Brainscape's Knowledge GenomeTM

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


See full index

102 > PT 2 Mental Health, Wounds, Labs > Flashcards

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)

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

How many American adults does bipolar affect

A

5.7 million (4.4%)

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

Does bipolar occur more in higher or lower socioeconomic classes

A

Higher

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

What is the onset age of bipolar

A

25

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

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

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

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

What is substance-induced bipolar disorder

A

Mood disturbance caused by the result of a medication

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

What is the best environment for someone with bipolar

A
  • Low lighting
  • Few people
  • Simple décor
  • Low noise level

LOW STIMULI

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

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

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

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

What are 7 nursing diagnosis for bipolar

A
  1. Risk for injury
  2. Risk for violence: self-directed or other-directed
  3. Imbalanced nutrition: less than body requirements
  4. Disturbed thought processes
  5. Disturbed sensory-perception
  6. Impaired social interaction
  7. Insomnia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are important to set for people who are bipolar

A

Limitations and consequences

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

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

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

What medications are used to treat manic episodes of bipolar

A

Lithium and anticonvulsant drugs with mood-stabilizing effects

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

What are s&s of lithium toxicity 11

A
  1. Severe n&v
  2. Severe diarrhea
  3. Ataxia (loss of coordination (unsteady))
  4. Blurred vision
  5. Tinnitus
  6. Excessive urine output
  7. Increasing tremors
  8. Mental confusion
  9. Convulsions
  10. Slurred speech
  11. Coma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are the medical conditions that can cause MDD 9

A
  1. Stroke
  2. Traumatic brain injuries
  3. Thyroid disorders
  4. Cushing’s disease
  5. Huntington’s disease
  6. Parkinson’s disease
  7. Multiple sclerosis
  8. Brain tumor
  9. Alzheimer’s
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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)

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

What is the criteria for diagnosing dysthymic disorder

A
  1. Feeling sad or “down in the dumps”
  2. No evidence of psychotic symptoms
  3. Essential feature is a chronically depressed mood for most of the day, more days than not, for at least 2 years
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are the behavioral symptoms of transient depression (life’s everyday disappointments)

A

Some crying

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

What are the behavioral symptoms of mild depression 5 (normal grief response)

A
  1. Tearfulness
  2. Regression
  3. Restlessness
  4. Agitation
  5. Withdrawal
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What are the behavioral symptoms of moderate depression 8 (dysthymia)

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

What are the behavioral symptoms of severe depression 7 (MDD)

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

What is the diagnostic criteria for MDD 5

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

What are nursing interventions for suicide 8

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

What is the most important intervention when someone is at risk for suicide

A

Spend time with them. Make them feel wanted.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What are the presumed causes of depression 5

A
  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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What are the two conditions associated with neuroendocrine disturbances

A
  1. Hypothalamic pituitary adrenocortical axis

2. Hypothalamic pituitary thyroid axis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What happens in hypothalamic pituitary adrenocortical axis

A

Hypersecretion of cortisol (stress hormone)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What happens in hypothalamic pituitary thyroid axis

A

Where not enough of your thyroid hormone is being released

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What are physiological influences for MDD 5

A
  1. Medication side effects
  2. Neurological disorders
  3. Electrolyte disturbances
  4. Hormonal disorders
  5. Nutritional deficiencies
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What neurological disorders may lead to MDD 6

A
  • CVA
  • Brain tumors
  • Alzheimers
  • Parkinsons
  • Huntingtons
  • Multiple sclerosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What electrolyte disturbances may lead to MDD

A
  • Excessive levels of sodium or calcium or potassium

- Deficient levels of magnesium, sodium or potassium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What are the psychosocial theories that may lead to MDD 5

A
  • 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)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

How long until therapeutic effects are achieved from antidepressants

A

At least 4 weeks.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Define phobia

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What are two of the more common phobias

A
  • Agoraphobia

- Social anxiety disorder (social phobia)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What is agoraphobia

A

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.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

What happens in social anxiety disorder

A

Fear of being around people where you might become embarrassed “such as fear of public speaking”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

What is the difference between obsessions and compulsions

A

Obsessions are the thoughts, where the compulsions are you acting out those thoughts (in order to get rid of the obsessive thoughts)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Why does a person complete an OCD task

A

Because it relieves anxiety

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

What is the difference between GAD and panic disorder

A

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.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

What are some interventions for a person with anxiety or who have a panic disorder

A
  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)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

What medications are commonly used to treat panic disorders

A
  • SSRIs (paroxetine, fluoxetine and sertraline)
  • SNRI (venlafaxine, duloxetine, bupropin)
  • Benzodiazepines
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

What is depersonalization

A

When you feel cut off from yourself, you don’t feel like yourself, out of body experience.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

What is derealization

A

When you feel cut off from your surroundings, surroundings can be blearily or unusually clear, time feels weird.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

What is somatic symptom disorder

A

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)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

What are common personality characteristics for someone who has somatic symptom disorder

A
  • Heightened emotionality
  • Strong dependency needs
  • Preoccupation with symptoms and oneself
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

What are the primary and secondary gains for a person with somatic symptom disorder

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

What are some of the causes of dissociative disorders 8

A
  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)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

What is the most common explanation of dissociative disorders (what function does it serve)

A

Begins as a survival strategy to help children cope from a traumatic experience or abuse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

How should you handle someone with a disturbed personal identity diagnosis 3

A
  • 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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

How can you help someone who has an impaired memory diagnosis 3

A
  • 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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

What is dissociative identity disorder formerly known as

A

Multiple personality disorder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

What is dissociative fugue

A

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.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

What is the difference between anxiety and fear

A

Anxiety is an emotional response and fear is a cognitive response

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

If there is inflammation, will there always be an infection?

A

No, there may not be an infection. Inflammation can also be caused by trauma, chemicals, allergies or an autoimmune reaction.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

Describe the 3 types of inflammation

A
  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.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

What are the four inflammatory responses

A
  1. Vascular
  2. Cellular
  3. Formation of exudate
  4. Healing
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

Give a brief overview on what happens during the vascular response 7

A
  • 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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

Besides having our blood spurt out, why is important for our blood to clot

A
  • Traps bacteria and prevents the spread of the wound
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

What do prostaglandins do 3

A
  • Vasodilation
  • Cause you to feel pain
  • Influence the production of a fever
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

What WBC arrives first on the scene

A

Neutrophils (6-12 hours)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

What do neutrophils do

A

Phagocytize bacteria, foreign materials and damaged cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

Describe “shift to the left”

A

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.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

What are mature neutrophils called

A

Segs for segmented

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

When would we typically see a patient “shift to the left”

A

When they are fighting an acute bacterial infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

After neutrophils have arrived, what are the next two WBC to arrive

A
  • Monocytes that turn into macrophages (clean up)

- Lymphocytes are the last to the party

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

What is exudate

A

Fluid and WBCs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

What does serous fluid look like

A

Clear, thin, watery. Normal for mild injury.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

What does sanguineous fluid look like

A

Fresh bleeding. Can be seen in deep to full thickness wounds.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

What does serosanguineous fluid look like

A

A mixture between serous fluid and sanguineous fluid. It’s pale, pink, watery. Usually after surgery. “Serous fluid with a little bit of blood”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

What does fibrinous fluid look like

A

Thick and sticky. Usually following surgery.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

What does hemorrhagic exudate look like

A

From a ruptured blood vessels. Just tons of blood.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

What does purulent exudate look like

A

Thick, yellow, green, opaque. Infected.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

What is catarrhal exudate

A

Thick mucus. Usually from an infection in your nose.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

What does seropurulent exudate look like

A

Thin, watery, cloudy, yellow to tan. (might start be getting an infection)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

What symptoms would you see for local inflammation

A
  • Redness
  • Heat
  • Pain
  • Swelling
  • Loss of function
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

What symptoms would you see for systemic inflammation 6

A
  • Increased WBC count with shift to the left
  • Malaise (feeling of discomfort/illness)
  • Nausea
  • Anorexia
  • Increased HR and RR
  • Fever
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

What triggers a fever

A

Cytokines (why then wake up prostaglands, which then raises the set point temp of our body)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

What in our body regulates our temperature

A

Hypothalamus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

What sets our temperature point

A

Prostaglandins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

When starting a fever, what does the hypothalamus do

A

Activates the autonomic nervous system to increase muscle tone and shivering, and decrease perspiration and blood flow to the periphery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

For a fever, what is released from the adrenal medulla to increase our metabolic rate

A

Epinephrine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

What is the purpose of shivering

A

It is how the body raises our temperature

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

Why do we feel chilled when we have a fever

A

Because our set point is higher, the body thinks it is cold because it is trying to achieve this higher temp

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

When will our chills and shivering stop

A

When we reach our new set point

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

What is the purpose of a fever 3

A
  • 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.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

What temperature starts to become dangerous

A

104 - start to damage body cells, delirium, seizures.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
93
Q

What temperature can lead to brain damage

A

105.8

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
94
Q

What happens to older adults and inflammation

A

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)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
95
Q

For every 1 degree over 100, how much does your metabolism increase by

A

7%

96
Q

Do we want to always treat a fever with an antipyretic

A

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
Q

What happens if a immunosuppressed patient has a fever

A

They should immediately be treated with antibiotics, because they could rapidly progress to septicemia.

98
Q

Do cooling blankets/sponge baths reduce fevers

A

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
Q

How do corticosteroids impact fever

A

They prevent both cytokine and PG synthesis.

100
Q

How do chemo drugs impact fever

A

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
Q

What drugs can be given for healing and inflammation

A
  • Antipyretic drugs (acetaminophen, NSAIDs, Aspirin)
  • Anti-inflammatory drugs (corticosteroids, NSAIDs, aspirin)
  • Vitamins A, B, C or D (help accelerate the healing process)
102
Q

What acronym should we remember when treating soft tissue injuries and inflammation

A

RICE

103
Q

What happens in RICE

A

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
Q

When would you not want to use elevation

A

For a patient with significantly reduced arterial circulation

105
Q

When will primary intention occur

A

When wound margins are neatly approximated - like a surgical cut or paper cut

106
Q

What happens at the three phases of primary healing

A
  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
Q

What is the difference between primary and secondary intention

A

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
Q

How do secondary intention wounds heal

A

The same way as primary. They’ll just have a much larger scar

109
Q

What is tertiary intention

A

Contaminated wound

110
Q

What is the difference with tertiary healing

A

We will leave the wound open so that the infection can clear out

111
Q

Why does diabetes put you at risk for poor wound healing

A
  • 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
Q

Why does poor oxygenation put you at risk for poor wound healing

A

Lack of oxygen causes vasoconstriction, when you really should be having vasodilation. This constriction does not let WBC in, and delays healing.

113
Q

Why do sex hormones put you at risk for poor wound healing

A

Sex hormones help to promote healing. As we age, these hormones decrease, so we lose this help.

114
Q

Why does stress put you at risk for poor wound healing

A

Stress increases our cortisol, and cortisol inhibits your inflammatory response, so you are not able to heal very well.

115
Q

Why does obesity put you at risk for poor wound healing

A

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
Q

Why does alcohol put you at risk for poor wound healing

A

It diminishes the body’s resistance to bacteria.

117
Q

What nutrients are important for wound healing

A

Protein, vitamins C, A, zinc and copper

118
Q

Why does smoking put you at risk for poor wound healing

A

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
Q

What are adhesion complications

A
  • Scar tissue that forms around organs

- Adhesions may cause intestinal obstruction

120
Q

Are contractions a normal part of healing

A

Yes

121
Q

How can you prevent contractions

A
  • ROM exercises

- Splint to keep the joint from contracting

122
Q

What is dehiscence

A

When your wound bursts

123
Q

What can cause dehiscence

A
  1. Inflammatory response from infection
  2. Granulation tissue can’t stay together
  3. Obesity
  4. Pocket of fluid that develops (edema)
124
Q

What are risk factors for dehiscence

A

Things that don’t allow good blood flow like obesity, COPD, CHF.

125
Q

What is evisceration

A

When wound separates and intestines protrude

126
Q

What do we do if there is evisceration

A

Do not put anything back in - use sterile gauze and sterile saline to cover wound and call the doctor right away

127
Q

How can you prevent evisceration

A

Limit things that strain your abdominal muscles

128
Q

What if there is excess granulation tissue

A

It can be cauterized or cut off, and normal healing will continue

129
Q

What are hypertrophic scars

A

Big, protruding scars. They are still within the borders of the wound.

130
Q

What are keloids

A

Big, protruding scar that extends past wound margins (looks like a giant tumor).

131
Q

Can you remove a keloid

A

No, they are permanent

132
Q

Can keloids be painful

A

Yes they can be painful and tender

133
Q

Who is usually at risk for keloid scars

A

People of color and/or hereditary

134
Q

Can necrotic tissue (dead cells) increase your risk for infection

A

Yes - because this usually means your blood supply has been decreased, which also increases your risk for infection

135
Q

What is a hemorrhage

A

When you’re bleeding all over the place

136
Q

Why might a patient hemorrhage 4

A
  • Suture failing
  • Clotting abnormalities
  • Dislodged clot
  • Infection
137
Q

What should you do if someone is hemorrhaging

A

Apply pressure - apply a tourniquet as a last resort, because this can cause the patient to lose the limb

138
Q

What is a fistula

A

An abnormal passage between organs or a hollow organ and skin

139
Q

What increases your risk for an infection during wound healing 6

A
  • Increase in necrotic tissue
  • Decrease in blood supply
  • Decrease in body’s immune response
  • Undernutrition
  • Multiple stressors
  • Hyperglycemia in diabetes
140
Q

What 3 ways can we classify wounds

A
  1. Cause of the wound (surgical, accidental, injury)
  2. Depth (superficial, partial thickness, full thickness)
  3. Type (acute or chronic)
141
Q

What are we assessing on a wound 7

A
  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
Q

What are we assessing for when we look at the wound margin

A

Is it normal, macerated (soft, pruny), erythema (redness), etc.

143
Q

What are we assessing for when we are looking at the wound base

A

Is there any eschar (dark scab), slough, exudate.

144
Q

When thinking about a clock when measuring a wound, where does the 12 o’clock go

A

12 o’clock goes towards the patient’s head (6 o’clock points to their feet)

145
Q

What fluid is best to clean a wound

A

Sterile saline

146
Q

What other fluids can be used to clean a wound, but should be used with caution

A
  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
Q

What acronym can we used to help with wound healing

A

TIME

148
Q

What does TIME stand for

A

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
Q

If the wound is superficial, how can we close it 4

A
  • Use adhesive strips (steri-stirps, butterflies)
  • Sutures (stitches)
  • Staples
  • Tissue adhesives
150
Q

Do we prefer to use sutures

A

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
Q

Is “airing out” a wound good?

A

No, this can lead to a dry wound

152
Q

What is the first step in treating a contaminated wound

A

Clean the wound first, otherwise healing will not occur

153
Q

What is autolytic debridement

A

Body’s own enzymes break down the infection

154
Q

What is biological debridment

A

Using larvae to eat up the dead tissue

155
Q

What is surgical/sharp debridement

A

Just as it sounds - clean the wound with a scalpel or something else

156
Q

What is mechanical debridement

A
  1. Wet-to-dry dressing

2. Wound irrigation

157
Q

How does a wet to dry dressing work

A

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
Q

What is important about wound irrigation

A

Do not use a high pressure, because you could be spraying bacteria further into the wound.

159
Q

What do stage 1 pressure injuries look like

A

Intact skin with non-blanchable erythema

160
Q

What does a stage 2 pressure injury look like

A
  • partial thickness skin loss with exposed dermis
  • Looks like an intact or ruptured blister
  • Cannot see adipose or deeper tissues
161
Q

What does a stage 3 pressure ulcer look like

A
  • Full thickness skin loss
  • Can see adipose tissue
  • Might see eschar and/or slough
162
Q

What does a stage 4 pressure injury look like

A
  • Full thickness skin loss with exposed muscle, tendon, bone, etc.
  • Slough and/or eschar may be visible
163
Q

What is the difference between a stage 1 pressure injury and a deep tissue pressure injury

A

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
Q

What dressing can be combined with many other dressings

A

Gauze

165
Q

When would you use gauze

A
  • Can be used on almost any kind of wound

- Used for cleansing, packing and covering

166
Q

Describe a non-adherent dressing

A
  • Not absorbent

- Can be soaked in saline, petrolatum or antimicrobials

167
Q

When would you use non-adherent dressing

A
  • Minor wounds, that do need a lot of drainage.

- These are nice, because they don’t stick to the wound

168
Q

Describe transparent film

A
  • Allows you to visualize the wound

- But they can trap in moisture, so really only use over a dry wound or IV site

169
Q

Describe foam dressing and uses 5

A
  • 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
Q

What do hydrocolloid dressings do, and what are they good for

A
  • 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
Q

What are hydrogels and what are they good for

A
  • 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
Q

What are alginate dressings and what are they used for

A
  • Made from seaweed or kelp
  • High absorbent (used on pressure injuries and infected wounds)
  • Used for packing
173
Q

What are antimicrobial dressings and what are they used for

A

Can be multiple kinds of dressings that contain natural antimicrobials to help with wounds that are really infected

174
Q

How do negative pressure wound vacs work

A

They provide continuous negative pressure to remove fluid, exudates and infectious material to prepare the wound for healing

175
Q

How do wound vacs promote healing

A

They pull excess fluid from the wound, reduce bacterial load and encourage blood flow to the wound base.

176
Q

What is important to monitor when someone is on a wound vac

A
  • Protein and fluid and electrolyte levels due to the high amount of drainage
  • Also clotting times (PT/PTT)
177
Q

What percentage of oxygen is a patient receiving in a hyperbaric chamber

A

100% oxygen

178
Q

How do hyperbaric chambers work

A

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
Q

Besides the oxygen in the serum, what else can hyperbaric chambers do 3

A
  • Stimulate angiogenesis (production of new blood vessels)
  • Kill anaerobic bacteria
  • Increase the killing power of WBCs and certain antibiotics
180
Q

How does undisturbed wound healing work

A

Do dressing changes every 7 days. By not changing and disturbing the wound everyday, you can help speed up recovery.

181
Q

Should you increase or decrease fluids during wound healing

A

Increase fluids due to the fluid loss and high metabolic rate

182
Q

Should you increase or decrease protein during wound healing

A

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
Q

What are carbs good for during wound healing

A

Used for energy so your body doesn’t break down protein for energy

184
Q

What are fats good for during wound healing

A

Creating fatty acids and triglycerides which make up cell membranes

185
Q

What is vitamin C good for during wound healing

A

Capillary synthesis and collagen production by fibroblasts

186
Q

What are the B complex vitamins good for during wound healing

A

Necessary coenzymes for many of the metabolic reactions

187
Q

What is vitamin A good for during wound healing

A
  • Epithelization

- Increases collagen synthesis and tensil strength

188
Q

Who might receive prophylactic antibiotics

A

Someone whose immunodeficient

189
Q

If an infection does develop in a wound, what should you do

A

Get a culture and sensitivity

190
Q

What is a CBC with differential indicating

A
  • Inflammation
  • Infection
  • Pre-surgical
  • Response to chemo
191
Q

What goes into a CBC with diff.

A

Looks at red blood cells, white blood cells and platelets

192
Q

What does the differential mean in CBC

A

You are also measuring all of the different WBCs

193
Q

Does a CMP only measure electrolytes? What else does it measure?

A

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.

194
Q

What can a UA help measure 6

A
  • If there is infection
  • Looking for blood
  • Bilirubin
  • Urobilinogen
  • Nitrates (helps us diagnose UTIs - nitrites)
  • Protein (kidneys aren’t working well)
195
Q

What can a dipstick in a UA measure

A

pH, protein, glucose, ketones, etc.

196
Q

What does PT measure

A

The amount of time it takes for your blood to clot

197
Q

What lab are we running to look at the effectiveness of heparin

A

aPTT (we are checking how long it takes the blood to clot on heparin)

198
Q

What is the difference between cardiac arrest and a heart attack.

A

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.

199
Q

What is disseminated intravascular coagulation (DIC)

A

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)

200
Q

What is the purpose of running a troponin lab

A

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)

201
Q

What does brain natriuretic peptide (BNP) measure (these are released into the blood when the heart is under stress)

A

Heart failure

202
Q

What does creatine kinase (CK) measure

A

Monitors myocardial infarction

203
Q

What does C-Reactive protein (CRP) measure

A

Will tell us if there is inflammation

204
Q

What does prealbumin and albumin measure

A
  • Malnutrition

- Kidney disease

205
Q

Why would we want to measure cerebrospinal fluid

A

It can tell us if someone has sepsis

206
Q

What tests could we run for stroke

A
  • CBC with diff
  • PT and PTT
  • INR
  • C-reactive protein
207
Q

If someone is on coumadin (warfarin), what test are we going to run

A

PT/INR to look at their clotting times

208
Q

What is important to remember about gentamicin and vancomycin

A

To get peaks and troughs

209
Q

What are the critical ranges of PT and INR

A

PT > 20 seconds

INR > 5 seconds

210
Q

What is the antidote for blood thinners

A

Vitamin K - makes your blood clot

211
Q

Why would we draw a blood culture first, before getting our other lab draws

A

Because we do not want to contaminate the blood culture samples. We want them to be straight from the source without contamination.

212
Q

What two tests can we run if we suspect DIC

A
  • PT and aPTT
213
Q

Besides the other assessments, what are we also assessing for before we draw blood

A

If the patient has any phobias associated with blood draws

214
Q

If you’re trying to measure your blood gases like Po2, should you get arterial blood or venous blood

A

Arterial blood

215
Q

For all other blood draws other than ABGs, are we getting blood from the arteries or the veins

A

Veins

216
Q

What is the max amount of time you can leave the tourniquet on

A

1 min

217
Q

Should you ever draw blood from a previous site

A

No, this can increase the risk of infection

218
Q

When assessing what side to draw a sample from, what should we consider

A
  • 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)
219
Q

How do we want people to lay when obtaining CSF

A

Knees to chest, so that the spine will be elongated, so we have a maximum entry point

220
Q

What is the most common side effect after pulling a CSF

A

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.

221
Q

How long does a patient have to stay horizontal after drawing CSF

A

At least 8 hours

222
Q

What should you keep urine samples on

A

Ice or refrigerated

223
Q

How can you prevent a hematoma after a blood draw

A

Apply pressure for a few hours and use warmth (goggle says apply cold)

224
Q

What should you do to avoid fainiting when giving blood

A
  • Eat a meal
  • Drink water
  • Lie down when giving
  • Distract yourself
225
Q

Should you draw blood above an IV site

A

No - always below

226
Q

How do they collect blood from babies

A

Skin puncture

227
Q

Can you draw samples from an indwelling venous catheter

A

Yes

228
Q

What are potential complications after draining fluid 6

A
  • 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
Q

Why would we get a first morning urine sample

A

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
Q

When a person is on a 24 hour watch, when do you start the time

A

You start the time right when the first void occurs (remember to discard this void though)

231
Q

What is a double voided specimen

A

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
Q

When we’re trying to get a culture and sensitivity through a urine sample, should we use an aseptic technique

A

Yes

233
Q

If you’re getting a stool sample, can you get urine in your sample

A

No

234
Q

What can lead to lithium toxicity

A
  • 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
Q

What are the 3 dissociative disorders

A
  1. Dissociative amnesia (memory loss)
  2. Dissociative identity disorder (multiple personality disorder)
  3. Depersonalization-derealization disorder (can experience one, the other, or both)
236
Q

What is the main difference between mania and hypomania

A

A person who is manic cannot perform ADLs. A person with hypomania can function in every life.

102 (5 decks)

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