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BSNC 7110 > Quiz 1 - Modules 1, 2, 3 > Flashcards

Quiz 1 - Modules 1, 2, 3 Flashcards

1
Q

Canadian Triage Acuity Scale (CTAS)

A

help assess and determine severity of presenting problems
organize patient care so that most acute cases are prioritized
help determine appropriate treatment

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2
Q

CTAS scores

A

red evos use less noobs

1 - resuscitation
2 - emergent
3 - urgent
4 - less urgent
5 - non urgent

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3
Q

Level of urgency definition

A

classification + prioritization of pt health concern, problem, condition

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4
Q

Levels of urgency

A

stable
unstable
potentially unstable

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4
Q

Stable LOU

A

normal clinical findings
hx not life or limb threatening

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5
Q

Unstable LOU

A

abnormal clincial findings
history considered life or limb threatening

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6
Q

Potentially unstable LOU

A

normal clinical findings
history warrants concern/ongoing observation
potential for deterioration

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7
Q

Emergency assessment framework

A

Primary assessment
Secondary assessment

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8
Q

Primary assessment components “CABCDEFG”

A

CAB vs. ABC (need for compressions/control bleeding)
airway/c-spine control
breathing
circulation
disability, doctor, dextrose, discomfor,
expose
full vital signs + family presence
go back and reassess

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9
Q

Secondary assessment components

A

subjective hx (LOTTAARP - hx of presenting illness)
objective assessment (H2T)
focused system assessment
journey (admission, diagnostics, discharge)

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10
Q

Subjective data

A

data obtained from individual or witnesses
ex: pt reports feeling SOB

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11
Q

Objective data

A

data observable to others
ex: pt has demonstrated WOB

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12
Q

Airway interventions

A

oropharynx suction
jaw thrust/chin lift
oral/nasopharyngeal airway
consider/prepared for advanced airway
spinal motion restriction

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13
Q

Breathing interventions

A

assisted ventilations (BVM/ventilator)
supplemental o2
pulse oximetry

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14
Q

Circulation interventions

A

inititiate IV/IO access
fluid resuscitation
cardiac monitor
12 lead ECG

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15
Q

Disability interventions

A

pain management
anti-emetics
notify emergency physician/specialist
prep for CT

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16
Q

Disability assessments

A

AVPU
GCS
PERRLA
Cincinnati stroke scale (FAST)
Dextrose –> CBG
barriers to assessment: pain, vomiting
need for emergency physician (LOU)

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17
Q

Expose interventions

A

gown + blanket
active warming procedures

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18
Q

F interventions

A

full set of vitals
family presence

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19
Q

History/head-to-toe assessment

A

allergies
medication
past medical hx
last meal
personal hx
risk behaviors (smoking/ETOH/drugs)
safety at home

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20
Q

Journey assessment

A

lab work
imaging
OR/IR
tubes/lines
unit admission
intrahospital transfer
discharge

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21
Q

LOTTAARP

A

used for history of present illness

location
onset
type/time
aggravating/alleviating/associated symptoms
radiating
precipitating events

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22
Q

Pediatric secondary assessment

A

chief complaint
immunizations
isolation
allergies
medications
past medical hx
caregiver impression
events surrounding illness/injury
diet
diapers (hydration status)
symptoms associated w/ illness or injury

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23
Q

AVPU

A

assess level of consciousness
alert
verbal
pain
unresponsive

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24
Q

GCS components

A

eye opening
verbal response
motor response

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25
Q

PERRLA

A

pupils
equal
round
reactive to light
accommodation

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26
Q

FAST components

A

facial droop
arm drift
slurred speech (or jumbled)
time (immediate intervention)

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27
Q

Adult subjective history

A

biographical info
chief concern/presenting problem
history of illness (LOTTAARP)
review of systems (what other S/S are present, what other systems may be involved)
allergies/sensitivities
medications
past health history
last meal –> in case emergent procedures needed
personal history –> risk behaviors/safety at hoem
family health history

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28
Q

Neuro assessment

A

GCS
PERRLA
ROMS
limb strength/equality
arm drift

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29
Q

Respiratory assessment

A

look (mental status, WOB, cyanosis, cough/sputum, tracheal deviation, injury, chest symmetry)
palpate (tracheal position, areas of tenderness, crepitus, movement of air)
auscultate (presence, depth, bilateral A/E, adventitious sounds)

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30
Q

Cardiovascular assessment

A

inspect (CWMS, LOC, position, edema)
palpate (pulses, skin, edema)
auscultate (HR, pulse deficit)
heart sounds (quality, s1/s2, abnormal: s3, s4, murmurs, gallops)
pulse deficit
ankle-brachial index (ABI) –> assess for impaired peripheral perfusion

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31
Q

Abdominal assessment

A

inspect: position, skin, trauma, pulsating masses, symmetry, abdominal control/hernia
auscultate: bowel sounds, bruits over aortic area, fetal HR
palpate: tenderness, guarding/rigidity, masses/pulsations

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32
Q

MSK assessment

A

inspect: position of extremities (flexion, textension, shortening, rotation), deformities, color
palpate: pain/tenderness, crepitus, CWMS, movement (ROM)

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33
Q

ABG components

A

pH (7.35-7.45)
HCO3 (22-26)
PaO2 (80-100)
PaCO2 (35-45
SpO2 (>95)

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34
Q

Partial compensation

A

adjustment in compensatory system but pH still not WIL

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35
Q

Complete compensation

A

adjustment in compensatory system and pH WIL

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36
Q

Types of buffer systems

A

chemical (phosphate, red blood cells, protein, ammonia)
respiratory (ventilation)
renal buffering (excretion of acids/retention of bicarbonate)

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37
Q

Pulmonary shunt

A

alveoli perfused but not ventilated

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38
Q

Anatomic dead space

A

air that gets stuck in upper respiratory tract + does not participate in gas exchange

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39
Q

Physiologic dead space

A

alveoli not perfused, but ventilated

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40
Q

Oxyhemoglobin dissociation curve

A

graph that depicts the relationship between spo2 and paO2

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41
Q

Left shift

A

increased oxygen affinity
o2 unloading decreases

caused by:
alkalosis
decreased temp
lower 2,3 DPG concentration

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42
Q

Right shift

A

decreased oxygen affinity
o2 unloading increases

hemoglobin releases oxygen more readily into peripheral tissue, but less able to pick up oxygen

caused by:
acidosis
increased temp
increased 2,3 DPG concentration

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43
Q

Factors affecting hemoglobin binding to oxygen

A

partial pressure of oxygen (high in lungs, lower in tissue beds)

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44
Q

Mild hypoxemia

A

Pao2 60-79
SpO2 >/= to 90%

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45
Q

Moderate hypoxemia

A

PaO2 40-59
SpO2 >/= 75%

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46
Q

Severe hypoxemia

A

PaO2 <40
SpO2 <75%

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47
Q

End organ perufsion

A

body’s ability to supply enough oxygen to meet metabolic demand of vital organs (oxygen and nutrients transported via blood)

brain, heart, lungs, GI tract, liver, kidney

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48
Q

Determinants of oxygen supply

A

arterial oxygen (ventilation [neuromuscular function, compliance], gas exchange [diffusion distance, surface area, hemoglobin saturation])
cardiac output (stroke volume, heart rate)

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49
Q

Ventilation equation

A

tidal volume x RR

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50
Q

Determinants of oxygen demand

A

activity
temperature
emotional stressors

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51
Q

Concentration of oxygen in room air

A

21%

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52
Q

Nasal cannula paramters

A

flow: 1-6 L
FiO2: 24-44%

53
Q

Simple face mask parameters

A

flow:6= 6-10
FiO2 50-60%

54
Q

Non-rebreather mask

A

flow: 12-15 L
FiO2: 60-100

55
Q

Ventilation

A

physical exchange of air between body + environment
determined by: tidal volume x RR

56
Q

Diffusion

A

exchange of gases across the respiratory membrane (alveolar wall + capillary)
influenced by partial pressure of gases (affects concentration gradient)

57
Q

Perfusion

A

gas exchange determined by alveolar perfusion + alveolar ventilation

58
Q

Causes of V/Q mismatch

A

physiologic shunt
dead space
pulmonary embolus

59
Q

RUQ organs

A

liver
R. kidney
colon
pancreas
gallbladder

60
Q

LUQ organs

A

liver
spleen
L. kidney
stomach
colon
pancreas

61
Q

RLQ organs

A

colon
small intestine
major artery/vein to right left
ureter
appendix

62
Q

LLQ organs

A

small intestine
large intestine
left ureter
sigmoid colon
fallopian tube, ovary, spermatic cord

63
Q

CAB vs. ABC ax

A

need for CPR –> start compressions before rescue breaths
uncontrolled bleeding

64
Q

Airway/C-spine ax

A

look, listen, feel for air movement (stridor, gurgling, anxiety, pt position, chest symmetry)
clarity of speech –> gasping, full setnences
patency vs. obstruction (stridor, gasping, wheezing, snoring, drooling, gurgling)
AVPU –> LOC to determine ability to maintain airway
C-spine injury trauma

65
Q

Breathing ax

A

rate + quality of respirations
WOB
lung auscultation
skin color

66
Q

Circulation ax

A

skin –> color, warmth, moisture
cap refill
palpate pulses –> quality, rate, rhythm
chest pain

67
Q

Disability ax

A

reassess AVPU –> GCS
PERRLA
Cincinatti stroke scale
Dextrose
Barriers to ax: pain, vomiting
Need for emergency physician - LOU

68
Q

Expose ax

A

Skin assessment
bruising
wounds
bleeding
mottling

69
Q

Full set of VS/Family ax

A

Vital signs
Notify family

70
Q

Causes of gross abdominal distension

A

fluid
flatus
feces
fetus
fat

71
Q

Causes of localized abdominal distension

A

loculated fluid
mass
hernia
organomegaly
impacted feces

72
Q

6 P’s of dyspnea

A

pulmonary/bronchial constriction
possible foreign body (aspiration)
PE
Pneumonia
Pneumothorax
Pump failure (cardiogenic pulmonary edema)

73
Q

Types of abdominal pain

A

tension
inflammatory
ischemic

74
Q

Tension abdominal pain

A

d/t increased peristalsis
bowel trying to eject irritating substance
stretching of organ capsule (obstruction, inflammation)
frequently change positions to get comfortable

75
Q

Inflammatory abdominal pain

A

inflammation of visceral peritoneum (type C fibers)
eventually involves parietal peritoneum –> sharp, localized pain
pain exacerbated by movement

76
Q

Ischemic abdominal pain

A

less common but most serious
sudden onset, intense, continuous, progressive
pain not relieved with analgesia

77
Q

Characteristics of ischemic pain

A

sudden onset
intense
continuous
progressive –> gets worse with time

78
Q

Causes of tension abdominal pain

A

early-stage obstruction
lactose intolerance
gastroenteritis
GERD
celiac
constipation
peptic ulcer
pyelonephritis
IBS

79
Q

Causes of inflammatory abdominal pain

A

appendicitis
meckel’s diverticulum
cholecystitis
cholelithiasis
urolithiasis
pancreatitis
ruptured ectopic pregnancy
pelvic inflammatory dx
perforated ulcer
familial mediterranean fever
mittelschmerz

80
Q

Causes of ischemic abdominal pain

A

strangulated bowel
late-stage obstruction
intestinal ischemic syndrome
embolism, thrombosis
mesenteric ischemia
torsional occlusion (volvulus)
sickle cell crsisi
ruptured AAA

81
Q

Perfusion of intestinal mucosa

A

receives 20-25% of CO
GI system very sensitive to changes in perfusion –> ischemic pain
necrosis can occur 6 hours after symptom onset

82
Q

WOB indicators

A

nasal flaring
accessory muscle use
grunting
head bobbing

83
Q

Effectiveness of breathing indicators

A

lung auscultation –> air entry to bases
symmetry/extent of chest expansion (deep vs. shallow respirations)
abnormal lung sounds

84
Q

Inadequate perfusion indicators

A

tachycardia
decreased LOC
skin color/warmth (pallor, cool)
SpO2

85
Q

Peds CIAMPEDS

A

chief complaint
immunizations
isolation
allergies
medications
past history/parental perception
events around illness
diet/diapers
associated symptoms

86
Q

Types of pain fibers

A

type a delta (fast, localized, sharp)
type c (slow, diffuse, dull)

87
Q

Types of pain

A

parietal = type a
visceral = type c

88
Q

Types of visceral pain

A

inflammatory
ischemic
tension (increased peristalsis)

89
Q

Tension pain

A

increased force of peristalsis
1) forcefully eliminating an irritating substance
2) moving around an obstruction
3) stretching of organ capsule

90
Q

S/S tension pain

A

moving around to get comfortable
vague, deep, poorly localized

91
Q

Inflammatory pain

A

usually, deep, poorly localized, diffuse
begins in visceral then spreads to parietal where it becomes sharp + localized
1) appendicitis

92
Q

Ischemic pain

A

less common, but most serious
sudden onset, intense, progressive pain, unresponsive to analgesia
1) strangulated bowel
2) mesenteric artery infarct

93
Q

Treatment for ischemic pain

A

usually surgical

94
Q

Injury patterns

A

blunt
penetrating

95
Q

Blunt injury

A

skin surface intact
hematoma, bruising

96
Q

Penetrating injury

A

skin surface disrupted
damage to internal tissues
higher r/o infection

97
Q

Acceleration/deceleration forces

A

shearing = parallel force causes organs to pull away/fold around ligaments causing hemorrhage
compression = contact with another object

98
Q

Cavitation

A

pressure variations caused by internal disruption
with penetrating injury, the force of the object radiates outward (energy transfer) causing displacement of internal structures
can be difficult to detect externally.
ex: gunshot wounds

99
Q

Permanent cavitation

A

hole caused by penetrating injury

100
Q

Temporary cavitation

A

damage to surrounding tissue

101
Q

Types of nociceptive pain

A

superficial
somatic
visceral

102
Q

Substances associated with pain

A

bradykinin
prostaglandin
histamine
cytokinin
serotonin
protons
cytokines
neuropeptides (substance P = sensitizes nerve endings)

103
Q

COX-1 enzymes

A

involved in homeostasis
found in most tissues + regulate organ function
ex: prostaglandins in kidneys promote afferent arteriole vasodilation + production of stomach mucus + platelet aggregation

104
Q

COX-2 enzymes

A

usually inactive except for inflammatory states
activated by trauma/injury
increase nerve sensitivity + function of other mediators

105
Q

Which drug inhibits phospholipase A2

A

steroids

106
Q

Which drug inhibits production of COX-2 enzymes

A

NSAID
aspirin
COX-2 selective inhibitors

107
Q

Which drug inhibits central prostaglandins

A

Tylenol

108
Q

NSAIDs + digoxin

A

can increase digoxin levels
r/o toxicity

109
Q

NSAIDs + methotrexate

A

can increase methotrexate levels

110
Q

NSAIDs + lithium

A

increase plasma concentration of lithium
r/o toxicity

111
Q

NSAIDs + bleeding

A

increased r/o bleeding when combined with
steroids
anticoagulants

112
Q

NSAIDs + renal impairment

A

increase risk when combined w/
diuretics
ACE-I/ARB
hypovolemic state

113
Q

Adverse fx of NSAIDs

A

GI: r/o ulcers + bleeding (inhibits production of mucus + inhibits platelets)
RENAL: r/o AKI d/t afferent arteriole vasoconstriction
RESP: can upregulate LOX causing bronchospasm
BLEEDING: platelet inhibition increases r/o bleedingL

114
Q

Local anesthesia MOA

A

block transmission of nerve impulses + ion channels preventing propagation
alters pain sensation without affecting LOC
affects sensory + autonomic nerves

115
Q

Local anesthesia + nerve fibers affected

A

sensory = decreased pain
sympathetic = vasodilation + hypotension
motor = muscular weakness

116
Q

Types of opioids

A

agonist
partial agonist

117
Q

Adverse fx of opioids

A

RESP: decreased LOC = airway risk, respiratory depression, shallow breathing = decreased tidal volume
GI: nausea/vomiting, ileus, constipation
GU: urinary retention
SKIN: pruritis (release of histamine)
CV: hypotension (block sympathetic outflow + histamine rls)
ADDICTION: not for longterm pain mgmt

118
Q

Early S/S of resp distress

A

tachycardia
tachypnea
cyanosis
agitation
altered mental status

119
Q

Causes of anaerobic metabolism

A

decreased perfusion (less delivery of O2 to tissues)
decreased arterial oxygen content (resp issue)

120
Q

PaCO2

A

r/t to metabolic activity
more metabolism = more PaCO2
regulated by ventilation
high ventilation = low PaCO2
low ventilation = high PaCO2

121
Q

Maximum pH before cellular function fails

A

<6.8
>7.8

122
Q

Anion gap

A

helps classify metabolic acidosis
determined by phosphate/albumin

123
Q

High anion gap

A

low bicarbonate (used up for buffering)
metabolic acidosis

124
Q

Low anion gap

A

may be d/t low albumin levels (primary anion)
low albumin = increased retention of other anions like chloride of bicarbonate
this then increases the level of anions compared to cations resulting in low anion gap

125
Q

Unmeasured anions in anion gap

A

albumin
phosphorous
proteins

126
Q

Normal anion gap

A

4-12T

127
Q

Types of pnuemonia

A

typical = bacterial (fever, productive cough, sob, consolidation, pleuritic chest pain)
atypical = viral (dry cough, SOB, rales, myalgia, fatigue)

128
Q

Pneumonitis

A

non-infectious cause of pulmonary inflammation
usually resolves on its own

129
Q

Central chemoreceptors

A

located in the medulla
detect changes in pH of CSF
when pH drops (high CO2) triggers respiratory center to increase breathing
in chronic conditions like COPD, this mechanism can fail and then the body relies on changes in PaO2 to maintain breathing

130
Q

Peripheral chemoreceptors

A

located in aortic/carotid bodies
detect changes in PaO2
strongly stimulated when PaO2 <60 transmits signal to increase breathing

BSNC 7110 (4 decks)

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