PT 2 Mental Health, Wounds, Labs Flashcards
1
Q
What is the difference between mood and affect
A
A mood is an emotion or feeling (like depression or joy), where an affect is what we can see externally (you’re observing your patient express depression or joy)
2
Q
How many American adults does bipolar affect
A
5.7 million (4.4%)
3
Q
Does bipolar occur more in higher or lower socioeconomic classes
A
Higher
4
Q
What is the onset age of bipolar
A
25
5
Q
What are the characteristics of bipolar 1 disorder
A
Patient has experienced a manic episode, and maybe some depression. (they have very high highs, with a possibility to have a low)
6
Q
What are the characteristics of bipolar 2 disorder
A
Patient has experienced major depression symptoms but has never been full manic (only hypomanic) (can be misdiagnosed with as depression)
7
Q
What are the characteristics of cyclothymic disorder
A
Mood disturbances lasting at least 2 years. You’ll have highs that are hypomania and lows like depression, but your highs and your lows are not as severe as bipolar 1 or 2 (this is a milder form). It can turn into bipolar disorder.
8
Q
What is substance-induced bipolar disorder
A
Mood disturbance caused by the result of a medication
9
Q
What is the best environment for someone with bipolar
A
- Low lighting
- Few people
- Simple décor
- Low noise level
LOW STIMULI
10
Q
What is there a high incidence of with people who are bipolar, and what does this effect?
A
High incidence of substance abuse. This may increase the patient’s risk for harming self or others. It may also may it difficult to treat with medication.
11
Q
If you see someone who is bipolar start to get agitated or aggressive, what should you do?
A
Intervene at the first sign of this behavior. Say “you seem anxious about the situation, how can I help” (important to validate their feelings)
12
Q
As their anxiety increase (they have bipolar), what can you do?
A
Offer an alternative, maybe go for a walk, talk about the situation, take some antianxiety medication, etc.
13
Q
What are 7 nursing diagnosis for bipolar
A
- Risk for injury
- Risk for violence: self-directed or other-directed
- Imbalanced nutrition: less than body requirements
- Disturbed thought processes
- Disturbed sensory-perception
- Impaired social interaction
- Insomnia
14
Q
What are important to set for people who are bipolar
A
Limitations and consequences
15
Q
If a bipolar patient is in a hyperactive state and you are trying to get them to eat more, what are some strateigies
A
Have finger foods and “grab and go” foods readily available
16
Q
Is medication alone good enough to treat bipolar
A
No, evidence shows that a combination of psychoeducation and medication can provide the best outcomes
17
Q
What medications are used to treat manic episodes of bipolar
A
Lithium and anticonvulsant drugs with mood-stabilizing effects
18
Q
What are s&s of lithium toxicity 11
A
- Severe n&v
- Severe diarrhea
- Ataxia (loss of coordination (unsteady))
- Blurred vision
- Tinnitus
- Excessive urine output
- Increasing tremors
- Mental confusion
- Convulsions
- Slurred speech
- Coma
19
Q
What behaviors would you see for someone experiencing mania
A
- Rapid flow of ideas
- Accelerated speech
- Hallucinations and delusions
- Excessive motor activity
- Social and sexual inhibition
- Little need for sleep
- Labile mood (uncontrollable, intense mood changes)
- Panic anxiety
- Clouding of consciousness
- Disorientation
- Exhaustion
20
Q
What are the medical conditions that can cause MDD 9
A
- Stroke
- Traumatic brain injuries
- Thyroid disorders
- Cushing’s disease
- Huntington’s disease
- Parkinson’s disease
- Multiple sclerosis
- Brain tumor
- Alzheimer’s
21
Q
What is persistent depressive disorder (dysthymia)
A
Similar to MDD, if somewhat milder (gloomy, complaining, can’t have fun - like MDD but a little milder, chronic, lasts for years)
22
Q
What is the criteria for diagnosing dysthymic disorder
A
- Feeling sad or “down in the dumps”
- No evidence of psychotic symptoms
- Essential feature is a chronically depressed mood for most of the day, more days than not, for at least 2 years
23
Q
What are the behavioral symptoms of transient depression (life’s everyday disappointments)
A
Some crying
24
Q
What are the behavioral symptoms of mild depression 5 (normal grief response)
A
- Tearfulness
- Regression
- Restlessness
- Agitation
- Withdrawal
25
What are the behavioral symptoms of moderate depression 8 (dysthymia)
1. Sluggish physical movements
2. Slumped posture
3. Slowed speech
4. Limited verbalizations
5. Talking about life's failures or regrets, social isolation
6. increased use of substance
7. Self-destructive behavior
8. Decrease in personal hygiene
26
What are the behavioral symptoms of severe depression 7 (MDD)
1. Physical movements may stop
2. Slumped posture
3. Curled up
4. Walking slowly and rigidly
5. No communication
6. No personal hygiene
7. Isolation
27
What is the diagnostic criteria for MDD 5
1. Depressed mood
2. Loss of interest or pleasure in usual activities
3. Symptoms present for at least 2 weeks
4. No history of manic behavior
5. Cannot be attributed to use of substances or other medical conditions
28
What are nursing interventions for suicide 8
1. Remove harmful objects
2. Maintain close observation
3. Perform frequent checks at inconsistent times
4. Don't give a private room
5. Keep close to the nurses station
6. Make sure they are taking their medications and not stashing them away to take later to OD
7. Talk openly and matter of factly about suicide
8. Encourage patient to express their feelings and thoughts. Be direct.
29
What is the most important intervention when someone is at risk for suicide
Spend time with them. Make them feel wanted.
30
What are the presumed causes of depression 5
1. Genetics might be involved
2. Deficiency of norepinephrine, serotonin and dopamine
3. Neuroendocrine disturbances
4. Physiological influences (related to your body - stress inactivity, etc.)
5. Psychosocial theories
31
What are the two conditions associated with neuroendocrine disturbances
1. Hypothalamic pituitary adrenocortical axis
| 2. Hypothalamic pituitary thyroid axis
32
What happens in hypothalamic pituitary adrenocortical axis
Hypersecretion of cortisol (stress hormone)
33
What happens in hypothalamic pituitary thyroid axis
Where not enough of your thyroid hormone is being released
34
What are physiological influences for MDD 5
1. Medication side effects
2. Neurological disorders
3. Electrolyte disturbances
4. Hormonal disorders
5. Nutritional deficiencies
35
What neurological disorders may lead to MDD 6
- CVA
- Brain tumors
- Alzheimers
- Parkinsons
- Huntingtons
- Multiple sclerosis
36
What electrolyte disturbances may lead to MDD
- Excessive levels of sodium or calcium or potassium
| - Deficient levels of magnesium, sodium or potassium
37
What are the psychosocial theories that may lead to MDD 5
- Psychoanalytical theory (loss after something loved is gone or dies)
- Learning theory (learned helplessness makes them feel depressed)
- Object loss (separated from a significant other during the first 6 months of life)
- Cognitive theory (negative thinking)
- Transactional theory (everything combined, genetics, biochemical, etc. predisposes an individual to MDD)
38
How long until therapeutic effects are achieved from antidepressants
At least 4 weeks.
39
Define phobia
A persistent, intensely felt, and irrational fear of a specific object, activity, or situation that results in a compelling desire to avoid the feared stimulus
40
What are two of the more common phobias
- Agoraphobia
| - Social anxiety disorder (social phobia)
41
What is agoraphobia
Fear of being in places or situations where you might not be able to get out if you start to panic "fear of the marketplace." People with this phobia may never leave their house.
42
What happens in social anxiety disorder
Fear of being around people where you might become embarrassed "such as fear of public speaking"
43
What is the difference between obsessions and compulsions
Obsessions are the thoughts, where the compulsions are you acting out those thoughts (in order to get rid of the obsessive thoughts)
44
Why does a person complete an OCD task
Because it relieves anxiety
45
What is the difference between GAD and panic disorder
A panic disorder is when you have a sudden attack where you feel overwhelming terror or impending doom, whereas anxiety can range from mild to sever and be these thoughts of worry in the back of your mind throughout the day.
46
What are some interventions for a person with anxiety or who have a panic disorder
1. Do not leave them when they are experiencing panic anxiety
2. Stay calm so they don't feed off of any nervous energy
3. Use simple words and brief messages of what is going on
4. Keep a low stimulation environment (low lights, etc.)
5. Help patient to realize the s&s of a panic attack and then doing something distracting (like going for a walk)
47
What medications are commonly used to treat panic disorders
- SSRIs (paroxetine, fluoxetine and sertraline)
- SNRI (venlafaxine, duloxetine, bupropin)
- Benzodiazepines
48
What is depersonalization
When you feel cut off from yourself, you don't feel like yourself, out of body experience.
49
What is derealization
When you feel cut off from your surroundings, surroundings can be blearily or unusually clear, time feels weird.
50
What is somatic symptom disorder
When a person has a significant focus on physical symptoms, such as pain, weakness, or shortness of breath, to a level that results in major distress and/or problems functioning (you always think your dying)
51
What are common personality characteristics for someone who has somatic symptom disorder
- Heightened emotionality
- Strong dependency needs
- Preoccupation with symptoms and oneself
52
What are the primary and secondary gains for a person with somatic symptom disorder
Primary gain: "due to their fake illness" they become excused from troublesome duties.
Secondary gain: they become the prominent focus of attention because of their "fake" illness
53
What are some of the causes of dissociative disorders 8
1. Majority have a history of physical and sexual abuse
2. Migraines
3. Marijuana use
4. SSRIs
5. Low tryptophan (makes proteins)
6. Certain neurological conditions (temporal lobe epilepsy and severe migraine headaches)
7. By suppressing bad memories
8. Response to a severe trauma (only way to cope is dissociation)
54
What is the most common explanation of dissociative disorders (what function does it serve)
Begins as a survival strategy to help children cope from a traumatic experience or abuse
55
How should you handle someone with a disturbed personal identity diagnosis 3
- Help the patient understand the existence of each personality and the need each serves
- Help the patient identify stressful situations that cause the change in personalities
- Help the subpersonalities understand that their "being" will not be destroyed, instead they will be unified within the individual
56
How can you help someone who has an impaired memory diagnosis 3
- Do not confront the patient with information that they do not remember
- Instead, expose the patient to stimuli that represents pleasant experiences from the past, which might help them recall memories
- Help identify conflicts that have not been resolved and solutions
57
What is dissociative identity disorder formerly known as
Multiple personality disorder
58
What is dissociative fugue
A type of dissociative amnesia, which is sudden, unexpected traveling away from customary places or wandering, with the inability to recall one's past or identity. They often assume a new identity.
59
What is the difference between anxiety and fear
Anxiety is an emotional response and fear is a cognitive response
60
If there is inflammation, will there always be an infection?
No, there may not be an infection. Inflammation can also be caused by trauma, chemicals, allergies or an autoimmune reaction.
61
Describe the 3 types of inflammation
1. Acute: first 2-3 weeks. Basic inflammation.
2. Subactue: Weeks - months. Bacteria may have settled in heart valves, etc.
3. Chronic: months - years. Arthritis, etc.
62
What are the four inflammatory responses
1. Vascular
2. Cellular
3. Formation of exudate
4. Healing
63
Give a brief overview on what happens during the vascular response 7
- Vessels will initially contract
- Histamines will be released
- Vessels will dilate
- Fluid will move into the space
- Proteins like albumin are released into the space, and help draw more fluid out of the vessels due to pressure
- Blood clots
- This rush of activity is what causes redness, heat and swelling
64
Besides having our blood spurt out, why is important for our blood to clot
- Traps bacteria and prevents the spread of the wound
65
What do prostaglandins do 3
- Vasodilation
- Cause you to feel pain
- Influence the production of a fever
66
What WBC arrives first on the scene
Neutrophils (6-12 hours)
67
What do neutrophils do
Phagocytize bacteria, foreign materials and damaged cells
68
Describe "shift to the left"
When the body is trying to keep up with the demand for neutrophils, it starts to release immature neutraphils called bands. We say that you are "shifting to the left" when this happens.
69
What are mature neutrophils called
Segs for segmented
70
When would we typically see a patient "shift to the left"
When they are fighting an acute bacterial infection
71
After neutrophils have arrived, what are the next two WBC to arrive
- Monocytes that turn into macrophages (clean up)
| - Lymphocytes are the last to the party
72
What is exudate
Fluid and WBCs
73
What does serous fluid look like
Clear, thin, watery. Normal for mild injury.
74
What does sanguineous fluid look like
Fresh bleeding. Can be seen in deep to full thickness wounds.
75
What does serosanguineous fluid look like
A mixture between serous fluid and sanguineous fluid. It's pale, pink, watery. Usually after surgery. "Serous fluid with a little bit of blood"
76
What does fibrinous fluid look like
Thick and sticky. Usually following surgery.
77
What does hemorrhagic exudate look like
From a ruptured blood vessels. Just tons of blood.
78
What does purulent exudate look like
Thick, yellow, green, opaque. Infected.
79
What is catarrhal exudate
Thick mucus. Usually from an infection in your nose.
80
What does seropurulent exudate look like
Thin, watery, cloudy, yellow to tan. (might start be getting an infection)
81
What symptoms would you see for local inflammation
- Redness
- Heat
- Pain
- Swelling
- Loss of function
82
What symptoms would you see for systemic inflammation 6
- Increased WBC count with shift to the left
- Malaise (feeling of discomfort/illness)
- Nausea
- Anorexia
- Increased HR and RR
- Fever
83
What triggers a fever
Cytokines (why then wake up prostaglands, which then raises the set point temp of our body)
84
What in our body regulates our temperature
Hypothalamus
85
What sets our temperature point
Prostaglandins
86
When starting a fever, what does the hypothalamus do
Activates the autonomic nervous system to increase muscle tone and shivering, and decrease perspiration and blood flow to the periphery
87
For a fever, what is released from the adrenal medulla to increase our metabolic rate
Epinephrine
88
What is the purpose of shivering
It is how the body raises our temperature
89
Why do we feel chilled when we have a fever
Because our set point is higher, the body thinks it is cold because it is trying to achieve this higher temp
90
When will our chills and shivering stop
When we reach our new set point
91
What is the purpose of a fever 3
- Increased killing of microorganisms
- Increased phagocytosis by neutrophils
- Increased creation of T cells
Basically we are trying to make our body inhospitable.
It also speeds up our metabolism, which speeds up our immune response.
92
What temperature starts to become dangerous
104 - start to damage body cells, delirium, seizures.
93
What temperature can lead to brain damage
105.8
94
What happens to older adults and inflammation
They not have much of an inflammation response or fever. This can be hard to treat because they don't really show the classic symptoms (their symptoms are more mild)
95
For every 1 degree over 100, how much does your metabolism increase by
7%
96
Do we want to always treat a fever with an antipyretic
Not always, a fever is usually a good response from the body. As long as the fever is not very high, the patient isn't uncomfortable or they are not young or old. Just try to have them ride it out.
97
What happens if a immunosuppressed patient has a fever
They should immediately be treated with antibiotics, because they could rapidly progress to septicemia.
98
Do cooling blankets/sponge baths reduce fevers
They can, but only after a patient is given an antipyretic, which lowers the body's set point. Otherwise, without an antipyretic, the set point is still high, and the body will compensate to try to keep the temperature up.
99
How do corticosteroids impact fever
They prevent both cytokine and PG synthesis.
100
How do chemo drugs impact fever
These drugs suppress the immune system, so if there is an infection, your body does not have a strong immune system to raise your set point temperature
101
What drugs can be given for healing and inflammation
- Antipyretic drugs (acetaminophen, NSAIDs, Aspirin)
- Anti-inflammatory drugs (corticosteroids, NSAIDs, aspirin)
- Vitamins A, B, C or D (help accelerate the healing process)
102
What acronym should we remember when treating soft tissue injuries and inflammation
RICE
103
What happens in RICE
R - rest (help the body absorb nutrients and oxygen for healing)
I - Ice (cold/heat - cold in the first 24hrs to help stop swelling and edema. Heat in the next 24-48hrs to help promote circulation and bringing in WBC)
C - Compression/immobilization (helps to stop vasodilation and the development of edema.)
E - Elevation (above the heart, increase venous and lymphatic return, decreases pain)
104
When would you not want to use elevation
For a patient with significantly reduced arterial circulation
105
When will primary intention occur
When wound margins are neatly approximated - like a surgical cut or paper cut
106
What happens at the three phases of primary healing
1. Initial phase - initial inflammatory phase. Looks like a large blood clot (3-5 days)
2. Granulation (new capillaries) - wound starts to look pink. Granulation tissue filled in wound Should be resistant to infection (5-4 weeks)
3. Maturation - Scar forms (7 days - months/years)
107
What is the difference between primary and secondary intention
Primary intention has defined margins with minimal tissue loss, where secondary intention have edges that cannot be approximated (brought together), they have extensive tissue loss, we may need to clear debris away.
108
How do secondary intention wounds heal
The same way as primary. They'll just have a much larger scar
109
What is tertiary intention
Contaminated wound
110
What is the difference with tertiary healing
We will leave the wound open so that the infection can clear out
111
Why does diabetes put you at risk for poor wound healing
- Diminished sensation due to damaged nerves and vessels.
- Poor blood flow to extremities due to narrowed vessels.
- High sugar prevents nutrients and oxygen from energizing the cell, prevents immune system from functioning efficiently, increases inflammation.
- Risk for infection due to the added sugar.
112
Why does poor oxygenation put you at risk for poor wound healing
Lack of oxygen causes vasoconstriction, when you really should be having vasodilation. This constriction does not let WBC in, and delays healing.
113
Why do sex hormones put you at risk for poor wound healing
Sex hormones help to promote healing. As we age, these hormones decrease, so we lose this help.
114
Why does stress put you at risk for poor wound healing
Stress increases our cortisol, and cortisol inhibits your inflammatory response, so you are not able to heal very well.
115
Why does obesity put you at risk for poor wound healing
Difficult to get a cell response to the area of trauma, because they have to go through a lot of adipose tissue. It's also hard to close wounds.
116
Why does alcohol put you at risk for poor wound healing
It diminishes the body's resistance to bacteria.
117
What nutrients are important for wound healing
Protein, vitamins C, A, zinc and copper
118
Why does smoking put you at risk for poor wound healing
Nicotine is a vasoconstrictor, which means that it blocks cells from going to fight in the increase. It also increases your risks for blood clots.
119
What are adhesion complications
- Scar tissue that forms around organs
| - Adhesions may cause intestinal obstruction
120
Are contractions a normal part of healing
Yes
121
How can you prevent contractions
- ROM exercises
| - Splint to keep the joint from contracting
122
What is dehiscence
When your wound bursts
123
What can cause dehiscence
1. Inflammatory response from infection
2. Granulation tissue can't stay together
3. Obesity
4. Pocket of fluid that develops (edema)
124
What are risk factors for dehiscence
Things that don't allow good blood flow like obesity, COPD, CHF.
125
What is evisceration
When wound separates and intestines protrude
126
What do we do if there is evisceration
Do not put anything back in - use sterile gauze and sterile saline to cover wound and call the doctor right away
127
How can you prevent evisceration
Limit things that strain your abdominal muscles
128
What if there is excess granulation tissue
It can be cauterized or cut off, and normal healing will continue
129
What are hypertrophic scars
Big, protruding scars. They are still within the borders of the wound.
130
What are keloids
Big, protruding scar that extends past wound margins (looks like a giant tumor).
131
Can you remove a keloid
No, they are permanent
132
Can keloids be painful
Yes they can be painful and tender
133
Who is usually at risk for keloid scars
People of color and/or hereditary
134
Can necrotic tissue (dead cells) increase your risk for infection
Yes - because this usually means your blood supply has been decreased, which also increases your risk for infection
135
What is a hemorrhage
When you're bleeding all over the place
136
Why might a patient hemorrhage 4
- Suture failing
- Clotting abnormalities
- Dislodged clot
- Infection
137
What should you do if someone is hemorrhaging
Apply pressure - apply a tourniquet as a last resort, because this can cause the patient to lose the limb
138
What is a fistula
An abnormal passage between organs or a hollow organ and skin
139
What increases your risk for an infection during wound healing 6
- Increase in necrotic tissue
- Decrease in blood supply
- Decrease in body's immune response
- Undernutrition
- Multiple stressors
- Hyperglycemia in diabetes
140
What 3 ways can we classify wounds
1. Cause of the wound (surgical, accidental, injury)
2. Depth (superficial, partial thickness, full thickness)
3. Type (acute or chronic)
141
What are we assessing on a wound 7
1. Location on body
2. Size of the wound (length - head to toe, width - side to side)
3. Measure any undermining ("lip" around the wound) using a cotton swab
4. Measure any tunneling using a cotton swab
5. Wound margin
6. Wound base (bed)
7. Consistency, color and odor of drainage
142
What are we assessing for when we look at the wound margin
Is it normal, macerated (soft, pruny), erythema (redness), etc.
143
What are we assessing for when we are looking at the wound base
Is there any eschar (dark scab), slough, exudate.
144
When thinking about a clock when measuring a wound, where does the 12 o'clock go
12 o'clock goes towards the patient's head (6 o'clock points to their feet)
145
What fluid is best to clean a wound
Sterile saline
146
What other fluids can be used to clean a wound, but should be used with caution
1. Povidone-iodine (betadine)
2. Sodium hypochlorite (Dakins)
3. H2O2 (hydrogen peroxide)
4. Chlorhexidine (Hibiclens)
(these fluids can kill the new tissue - never apply to a clean wound)
147
What acronym can we used to help with wound healing
TIME
148
What does TIME stand for
T - tissue (is there viable tissue - figure out how to get the dead tissue out)
I - infection and/or inflammation (look for infection or inflammation)
M - moisture (is there a moisture imbalance? is the wound too moist or too dry?)
E - edges of the wound (what do our edges look like)
149
If the wound is superficial, how can we close it 4
- Use adhesive strips (steri-stirps, butterflies)
- Sutures (stitches)
- Staples
- Tissue adhesives
150
Do we prefer to use sutures
No, because they can cause scarring. It is easier to use strips because they do not cause scarring and they're easier to clean
151
Is "airing out" a wound good?
No, this can lead to a dry wound
152
What is the first step in treating a contaminated wound
Clean the wound first, otherwise healing will not occur
153
What is autolytic debridement
Body's own enzymes break down the infection
154
What is biological debridment
Using larvae to eat up the dead tissue
155
What is surgical/sharp debridement
Just as it sounds - clean the wound with a scalpel or something else
156
What is mechanical debridement
1. Wet-to-dry dressing
| 2. Wound irrigation
157
How does a wet to dry dressing work
Gauze is moistened with normal saline, lightly packed into the wound and the outer layer drys. Wound debris adheres to dressing and then dressing is removed.
158
What is important about wound irrigation
Do not use a high pressure, because you could be spraying bacteria further into the wound.
159
What do stage 1 pressure injuries look like
Intact skin with non-blanchable erythema
160
What does a stage 2 pressure injury look like
- partial thickness skin loss with exposed dermis
- Looks like an intact or ruptured blister
- Cannot see adipose or deeper tissues
161
What does a stage 3 pressure ulcer look like
- Full thickness skin loss
- Can see adipose tissue
- Might see eschar and/or slough
162
What does a stage 4 pressure injury look like
- Full thickness skin loss with exposed muscle, tendon, bone, etc.
- Slough and/or eschar may be visible
163
What is the difference between a stage 1 pressure injury and a deep tissue pressure injury
Both are non-blanchable, however, a stage one is red/pink. Deep tissue is a deep red, maroon or purple (might have a stage 3-4 underneath)
164
What dressing can be combined with many other dressings
Gauze
165
When would you use gauze
- Can be used on almost any kind of wound
| - Used for cleansing, packing and covering
166
Describe a non-adherent dressing
- Not absorbent
| - Can be soaked in saline, petrolatum or antimicrobials
167
When would you use non-adherent dressing
- Minor wounds, that do need a lot of drainage.
| - These are nice, because they don't stick to the wound
168
Describe transparent film
- Allows you to visualize the wound
| - But they can trap in moisture, so really only use over a dry wound or IV site
169
Describe foam dressing and uses 5
- Used to absorb minimal to moderate drainage.
- Usually affixed with a secondary dressing.
- Primary dressing for absorption
- Used for wound packing
- Used to prevent sacral pressure injuries
170
What do hydrocolloid dressings do, and what are they good for
- Form a gel over the surface of the wood
- Good for light-moderate drainage
- Best choice to support autolytic debridement.
- Used for necrotic wounds (this dressing is going to eat away at the bad stuff)
- Best to stop secondary infection
171
What are hydrogels and what are they good for
- Give moisture to a dry wound and maintain a moist environment
- Used to rehydrate a wound
- Can also help with autolytic debridement due to moisturizing effects
- Also used on necrotic wounds
- Minimal drainage
172
What are alginate dressings and what are they used for
- Made from seaweed or kelp
- High absorbent (used on pressure injuries and infected wounds)
- Used for packing
173
What are antimicrobial dressings and what are they used for
Can be multiple kinds of dressings that contain natural antimicrobials to help with wounds that are really infected
174
How do negative pressure wound vacs work
They provide continuous negative pressure to remove fluid, exudates and infectious material to prepare the wound for healing
175
How do wound vacs promote healing
They pull excess fluid from the wound, reduce bacterial load and encourage blood flow to the wound base.
176
What is important to monitor when someone is on a wound vac
- Protein and fluid and electrolyte levels due to the high amount of drainage
- Also clotting times (PT/PTT)
177
What percentage of oxygen is a patient receiving in a hyperbaric chamber
100% oxygen
178
How do hyperbaric chambers work
The high oxygen pressure allows O2 to diffuse directly into the serus versus RBC, and then be transported to tissues. The O2 in the serum can even move through narrowed arteries and capillaries where RBCs cannot go.
179
Besides the oxygen in the serum, what else can hyperbaric chambers do 3
- Stimulate angiogenesis (production of new blood vessels)
- Kill anaerobic bacteria
- Increase the killing power of WBCs and certain antibiotics
180
How does undisturbed wound healing work
Do dressing changes every 7 days. By not changing and disturbing the wound everyday, you can help speed up recovery.
181
Should you increase or decrease fluids during wound healing
Increase fluids due to the fluid loss and high metabolic rate
182
Should you increase or decrease protein during wound healing
Increase protein to help correct the negative nitrogen balance from the increased metabolic rate.
- Protein also helps the synthesis of immune factors, leukocytes, fibroblasts and collagen
183
What are carbs good for during wound healing
Used for energy so your body doesn't break down protein for energy
184
What are fats good for during wound healing
Creating fatty acids and triglycerides which make up cell membranes
185
What is vitamin C good for during wound healing
Capillary synthesis and collagen production by fibroblasts
186
What are the B complex vitamins good for during wound healing
Necessary coenzymes for many of the metabolic reactions
187
What is vitamin A good for during wound healing
- Epithelization
| - Increases collagen synthesis and tensil strength
188
Who might receive prophylactic antibiotics
Someone whose immunodeficient
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If an infection does develop in a wound, what should you do
Get a culture and sensitivity
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What is a CBC with differential indicating
- Inflammation
- Infection
- Pre-surgical
- Response to chemo
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What goes into a CBC with diff.
Looks at red blood cells, white blood cells and platelets
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What does the differential mean in CBC
You are also measuring all of the different WBCs
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Does a CMP only measure electrolytes? What else does it measure?
No, it measures your electrolytes, but it also checks how your liver and kidneys are functioning. So it also includes BUN/Creatinine, AST/ALT, bilirubin, etc.
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What can a UA help measure 6
- If there is infection
- Looking for blood
- Bilirubin
- Urobilinogen
- Nitrates (helps us diagnose UTIs - nitrites)
- Protein (kidneys aren't working well)
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What can a dipstick in a UA measure
pH, protein, glucose, ketones, etc.
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What does PT measure
The amount of time it takes for your blood to clot
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What lab are we running to look at the effectiveness of heparin
aPTT (we are checking how long it takes the blood to clot on heparin)
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What is the difference between cardiac arrest and a heart attack.
Cardiac arrest is when the heart stops beating due to an "electrical" problem. A heart attack is when blood flow is blocked to the heart, which is a "circulation" problem.
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What is disseminated intravascular coagulation (DIC)
It is when your blood begins to accelerate it's clotting. This actually lowers clotting factors in your body, which then leads to you hemorrhaging (spurting blood everywhere)
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What is the purpose of running a troponin lab
Troponin is a protein found in cardiac muscle. When there is damage to heart, such as an infarction, then increased amounts of troponin is released into the bloodstream. This helps us to determine is someone had an MI (heart attack)
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What does brain natriuretic peptide (BNP) measure (these are released into the blood when the heart is under stress)
Heart failure
202
What does creatine kinase (CK) measure
Monitors myocardial infarction
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What does C-Reactive protein (CRP) measure
Will tell us if there is inflammation
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What does prealbumin and albumin measure
- Malnutrition
| - Kidney disease
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Why would we want to measure cerebrospinal fluid
It can tell us if someone has sepsis
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What tests could we run for stroke
- CBC with diff
- PT and PTT
- INR
- C-reactive protein
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If someone is on coumadin (warfarin), what test are we going to run
PT/INR to look at their clotting times
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What is important to remember about gentamicin and vancomycin
To get peaks and troughs
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What are the critical ranges of PT and INR
PT > 20 seconds
| INR > 5 seconds
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What is the antidote for blood thinners
Vitamin K - makes your blood clot
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Why would we draw a blood culture first, before getting our other lab draws
Because we do not want to contaminate the blood culture samples. We want them to be straight from the source without contamination.
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What two tests can we run if we suspect DIC
- PT and aPTT
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Besides the other assessments, what are we also assessing for before we draw blood
If the patient has any phobias associated with blood draws
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If you're trying to measure your blood gases like Po2, should you get arterial blood or venous blood
Arterial blood
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For all other blood draws other than ABGs, are we getting blood from the arteries or the veins
Veins
216
What is the max amount of time you can leave the tourniquet on
1 min
217
Should you ever draw blood from a previous site
No, this can increase the risk of infection
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When assessing what side to draw a sample from, what should we consider
- Do not draw on the side where a patient had a mastectomy
- Where there is an AV fistula (where blood flows directly from an artery into a vein - bypassing any capillaries)
- Do not draw where there is lymphedema (swelling)
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How do we want people to lay when obtaining CSF
Knees to chest, so that the spine will be elongated, so we have a maximum entry point
220
What is the most common side effect after pulling a CSF
Headache - let the doctor know. They can perform a blood patch by inserting patient's own blood back in to clot the leak of fluid.
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How long does a patient have to stay horizontal after drawing CSF
At least 8 hours
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What should you keep urine samples on
Ice or refrigerated
223
How can you prevent a hematoma after a blood draw
Apply pressure for a few hours and use warmth (goggle says apply cold)
224
What should you do to avoid fainiting when giving blood
- Eat a meal
- Drink water
- Lie down when giving
- Distract yourself
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Should you draw blood above an IV site
No - always below
226
How do they collect blood from babies
Skin puncture
227
Can you draw samples from an indwelling venous catheter
Yes
228
What are potential complications after draining fluid 6
- Injury to the surrounding organ
- Bleeding
- Reflex bradycardia and hypotension
- Infection at the injection site or in the fluid
- Tumor seeding (needle causes a tumor to dislodge and spread cancer cells)
- Effusion fluid leakage (causes swelling)
229
Why would we get a first morning urine sample
Because this urine is going to be very concentrated, it may help us detect something difficult to find in more diluted urine. (As the day goes on, our urine becomes more diluted)
230
When a person is on a 24 hour watch, when do you start the time
You start the time right when the first void occurs (remember to discard this void though)
231
What is a double voided specimen
You void, throw that sample away, go drink some water and wait 30 minutes, then pee again and collect that sample (used for glucose and ketones)
232
When we're trying to get a culture and sensitivity through a urine sample, should we use an aseptic technique
Yes
233
If you're getting a stool sample, can you get urine in your sample
No
234
What can lead to lithium toxicity
- Dehydration (this increases lithium levels in blood)
- Hyponatremia (don't start a low sodium diet)
- Old age (lithium is excreted from kidneys, kidneys start to slow down when you're older)
235
What are the 3 dissociative disorders
1. Dissociative amnesia (memory loss)
2. Dissociative identity disorder (multiple personality disorder)
3. Depersonalization-derealization disorder (can experience one, the other, or both)
236
What is the main difference between mania and hypomania
A person who is manic cannot perform ADLs. A person with hypomania can function in every life.
