...it may only be a working diagnosis, but this DX is the biggest concern you have for the Pt (do not list S/SX as a diagnosis) List in order of priority if you mention multiple and break the into two groups: first the new/acute problem; second the chronic problems \*Listing chronic problems can be helpful in allowing those processing the orders to know the chronic conditions that lead to or are contributing to the admission

Answer 31

Patients typically are going to ICU as they are potentially unstable or have been unstable prior to the admission and affectively stablilized enough to be transitioned to a medical unit that is appropriate for their diagnosis and care

Answer 32

1. frequency...usually every 4-8 hours, but can be special instructions such as every 2 hours for 8 hours, then move to every 4 hours 2. parameters for notifying the physician

Answer 33

Orders specific for nursing functions, usually not needed any longer as nurses now develop care plans for pts which include nursing orders. Examples: deep breathing exercises every 2 hours Routine oral care Routine hygiene

Answer 34

Medical Specialists Nutrition Phys/Occ Therapy WOund CAre Metabolic support Palliative Care/Hospice

Answer 35

Medications - Medication reconciliation - ID all meds and doses - Delete/Add - Specific to admission \*\*a patient must have a diagnosis for each medication, cannot state it is something the pt already takes (if the pt takes a PPI every day, even OTC, a diagnosis of GERD needs to be made or the med d/c'd)

Answer 36

ECW = 20% (plasma and interstitial) Colloids remain in plasma, NS/LR stay in ECW ICW = 40% 5DW/Dex Saline spread through ECW and ICW Minerals, proteins, Fat, glycogen = 40%

Answer 37

Resuscitation Replacement-Redistribute Routine Maint. Oral/Enteral Maint.

Answer 38

Isotonic: NS, LR, D5W (+/-) Hypotonic: 1/2NS. D5W (+/-) Hypertonic: 3%NaCl, D10W, D5 1/2NS, D5NS, D5LR

Answer 39

25-30 ml/kg water per day and about 1 mmol/kg of Na and K

Answer 40

First 10kg = 100ml/kg in 24\* second 10kg = 50ml/kg in 24\* remaining kg = 20ml/kg in 24\* \*\*24kg kid = 1000mL + 500ml + 80ml = 1580 ml/24 hours = 66 ml/hr -With volume loss, compare normal weight to lost weight: 1 kg = 1 L; Replace 1/2 the fluid vol in 8 hours and the rest over the next 16 hours with monitoring

Answer 41

With severe volume depletion, 1-2 L of isotonic saline are given bolus, then replacement is continued at a rapid rate until cinical signs improve

Answer 42

LR is favored by surgical specalties - LR has a tendency to increase the chance of emboli formation in the midst of PRBC transfusion - In thoery, the Ca in LR could overwhelm the chelating capacities of the citrate in stored blood, resulting in clot formation \*\*Avoid use in Rhabdo! , NS is the better choice

Answer 43

Thsi isotonic solution can induce a metabolic acidosis with aggressive resuscitation

Answer 44

It is considered isotonic, but may cause significant electrlyte shifts d/t hypotonicity after the initial response phase