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patho-pharm > Patho-Pharm Final > Flashcards

Patho-Pharm Final Flashcards

1
Q

Pathologic Fractures

A

Fracture resulting from an abnormality, commonly observed in hospitals. That is caused by abnormalities such as cancerous growth or lack of blood supply.

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2
Q

Stress Fractures

A

result from repetitive stress, common in athletes or those with excessive physical activity. Rest is crucial.

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3
Q

Transchondral Fractures

A

Breaking through cartilage in a joint, leads to potential long-term issues. Separation of a portion of articular cartilage. Lifetime joint problems and limitations affecting daily activities. Breaking through cartilage can lead to irreversible consequences, especially in the wrist.

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4
Q

simple fracture

A

Basic break through a bone. Reputation built on anatomically aligning fractures for optimal healing.

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5
Q

Comminuted Fracture

A

Bone broken into at least three pieces. (Butterfly Fragment). Central piece resembling the wings of a butterfly.

Expertise crucial in reconstructing comminuted fractures.

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6
Q

Open compound fracture

A

Bone breaks through the skin, exposing it to the open air.

High potential for infection, always taken to the operating room.

Thorough examination is crucial to avoid missed open fractures.

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7
Q

Green stick fracture

A

Common in young individuals; bone bends but doesn’t fully break.

Often seen in children, where the bone can be easily straightened. One side of the bone typically remains intact.

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8
Q

Transverse Fracture

A

Straight-across break; offers some stability.

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9
Q

Spiral fracture

A

Twisting break; lacks stability, requires external or internal fixation.

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10
Q

Oblique fracture

A

Diagonal break; prone to sliding displacement.

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11
Q

Bone Repair Process

A

Periosteum disruption
Clot Formation
Inflammatory response
Vascular Tissue formation
Osteoblasts activation
Collegen and mineralization
Healing

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12
Q

Periosteum Significance

A

Outer surface of the bone with rich blood supply.

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13
Q

Muscles on the Bone

A

muscles determine the shape of the bone.

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14
Q

Muscle effect on fractures

A

Muscles pull fractured bones towards the strongest muscle group.

Shortening and external rotations

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15
Q

Shortening

A

seen in the elderly when a fractured hip leads to leg shortening and external rotation.

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16
Q

Closed reduction

A

externally

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17
Q

Open reduction

A

Internally or externally

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18
Q

reduction is used for

A

proper healing and alignment

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19
Q

ORIF open reduction internal fixation

A

Surgical procedure involving bone realignment and internal hardware. Used in complex fractures requiring precise realignment and stabilization.

Plates, screws, wires, or pins used for internal fixation. Surgeons cut along the bone, manipulate fragments, and use hardware for stability. Must go under any arteries and muscles.

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20
Q

Intramedullary Rods

A

common in fractures of long bones, typically remains in body for entire life.

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21
Q

External fixations

A

Pins inserted into the bone and connected to an external device for stabilization. easily removed with a low infection rate.

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22
Q

anterior dislocation

A

common, typically in the front

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23
Q

posterior dislocation

A

usually in severe trauma cases, often from accidents

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24
Q

Subluxations Defined

A

Partial joint movement, typically less than 20 degrees. Usually due to joint degeneration

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25
Q

Shoulder Dislocations

A

True dislocations are challenging to relocate; ease of reduction may indicate a recurrent issue. Must be quick because after 12 hours remodeling occurs.

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26
Q

Ligaments

A

bones to bones and commonly injured sprain

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27
Q

Tendons

A

Connect muscle to bones, prone to tears or strains

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28
Q

Rotator cuff tears

A

often don’t ever hear, surrounding muscle just takes over.

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29
Q

Achilles tendon tear test

A

squeeze test to ensure food flexion.

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30
Q

Soft tissue healing challenges

A

Multiple repairs lead to scar tissue formation

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31
Q

Bursitis

A

Inflammation of bursae, fluid-filled sacs near joints. Needle drainage followed by steroid injection for relief.

Common areas Prepatellar, shoulder, elbow, hip.

Bursa not connected to the joint’s interior; independent inflammation.

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32
Q

Primary arthritis

A

idiopathic, related to genetics and aging factors

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33
Q

Secondary arthritis

A

results from specific damage, like joint trauma, damage. A known cause

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34
Q

Osteoarthritis

A

The breakdown of cartilage due to bone rubbing on bone.

It never improves, manage discomfort.

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35
Q

Indicators for osteoarthritis

A
  1. Erosion of articular cartilage: cartilage loss leads to bone rubbing on bone
  2. Subchondral sclerosis: stress on the body prompts extra calcium deposition.
  3. Osteophytes (bone Spurs): joint damage due to potential deterioration.
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36
Q

Osteoarthritis symptoms:

A

pain in weight baring joints, stiffness, discomfort, limited range of motion.

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37
Q

Treatment for Osteoarthritis

A

Autoinflammatory, rest, weight loss.

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38
Q

Joint effusion

A

an inflammatory exudate or blood in the synovial cavity caused by osteophyte fragments in the synovial cavity, drainage of cysts from diseased subchondral bone, and acute trauma to a joint structure.

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39
Q

Two level prosthesis

A

A spacer put between the femur and tibia. To prevent the rubbing of bone on bone

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40
Q

Chondroitin and Glucosamine

A

Widely used for potential cartilage regeneration. Two compounds that form cartilage can be found in supplements.

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41
Q

Rheumatoid Arthritis

A

Severe rheumatoid arthritis, is an autoimmune disease that primarily affects hands, causing gradual degeneration.

Inevitable progression, characterized by the body’s autoimmune response targeting inflammation of connective tissue and affects synovial membranes.

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42
Q

symptoms of rheumatoid arthritis

A

loss of function in multiple joints, mostly in fingers, toes, feet, and wrists.

Can effect skin and lungs with myocarditis possibilities

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43
Q

Treatment for rheumatoid arthritis

A

focus on controlling inflammation, using steroids for short term relief.

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44
Q

Diagnostic tests for rheumatoid arthritis

A

ESR: erythrocyte sedimentation rate, general inflammation

CRP: C-reactive protein, measures inflammation

RF: rheumatoid factors, testing for positive RH factors

White blood cell count: is elevated in positive RH cases

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45
Q

What are the rheumatoid nodules

A

Solid lumps in affected areas with potential complications if improperly managed.

Removal attempts carry risks of tissue damage. They do not get removed

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46
Q

Ankylosing Spondylitis

A

Chronic inflammatory joint disease is characterized by fusion (ankylosis) of the spine and sacroiliac joints,

Males are more prevalent than females.

HLA B27 genotype associated

Form a classic bamboo spine (hardening of the spine)

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47
Q

Gout

A

Deposition of uric acid: Crystal deposition in joints, especially the big toe, is associated with elevated blood uric acid levels.

Acute attacks, is exquisite pain during attacks; treatment includes NSAIDs, allopurinol, and hydration to prevent crystal formation.

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48
Q

Contractures

A

Resulting from physiological or pathological conditions, often observed in diabetics

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49
Q

Osteomyelitis

A

Infectious bone disease caused by bacteria, viruses, fungi, parasites

Infectious bone disease caused by bacteria, viruses, fungi, parasites

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50
Q

Treatment for Osteomyelitis

A

Intravenous antibiotics, surgical debridement, hyperbaric oxygen therapy for anaerobic infections.

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51
Q

Exogenous osteomyelitis

A

is an infection from outside the body, that spreads from soft tissues to bone (open fractures or surgery)

caused by human bites or fist blows to the mouth, shallow bites can infect soft tissues, and deep bites may infect bone directly. The most common organism for human bites is S. Aureus

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52
Q

Endogenous osteomyelitis

A

is an infection carried in the blood from other sites within the body and spreads from bone to soft tissue.

Staph aureus is the most common bacteria causing osteomyelitis and, the most common source of bacteria (cutaneous, sinus, ear, and dental infection).

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53
Q

Osteoporosis

A

Involves decreased bone density, increasing susceptibility to fractures.

Osteoporosis is present with a BMD of -2.5 SD

Symptoms like back pain, kyphosis hunchback, height loss, improper fit of clothing, protruding abdomen, and negative body image.

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54
Q

when is your peak bone mass

A

mid 20s

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55
Q

risk factors for osteoporosis

A

Age, family history, lack of physical activity, hormonal changes.

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56
Q

Prevention for osteoporosis

A

Weight-bearing exercises, calcium, and vitamin D supplementation, hormonal replacement therapy

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57
Q

Secondary care for osteoporosis

A

HRT: estrogen allows for bone to absorb

Calcitonin: acts as an anti-resorptive agent by acting on osteoclasts

Bisphosphonates: Effects osteoclast apoptosis, clodronate, etidronate alendronate, risedronate

Calcium and vitamin D intake is important

Statins (Lovastatin) have been show to significantly increase bone growth in mice and rats.

The key is bone mineral density testing

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58
Q

Osteosarcoma

A

Aggressive tumor from osteoblasts, often with poor outcomes

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59
Q

Chondroma and Chondrosarcoma

A

Tumors related to cartilage, with chondrosarcoma being more serious.

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60
Q

Fibroma and Fibrosarcoma

A

Benign and malignant tumors originating from fibrous tissues.

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61
Q

Giant cell tumor

A

A tumor affecting the bone’s reticular tissue, generally benign.

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62
Q

Multiple Myeloma

A

cancer of plasma cells in bone marrow, leading to weakened bones.

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63
Q

Reticulum

A

blood cell precursors

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64
Q

Ewing Sarcoma

A

Aggressive bone tumor, common in adolescents and young adults, usually affecting long bones.

Can be misdiagnosed initially, leading to delayed treatment.

Emphasizes the difficulties in treating certain conditions, such as osteomyelitis in drug abusers and infections in joint replacements.

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65
Q

Vomiting

A

Forceful expulsion of stomach contents

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66
Q

Vomiting Reflex

A

Medulla’s vomiting center is influenced by various stimuli.

Labyrinths

Evolutionary theory links vomiting to disorientation and poisoning.

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67
Q

Vomiting Process

A

Retching, gastric content movement; aspiration risk.

Aspiration pneumonia is common in alcoholics.

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68
Q

Medications for projectile vomiting

A

Scopolamine (anticholinergic)
Dimenhydrinate (antihistamines) Ondansetron (seratonin blockers)

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69
Q

Psyllium (Metamucil)

A

Bulk-forming agent; prevents constipation.

Absorbs water, and increases stool size.

Not effective with pre-existing stool plug.

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70
Q

Lubricants and Softeners

A

Emollient

Mineral oil, and lubricants; are effective for stubborn stool plugs.

Colace and similar; milder effect.

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71
Q

Hyperosmotic Agents

A

Polyethylene glycol (PEG), Lactulose.

PEG for thorough bowel evacuation, lactulose for pediatrics.

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72
Q

Pediatric Considerations

A

Lactulose suitable for pediatrics.

Tailor interventions for individual needs.

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73
Q

Large Volume Diarrhea

A

associated with infections; focus on rehydration.

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74
Q

Small Volume Diarrhea

A

Caused by irritation, frequent urges with minimal stool.

Steatorrhea

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75
Q

Steatorrhea

A

Oily/fatty stool

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76
Q

Medications for Diarrhea

A

Adsorbents: coat the walls of the GI tract, and bind to the causative bacteria. Bismuth Subsalicylate (petto-Bismol)

Anticholinergics: decrease intestinal muscle tone and peristalsis of the GI tract, slowing down the movement of fecal matter (atropine)

Opioids, Laxatives.

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77
Q

Abdominal Pain

A

Visceral (organs), parietal (parietal peritoneum), referred pain (gall bladder).

Understanding origin aids in diagnosis.

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78
Q

Upper GI bleed

A

from jejunum, ileum, colin, rectum. Can be caused by polyps, inflammatory disease, cancer, or hemorrhoids.

acute to severe bleeding is life-threatening

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79
Q

Lower GI bleed

A

the esophagus, and stomach, often caused by bleeding ulcers

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80
Q

Hematemesis

A

blood in vomitus

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81
Q

Hematochezia

A

Bright blood from the rectum

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82
Q

Melena

A

dark, tarry stools

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83
Q

Occult bleeding

A

slow chronic blood loss in stool, found by guaiac test, results in iron deficiency anemia. Look for changes in blood pressure and heart rate with acute bleeding.

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84
Q

LFT

A

liver function test

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85
Q

BAIT test

A

B: Bilirubin
A: Albumin
I: INR
T: Total protein

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86
Q

Peptic Ulcers

A

Overview of peptic ulcers: General classification into lower softdel, duodenal, or gastric ulcers.

Factors influencing ulcer occurrence, including acidity levels and pH in the ileum.

Protective mechanisms of the gastrointestinal system against acid, including mucosal barriers.

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87
Q

Duodenal Ulcers

A

The most frequent type of peptic ulcer, the acid and pepsin concentrations penetrate the mucosal barrier and cause ulceration. Rapidly relieved with antacids.

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88
Q

Gastric ulcers

A

Develop adjacent to acid-secreting mucosa, increasing mucosal barrier’s permeability to hydrogen ions.

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89
Q

Hiatal Hernia

A

occurs when the upper part of the stomach bulges through the diaphragm and into the chest.

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90
Q

GERD

A

(gastroesophageal reflux disease), and symptoms like heartburn.

Management strategies for GERD, including lifestyle changes and medications.

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91
Q

Treatment Options for Gastrointestinal Disorders

A

antiacids to neutralize stomach acids

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92
Q

types of antacids

A

aluminum, magnesium, calcium, and sodium bicarbonate.

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93
Q

side effects for antiacids

A

constipation, and kidney issues

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94
Q

pH and Medication Absorption

A

Body pH affects medication absorption.

Changing body pH can impact the effectiveness of certain drugs.

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95
Q

H2 blockers

A

reduces acid secretions, blocks histamine H2 at the receptors

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96
Q

Mucus

A

a protective barrier against HCL

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97
Q

Bicarbonate

A

helps buffer acidic properties of HCL

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98
Q

Prostaglandins

A

event activation of the proton pump.

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99
Q

Proton Pump Inhibitors (PPIs)

A

inhabit gastric production, for GERD and peptic ulcers
‘prazole’

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100
Q

PPIs are effective for conditions like

A

GERD and peptic ulcers.

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101
Q

H. pylori Treatment

A

Importance of treating H. pylori bacterial infection with antibiotics.

Challenges of antibiotic therapy, including potential side effects.

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102
Q

Nexium

A

medication that reduces stomach acid

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103
Q

Small Bowel Obstruction

A

Obstruction leads to distress, anorexia, weight loss, and vomiting after eating.

Small bowel obstruction is characterized by mechanical or functional blockage.

Obstruction can lead to ischemia, tissue death, and potentially perforation.

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104
Q

Intestinal obstruction

A

anything that prevents the normal flow of chyme through the intestine.

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105
Q

Pyloric obstruction

A

primarily affects children, causing projectile vomiting. Narrowing of opening between stomach and duodenum

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106
Q

Functional Bowel Obstruction (Ileus)

A

Temporary bowel dysfunction; common after surgery.

Mechanical vs. functional obstruction.

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107
Q

Ulcerative Colitis

A

Ulcerative colitis primarily affects the large bowel and rectum. It involves chronic inflammation and antibody presence.

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108
Q

common symptoms of Ulcerative Colitis

A

low-volume diarrhea with blood and mucus, dehydration, weight loss, and anemia.

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109
Q

primary treatment for ulcerative colitis

A

conservative treatment, surgery is used when medications fails

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110
Q

Diagnostic Tools for Colitis

A

Colonoscopy and sigmoidoscopy play a crucial role in diagnosing colitis.

Endoscopic procedures provide direct visualization of the colon and rectum.

Conservative therapy includes medications, with surgery as a last resort.

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111
Q

Appendicitis

A

Inflammation of the appendix, most common surgery of the abdomen.

May arise from obstruction, or bacterial infection. Right lower quadrant pain is associated with extension of inflammation.

Classic symptoms include central abdominal pain migrating to the right lower quadrant.

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112
Q

Crohn’s Disease

A

Inflammatory bowel disease affecting any part of the gastrointestinal tract. Characterized by skip lesions, forming fistulas between hollow organs.

Symptoms include chronic diarrhea, weight loss, and abdominal pain.

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113
Q

Medications for Crohn’s disease

A

steroids (during flares), immunosuppressants (e.g., methotrexate), and biologics.

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114
Q

IBD medication and treatment

A

steroids, for treatment of diseases that have chronic inflammation in the digestive tract

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115
Q

Dysphagia

A

(Swallowing Difficulty):

A complex process involving the formation of a bolus and peristalsis. Due to neuromuscular issues often has multifactorial complications.

Aspiration risk arises when food enters the lungs, requiring careful decision-making.

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116
Q

Obstructions

A

Liquids pass through easily, solids feel stuck.

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117
Q

Neurological

A

Difficulty forming a bolus, impacting both liquids and solids.

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118
Q

Barium tests

A

identifying the underlying cause with dysphagia

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119
Q

Malabsorption

A

Failure to absorb broken-down nutrients at the brush border. (enzyme deficiencies)

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120
Q

Maldigestion

A

Inability to break down substances, seen when recognizable food passes through. (impaired breakdown)

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121
Q

Anorexia nervosa

A

involves severe food restriction and distorted body image.

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122
Q

Bulimia nervosa

A

features episodes of overeating followed by compensatory behaviors.

challenges due to recurrent binge-purge cycles, affecting overall health.

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123
Q

Viral hepatitis

A

a common systemic disease that affects the liver, 6 strains known.

Also, look at liver function tests to rule out other concerns. No specific treatment (low-fat, high carbohydrate diet if bile flow is obstructed) Prophylactic immune globulin can prevent HBV.

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124
Q

Hep A (HAV)

A

used to be infectious, the transmission of fecal-oral route, spreads rapidly

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125
Q

Hep B

A

used to be called the serum hep, transmitted through infected blood, body fluids, needles, IgG antibodies rise more slowly.

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126
Q

HCV (hep C)

A

causes most cases of post-transfusion hep, RNA virus, uses a screen for all blood products, incurable.

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127
Q

Cholelithiasis

A

the presence of gallstones in the gallbladder, affects about 20% of the population over 40 years of age.

More prevalent in women.

For unlocalized abdominal discomfort, eructation, and intolerance to certain food, in clients with severe pain, cholecystectomy is recommended.

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128
Q

Cholecystitis

A

acute or chronic inflammation of the gallbladder. Acute is usually caused by gallstones that cannot pass through the cystic duct. There is a QUR pain of the abdomen and N&V, eructation, and flatulence. Diagnosed by ultrasound. Treatments are usually surgery.

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129
Q

Gallbladder

A

Gallbladder attacks are often caused by gallstones. gallbladder removal (cholecystectomy) is preferred for unresolved attacks.

Surgery, preferably laparoscopic, is more successful in women than men. Especially those approaching menopause.

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130
Q

Common Bile Duct and Gallbladder

A

The common bile duct connects to the hepatic ducts and the cystic duct.

Stones passing through the common bile duct lead to gallbladder attacks.

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131
Q

Pancreatitis

A

Pancreatitis involves inflammation of the pancreas.

Most commonly seen in alcoholics; linked with alcoholism and Hepatitis C.

Chronic pancreatitis may lead to scarring and long-term complications. Chronic pancreatitis may contribute to the development of diabetes.

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132
Q

Culdoscopy

A

invasive surgical procedure used to examine and diagnose conditions within the pelvic cavity of the female reproductive system.

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133
Q

Vaginitis

A

infection of the vagina caused by sexually transmitted bacteria and candida albicans.

Symptoms like discharge may prompt treatment.

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134
Q

Fibroids (Uterine Leiomyomas)

A

benign tumors that develop from smooth muscle cells in the myometrium

About a quarter of women develop fibroids.

Most are asymptomatic; symptoms depend on size and location.

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135
Q

Fibroids treatment

A

NSIADS, hormones

Treatment options vary based on age, desire for future pregnancies, and symptoms.

Surgical interventions include hysterectomy or myomectomy

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136
Q

Dysfunctional Uterine Bleeding

A

Characterized by irregular or excessive menstrual bleeding.

Often associated with fibroids or hormonal imbalances.

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137
Q

Endometriosis

A

Tissue growth outside the uterus, influenced by hormonal cycles. causing pain and complications may include fibrosis, leading to adhesions and blockages.

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138
Q

Cervical Cancer Staging

A

Cervical cancer stages progress from mild cell changes to invasive cancer. Stages range from early changes in surface cells to invasive cancer penetrating deeper layers.

Pap smears revolutionized cervical cancer detection.

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139
Q

Initial Screening

A

Positive test requires location biopsies to determine affected areas.

Depth of affected tissue is crucial for treatment decisions.

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140
Q

Biopsy Support

A

Biopsies help identify affected parts and assess depth.

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141
Q

Infertility

A

impaired fertility may warrant evaluation after a year of unsuccessful attempts.

Secondary infertility often stems from untreated STDs affecting the reproductive system.

A year of unprotected sex

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142
Q

Female infertility test

A

include X-ray and laparoscopic exams to identify tract abnormalities.

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143
Q

Hysterosalpingogram

A

x-ray of the womb and fallopian tubes

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144
Q

Male infertility test

A

Testing focuses on sperm activity and quantity

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145
Q

Epididymitis

A

Inflammation of the epididymis, recent UTI, or urethral discharge. (swab and gram stain)

Generally, occurs in young, sexually active men

The most common cause is gonorrhea or chlamydia

complications include: abscess, infarction, infection, infertility

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146
Q

UTI antibiotics

A

Females - 10-12 days
Males - 4-6 weeks

Ciprofloxacin
Doxycycline
Trimethoprim-sulfamethoxazole (Septra)
Nitrofurantoin (Macroid)

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147
Q

Testicular Torsion

A

Testicular torsion is an emergent condition where the testicle loses blood supply.

Prompt diagnosis and manual detorsion within six hours are crucial for salvage.

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148
Q

Prostatic hyperplasia

A

enlargement of the prostate gland

occurs at the age of 40-45, becomes problematic when the urethra is compressed.

80% of men will have this by their 80th year. Urine retention becomes chronic.

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149
Q

Acute bacterial prostatitis

A

Assessing infection of the urinary tract, inflammation of the prostate

low back pain, perineal pain, high fever, chills, dysuria, inability to empty bladder nocturia

Acutely ill and toxic, complications can include bacteremia and septic shock. Same treatment as UTI and epididymitis.

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150
Q

Nonbacterial prostatitis

A

Most common prostatitis syndrome, no bacterial infection

diagnosis by exclusion

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151
Q

Testing for STDs

A

has advanced significantly, moving from cell cultures to PCR-based DNA testing.

Most testing is now urine-based, making it more accessible and efficient.

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152
Q

STD

A

STDs like gonorrhea and chlamydia are common but often asymptomatic.

Testing is crucial, especially for sexually active individuals.

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153
Q

Gonorrhea

A

Caused by gonocci, endocervical canal usual site of original infection in women, urethra in males.

Incubation 3-10 days, females up to 10 days. 50% are asymptomatic

80% infection for women – 30% infection for men

route of transmission (vaginal, oral, anal, mom to baby)

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154
Q

treatment for gonorrhea

A

Ceftriaxone IM

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155
Q

Chlamydia tratment

A

treatment: ABX for affected person and partners (Azithromycin)

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156
Q

Chlamydia

A

Most common STD, puss in the urine, frequency of urinating

asymptomatic, reportable disease, highest in women under 20

obligated, gram-negative intracellular bacteria that cannot reproduce independently

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157
Q

Chlamydia and Gonorrhea

A

often occur together

Chlamydia can lead to Pelvic Inflammatory Disease (PID), causing severe complications like infertility, which may invade any organ.

Dysuria or irregular bleeding may be present.

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158
Q

Complications of STDs

A

Pelvic Inflammatory Disease (PID) can lead to serious long-term sequelae and mortality if not treated promptly.

Delayed treatment can result in irreversible damage and even death, as seen in severe cases.

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159
Q

Reportable STDs

A

Syphilis
Gonorrhea
Chlamydia

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160
Q

Genital herpes

A

Blisters (cold sore) to genital areas, HSV 1 and HSV 2. not curable

Spread through intimate contact from those without signs and symptoms

may occur 5-8 times a year, vaginal discharge, and dysuria, 50% mortality

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161
Q

Herpes and Testing

A

blood tests (positive antigen) and pap smear

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162
Q

Herpes Treatment

A

Antiviral medication
Prophylactic

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163
Q

ABC - The primary survey

A

Airway, Breathing, Circulation

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164
Q

Trauma deaths follow a trimodal distribution

A

immediate deaths

early deaths

deaths from complications that are often weeks later.

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165
Q

the focus in trauma care is

A

treating threats to life first resuscitation and stabilization , then diagnosing the underlying issues.

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166
Q

ABCDE

A

Airway: Ensure patent airway and protect C-spine.

Breathing: Assess oxygenation and ventilation.

Circulation: Evaluate circulation and control bleeding.

Disability: Assess neurological status using the Glasgow Coma Scale (GCS).

Exposure/Environment: Examine for additional injuries and environmental factors.

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167
Q

AMPLE history

A

Allergies, Medications, Past illness, Last meal, Events related to injury.

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168
Q

Airway Management

A

Assess airway patency and protect the cervical spine.

Maintain sufficient air reserve for speech and adequate oxygenation.

Consider potential complications like increased intracranial pressure (ICP) and coning.

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169
Q

Nursing Interventions for Closed Head Injury Implement measures to decrease intracranial pressure (ICP)

A

Elevate the head of the bed to reduce ICP to 45 degrees.

Administer hypertonic saline to draw fluid from the brain.

Consider Mannitol to decrease ICP by drawing fluid from brain tissue.

Hyperventilate to induce vasoconstriction and create more space in the skull.

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170
Q

Assessment of Consciousness

A
  1. Who are you?
  2. Do you know where you are?
  3. Do you know what happened?
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171
Q

Elderly Patients special considerations

A

Increased vulnerability due to pre-existing conditions and reduced functional reserve. Most are on anticoagulants.

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172
Q

Anterograde Amnesia

A

Inability to form new memories after the injury

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173
Q

Retrograde Amnesia

A

Inability to remember events before the injury

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174
Q

Pediatric Patients special considerations

A

Use Braslow Tape for trauma management, which provides size-appropriate equipment. Different mechanism of injury, treatments must be scaled.

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175
Q

Trauma in Pregnancy

A

Monitor two patients, consider medication effects on the fetus, and be aware of physiological changes. Preterm labour. Different normal lab values hemoglobin.

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176
Q

Glasgow Coma Scale (GCS)

A

Used to assess consciousness based on eye, verbal, and motor responses.

Score below 8 requires immediate airway management and potential intubation.

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177
Q

Ambulance Transport Criteria

A

Ambulance services may not transport patients with a GCS score below 8 without airway management (intubate

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178
Q

Tension Pneumothorax

A

Condition where air enters the pleural space but cannot exit, leading to increased pressure and potential life-threatening complications.

Symptoms include shortness of breath, chest pain, decreased blood pressure, and tracheal deviation. Jugular vein distention

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179
Q

Hyperresonance lung sounds

A

percussion notes and decreased breath sounds suggest the presence of air-filled spaces within the lung.

Hyperresonance can indicate conditions like emphysema or pneumothorax and guides diagnostic assessment and management.

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180
Q

Treatment for tension pneumothorax

A

Needle Decompression

Insert a needle into the second intercostal space midclavicular line to release trapped air.

Allows air escape, buys time for chest tube insertion.

Chest tube is standard treatment for pneumothorax; monitors drainage and maintains lung function.

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181
Q

Open Pneumothorax

A

Air build up in the pleural cavity, caused by a hole in the chest wall. Puts pressure eon the lung and can lead for lung to collapse.

sudden chest pain, shortness of breath, rapid shallow breathing, fast heart rate, hypoxia.

Caused by trauma, burnt, penetrating

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182
Q

treatment for open pneumothorax

A

Three way testing, chest tube or surgical repair.

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183
Q

Flail Chest

A

Two consecutive ribs fractured in two places each, causing paradoxical chest movement.

Historically common in car accidents before modern safety features in crs.

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184
Q

treatment of flail chest

A

Requires wiring of ribs; life-threatening if extensive.

Leads to ventilation-perfusion mismatch, potentially fatal if severe.

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185
Q

Massive Hemothorax

A

Accumulation of blood in pleural space, often due to trauma

Chest X-ray, thoracostomy to drain blood.

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186
Q

Treatment of a massive hemothorax

A

Transfusion, drainage, surgical intervention if bleeding persists.

Reduced cardiac output due to pressure on the heart.

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187
Q

Cardiac/Pericardial Tamponade

A

Fluid accumulation around the heart in the pericardium, impairs cardiac function.

Reduced cardiac output due to pressure on the heart.

May lead to Beck’s Triad

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188
Q

Becks Triad

A

low blood pressure, distended neck veins, and muffled heart sounds.

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189
Q

Treatment for a cardiac tamponade

A

Locate the sternal notch.

Insert a large needle into the sternal notch.

Aim towards the left middle VIC (vertebral interspace clavicle).

Verify correct placement using an ECG lead.

Treat until the QRS complex indicates correct positioning.

In severe cases, a cardiac window may be required for further treatment.

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190
Q

Hemorrhage Control and Volume Restoration

A

Identify and clamp bleeding vessels.

Apply pressure and isolate single vessels.

Prevent excessive blood loss to stabilize the patient’s condition.

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191
Q

Preferred IV sites

A

Antecubital fossa offers easy access but may restrict movement.

Avoid multiple IVs in different locations to prevent complications.

Large bore IVs (16-18 gauge) are preferred for trauma patients.

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192
Q

Intraosseous access

A

Useful for infants and small children during emergencies.

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193
Q

D5W (Dextrose 5% in Water)

A

End up in cells, not ideal for increasing pressure.

Provides calories during hyperglycemia and intracellular fluid.

Not suitable for patients with head injuries or severe edema.

Not effective for volume deficit or resuscitation.

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194
Q

Normal saline (0.9% NaCl)

A

Most ends up in interstitial space, suitable for increasing intravascular volume and pressure.

Isotonic with the body.

Contains sodium chloride; inexpensive and commonly used.

Used for resuscitation efforts and administering blood products.

Can cause metabolic acidosis

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195
Q

Hypertonic saline (3%)

A

used for increasing intracranial pressure temporarily.

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196
Q

Half-normal saline (0.45%)

A

for hyperosmolar states, requiring close monitoring.

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197
Q

Ringers lactate

A

used mainly only for burns

Contains various components, including lactate as a buffer

Preferred for GI tract issues in some cases.

Commonly used in the US but less so in other regions due to cost.

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198
Q

Crystalloids

A

Used for fluid resuscitation.

Normal saline (0.9% NaCl) and lactated Ringer’s are common examples.

Used for hemorrhage, dehydration, and mild hyponatremia.

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199
Q

Colloids

A

Large molecules that hold water in the intravascular space.

Examples include albumin and starches.

Used in situations like ascites drainage to prevent fluid shifts.

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200
Q

Albumin

A

Derived from human donors and can cause allergic reactions.

Used to prevent fluid shifts during ascites drainage.

Cross-matching is not required.

201
Q

Fresh Frozen Plasma (FFP)

A

Administered to prevent coagulopathy in massive transfusions.

Contains clotting factors and platelets.

Necessary when blood loss exceeds a certain threshold.

202
Q

Massive Transfusion Protocol

A

Involves blood transfusion to restore intravascular volume.

O-negative blood is universal donor type.

203
Q

severe blood loss is how much

A

1500 to 2000 ml

204
Q

plasma comes

A

in a pressurized bag

often given with blood to prevent clotting

205
Q

Platelets are

A

Derived separately, requiring a large number of donations.

206
Q

Group and Screen

A

Determines potential need for blood, identifies blood group, and screens for antibodies.

207
Q

Typing cross

A

Determines the patient’s blood type.

208
Q

cross match

A

Ensures compatibility between donor blood and recipient.

209
Q

Universal donner

A

O-negative and never requires cross matching

210
Q

FAST

A

Focused Abdominal Sonography for Trauma

211
Q

Diagnostic Peritoneal Lavage

A

Quick assessment of peritoneal fluid, helpful for detecting bleeding or infections

212
Q

Gram stain

A

rapid, specific for current infection, but not very sensitive.

213
Q

culture and sensitivity

A

Takes days, provides detailed information on bacterial growth and antibiotic sensitivity.

214
Q

Urinalysis

A

Routine and Microscopic: dipstick and microscopic examination of urine for infection and abnormalities.

215
Q

true or false MRIs are often used in traumas

A

false

216
Q

Treatment of diabetic ketoacidosis

A

FASTA: Fluids, Electrolytes, Acidosis, Sugar, Treatable causes, Assessment.

Sequential approach to managing DKA, addressing volume deficits and electrolyte imbalances before addressing hyperglycemia.

217
Q

FASTA

A

Fluids, Electrolytes, Acidosis, Sugar, Treatable causes, Assessment.

218
Q

Vitamins

A

Vitamins are organic molecules that serve as cofactors and coenzymes in metabolic reactions.

219
Q

Fat-Soluble Vitamins

A

Vitamins that dissolve in lipids and can be stored in the body for extended periods.
Includes Vitamin A, Vitamin D, Vitamin E, and Vitamin K.

220
Q

Water-Soluble Vitamins

A

Vitamins that dissolve in water and are not stored in the body.
Includes B vitamins (B1, B2, B3, B5, B6, B7, B9, B12) and Vitamin C.

221
Q

Vitamin A

A

Retinol
Important for vision and maintaining healthy skin.

Found in retinol and beta-carotene.

222
Q

Vitamin D

A

Calciferol (sun vitamin)

Essential for bone health and calcium absorption.

Synthesized by the body through sun exposure.

223
Q

Vitamin E

A

Tocoferols

Acts as an antioxidant, helps with skin healing, and prevents scarring.

224
Q

Vitamin K

A

Essential for blood clotting and bone health.
too much can cause toxicity.

225
Q

B Vitamins

A

Various B vitamins serve different functions including energy metabolism, red blood cell production (B12), and nerve function (B1, B6).

226
Q

Vitamin B1

A

Thiamine
helps tiredness
severe deficiency leads to beriberi

227
Q

Vitamin B2

A

Riboflavin
Needed for good vision and healthy skin

228
Q

Vitamin B3

A

Niacin
cholesterol and nerve function

229
Q

Vitamin B5

A

Pantothenic Acid
wound healing and healthy skin

230
Q

Vitamin B6

A

Pyridoxine
formation of red blood cells, cure of anemy
Antiacids and protein metabolism

231
Q

Vitamin B12

A

Cobalamin
formation of red blood cells

232
Q

Vitamin C

A

Ascorbic Acid
Collagen, wound healing

233
Q

Low vitamin C causes

A

Hypovitaminosis - scurvy

234
Q

B12 injections

A

Necessary for red blood cell formation and can be administered through injections or supplements.

235
Q

Vitamin A toxicity

A

Overconsumption, especially from sources like polar bear liver, can lead to toxicity due to its fat-soluble nature

236
Q

Recommended Daily Allowance (RDA)

A

RDA is determined based on the average requirements of a healthy population.

It varies for different vitamins and is used to guide dietary intake.

237
Q

Food and Drug Act (1953)

A

(all the definitions come from)
Protect consumers from contaminated, adulterated, or unsafe drugs and address drugs with misleading or deceptive labeling.

238
Q

Controlled Drug and Substances Drug Act (1997)

A

Regulates possession, sale, manufacture, and disposal, of certain drugs. Schedules categorize drugs based on their control level.

239
Q

New drug development

A

Clinical investigational drug studies (4 phases).

240
Q

Clinical investigational phases

A

Phase I: Safety. (done on healthy people to see if they can do okay, evaluate pharmacokinetics)

Phase II: Effectiveness. (limited scope on patients who have problems)

Phase III: Long-term impacts. 10 thousand, 60 thousand, and see what happens, recording responsibilities) (can’t get rid of the records for 25 years)

Phase IV: Post-marketing studies. ways to get doctors to prescribe for stuff

241
Q

Special access program

A

If you have a drug people want but have not gone through the phases of the trial yet. But if they are dying anyway, they are annoyed at why they can’t use it.

242
Q

Limited access program

A

someone with cancer saw a trial work somewhere else, but it can’t be prescribed yet.
Provides access to drugs not yet approved, limited to serious or life-threatening illnesses.

243
Q

Euphoria

A

state of intense happiness, excitement, or well-being.

244
Q

Analgesia

A

refers to the inability to feel pain or a reduction in pain sensation.

245
Q

Narcotics

A

Substances binding to opiate receptors in CNS and ANS. Includes morphine, heroin, codeine (natural substances)

246
Q

Narcotic Intoxication

A

Euphoria
Poor comprehension, memory disturbances
Drowsiness
Miosis/contraction of pupils

247
Q

what do you treat a narcotic over dose with

A

Narcan

248
Q

what do you treat a narcotic with drawl with

A

Benzo

249
Q

Narcotic withdrawal

A

Not life-threatening,
8-12 hours after use
Peak 48-72 hours

Diarrhea, runny nose, yawning, insomnia, irritability, tremors, stomach cramps

250
Q

Morphine is used for what

A

causes nausea, is the narcotic of choice for chest pain (decreases oxygen demand) (is a good pain relief kick, good for shortness of breath and angina)

251
Q

MONA

A

M- morphine (decreases workload of the heart and decreases pain)

O- Oxygen (increases Oxygen to the heart)

N- Nitroglycerin (opens up the vessels)

A- Aspirin (prevents platelets from sticking together)

252
Q

Opium

A

morphine, codeine
very high tolerance

253
Q

Semi-synthetic

A

Heroine a special version of morphine, no practical use, all you get is high. There is pain relief but that’s it.

254
Q

Dilaudid

A

super CLEAN, no reaction with other medications (severe pain

255
Q

Percodon and percocets

A

oxycodone family, not viable IV, or sub-Q. (well tolerated, gives a high)
Percocet is oxycodone with acetaminophen

256
Q

LSD

A

hard to figure out, no dose, only withdrawals (no predictability)

257
Q

Hallucinogens

A

CNS stimulant and depressant)
(no evidence of dependency)

Euphoria with transcendent experience

Perceptual alterations
Altered thought process
Distractibility
dilated pupils
tremors

258
Q

Hallucinogens overdose response

A

Anxiety
Panic
Hypervigilance
Paranoid delusions

259
Q

Psilocybin Mushrooms

A

Euphoria
Easily distracted
Inc T, P, BP
Involve limb movement
Hallucinations

260
Q

Stimulants cause

A

weight loss
heart disease
appetite decrease

261
Q

Cocaine

A

stops blood flow (vasoconstriction)
has a huge cardiac effect

262
Q

Amphetamines

A

DREM and insanely addictive

263
Q

Dextroamphetamine

A

dixies

264
Q

Methamphetamines

A

Addictive, crystal meth

265
Q

Methylphenidates

A

Adderall, Ritalin.

266
Q

Ritalin

A

used for the treatment of hyperactivity in children, helps focus attention and filter out extra stimulants, stimulants enhance the reticular activating system.

267
Q

Simulant intoxication

A

no crazy addiction rate
Euphoria
Inc energy and alertness
Impaired decision-making
psychotic reaction
violent behavior

268
Q

Stimulant withdrawal

A

Severely depressed mood
Prolonged sleep
Irritability

269
Q

Nicotine

A

Increased HR and BP

Constricts peripheral blood vessels and lowers the oxygen-carrying capacity of hemoglobin

270
Q

bad side effects of nicotine

A

coronary artery disease, bronchospasm, and constriction, paralysis of cilia, thickening of mucous, COPD

271
Q

Alcohol is used for

A

depressant
to relax
to reduce inhibitions
for pleasure
rituals and celebrations

272
Q

alcohol intoxication

A

affects judgment, motor activity, and sedation. Metabolism by alcohol dehydrogenase; affects the liver leading to fatty liver, hepatitis, and cirrhosis. Withdrawal symptoms range from minor tremors to seizures and delirium tremens.

273
Q

what part does the brain does alcohol have an effect on

A

Cerebrum: judgment, inhibitions, reasoning

274
Q

Alcohol on the liver

A

alcohol dehydrogenase, fatty liver, alcohol hepatitis (inflammation of the liver due to alcohol, leads to scaring and sclerosis)

275
Q

Alcohol Withdrawal

A

often causes seizures
use lorazepam and benzo and anti-seizure medication

276
Q

Alcohol withdrawals peaks

A

Minor: peaks 24-36hrs Coarse tremor, anxiety

Major: occurs 24hrs, peaks 50hrs fever, disorientation, hallucinations

Extreme: Grand mal seizures (tonic/colonic) (frequently), Delirium Tremors, profound confusion,

277
Q

Wernicke-Korsakoff’s syndrome

A

a neurological disorder that results from severe deficiency of thiamine (vitamin B1), typically due to chronic alcohol abuse

278
Q

Marijuana

A

Psychological effects include altered perception, cognitive skills, appetite, tolerance, and psychological dependence.

Withdrawal symptoms include irritability and sleeplessness

279
Q

Marijuana use ethical uses

A

Glaucoma: reduces intraocular pressure
Nausea and Vomiting
Asthma: a bronchodilator (terrible)
Appetite stimulant
Muscle relaxant: related to paralysis (a little bit)

280
Q

amotivational syndrome

A

psychological condition characterized by a lack of motivation, particularly in goal-directed behavior and activities. It’s often associated with long-term and heavy cannabis (marijuana) use.

281
Q

Psychotherapeutic

A

Used in the treatment of emotional and mental disorders

Used in small, dispensed amounts to reduce suicide attempts

282
Q

Anxiolytic drugs

A

Benzodiazepines, SSRI, SNRI, Beta-blockers

283
Q

Mood-stabilizing drugs

A

lithium, anticonvulsants, atypical antipsychotics

284
Q

Antidepressant drugs

A

SSRI, SNRI, tricyclic antidepressants, MAIOS, atypical antidepressants

285
Q

Antipsychotic drugs

A

typical antipsychotics first generation, atypical antipsychotics second generation

286
Q

Anxiety is diagnosed with what

A

DSM

287
Q

Benzodiazepines

A

Pure sedatives, muscle relaxants, can be used in seizures, very effective, short-term, or long-term. Depress activity in the brainstem.

288
Q

alprazolam (Xanax®)

A

fast on set, fast come off, for panic attacks, a poor choice for long-term use, addictive and habit forming. (not great for generalized anxiety)

Most commonly used as an anxiolytic

short-term relief of anxiety symptoms, panic disorder, and anxiety associated

289
Q

diazepam (Valium®)

A

very effective for seizures, only available in deploy form,

relief of skeletal muscle spasms

Avoid in patients with hepatic dysfunction.

poor interactions with alcohol, oral contraceptives, and others

290
Q

lorazepam (Ativan®)

A

very common, fantastic, helps with sleep, and anxiety, 30 minutes onset

Very effective, most first choices for seizures, can also be used for seizures, sedation or agitation can be given any route.

Used to treat or prevent alcohol withdrawal

291
Q

Adverse effects of benzodiazepines

A

Decreased CNS activity, sedation, amnesia

Hypotension

Drowsiness, loss of coordination, dizziness, headaches
Nausea, vomiting, dry mouth, constipation

292
Q

True or false you can overdose on benzos

A

false there is no overdose on benzos, they are dangerous when taken with alcohol

293
Q

Flumazenil

A

may reverse the effects of benzos

294
Q

what happens if you mix benzos and alcohol

A

you will die

295
Q

Anxiolytic drugs

A

Reduce anxiety by reducing overactivity in the central nervous system (CNS)

296
Q

buspirone (BuSpar®)

A

Nonsedating and non–habit forming

May have a drug interaction with selective serotonin reuptake inhibitors (SSRIs) (serotonin syndrome)

Do not administer with monoamine oxidase inhibitors (MAOIs)

297
Q

Affective Disorders

A

Mood Disorders

Changes in mood that range from mania (abnormally pronounced emotions) to depression (abnormally reduced emotions)

Some patients may exhibit both mania and depression: bipolar disorder (BPD)

298
Q

Psychosis

A

out of touch with reality, can’t figure out what’s real and not real

Severe emotional disorder that impairs the mental function of the affected individual to the point that the individual cannot participate in activities of daily living.

299
Q

Mood-Stabilizing Drugs

A

Lithium used for bipolar, nothing for anything but bipolar

300
Q

Lithium

A

used for bipolar and bipolar only

Frequent drug tests till stable then every three months

Drug of choice for the treatment of mania

Narrow therapeutic range

Can cause cardiac dysrhythmias, Long-term can cause hypothyroidism. Drowsiness, slurred speech, seizures, ataxia and hypotension

301
Q

Antidepressants

A

Inform patients to take several weeks to see therapeutic effects

Monitor for suicidal attempts

Falls prone in older adults due to postural hypotension

Avoids anesthetics and tricyclics

302
Q

Tricyclic antidepressants

A

first generation

Inhibition of serotonin and norepinephrine reuptake into nerve endings. Helps regulate the malfunction of neurons, used for neuropathic pain, insomnia, orthostatic hypotension, insomnia, bedwetting, OCD, and anorexia. Overdose is lethal

Largely been replaced by SSRIs as first-line antidepressants

303
Q

amitriptyline (Elavil®)

A

large dose range, can kill yourself very easily

Oldest and most widely used of all the tricyclic antidepressants

Commonly used to treat insomnia and neuropathic pain (works well)

may cause dry mouth, constipation, blurred vision, urinary retention, and dysrhythmias, erectile dysfunction

304
Q

true or false most antidepressants cause erectile dysfunction

A

true

305
Q

Overdose of tricyclic antidepressants

A

Lethal; 70 to 80% die before reaching the hospital.

CNS and cardiovascular systems are
mainly affected. Death results from seizures or dysrhythmias.

Speed elimination by alkalinizing urine. Manage seizures and dysrhythmias.

306
Q

true or false you can mix MAOIs and Tyramine

A

false, it can cause a life threating reaction.

It can lead to a cerebral hemorrhage, stroke, coma or death.

307
Q

What is Tyramine

A

aged cheese, smoked foods, yeast extract, red wines, italian broad beans FAVA

308
Q

MAOIs (monoamine oxidase inhibitions)

A

Prevent the breakdown of serotonin, norepinephrine, and dopamine

Rarely used for depression. Used for Parkinson’s disease

Potential to cause hypertensive crisis when taken with tyramine

309
Q

Second-Generation Antidepressants

A

Depression, anxiety (will treat one will treat the other), and many others.

may cause insomnia (partly caused by reduced rapid eye movement sleep), weight gain increased appetite, and sexual dysfunction

310
Q

Serotonin Syndrome

A

too much serotonin

can cause delirium, agitation, tachycardia, sweating, myoclonus (muscle spasms) excess muscle spasms

311
Q

Second generation medications

A

SSRI

312
Q

SSRI

A

an antidepressant that inhibits the reuptake of serotonin in the brain, used to treat depression, anxiety, panic disorders, OCD, and PTSD, less severe side effects, more tolerable, less cost-effective

313
Q

fluoxetine (Prozac®)

A

SSRI
the first one, very effective, mainly used now for pediatric, available in liquid form

314
Q

sertraline (Zoloft®)

A

very popular, earliest SSRI, fairly wide dose, second choice, generally has very low side effects, with very good results

315
Q

paroxetine (Paxil®)

A

SSRI
crazy strong, if you go on it you don’t come off it, long tapper with custom pills, works very well, nearly last choice, drugs in the family if the drug works in the family it will work for you, give electric shock from getting off it

316
Q

Celexa and Cipralex

A

Are the same Celexa lost its patent and made Cipralex

common to start on this unless special indication, lowest side effect with it works well, same drug above, must need double the dose of the one above

317
Q

trazodone (Oleptro®)

A

elderly patients, used for sleep, rarely for depression by itself, it’s too weak and not effective, usually combined

318
Q

bupropion (Wellbutrin®)

A

an antidepressant that gives you energy, and gives you a boost, only one that doesn’t give you erectile dysfunction

319
Q

what is the only antidepressant that doesn’t give you erectile dysfunction

A

bupropion (Wellbutrin®)

320
Q

SNIR

A

anti-depressant medicine, which acts on neurotransmitters of the brain that affect the person’s mood, inhibits serotonin and norepinephrine. Treats major depressive disorders, anxiety disorders, mood disorders, and ADHD, less tolerant, more cost-effective.

321
Q

Zyban

A

originally indicated for the treatment of depression, can help in smoking cessation, added as an adjunct antidepressant for patients experiencing sexual adverse effects secondary to SSRI

322
Q

Duloxetine hydrochloride, Cymbalta

A

is a selective serotonin and norepinephrine reuptake inhibitor antidepressant (SSNRI).

Duloxetine affects chemicals in the brain that may be unbalanced in people with depression.

323
Q

Fluoxetine

A

prototypical SSRI, used in depression, bulimia, OCD, panic disorders, contraindicated in MAOIs, causes dizziness and anxiety, insomnia

324
Q

Mirtazapine (Remeron)

A

promotes the presynaptic release of serotonin and norepinephrine in the brain, is used in depression and sexual adverse effects, additive CNS depressant effects with alcohol and cytochrome P-450.

Piles on weight like crazy. Causes dry mouth, constipation, and increased appetite

325
Q

Antipsychotics

A

Drugs used to treat serious mental illness like psychoses, schizophrenia, and autism, extreme mania

Dopamine levels in the CNS are decreased.

tranquilizing effect in psychotic patients

326
Q

What medication has a tranquilizing effect in patients

A

antipsychotics

327
Q

Positive symptoms of schizophrenia

A

hallucinations, delusions, and conceptual disorganization

328
Q

Negative symptoms of schizophrenia

A

apathy, social withdrawal, blunted affect, poverty of speech, catatonia, sitting there won’t move

329
Q

Antipsychotics and schizophrenia

A

often improve positive symptoms but have a lesser effect on negative symptoms

330
Q

Atypical antipsychotics

A

Help both positive and negative symptoms of schizophrenia

331
Q

Adverse effects of antipsychotics

A

Agranulocytosis cant make white blood cells and hemolytic anemia, blood isn’t produced properly

332
Q

Extrapyramidal symptoms (EPS)

A

group of movement disorders that can occur as a side effect of certain medications, particularly antipsychotic medications

333
Q

Tardive dyskinesia

A

non stop chewing motion

334
Q

Choreoathetosis

A

Wavelike movements of extremities occurs with long-term use of antipsychotics

335
Q

Haloperidol

A

settle down anyone, orally, IM, can lower BP.

may cause hypersensitivity, Parkinson’s disease, large amounts of CNS depressants taken

Useful in treating patients with schizophrenia who were nonadherent to their drug regimen

336
Q

clozapine (Clozaril®)

A

only the sickest go on, There huge side effects, big weight gain, regular blood tests, psychotic monitoring, and close monitoring.

Blocks dopamine receptors in the mesolimbic region of the brain. No EPS. Adverse effects- blood dyscrasias.

337
Q

risperidone (Risperdal®)

A

is atypical in the elderly for sundowning, long-term side effects, negative symptoms of schizophrenia, minimal EPS at a therapeutic dose, oral and injectable

338
Q

olanzapine (Zyprexa®)

A

atypical in the elderly for sundowning

339
Q

quetiapine (Seroquel®)

A

helps if you have treatment-resistant depression, and helps sleep, and psychomotor agitation, really good drug, orally) (well tolerated) (massive dose)

340
Q

aripiprazole (Abilify®)

A

adjacent used with antidepressants, used for adjunct treatment resistance depression) (Massive doses for psychosis

341
Q

Herbal Products

A

Used for depression, anxiety, sleep disorders, nervousness

May cause GI upset, fatigue, dizziness, confusion, dry mouth, photosensitivity

Severe interactions if taken with MAOIs and SSRIs; many other drug interactions

Food–drug interaction with tyramine-containing foods

342
Q

Psychotherapeutic Drugs

A

Before beginning therapy, assess the physical and emotional status of patients.

Obtain baseline vital signs, including postural blood pressure readings.

Obtain liver and renal function tests.

Check the patient’s mouth to make sure
oral doses are swallowed.

343
Q

Influenzas (flu vaccine)

A

Recommended vaccine
Inactivated influenza vaccine

It helps prevent the severity of the flu 40-60% success rate on the strain circulating

Rare: Hoarseness wheezing, tachycardia

344
Q

Measles, mumps, rubella (MMR)

A

Routine vaccine
Live attenuated

Measles, mumps, rubella
Two dose series
78-97% (Often protected for life.)

Rare: febrile seizures, swelling, low platelet count

MMR does not cause autism

345
Q

Inactivated polio Vaccine (IPV)

A

Routine vaccine
Inactivated vaccine

Prevents 3 types of polio

95% after receiving all 3 doses

Polio is defined as a paralytic disease

346
Q

Hepatitis B Vaccine (hep B)

A

Routine vaccine
Recombinant

Hepatitis B infection

Common to be administered right after birth

95-100% effectiveness

HepB will be eradicated by 2023, 9 out of 10 who are not vaccinated will get ill

347
Q

Shingles (herpes zoster vaccine) (HZ)

A

Not routine
New adjunctive, nonlive, recombinant

Herpes Zoster (shingles)

Adults aged 50 and older (especially with a hx of chickenpox)

1 in 3 will develop shingles, the vaccine was approved in Canada in 2017, and 90% of Canadians who have had chicken pox will get shingles

90% effective

348
Q

Yellow fever vaccine (YF-VAX)

A

Not routine
Live attenuated

Yellow fever

Do not get it if you are allergic to eggs, chicken proteins, gelatin

99% effective (first 10 days 80-100%)

Vaccines have been available for more than 80 years, the name came from victims who became jaundiced from the disease

349
Q

Tuberculosis Vaccine (BCG)

A

Not routine
Live attenuated

Prevents tuberculosis menial TB

Administered soon after birth, single dose, unless there is a risk of exposure

51% TB, 78% in protecting newborns

¼ of the world is affected by TB

350
Q

COVID-19 mRNA (mRNA-1273)

A

Not routine
Pfizer, Moderna

Helps prevent Covid-19

Pfizer=90-100%, Moderna 37-100%

Rare: Bell’s Palsy myocarditis

351
Q

Smallpox vaccine

A

No longer required
Live attenuated

Protect from smallpox

Given at year old and booster every 3 years, typically, a single dose

Administered Via Scarification

The vaccine worked so well it eradicated the disease

352
Q

Hepatitis A (HAV)

A

Not routine
Inactivated vaccine

Hepatitis A which infects the liver

Travelers, children in high-risk groups, men who have sex with men, people who use injectable drugs, those with chronic liver disease

90-97% after both doses

The first vaccine was used in the US in 1995

353
Q

Typhoid Vaccine

A

Not routine
Live attenuated (TYPH-o)(Typh-I)

Protects you from typhoid fever and salmonella typhi bacteria

Oral capsule and IM injection

50% effectiveness

10% die if untreated

354
Q

Diphtheria, tetanus, pertussis (DTaP)

A

Routine vaccine
Combination toxoid

Diphtheria, Tetanus (Lockjaw), Pertussis (Whooping Cough).

2 months old. Oral 4 capsules over 8 days or injectable single dose

50% effective

10% die if untreated, 1% die if treated

355
Q

Meningococcal Vaccine (MEN-C, MEN-B)

A

Not routine
Inactivated

Meningococcal disease

Everyone over 2 months old
70-85% effective

Only vaccine that protects against bacterial meningitis

356
Q

Respiratory syncytial RSV

A

Not routine

Lower respiratory tract disease

Embryo and 65+ and older

Single dose

80% effective

357
Q

Tetanus and diphtheria (Td)

A

Routine vaccine
Inactivated vaccine

Tetanus and diphtheria

Tetanus = 100% and diphtheria = 97%

Diphtheria is transmitted through human contact where whereas tetanus is transmitted through solids and feces.

There are three types of vaccines (localized, generalized, and cephalic)

358
Q

Varicella vaccine aka chickenpox VAR

A

Not routine
Live attenuated

Risk of getting chicken pox

No during pregnancy or a recent blood transfusion

The first dose was 94% and the second was 98%

359
Q

Human papillomavirus (HPV) (HPV2= protects against 2 types) (HPV 9 protects from 9 types)
Not routine

A

Not routine
Live attenuated

Protects from human papilloma, genital warts that cause most cases of cervical cancer

2 doses for those before their 15th birthday and 3 doses for those after their 15th birthday

Close to 100%

This vaccine will replace pap smears

360
Q

Haemophilus influenza type b (Hib)

A

Routine vaccine

Polysaccharide conducted

Haemophilus influenza type b and meningitis

Only a single dose if you are over the age of 5

95-100% effective

1000 children die from Hib every year

361
Q

Dukoral cholera

A

Not routine
Live attenuated

Protects from cholera (contaminated food and water)

Two doses given at least one week apart. Orally

85% protection

Patients can only drink water an hour after taking the vaccine

362
Q

Rotavirus (RV5) (RV1)

A

Not routine
Live attenuated

Severe rotavirus infection

2 months old

Orally

Effective 85-96%

363
Q

Pneumococcal conjugate vaccine (PCV)

A

Routine vaccine

Parents illnesses caused by pneumococcal bacteria

All children younger than 5, adults older than 65, and those at risk

86-97% effective

Spread Via droplets, can host in the nasopharynx

364
Q

Rabies Vaccine (RAB)

A

Not routine
Inactivated imovax rabavert

Protects you from developing rabies

Safe for all ages, only use (4 doses on days 1, 3, 7, 14)

Rabies can take 2 weeks to a year to appear

365
Q

Japanese encephalitis (JE)

A

Not routine
Inactivated

2 doses IM

Travellers receive it

60-100% effective

366
Q

The anti-infective drugs

A

Anti-infective agents are drugs that are designed to act selectively on foreign organisms that have invaded and infected the body.

367
Q

Three mental health disorders

A

Anxiety
Affective disorders
Psychotic disorders

368
Q

The mechanisms for anti-infective agents are

A

Inhibition of the biosynthesis of bacterial cell WALL

Inhibition of protein synthesis

Some change the cell membrane permeability.

Some inhibit DNA synthesis

369
Q

Narrow spectrum antibiotics

A

anti-infectives affect only a few bacterial types because they are selective. The early penicillin drugs are examples.

370
Q

Broad spectrum antibiotics

A

anti-infectives affect many bacteria. Meropenem is an example.

371
Q

Bacteriostatic

A

keep the bacteria in status, doesn’t fully kill it

372
Q

Bactericidal

A

Kills the bacteria

373
Q

Gram positive

A

Blue stain
massive outer cell wall
On the outside of the body

374
Q

The Penicillin’s

A

Bactericidal
beta-lactamase
No side effects because we don’t have a cell wall
treats syphilis, tetanus

375
Q

amoxicillin

A

oral form

376
Q

ampicillin

A

IV form

377
Q

Cloxacillin used for

A

for skin infections

378
Q

Piperacillin is used for

A

Advanced infections

379
Q

Clavulanic acid is used for

A

enhancing the range of amoxicillin

380
Q

Side effects after stopping penicillin

A

rashes, pruritus, fever and urticaria

5-10% of those taking penicillin

381
Q

Gram negative

A

Pink stain
a tiny cell that does not pick up dye
is on the inside of the body

382
Q

Obtain culture and sensitivity when

A

Before starting any antibiotic

383
Q

amoxicillin is mostly used for what

A

for a pregnant woman with UTI, because we know most of the penicillin.

384
Q

The Cephalosporins

A

as you move higher in a generation you get better gram-negative coverage, but you lose gram-positive coverage

The cephalosporins also belong to the beta-lactam group of antibiotics.

385
Q

side effects of cephalosporins

A

abdominal pain
headache
N&V
rash
dyspepsia
diarrhea

386
Q

First generation cephalosporins

A

same coverage as penicillin

387
Q

Second generation cephalosporins

A

Adding effectiveness against Neisseria, and Haemophilus, less effective towards gram-positive

388
Q

Third generation cephalosporins

A

All of the gram-negative

389
Q

Cefazolin

A

Iv form, often given before an operation

1st

390
Q

Cephalexin

A

Oral form

1st

391
Q

Cefprozil

A

Oral form, same as amoxicilln but only required twice a day

2nd

392
Q

Cefuroxime

A

IV form

2nd

393
Q

Ceftriaxone

A

IV form

3rd

394
Q

Cefixime

A

Oral form often never needed

3rd

395
Q

Cephalosporins and penicillin

A

10% cross reactivity, if one is allergic to one they are probably allergic to the other.

396
Q

The Aminoglycosides types

A

no oral form
Gentamycin- IV
Tobramycin- Eye drops (absorbed well)
Amikacin- IV

397
Q

Aminoglycosides

A

Bactericidal

They inhibit protein synthesis in susceptible strains of gram-negative bacteria ONLY

Having problems with ear problems (pre-existing hearing loss)

Auto-toxic (hearing) and nephron toxic (renal) and hematoxic (bone marrow depression), may lead to immune suppression.

Ensure hydration, to minimize toxicity

398
Q

dethamexazone is used for

A

inflammatory infections and skin infections

399
Q

The Macrolides

A

Bacteriostatic

used for strep and listeria

Food does not interfere with the absorption of the macrolides.

Have problems with liver and no pregnant women should take

400
Q

Azithromycin is used for

A

Used for STDs (treats chlamydia)

Respiratory

401
Q

Clarithromycin

A

Strongest of macrolides

Extensive uses including skin and resp.

402
Q

Erythromycin

A

terrible stomach side effects

Long half-life, meaning more resistance.

Erythromycin is destroyed by the gastric juice, which is why slats are added to stabilize the drug.

403
Q

Adverse effects of macrolides

A

Gi problems
N&V
hepatoxicity
confusion

404
Q

The Tetracyclines

A

bacteriostatic
major sun effect
can cause weakening of bones and yellowing of teeth, may cause a rash.

405
Q

Doxycycline and minocycline

A

You’ll need it till you grow out of it, they are long acting. used for skin and infections

406
Q

Drug interactions with tetracycline

A

oral contraceptives decrease the effectiveness, must be given with a meal and try to avoid dairy.

407
Q

The Fluoroquinolones

A

are broad-spectrum antibiotics.

Bacteriostatic

Can’t use under the age of 18, can damage cartilage and stunt growth. Can cause plastic anemia and effect bone marrow.

408
Q

Ciprofloxacin

A

Fluoroquinolones
gram negative only, oral treatment for pneumonia

409
Q

Levofloxacin

A

fluoroquinolones
used for respiratory infections

410
Q

Moxifloxacin

A

strongest and widest used, mostly used for UTI

411
Q

Sulfonamides

A

Used mostly for urinary tract infections and skin infections

bacteriostatic

Sulfasalazine
Sulfamethoxazole

photosensitivity and rash and hypersensitivity, harmful during pregnancy

412
Q

Vancomycin

A

Comes IV and oral

Oral is not absorbed at all it is only used for C-diff.

IV works exclusively towards gram-positive and covers MRSA

413
Q

The anti-tubercular

A

treat all of them at once for a long time, sometimes weeks to months, take all four at once. stop growth of bacteria that causes TB.

they treat mycobacterium tuberculosis

o Isoniazid
o Rifampicin
o Pyrazinamide
o Ethambutol

(all-cause liver problems)

414
Q

responsibilities with taking anti-tubercular

A

Take as prescribed
check the liver with liver function tests
supplement B6

415
Q

Antifungals

A

AZOLES
bactericidal

416
Q

Side effects of anti-fungal

A

Headache and Dizziness
Pruritus
kidney damage

417
Q

Antivirals

A

VIR
bacteriostatic

418
Q

Antivirals adverse effects

A

Phlebitis and bone marrow depression and nephrotoxicity

419
Q

Nephrotoxicity

A

Antibiotics that are metabolized and excreted in the kidney most frequently cause kidney damage.

420
Q

Gastro-intestinal toxicity

A

Direct toxic effects on the cells of the GI tract can cause nausea, vomiting, stomach pain, and diarrhea.

421
Q

CNS toxicity

A

When drugs can pass through the brain barrier and accumulate in the nervous tissues, they can interfere with neuronal function. Crosses it can’t get back out.

422
Q

Cancer

A

Uncontrolled cell growth

423
Q

Benign

A

Non cancerous
Don’t grow into other tissue

424
Q

Malignant

A

Cancerous
Invade tissue or spread

425
Q

Carcinoma

A

covers external and internal organs and glands

426
Q

Sarcoma

A

always bad, starts in supporting tissue of the body, bone cartilage, fat

427
Q

Lymphoma

A

Lymph nodes

428
Q

Leukemia

A

blood

429
Q

Adeno:
Chondro:
Eythra:
Hengioma:
Hepato:
Lipo:
Lympho:
Melano:
Mylo:
Myo:
Osteo:

A

Adeno: gland
Chondro: cartilage
Eythra: red blood
Hengioma: blood vessels
Hepato: liver
Lipo: fat
Lympho: lymph nodes
Melano: pigment
Mylo: bone marrow
Myo: muscle
Osteo: bone

430
Q

Lead time bias

A

Only sometimes finding cancer early helps (it doesn’t change when you die)

431
Q

Cervical cancer is screened with what

A

pap smear

432
Q

Breast cancer is screened with what

A

Mammogram

433
Q

Prostate cancer is screened with what

A

DRA

434
Q

Colon cancer is screened with what

A

colonoscopy and sigmoidoscopy, FIT test

435
Q

Lung cancer is screened with what

A

low-intensity CT scan

436
Q

Core biopsy

A

some of it

437
Q

Incisional biopsy

A

the whole thing

438
Q

high graded tumors

A

bad

439
Q

low grade tumors

A

not so bad

440
Q

well differentiated

A

means you can tell the cells and where they came from

441
Q

poor differentiated

A

doesn’t know where those calls came from

442
Q

TNM

A

(tumor node metastases) T= number of tumors, N= lymph nodes M= metastasis (spread)

443
Q

Stage 1 cancer

A

In the tissues it is supposed to be in

444
Q

Stage 4 cancer

A

Spread to distant tissue and organs

445
Q

Gene mutation

A

no cancer gene (you only have the same genes as the other person who does have cancer)

446
Q

Surgery

A

is only done for the cure (debulking making a person more comfortable, they will still have the cancer in them).

447
Q

Radiation

A

burns everything, just happens to also kill the bad stuff (skin changes, swelling, feel sick)

448
Q

Chemo

A

Nausea and vomiting, hair loss, mouth sores, pain (every cell gets chemo, to kill the cancer)

449
Q

Neo-adjuvant

A

chemo, radiation, or hormone to shrink a tumor

450
Q

Adjuvant

A

hemo, chemo, radiation, targeted, biological

451
Q

Target therapy

A

medications that can very specifically kill some cancers

452
Q

Aggressive hormone therapy

A

is used in breast cancer and prostate cancer (the more hormones the better ie, estrogen, progesterone, and testosterone)

453
Q

Breast cancer

A

Cells involved: granular tissue, (ductal or lobular) (also skin ones involved)

Risk factors: age, family history, weight, menopause, radiation

Symptoms: painless lump, discharge in the nipple (inflammatory one), dipping of the skin (tumor is under the skin)

Screening: (non under 50) (screening every 2 years in Canada)

Detection: if you have a breast lump, the test to do is an ultrasound. biopsy, mammogram, MRI, FNAC (fine needle aspiration cytology)

Treatment: surgery, if possible, chemotherapy, hormones almost all receptor sensitive and long term, radiation

Survival: 89% (stage 0 - 2 is nearly 100% and stage 3 is high as well)

454
Q

lung cancer

A

Cells involved: small cell and non-small cell (4 types)

Risk factors: smoking, environment, genetics, asbestos, other lung disease, prior radiation

Symptoms: cough, shortness of breath, weight loss, chest pain

Screening: age 55-77, with more than 30 pack year history with no symptoms

Detection: Ct scan, biopsy, PET scan (see if it has metastasized), chest X-ray, bronchoscopy (scrape the wall to take a sample)

Treatment: Surgery only if you get rid of the cancer for good, chemotherapy (lung cancer does not respond well to it, small cell cancer does respond to it but the cancer will always come back), radiotherapy, immunotherapy, target therapy

Survival: Overall, 19% over 5 years

455
Q

Colon Cancer

A

Cells involved: adenocarcinoma

Risk factors: IBD, diet, meat cooked at high temps, low fiber diet

Symptoms: blood in stool, change in bowel habits, weight loss, anemia

Screening: two first-degree relatives with cancer for a colonoscopy, poop test first with average risk

Detection: colonoscopy, CT colonography, biopsy, blood and stool tests

Treatment: primary anastomosis (joining the two cancer-free parts together), osteotomy. Some rectal cancers don’t require radiation. Others get surgery with chemo or radiation

Survival: 67%, very good until stage 4 cancer

456
Q

Prostate cancer

A

Cells involved: Adenocarcinoma

Risk factors: Gender, age, diet, testosterone levels, family history (male sex main risk)

Symptoms: requinto urination, nocturia
Screening: does work. Not worth it.

Detection: rectal exam, PSA testing (only for those who have cancer), ultrasound, MRI, PCA3 RNA test, random 12-core biopsy

Treatment: surgery (very rare), hormone therapy, radiation, immunotherapy, target therapy

Survival: 97.1% (only treat aggressively if you have bone Mets)

457
Q

Pancreatic Cancer

A

Cells involved: pancreatic ductal adenocarcinoma

Risk factors: age, obesity, pancreatitis (alcohol abuse and high cholesterol), smoking, diabetes, family hx

Symptoms: stomach pain, back pain, starts in the middle and goes straight through you, weight loss, jaundice if obstructed, changes in stool.

Screening: screening tests imagine testing, staging, laparoscopy, blood tests

Treatment: The Whipple procedure is the only procedure, putting the pancreas into the side of a bowel. Surgery, radiation, chemo, target therapy

Survival: 10% over 5 years

458
Q

Brain Cancer

A

Cells involved: glioblastoma, astrocytoma (very bad ones) and meningioma, pituitary

Risk factors: alcohol, radiation, age, smoking, family history

Symptoms: headache, seizures (very common), cognition, vision, and speech

Screening: no screening tests
Detection: MRI, CT, lumbar puncture, hormone blood test, biopsy

Treatment: surgery, radiation (works very well because neurons don’t divide), chemotherapy, target therapy (gamma ray tumor)

Survival: depends on what type of cancer, glioblastoma is the most survivable

459
Q

Ovarian Cancer

A

Cells involved: epithelial cells, stromal cells, germ cell

Risk factors: family history, ovarian and breast cancer, genetic variation, age, more pregnancy, breastfeeding and contraceptives have less chance

Symptoms: bloating, pelvic pain, urinary frequency, shortness of breath (most common means it’s bad)

Screening: ultrasound

Detection: pelvic exam, blood test, imagining testing, biopsy, genetic testing

Treatment: surgery, debulk or removal, chemo, radiation

Survival: 45% over 5 years

460
Q

Renal cancer

A

Cells involved: sporadic, clear cell carcinoma

Risk factors: obesity, age, smoking, high blood pressure, kidney dialysis, exposure to asbestos

Symptoms: back pain, blood in the urine (microscopic will only show up in a urine dipstick), loss of appetite, weight loss, tiredness, fever

Screening: there is no screening

Detection: ultrasound or urine test, CT scan

Treatment: Surgery, chemo, radiation

Survival: survivals good if it’s inside the kidney capsule

461
Q

Macule

A

a flat circumscribed area that is a change in the color of the skin (freckles or small birth marks)

462
Q

Patch

A

flat, non-palpable irregularly shaped macule more than 1cm diameter (big macule, large birth marks)

463
Q

Papule

A

elevated, firm circumscribed area less than 1 cm (acne and moles)

464
Q

Plaque

A

elevated, firm and rough lesion with flat top surface area greater than 1 cm (large moles and sist, sclerosis)

465
Q

Circumscribed

A

you can tell exactly where it is

466
Q

Seborrheic keratosis

A

benign, obvious edge, no problems ever, skin off this type of tumour with a blade

467
Q

Actinic Keratosis

A

benign, sun damage, squamous cell carcinoma

468
Q

Nevi

A

benign, moles, overgrowth of normal tissue, as long as they don’t change its fine

469
Q

basal cell carcinoma

A

malignant, local cancer, never mastitis in the basal cell, red tissue with a pearly colour to it, never metastasis but it will keep growing.

470
Q

squamous cell carcinoma

A

malignant, not serious, nonhealing lesion, makes ulcers, usually doesn’t metastatic

471
Q

malignant melanoma

A

malignant, all you can do is cut it out and do a biopsy

472
Q

Burns

A

Alterations in skin integrity resulting in tissue loss or injury caused by thermal, chemical, electrical or radiation

473
Q

Thermal

A

dry heat (flame), moist heat (steam or liquid), cold (frostbite)

474
Q

Chemical

A

acidic or alkaline agents

475
Q

Electrical

A

dependent on voltage, duration, current

476
Q

Radioactive

A

sunburn, cancer treatment

477
Q

1st degree burn

A

Superficial thickness injury (sun burn), Only involves epidermis

Maintains water vapor and bacterial barrier functions

Local pain and erythema, no blisters for 24 hours

No treatment
Heal in 3-5 days

478
Q

Types of 2nd degree burns

A

Superficial partial thickness
and deep partial thickness

479
Q

Superficial partial thickness

A

fluid-filled blisters appear immediately, pain dt exposures of nerve endings to air if blisters break open, heal in 3-4 weeks, usually no scar. Drain with a needle and leave the skin on and put a dressing on it.

480
Q

deep partial thickness

A

usually involves entire dermis but hair follicles are preserved, looks waxy white surrounded by superficial partial thickness injury, can’t distinguish between this and 3rd degree until day 7 which skin buds appear, weeks to heal, treated with autograft, potential infection. Lots of scarring.

481
Q

3rd degree burn

A

Full thickness

Destruction of the entire epidermis, dermis, and subcutaneous, muscle or bone

Destroyed elasticity of dermis

Edema will shut off the circulation you need escharotomies to relieve pressure are painless due to destroyed nerve endings and allow more blood clow.

482
Q

rule of 9s draw it

A

doesn’t include first degree burns
99%

483
Q

body surface burns depends on

A

extent of body surface area involved

on depth of cutaneous injury

Burns exceeding 20% are considered major, massive

484
Q

How do bruns effect the body

A

by age, medical history, extent and depth of injury, involved body area

dramatic changes to the body in the first few minutes

within several hours, capillary integrity is lost dt release of several mediators of inflammation (histamine or prostaglandin) that cause vasodilation

485
Q

Burn shock

A

both a hypovolemic cardiovascular component and a cellular component

486
Q

Fluid resuscitation

A

administration of IV (lactated Ringers) -> restore circulating blood in time of inc. capillary permeability

Most reliable indicator of success = urine output

487
Q

Three main areas of burn

A

cardiovascular and systemic response

cellular response: metabolic and immunologic

evaporative water loss

488
Q

Fluid replacement

A

Basal fluid replacements per day

Total hourly maintenance fluids

basal fluid requirements per day / 24 hours + evaporated water loss per hour = ml/hr

Can cause edema in lungs and non burned areas due to fluid shifting in massive amounts

489
Q

End point of burn shock

A

when individual has adequate urine output for 2 hours + (30 ml/hr)

490
Q

Capillary integrity

A

usually restored within 24 hours (hallmark sign that burn shock is over) is termed capillary sealed

491
Q

whathappens at a cellular level during burns

A

altered cell membrane permeability, loss of normal electrolyte homeostasis - contributes to shock

492
Q

Transmembrane

A

changes also occur in undamaged cells

493
Q

Metabolic response

A

to injury involves SNS, and other homeostatic regulators (all the sress hormones release at once)

increase catecholamines, cortisol, glucagon, and insulin levels -> inc. gluconeogenesis, lipolysis, proteolysis

494
Q

Cells cannot maintain adequate electrolyte shifts and results in the following

A

excess Na

excess K

Which eventually can lead to cardiac dysrhythmias and altered central nervous system function
Produce a hypermetabolic state

495
Q

Chemical mediators

A

cause peripheral vasodilation, pulmonary vasoconstriction, inc. capillary permeability and local tissue ischemia

496
Q

Burn shock

A

can induce changes in integrity of intestinal wall

WBC are also altered, when needed to inhibit sepsis

Persons with pre burn altered immune status are at increased risk - elderly, malnutrition, cardiac disease, hx of alcohol or drug abuse

Ability of skin to serve as a barrier to evaporative water loss is lost

497
Q

Estimated evaporative water loss for burns is

A

20X normal. Replacement is mandatory to prevent volume deficit

498
Q

Burns recovery

A

Goal is wound closure that promotes survival

Scar formation

Three elements of survival
o meticulous wound management
o adequate fluids and nutrition
o earlier surgical excision and grafting

499
Q

Diagnosis and treatment for burns

A

Rule of Nines
BUN, creatinine clearance
urine output
CBC, electrolytes
Narcotics for pain relief
Remove rings and jewellery ASAP
O2 administration
Hydration

patho-pharm (1 decks)

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