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AGACNP Board Review > Mild/Moderate Hospital Problems > Flashcards

Mild/Moderate Hospital Problems Flashcards

1
Q

What is pain?

A

A description of a subjective perception of distress

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2
Q

What are the two types of pain?

A

Acute vs Chronic

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3
Q

What is acute pain?

A

Pain duration that is under 6 months

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4
Q

What is chronic pain?

A

Episodic pain that is longer than 6 months

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5
Q

What are the four locations of pain?

A
  1. Cutaneous
  2. Visceral
  3. Somatic
  4. Neuropathic
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6
Q

What is cutaneous pain?

A

Localized on the skin or surface of the body

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7
Q

What is visceral pain?

A

Poorly localized pain that is associated with internal organs

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8
Q

What is somatic pain?

A

Non localized; orignates in muscle, bone, nerves, blood vessels, and supporting tissue

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9
Q

What is neuropathic pain?

A

Pain associated with nerve pathway injury or compression

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10
Q

WHO’s ladder of pain management definition

A

A three-step progressive ladder that starts with ASA, APAP, or a NSAID and progressively continues in three steps with heavier narcotics added while maintaining the initial ASA, APAP, or NSAID

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11
Q

What medications are part of WHO’s step one pain management ladder?

A
  1. ASA
  2. APAP
  3. NSAID
  4. Adjuvants
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12
Q

What medications are part of Who’s step two pain management ladder?

A
  1. Codeine
  2. hydrocodone
  3. Oxycodone
  4. Dihydrocodeine
  5. Tramadol
  6. Adjuvants
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13
Q

What medications are part of WHO’s step three pain management ladder?

A
  1. Morphine
  2. Hydromorphone
  3. Methadone
  4. Levorphanol
  5. Fentanyl
  6. Oxycodone
  7. Nonopioid analgesics
  8. Adjuvants
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14
Q

What medication is typical used for cancer pain?

A

Fentanyl patches

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15
Q

What pain medication is used in metastatic bone pain management?

A

Biphosphonates

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16
Q

Whs

What are characteristics of a stage one pressure injury?

A

Intact skin with erythema that does not blanch

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16
Q

What are pressure ulcers?

A

Any lesions caused by unrelieved external pressure resulting in occlusion of blood flow, tissue ischemia, and cell death

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17
Q

What are characteristics of a stage two pressure injury?

A

Partial-thickness loss of skin with exposed dermis

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18
Q

What are characteristics of a stage three pressure injury?

A

Full-thickness skin loss with adipose tissue still present

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19
Q

What are characteristics of a stage four pressure injury?

A

Full-thickness skin and tissue loss with exposed, palpable fascia, muscle, tendon, ligament, cartilage, or bone in the ulcer

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20
Q

What are characteritics of a unstageable pressure injury?

A

Full-thickness skin and tissue loss and the wound is eschared leaving it unable to stage the wound as a three or four

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21
Q

What are characteristics of a deep tissue pressue injury?

A

Intact or non-intact skin with localized area of persistent non-blanachable deep red, maroon, purple discolaration or epidermal seperation

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22
Q

What is a fever?

A

A temperature above 37 C

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23
Q

What are 3 causes of a fever?

A
  1. Infection
  2. Autoimmune disease (SLE, arteritis)
  3. CNS disease
  4. Malignant neoplastic disease
  5. Hematologic disease
  6. Cardiovascular disease
  7. Gastrointestinal disease
  8. Endocrine disease
  9. Neuroleptic Malignant syndrome
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24
Q

Fever management

A
  1. Antimicrobials
  2. Antipyretics
  3. Treat underlying condition
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25
Q

Causes of non-infectious postoperative fever

A
  1. Postoperative atelectasis
  2. Increased basal metabolic rate
  3. Dehydration
  4. Drug reactions
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26
Q

Causes of infectious postopertative fever

A
  1. WBC with left shift
  2. Surgical incision
  3. IV site
  4. Point of entry for any catheter
  5. Urinary tract
  6. Lungs
  7. Siniusitis
  8. Abscess
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27
Q

Initial treatment of postoperative fever

A

Fluids and lung expansion

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28
Q

Management of postoperative fever

A
  1. Fluids
  2. Acetaminophen
  3. Treat the underlying source
  4. C&S all invasive lines and catheters as indicated
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29
Q

Clinical observations of malnutrtion

A
  1. Hair not easily plucked
  2. Musculature
  3. Clear nail beds free of ridges
  4. PMMM
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30
Q

Complications of Enteral Nutrtional Support

A
  1. Aspiration
  2. Diarrhea
  3. Emesis
  4. GI Bleeding
  5. Mechanical obstruction of tube
  6. Hypernatremia
  7. Dehydration
  8. Refeeding syndrome
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31
Q

What is Refeeding Syndrome?

A
  1. Hypophosphatemia
  2. Hypokalemia
  3. Hypomagnesmia
  4. Hypocalcemia
  5. Thiamine deficiency
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32
Q

Complications of parenteral nutritional support?

A
  1. Pneumothorax
  2. Hemothorax
  3. Arterial laceration
  4. Air emboli
  5. Catherter thrombosis
  6. Catheter sepsis
  7. Hyperglycemia
  8. HHS
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33
Q

What is included in gastrointestinal decontamination?

A
  1. Gastric Lavage
  2. Activated charcoal
  3. Cathartics (Sorbitol)
  4. Whole bowel irrigation
  5. Antidotes
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34
Q

What are the different types of drug intoxication?

A
  1. Acetaminophen
  2. Salicylate
  3. Organophophate
  4. Antidepressent
  5. Opioid
  6. Benzodiazepine
  7. Beta Blocker
  8. Antifreeze
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35
Q

Signs and symptoms of acetaminophen overdose

A
  1. Asymptomatic
  2. Nausea/Vomiting
  3. RUQ pain
  4. Signs of hepatotoxicity
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36
Q

Manamgement of acetaminophen overdose

A
  1. Activated charcoal
  2. Mucomyst
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37
Q

Signs and symptoms of ASA overdose

A
  1. Nausea/Vomiting
  2. Tinnitus
  3. Dizziness
  4. Headache
  5. Dehydration
  6. Hyperthermia
  7. Apnea
  8. Cyanosis
  9. Metabolic Acidosis
  10. Elevated LFTs
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38
Q

Management of ASA overdose

A
  1. Activated charcoal
  2. Sodium bicarbonate
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39
Q

Signs and symptoms of insectiside poisoning

A
  1. Nausea/Vomiting
  2. Cramping
  3. Diarrhea
  4. Excessive salvation
  5. Headache
  6. Blurred vision
  7. Miosis
  8. Bradycardia
  9. Mental Confusion
  10. Slurred Speech
  11. Coma
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40
Q

Managment of Insecticide poisoning

A
  1. Activated Charcoal
  2. Atropine
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41
Q

Signs and symptoms of antidepressent toxicity

A
  1. Confusion
  2. Hallucination
  3. Blurred vision
  4. Urinary retention
  5. Hypotension
  6. Tachycardia
  7. Dysrhythmias
  8. Hypothermia
  9. Seizure
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42
Q

Management for antidepressent toxicity

A
  1. Admit to ICU
  2. Activated charcoal
  3. Sodium bicarbonate
  4. Benzodiazepine IV
  5. Dantrolene for SS
  6. Cooling blankets
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43
Q

Signs and symptoms of opioid toxicity

A
  1. Drowsiness
  2. Hypothermia
  3. Respiratory depression
  4. Shallow respirations
  5. Miosis
  6. Coma
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44
Q

Managment of opioid toxicity

A
  1. Activated charcoal
  2. Naloxone
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45
Q

Managment of benzodiazepine overdose

A
  1. Respiratory and blood pressue support
  2. Romazicon
  3. Activated Charcoal
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46
Q

Signs and symptoms of benzodiapine overdose

A
  1. Drowsiness
  2. Confusion
  3. Slurred speech
  4. Respiratory depression
  5. Hyporeflexia
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47
Q

Signs and symptoms of beta blocker overdose

A
  1. Hypotension
  2. Bradycardia
  3. Delirum
  4. Coma
  5. Bronchospasm
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48
Q

Management of beta-blocker overdose

A
  1. Activated charcoal
  2. Glucagon
  3. Atropine
  4. Airway Managment
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49
Q

Antifreeze overdose stage one

A
  1. Loss of cordination
  2. Headache
  3. Slurred speech
  4. Nausea/vomiting
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50
Q

Antifreeze overdose stage two

A
  1. Irregular heartbeat
  2. Shallow breathing
  3. Changes in blood pressure
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51
Q

Antifreeze overdose stage three

A
  1. Kidney failure
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52
Q

Management of antifreeze overdose

A
  1. Antizol
  2. Ethanol only if antizol is not available
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53
Q

What is Compartment Syndrome?

A

Increased interstitial pressure within a closed fascial compartment resulting from hemorrhage, edema, sustained external pressure or constrictive cast

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54
Q

Signs and symptoms of compartment syndrome

A
  1. Severe ischemic pain
  2. Tensely swlloen
  3. Skin perfusion
  4. Parasthesia
  5. Muscle is painful
  6. Progressive loss of sensory/motor function
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55
Q

Diagnostics for compartment syndrome

A

Stryket tonometer reading is greater than 30 mm Hg

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56
Q

Managment of compartment syndrome

A

Release constricting appliances
Fasciotomy if performed within a first few hours of developing compartment syndrome

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57
Q

General pearls to bites

A
  1. All bites can lead to inefction
  2. High-pressure irrigation is indicated to reduce possibility for infection
  3. Confirm if the animal has rabies or not
  4. XRAY
  5. Primary closure of wound
  6. Wounds on the hand or lower extremity is left open to heal by secondary intention
  7. Plastics consult
  8. 3 to 7 day prophylatic antimicrobial coverage for all bites
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58
Q

General approach to managing infections

PSSP

A
  1. Establish **presence **of infection
  2. Establish severity of infection
  3. Establish site of infection
  4. Determine likely **pathogen **
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59
Q

Types of G+ bacteria

A
  1. Staphylococcus
  2. Streptococci
  3. Enterococci
  4. Bacilli
  5. Corynebacterium
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60
Q

Types of G- bacteria

A
  1. Serratia marcescens
  2. Escherichia coli
  3. Klebsiella
  4. Pseudomonas
  5. Proteus mirabilis
  6. Moraxella catarrhalis
  7. Acinetobacter
  8. Enterobacter
61
Q

Empiric therapy for OM, Sinusitis

A
  1. Amoxicillin
  2. Aumentin
  3. Bactrim
  4. Cefuroxime
62
Q

Empiric therapy for endocarditis

A

Vancomycin + ceftriaxone
or
penicillin + gentamicin

63
Q

Empiric therapy for peritonitis

A

Metronidazole + 3rd gen chephalosporin or zosyn

64
Q

Empiric therapy for intra-abdominal infections

A

Metronidazole + cefuroxime or ceftriaxone or ciprofloxacin or levofloxacin

65
Q

Empiric therapy for cellulitis

A

1st generation cephalosporin, cefazolin, vancomycin, clindamycin, linezolid, daptomycin

66
Q

Empiric therapy for sepsis

A

Vancomycin + cephalosorin or zosyn or imipenem or meropenem

67
Q

Organ transplant considerations

A
  1. All transplant patients are immunosuppresed patients
  2. Antiregection therapy is warranted when there is acute rejection of an organ
68
Q

Signs and symptoms of acute rejecction of an organ

A
  1. Immediate failure of that organ
  2. Flu-like symptoms
69
Q

Therapy for acute rejection of an organ

A
  1. Immediate biopsy of that organ
  2. Corticosteroids
  3. Antimetabolic
  4. Calcineurin inhibitor
70
Q

Steroids for organ rejection prevention

A
  1. Methylprednisolone
  2. Prednisone
71
Q

Antimetabolites for organ rejection prevention

A
  1. Azathioprine
  2. Mycophenolate mofetil
  3. Mycophenolate sodium
  4. Cyclophosphamide
72
Q

Calcineurin inhibitors for organ rejection prevention

A
  1. Tacrolimus
  2. Cyclosporine
73
Q

Mammalian target of rapamycin inhibitor for organ rejection prevention

A
  1. Sirolimus
  2. Temsirolimus
  3. Everolimus
74
Q

What is herpes zoster?

A

An acute vesicular eruption due to an infection wit hthe varicella-zoster virus

75
Q

Signs and symptoms of herpes zoster

A
  1. Pain along a single or grouped dermatomes
  2. Vesicle eruption along the dermatome with erythema and exudate
  3. Regional lymphadenopathy may be present
76
Q

Herpes zoster management

A
  1. Antivirals like acyclovir, famciclovir, valacyclovir
  2. Treat neuralgia with gabapentin or pregabalin
  3. Singrix vaccination
77
Q

When is the Shingrex vaccination indicated?

A
  1. Adults aged over 50 regardless of previous shingles vaccination
  2. It is a 2 step series given 2-6 months after initial dose
78
Q

What kind of skin cancer is shown in the image?

A

Actinic Keratoses
2. Small patches occuring on sun-exposed parts of the body
3. Premalignant
4. Asymptomatic
5. Rough, flesh colored, pink, and may be hyperpigmented

79
Q

Management of Actinic Keratoses

A

Liquid nitrogen

80
Q

What kind of skin cancer is shown in the image?

A

Squamos Cell Carcinoma
1. Arise out of actinic keratoses
2. Firm, irregular papule or nodule
3. Due to prolonged sun exposure
4. Keratotic, scaly bleeding

81
Q

Treatment for squamous cell carcinoma

A

Biopsy and surgical excision

82
Q

What kind of cancer is shown in this image?

A

Basal Cell Carcinoma
1. Most common skin cancer
2. Slow growth
3. Waxy, pearl appearance
4. Central depression or rolled edge
5. May have telangietatic vessels

83
Q

Treatment for Basal Cell Carcinoma

A

Shave/punch biopsy and surgical excision

84
Q

The keys to malignant melanoma

ABCDE

A
  1. Asymetry
  2. Border irregularity
  3. Color variation
  4. Diameter above 6 mm
  5. Elevation
  6. Enlargement
85
Q

Brain death considerations

A
  1. Meets brain death criteria
  2. Family education and support
86
Q

Brain death criteria

A
  1. EEG
  2. No cranial nerve function
  3. normothermic
87
Q

Terminal extubation consideration

A
  1. Preperation/Education/Support
  2. Opioid use
  3. Scopolamine patch/Atropine drops
88
Q

What are the different types of headache?

A
  1. Tension
  2. Migraine
  3. Cluster
89
Q

Signs and symptoms of a tension headache

A
  1. Vise-like or tight
  2. Generalized
  3. Intense around the neck and back
  4. No neurological deficet
  5. Usually last for several hours
90
Q

Management for tension headache

A
  1. OTC analgesics
  2. Relaxation
91
Q

What is a migraine headache?

A

A migraine headache is a headache that last for 2-72 hours that is usually caused by dilation and excessive pulsation of branches of the external carotid artery that follow the trigeminal pathway

92
Q

What are the two types of headache?

A
  1. Classic (with aura)
  2. Common (without aura)
93
Q

Common causes of migraines

A
  1. Female
  2. Emotional/Physical stress
  3. Lack of sleep
  4. Missed meals
  5. Specific foods
  6. Alcohol
  7. Menstrution
  8. Contraceptive use
94
Q

Signs and symptoms of migraines

A
  1. Unilateral throbbing headache that occurs in episodes
  2. Dull/Throbbing
  3. Pain gradually builds
  4. Focal neurologic distrubances (aura) before headache
  5. Visual disturbances
  6. Aphasia
  7. Numbness
  8. Tingling
  9. Clumsiness
  10. Weakness
  11. Nausea
  12. Vomiting
  13. Photophobia/Phonophobia
95
Q

Lab/Diagnostics for migraine headaches

A
  1. BMP
  2. CBC
  3. VDRL
  4. ESR
  5. CT of head
    6.
96
Q

Migraine Management

A
  1. Avoidance of trigger foods
  2. Relaxation/stress management
  3. Prophylatic daily therapy
  4. Dark, quiet room placement
  5. Imitrex
97
Q

Prophylatic therapy for migraines

A
  1. Anticonvulsants
  2. Beta-blockers
  3. Botox
  4. CCB
  5. TCA
  6. CGRP
  7. NSAIDs
98
Q

What are cluster headaches

A

Painful headache syndromes that usually affect middle-aged men

99
Q

Causes of cluster headaches

A
  1. Precipated by alcohol ingestion
  2. Severe unilateral, periorbital pain occuring daily for weeks
  3. Usually occurs at night
  4. Ipsilsilateral nasal congestion, rhinorrhea, and eye redness
100
Q

Management of cluster headaches

A
  1. Oxygen
  2. Imitrex
  3. Ergostat
101
Q

What is hyponatremia?

A

Low NA level

102
Q

Hyponatremia evaluation

A
  1. Urine sodium
  2. Serum osmolality
  3. Clinical Status
103
Q

What is Isotonic Hyponatremia

A

“Pseudohyponatremia”
1. Occurs with extreme hyperlipidemia or hyperproteinemia

104
Q

What is hypotonic hyponatremia

A

State of body water excess

105
Q

Causes of hypovolemic with urine NA+ less than ten

A
  1. Dehydration
  2. Diarrhea
  3. Vomiting
106
Q

Causes of hypovolemia with urine NA+ greater than 20

A
  1. Diuretics
  2. ACE inhibitors
  3. Minearalcorticoid deficiency
107
Q

Causes of hypervolemic, hypotonic, hyponatremia

A
  1. Edematous states
  2. Heart failure
  3. Liver Disease
  4. Advanced renal failure
108
Q

Causes of hypertonic hyponatremia

A
  1. Hyperglycemia
109
Q

Management of hyponatremia

A
  1. Treatment based on cause and underlying condition
  2. Hypovolemia indicates NSIV
  3. Hypervolemia indicates fluid restrictions
  4. Symptomatic patients get NSIV with loop diuretic
  5. CNS invovlment indicates 3% NS with loop diuretic
110
Q

What is hypernatremia

A

High NA level

111
Q

Causes of hypernatremia

A
  1. Excess water loss
  2. Cushings disease
  3. Hyperaldosteronism
112
Q

Management of hypernatremia

A
  1. NSIV transition to 1/2 NS
  2. Euvolemic hypernatremia indicates D5W
  3. Hypervolemic hypernatremia indicates NS with loo diuretics and possible dialysis
113
Q

What is hypokalemia

A

Low potassium level

114
Q

Signs and symptoms of hypokalemia

A
  1. Muscular weakness
  2. Fatigue
  3. Muscle cramps
  4. Constipation
  5. Ileus
  6. Flaccid paralysis
  7. Tetany
  8. Hyporeflexia
  9. Rhabdomyolysis
115
Q

Lab/Diagnostic for hypokalemia

A
  1. Abnormal T waves
  2. Prominent U waves
  3. PVCs
  4. V-tach
  5. V-fib
116
Q

Management of hypokalemia

A
  1. Potassium PO replacement
  2. IV replacement if <2.5 or with symptoms
117
Q

Causes of hypokalemia

A
  1. Chronic use of diuretics
  2. GI lossess
  3. Renal loss
  4. Alkalosis
118
Q

What is hyperkalemia

A

High potassium level

119
Q

Causes of hyperkalemia

A
  1. Renal failure
  2. Excess intake
  3. NSAIDs
  4. Hypoaldosteronism
  5. Cell death
120
Q

Hyperkalemia acidosis conversion

A

Each 0.1 drop in pH indicates a 0/7 mEq/L increase in K+

121
Q

Signs and symptoms of hyperkalemia

A
  1. Weakness
  2. Flaccid paralysis
  3. Abdominal distension
  4. Diarrhea
122
Q

Lab/Diagnostics of hyperkalemia

A
  1. Tall peaked T waves on ECG
123
Q

Management of hyperkalemia

A
  1. Calcium gluconate
  2. Insulin
  3. Glucose
  4. Kayexalate
124
Q

What is hypercalcemia

A

High calcium level

125
Q

Causes of hypercalcemia

A
  1. Hyperparathyroidism
  2. Hyperthyroidism
  3. Vitamin D intoxication
  4. Prolonged immobilization
126
Q

Signs and symptoms of hypercalcemia

A
  1. Fatigue
  2. Muscle weakness
  3. Depression
  4. Anorexia
  5. Nausea
  6. Vomiting
  7. Constipation
  8. Coma
  9. Death
127
Q

Management of hypercalcemia

A
  1. Calcitonin
  2. NS with loop diuretics
  3. Dialysis
128
Q

What is hypocalcemia

A

Low calcium level

129
Q

Causes of hypocalcemia

A
  1. Hypoparathyroidism
  2. Hypomagnesemia
  3. Pancreatitis
  4. Renal failure
  5. Severe trauma
  6. Multiple blood transfusion
130
Q

Signs and symptoms of hypocalcemia

A
  1. Increased DTRs
  2. Muscle/Abdominal cramps
  3. Trousseaus sign
  4. Convulsions
  5. Chvosteks sign
  6. Prolonged QT interval
131
Q

Management of hypocalcemia

A
  1. Observe for alkalosis
  2. IV calcium gluconate
  3. PO replacement
  4. Vitamin D
  5. Aluminum hydroxide
132
Q

Name the four acid-base imbalances

A
  1. Respiratory Acidosis
  2. Respiratory Alkalosis
  3. Metabiolic Acidosis
  4. Metabolic Alkalosis
133
Q

What is Respiratory Acidosis

A
  1. Low pH
  2. High CO2
134
Q

Signs and symptoms of respiratory acidosis

A
  1. Somnolence
  2. Confusion
  3. Coma
  4. Asterixis
135
Q

Causes of respiratory acidosis

A
  1. Decreased alveolar ventilation
  2. Obesity
  3. Head Injury
  4. Drug Injestion
  5. Airway obstruction
  6. Disorders of the chest wall
  7. Disorder of respiratory muscles
136
Q

Management of respiratory acidosis

A
  1. Naloxone
  2. Intubation
  3. Increase rate on ventilator
137
Q

What is Respiratory Alkalosis

A

Hyperventilation decreases arterial pCO2 and increases pH.

138
Q

Causes of respiratory alkalosis

A
  1. Hyperventilation due to hypoxemia
  2. Direct stimulation of central respiratory center
139
Q

Signs and symptoms of respiratory alkalosis

A
  1. Light-headedness
  2. Anxiety
  3. Parasthesia
  4. Tetany
140
Q

Lab/Diagnostics for respiratory alkalosis

A
  1. High pH
  2. Low pCO2
  3. Serum HCO3 low
141
Q

Management for respiratory alkalosis

A
  1. Manage underlying cause
  2. Paper bag breathing
  3. Decrease rate of ventilator
  4. Sedation
142
Q

What is matabolic acidosis

A

Low HCO3

143
Q

Anion gap equation

A

[(NA+) + (K+)] - (HCO3 + Cl-)

144
Q

Conditions where the anion gap is increased

A

Diabetic ketoacidosis
Alcoholic ketoacidosis
Lactic acidosis

145
Q

Management of increased gap

A
  1. Treat underlying disorder
  2. Fluids
146
Q

Conditions where the anion gap is decreased

A

Diarrhea
Ileostomy
Renal tubular acidosis
Recovery from DKA

147
Q

What is metabolic alklalosis

A

High HCO3

148
Q

What are causes of metabolic alkalosis

A
  1. Post-hypercapnia alkalosis
  2. NG suction
  3. Vomiting
  4. Diuretics
149
Q

Management of metabolic alkalosis

A
  1. Correct volume deficit
  2. Discontinue diuretics
  3. H2 blockers
  4. Acetazolamide
150
Q
A
151
Q
A

AGACNP Board Review (5 decks)

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