Random 4: hurst Flashcards
Anhedonia
loss of pleasure
as depression lifts, what happens to suicide risk?
it increases. they might now have energy to take action
ask suicidal ppl 3 Q’s
do you have a plan?
what is the plan?
how lethal is the plan?
do they have access to plan?
watch for…
> isolation, writing will, giving things away…
ECT treatments
> induce tonic clonic seizures for severe depression
> atopine is given so dont aspirate
> need signed consent
Echolilia
hear word and repeat it
Neolgisn
make up own words that have special meaning
what adult would hae lanego?
Anorexia nervosa
bulemia nervosa
> allow 30 min to eat
sit with PT at meals and observe for 1 hr after
build self-esteem
why do you give benzos for alcohol withdrawal?
they act as a sedative and anticonvulsion
Ex. Chlordiazepoide (Librium), Ativan, Diazepam (valium), lorazepam (ativan)
CIWA
tx begins with score 8-10
score 20 = ICU
Disilfiram
Antabuse
> must sign a consent bfr this can be given
stay away from alcohol when taking
Glomerulonephritis
> imflam from strep infection > tired = toxins > increased BUN craitinine > flank pain > blood in urine and protein
> tx: get rid of strep
how to determine fluid replacement>
fluid replace = 24 hrs fluid loss + 500mls
increased BUN =
decreased protein for all kidney probs
except in nephrotic syndrome»_space;>
Nephrotic syndrome
> inflam = big holes = decreased albumin = edema
> circulating vol decreases so dehydrated but into tissues
> kidneys sense decresed vol and RAAS kicks in
Aldosterone is produced and more Na and water retained but no protein to hold it in vas space
anasarca
generalized edema
probs associated to protein loss
> thrombosis
increased cholesterol and triglycerides (liver compensate and makes more albumin plus these)
S and S of nephrotic syndrome
> proteinuria
edema
hyperlipidema
hypoalbuminemia
tx nephrotic
> diuretics > ACE inhibitors - to block aldosterone > albumin > prednisone --> to shrink holes. causes imunosuppressed
> decreased Na and increased protein
anticoagulation
dialysis
why does renal failure PT have anemia?
bc not enough erythropoietin produciton–> stimulate RBC production
S and S renal failure
> Itching skin (frost uremic)–> provide good skin care
increased K+ bc cant excrete = metabolic acidosis
2 phases of renal failure
- Oliguric phase- decreased op. PT had FVE. K+ increases
2. Diuetic phase- sudden onset. OP goes up. PT into FVD and K+ goes down
what do you watch closely during hemodialysis
electrolytes and BP
what drugs do you hold prior to dialysis?
anything cleared by kidneys
how do you assess for patency for vascular access device
> thrill- cat purr palpation
bruit- turbulent blood flow
Feel thrill hear bruit
PD ppl need to increase what in diet?
protein and fiber
kidney stones
(urolithiasis, renal calculi)
> increased WBC in urine
hematuria»_space;>
> give ondansetron and NSAIDS/opioids
> ESWL = extracorporeal shock wave lithotripsy
what does it mean if an adult has a + babinski?
toes curl up.
= problem in central nervous system (tumor?), brain, spinal cord, MS (damage to mylin sheath), ALS (lou G disease; Amylotropic lateral sclerosis. death of nerves controling voluntary muscles.
what test to be used for diagnostic for neural assess?
- CT -dye need consent
- MRI- no dye
- Cerebral Angiography with X-ray - use dye through femoral artery
> iodine based dye, PT needs to be well hydrated
> watch BUN, creatinine and hold metformin
> allery shell fish and iodine
After:
> bedrest 4-6 hrs
> hemorrhage
> Embolus? watch for changes in LOC, weakness, paralysis
- EEG- electroencephalography -
> record electrical activity in the brain
> diagnose seizure disorders
> evaluate LOC and denentia, coma, brain death, sleep disorders
>hold sedatives. need full brain activity, no caffeine, NOT NPO
lumbar puncture
> in the subaracnoid space
lie flat 2-3 hrs after
increase fluids to replace
HA most common complication. increased when PT sits up
normal ICP
0-15mm Hg
cushings triad from?
increased ICP
- systolic pressure with widening pulse >60
- slow full bounding pulse
- irreg resps, cheyne stokes
posturing from increased ICP
notice posturing can be increased ICP
Decorticate
arms flex inward and bent toward body, legs extended
Decerebrate
all 4 extremities in rigid tight extension. WORST
complications of ICP
- brain herniation
- SIADH
- DI
treat ICP
> O2 > maintain adequate perfusion: isotonic > dobutamine (inotropic)- improve contractility > norepi- prevent hypotension > keep temp < 38 > elevate HOB > avoid restraints, bladder distension, hip flexion, valsalva, no sneeze > limit suction > space nursing interventions >Glasgo --> if below 8 = intubate
> dexamethasone - deceases cerebral edema
Autonomic dysreflexia
hyperreflexia. T6 and up
This occurs as response from the sympathetic nervous system to stimulus that happens below lesion
> Severe HTN > HA > bradycardia > nasal stuffy > flushing, sweating > blurred vision > anxiety
From: noxious stimuli, constipation, distended bladder
Tx: sit them up to lower BP, treat cause
Pancreatitis
- Endocrine - insulin
2. Exocrine - Digestive enzymes
types of Pancreatitis
- Acute - gallbladder disease or alcohol
2. Chronic- alcohol
S and S pancreatitis
> pain increases with eating > ascities > rigid board-like abd (think bleed) > bruising at umbilicus (Cullens) and Flank (Turners) > fever, inflam, jaundis > hypotension (bleeding or ascites)
4 major functions of the liver
- detox
- blood clotting
- metabolize drugs
- synthesis of albumin
if your liver is sick
decrease meds to 1/2 bc they wont be metabolized
avoid narcotics
what happens to protein>
breaks down to ammonia–> liver converts amonia to urea–> kidneys excrete uria
If uria buids up in blood can = hepatic coma
hepatic coma
decreased LOC
> ataxis liver flap > diff to awake > hand writing changes > decreased reflexes > EEG changes > Fetor - breath smells like ammonia > GI bleed
treat liver ppl
> lactulose decrease ammonia
cleansing enema
saline lavage - blood out of stomach
where are the bleeding esophageal varicies?
- stomach
- rectum
- esophagus >
Tx: Octreotide –> lowers BP in the liver
colonoscopy
Ulcer colitis and crohns
CF diet 12-24 hrs prior
NPO- 6-8 hrs prior
No NSAIDS prior for a few days
> give laxatives and enemas to clear path
> drink: polyethylene glycol
> sedated
> watch for perforation post-op- shouldnt have pain after
colon probs eat
low fiber - limit GI motility to save fluid
when would you notify MRP for chest tube drainage?
> 100mls in 1 hr and if color changes to bright red
TX: for tension pneumothorax
large bore needle into 2nd intercoastal space to allow excess air to escape
open pneumothorax
gun or stab:
> get PT to inhale and valsalva to increase thoracic pressure and plave gauze on 3 sides
flail chest
occurs with multiple rib fx
PEEP:
use + end expiratory pressure–> PT on ventilator
> on end expiration the vent puts pressure into lungs to keep alveoli open
Classic use for PEEP
Acute Respiratory Distress Syndrome ARDS
BiPAP
+ pressure airway
used for ARDS for ppl with COPD, HF
CPAP
continuous pressure airway for inhail and exhail
D-dimmer
for clotting. is increased with pulm emboli
PTT
INR
30-40 sec
2-3 sec
what hormone makes you stop period?
progesterone
goodell’s sign
softening of the cervix 2nd month
Chadwicks sign
blueish color vaginal mucosa and cervix (week 4)
vasocongestion
Hegars sign
soften of lower uterine segment (2-3 month)
fetal heart beat
10-12 weeks
greavidy
number of times someone has been pregnant
parity
number of pregnancies that have reached 20 weeks
viability
24 weeks
TPAL
Term
Preterm
Abortion
Living children
1st tri: 1-13 weeks
2nd tri: 14-26
3rd tri: 27-40
Naegele’s rule for due date expectancy
first day of last period. Add 7 days. Subtract 3 months and add 1 year
+/- 2 weeks
Increase calories
> 300/day after 1st trimester.
adolescent 500
> 500 for breastfeeding mothers
increase protein to 60 grams / day
weight gain
> 4 lbs in 1st trimester
> 1 lb/ week 2nd trimester
> no more than 1 lb/ week in 3rd trimester
exercise
dont let HR >140 BPM
smoking causes
SGA baby
how often prenatal visits>
first 28 weeks = once/month
28-36 weeks = 2/month
36-delivery = once/week
fetal movement
Quickening
16-20 weeks
fetal HR
2nd tri = 120-160
110-120 worried and watching
<110 panic
PIH
preg induced HTN
check protein in urine
how is fetal position determined?
Leopolds manouver
have PT void first
Lightening
2 weeks before term
head drops
Iscchial spine
= 0
-1 toward vagina
+1 toward belly button
when should mom go to hosp?
when contractions are 5 min apart or membranes rupture
non-stress test
want to see two or more accelerations of 15 BPM with fetal movement and lasts about 15 sec
heart should come back within 2 min
> want this test to be reactive POSSative
BPP
Biophysical Profile Test
> last trimester or 32-34 weeks in high risk preg
measurements done by US: 2 points for each
6 = worry
- HR- was NST reactive?
- muscle tone- 1 flexion/extension in 30 min
- movement- 3 x in 30 min
- breathing- at least once in 30 minutes
- amniotic fluid
CST
contraction stress test: oxytocin challenge
> want non-reactive result NEG test
> perform on high risk pregnancies : preeclampsia, maternal DM, or placental insufficent
> Determine if baby can handle stress of uterine contraction
> perform after 28 weeks
deceleration
HR decreases but causes hypoxia
early deceleration = not bad. Physiological hypoxia from fetal head compression
Do NOT want to see late deceleration = uteroplacental insuff
variable deceleration = bad umbilical cord compression
Epidural Anaestesia
does not go into spinal fluid
> give at stage 1 or 3-4 cm dilation
can cause hypotension monitor
–> bolus 1000mls NS/RL if need be
contraction rate
want 1 Q 2-3 min that last 60 sec long
when to discontinue oxytocin
if contractions too close together or
last too long or
fetal distress
fundal height
immediate after birth is 2-3 fingers below Umbili
a few hrs after it rises 1 finger above
will distend 1 finger / day (involution)
clots
no bigger than nickle
diurese
24 hrs post-delivery
mastitis
usually 2-4 weeks
> penicillin ok while breast feeding
heat
feed baby more frequently
offer bad breast first
APGAR
1 and 5 min
appearance- color pulse grimace- irritability activity- muscle tone resps
want 8-10 score
> Erythromycin for eyes (Neisseria gonococcus and chlamidia)
> Vit K = Phytonadione IM promotes clotting factor
cord care
dries and falls off om 10-14 days
why do babies hypoglycemia
bc they are not getting glucose from mother
diagnose Rh incompatibility
- Indirect Coombs - mother measures antibodies in blood
Direct coombs - baby cord blood to see if there are antibodies stuck to RBCs
when is RhoGAM given
Rho(D) immune/globulin
given with any bleeding episode. Destroys fetal cells that get into mothers blood before antibodies are formed
Hydatiform mole
no fetus. benign neoplasm
> uterus enlarges too fast
confirmed with US
need D and C
do not get preg. Dr. wants to follow to make sure not malignant. Will measure hCG weekly unitl normal for up to 6 months
tx for ectopic pregnancy
Methotrexate to stop growth of embryo
placenta previa
placenta implanted wrong
> begins to separate when cervix begins to dilate
decreased O2 to baby
> > painless bleeding in 2nd half of pregnancy
> C-sec
abruptio placenta
placenta implanted normal, but separates prematurely
> may be partial or complete
causes:
> MVA, violence, previous C-sec, membranes rupture (rapid decompression), drugs, smoking…
> rigid board-like abd with or without vag bleeding
abd pain and increased uterine tone
diff to palp fetus
> > > C-sec!
NO VAG exams
incompetent cervix
cervix dilates prematurely in 4th month of preg
> weight of baby causes cervix to prematurely dilate
painles
Tx: purse string (cerclage) at 14-18 weeks reinforce cervix
hyperemesis gravidarum
related to high levels of esterogen and hCG
> will have decreased K+ d/t vomit, but decreased urin op
will have ketones in urine
> NPO 48hrs
IVF 3000mls in 24hrs
vitamins
6-8 small meals.day
preeclampsia
- Proteinuria»,
- edema,
- increased BP»> after 20 weeks
130/90- 150/95 (mild)
> sudden weigh gain, swollen/edema
HA, blurred vision, seeing spots
hyper-reflexia
clonus –> seizure
severe preeclampsia
160/110 documented 6hrs apart
> give Mg sulfate
- acts like sedative, anticonvulsive, vasodilates (increase renal profusion)
- simple salt solution. Fluid goes back into vascular space and out of tissues, kidneys will diurese
when using Mg- labor will stop
N: check Mg toxicity Q2-3 hrs
> BP, resps, DTRs and LOC
> urine OP
If diastolic >100 give apresoline (hydralzine)
> > > > > DELIVER BABY»»>
eclampsia
when mother has a seizure
everything bad can happen!
PIH
preg induced HTN after 20 weeks
Key: proteinuria
Premature labor
20-37 weeks
give what for preterm labor?
Terbutaline- helps with breathing
Mag sulfate
Betamethasone - give IM to mom. 2 inject 24 hrs apart
> stimulate maturation of babies lungs
shoulder dystocia
> bracial plexus injury to baby
Erb’s palsy
hypoxia = cerebral palsy and asphyxia
broken clavical
> Robbert’s maneuver- hyperextend legs
GBS
Group B streptococcus
> culture around 35-37 weeks and at delivery
