Random 4: hurst Flashcards
1
Q
Anhedonia
A
loss of pleasure
2
Q
as depression lifts, what happens to suicide risk?
A
it increases. they might now have energy to take action
3
Q
ask suicidal ppl 3 Q’s
A
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…
4
Q
ECT treatments
A
> induce tonic clonic seizures for severe depression
> atopine is given so dont aspirate
> need signed consent
5
Q
Echolilia
A
hear word and repeat it
6
Q
Neolgisn
A
make up own words that have special meaning
7
Q
what adult would hae lanego?
A
Anorexia nervosa
8
Q
bulemia nervosa
A
> allow 30 min to eat
sit with PT at meals and observe for 1 hr after
build self-esteem
9
Q
why do you give benzos for alcohol withdrawal?
A
they act as a sedative and anticonvulsion
Ex. Chlordiazepoide (Librium), Ativan, Diazepam (valium), lorazepam (ativan)
10
Q
CIWA
A
tx begins with score 8-10
score 20 = ICU
11
Q
Disilfiram
A
Antabuse
> must sign a consent bfr this can be given
stay away from alcohol when taking
12
Q
Glomerulonephritis
A
> imflam from strep infection > tired = toxins > increased BUN craitinine > flank pain > blood in urine and protein
> tx: get rid of strep
13
Q
how to determine fluid replacement>
A
fluid replace = 24 hrs fluid loss + 500mls
14
Q
increased BUN =
A
decreased protein for all kidney probs
except in nephrotic syndrome»_space;>
15
Q
Nephrotic syndrome
A
> 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
16
Q
anasarca
A
generalized edema
17
Q
probs associated to protein loss
A
> thrombosis
increased cholesterol and triglycerides (liver compensate and makes more albumin plus these)
18
Q
S and S of nephrotic syndrome
A
> proteinuria
edema
hyperlipidema
hypoalbuminemia
19
Q
tx nephrotic
A
> diuretics > ACE inhibitors - to block aldosterone > albumin > prednisone --> to shrink holes. causes imunosuppressed
> decreased Na and increased protein
anticoagulation
dialysis
20
Q
why does renal failure PT have anemia?
A
bc not enough erythropoietin produciton–> stimulate RBC production
21
Q
S and S renal failure
A
> Itching skin (frost uremic)–> provide good skin care
increased K+ bc cant excrete = metabolic acidosis
22
Q
2 phases of renal failure
A
- Oliguric phase- decreased op. PT had FVE. K+ increases
2. Diuetic phase- sudden onset. OP goes up. PT into FVD and K+ goes down
23
Q
what do you watch closely during hemodialysis
A
electrolytes and BP
24
Q
what drugs do you hold prior to dialysis?
A
anything cleared by kidneys
25
how do you assess for patency for vascular access device
> thrill- cat purr palpation
> bruit- turbulent blood flow
Feel thrill hear bruit
26
PD ppl need to increase what in diet?
protein and fiber
27
kidney stones
(urolithiasis, renal calculi)
> increased WBC in urine
> hematuria >>>
> give ondansetron and NSAIDS/opioids
>ESWL = extracorporeal shock wave lithotripsy
28
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.
29
what test to be used for diagnostic for neural assess?
1. CT -dye need consent
2. MRI- no dye
3. 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
4. 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
30
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
31
normal ICP
0-15mm Hg
32
cushings triad from?
increased ICP
1. systolic pressure with widening pulse >60
2. slow full bounding pulse
3. irreg resps, cheyne stokes
33
posturing from increased ICP
notice posturing can be increased ICP
34
Decorticate
arms flex inward and bent toward body, legs extended
35
Decerebrate
all 4 extremities in rigid tight extension. WORST
36
complications of ICP
- brain herniation
- SIADH
- DI
37
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
38
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
39
Pancreatitis
1. Endocrine - insulin
| 2. Exocrine - Digestive enzymes
40
types of Pancreatitis
1. Acute - gallbladder disease or alcohol
| 2. Chronic- alcohol
41
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)
```
42
4 major functions of the liver
1. detox
2. blood clotting
3. metabolize drugs
4. synthesis of albumin
43
if your liver is sick
decrease meds to 1/2 bc they wont be metabolized
avoid narcotics
44
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
45
hepatic coma
decreased LOC
```
> ataxis liver flap
> diff to awake
> hand writing changes
> decreased reflexes
> EEG changes
> Fetor - breath smells like ammonia
> GI bleed
```
46
treat liver ppl
> lactulose decrease ammonia
> cleansing enema
> saline lavage - blood out of stomach
47
where are the bleeding esophageal varicies?
1. stomach
2. rectum
3. esophagus >
Tx: Octreotide --> lowers BP in the liver
48
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
49
colon probs eat
low fiber - limit GI motility to save fluid
50
when would you notify MRP for chest tube drainage?
> 100mls in 1 hr and if color changes to bright red
51
TX: for tension pneumothorax
large bore needle into 2nd intercoastal space to allow excess air to escape
52
open pneumothorax
gun or stab:
| > get PT to inhale and valsalva to increase thoracic pressure and plave gauze on 3 sides
53
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
54
Classic use for PEEP
Acute Respiratory Distress Syndrome ARDS
55
BiPAP
+ pressure airway
used for ARDS for ppl with COPD, HF
56
CPAP
continuous pressure airway for inhail and exhail
57
D-dimmer
for clotting. is increased with pulm emboli
58
PTT
INR
30-40 sec
2-3 sec
59
what hormone makes you stop period?
progesterone
60
goodell's sign
softening of the cervix 2nd month
61
Chadwicks sign
blueish color vaginal mucosa and cervix (week 4)
vasocongestion
62
Hegars sign
soften of lower uterine segment (2-3 month)
63
fetal heart beat
10-12 weeks
64
greavidy
number of times someone has been pregnant
65
parity
number of pregnancies that have reached 20 weeks
66
viability
24 weeks
67
TPAL
Term
Preterm
Abortion
Living children
1st tri: 1-13 weeks
2nd tri: 14-26
3rd tri: 27-40
68
Naegele's rule for due date expectancy
first day of last period. Add 7 days. Subtract 3 months and add 1 year
+/- 2 weeks
69
Increase calories
> 300/day after 1st trimester.
> adolescent 500
> 500 for breastfeeding mothers
increase protein to 60 grams / day
70
weight gain
> 4 lbs in 1st trimester
> 1 lb/ week 2nd trimester
> no more than 1 lb/ week in 3rd trimester
71
exercise
dont let HR >140 BPM
72
smoking causes
SGA baby
73
how often prenatal visits>
first 28 weeks = once/month
28-36 weeks = 2/month
36-delivery = once/week
74
fetal movement
Quickening
| 16-20 weeks
75
fetal HR
2nd tri = 120-160
110-120 worried and watching
<110 panic
76
PIH
preg induced HTN
check protein in urine
77
how is fetal position determined?
Leopolds manouver
have PT void first
78
Lightening
2 weeks before term
head drops
79
Iscchial spine
= 0
-1 toward vagina
+1 toward belly button
80
when should mom go to hosp?
when contractions are 5 min apart or membranes rupture
81
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
82
BPP
Biophysical Profile Test
> last trimester or 32-34 weeks in high risk preg
measurements done by US: 2 points for each
6 = worry
1. HR- was NST reactive?
2. muscle tone- 1 flexion/extension in 30 min
3. movement- 3 x in 30 min
4. breathing- at least once in 30 minutes
5. amniotic fluid
83
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
84
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
85
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
86
contraction rate
want 1 Q 2-3 min that last 60 sec long
87
when to discontinue oxytocin
if contractions too close together or
last too long or
fetal distress
88
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)
89
clots
no bigger than nickle
90
diurese
24 hrs post-delivery
91
mastitis
usually 2-4 weeks
> penicillin ok while breast feeding
> heat
> feed baby more frequently
> offer bad breast first
92
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
93
cord care
dries and falls off om 10-14 days
94
why do babies hypoglycemia
bc they are not getting glucose from mother
95
diagnose Rh incompatibility
- Indirect Coombs - mother measures antibodies in blood
Direct coombs - baby cord blood to see if there are antibodies stuck to RBCs
96
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
97
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
98
tx for ectopic pregnancy
Methotrexate to stop growth of embryo
99
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
100
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
101
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
102
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
103
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
104
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>>>>>
105
eclampsia
when mother has a seizure
everything bad can happen!
106
PIH
preg induced HTN after 20 weeks
Key: proteinuria
107
Premature labor
20-37 weeks
108
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
109
shoulder dystocia
> bracial plexus injury to baby
> Erb's palsy
> hypoxia = cerebral palsy and asphyxia
> broken clavical
> Robbert's maneuver- hyperextend legs
110
GBS
Group B streptococcus
> culture around 35-37 weeks and at delivery
