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KAPLAN > Safety & Risk video > Flashcards

Safety & Risk video Flashcards

1
Q

(ROP) Retinopathy of Prematurity

A

high concentrations of oxygen cause premature infant retinal vessels to constrict O2 > 40% or O2 at high levels for more than 48-72h Can cause retinal detachment

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2
Q

manifestations of detached retina

A

flashes of light blurred vision loss of vision particles moving in vision field (floaters) feeling of curtain coming down confusion, apprehension

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3
Q

Cataracts

A

distorted, blurred vision glare, double vision milky white pupil Post-op: Pt should sleep on unaffected side and wear night shield Pupil is constricted if new lens implanted, dilated if no implant sudden pain post-op may be hemorrhage

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4
Q

Glaucoma

A

abnormal increase in IOP -is an obstruction of outflow of aqueous humor -open is gradual onset -closed is sudden onset (allergy or vasomotor disturbance) assessment: brow arching blurred vision lights with halos decreased peripheral vision (tunnel) pain, h/a N/V Avoid Atropine, will close the angle

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5
Q

conductive vs sensorineural loss

A

conductive loss: d/o in auditory canal, ear drums, ossicles (d/t infection, inflammation, foreign body, trauma, ear wax)

sensorineural: d/o of organ of Corti or auditory nerve (d/t drug toxicity, trauma, congenital)

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6
Q

Administer ear drops: up or down

A

Adult: pull up on ear and backward

Child: pull down on ear and backward

Based on position of eustachian tube

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7
Q

Otitis media (middle ear infection)

A

bright red tympanic membrane

fluid filled

Need to position on affected side for drainage

may need ventilatory tubes (myringotomy) –> must avoid water in ear (bath/swimming)

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8
Q

Meniere’s disease

A

Meniere’s disease is a disorder of the inner ear that causes spontaneous episodes of vertigo — a sensation of a spinning motion — along with fluctuating hearing loss, ringing in the ear (tinnitus), and sometimes a feeling of fullness or pressure in your ear.

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9
Q

Bell’s Palsy

A

damage to cranial nerve 7 (facial)

  • inability to close eye, increased lacrimation
  • distorted side of face, speech difficulty

**NOT PERMANENT

Steroid use necessary.

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10
Q

Acoustic neuroma

A

cranial nerve 8 affected by tumor

need posteriorfasa craniotomy (at base of neck)

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11
Q

trigmeminal neuralgia

A

cranial nerve 5

is a nerve responsible for sensation in the face and motor functions such as biting and chewing.

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12
Q

Guillain–Barré syndrome

A

Guillain-Barre syndrome is a serious disorder that occurs when the body’s defense (immune) system mistakenly attacks part of the nervous system. This leads to nerve inflammation that causes muscle weakness and other symptoms.

PARALYSIS STARTS FROM PERIPHERY AND MOVES UP TO THE TRUNK

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13
Q

Meningitis

A

Lumbar puncture performed to determine the cause…

Assessment:

  • nuchal rigidity
  • Kerning’s sign: hips are flexed and knees can’t straighten w/o pain
  • Brudzinski’s sign: can’t do chin to chest
  • Change in LOC, seizures
  • Infant: bulging fontanels, high pitched cry

**Can cause SIADH- so monitor electrolytes, urine volume, specific gravity

**DROPLET PRECAUTIONS!!!

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14
Q

Migraine headache prevention and tx

A

Ergotamines are taken AT THE START of onset

Medications: aspirin a day, beta adrenergic blockers, ca channel blockers (relax smooth muscles); others are NSAIDs

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15
Q

Huntington’s dz

A

It is an autosomal dominant disorder.

rare familial, progressive, degenerative disease that’s passed from generation to generation

  • Pt start w/ depression and personality changes, then develop choreiform movements, which is constant movement, repetitive movement
  • Korea is used to describe Huntington’s dz
    • may start as restlssness, facial grimacing, arm and leg and tongue movements and can progress to constant mvmt by end of dz progression
  • Pt will become increasingly debilitated and unable to care for himself
  • aspiration and respiratory failure are usually causes of death

NO SURE, CARE IS SUPPORTIVE.

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16
Q

Diabetes Mellitus symptoms (regardless of type)

A

polyuria

polydipsia

polyphagia

weight change (loss or gain)

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17
Q

onset of DM Type 1 & 2

A

Type 1 (5% of population):

acute onsdet before age 30, beta cells destroyed and insulin required

ketosis prone, body breaks down fat when no insulin available

Type 2 (95% of population):

insidious onset after age 30, often related to obesity, causing insulin resistance

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18
Q

DM type 2 risk factors

A
  • parents or siblings with type 2 DM
  • obesity
  • African Am, Native Am, Hispanic Am, Asian Am
  • age > 45 years old
  • hypertension
  • hx of GDM
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19
Q

diagnostic tests for DM

A
  • FBS 60 - 110
  • GTT measures how the body responds to 75g of oral glucose, tested at timed intervals (before, 1h, 2h- should be less than 140 at 2h)
    • 140-200 impaired glucose
    • >200 diagnoses DM
  • HbA1c tells glucose over past 3 months
20
Q

How does insulin work?

A

facilitates uptake and utilization by muscles and fat cells

decreases release of glucose in the liver and lowers blood glucose

21
Q

how should insulin be mixed?

A

clear before cloudy

Regular before NPH

(because you would never want to accidentally put long acting NPH in short acting bottle, which could be detrimental to pt if pt things they are administering short acting)

22
Q

Sick day rules for insulin

A

sickness elevates blood glucose levels

  • take insulin as ordered
  • check more frequently, may need to increase dose
  • check urine for ketones
  • If vomiting, diarrhea, or fever; report to HCP and take liquids q30m or q1h
23
Q

diabetes foot care

A

inspect feet daily

wear well fitting shoes (shop for shoes when feet are largest late in the day; break in new shoes slowly)

don’t walk barefoot or use heat pad

cut toenails straight across

24
Q

Assessment and Implementation

of DKA

A

Assessment:

  • blood sugar 300 - 800
  • headache
  • drowsiness, weakness
  • skin warm and dry (sugar high), elevated temp
  • fruity odor
  • Kussmal’s respirations (body trying to rid acids that are forming)

Implementations:

  • Major complication: fluid volume deficit (major dehydration)
  • replace 0.9NS or 1/2NS
  • regular insulin IV 5units/hr
  • Potassium replacement or EKG (hypokalemia)
  • assess VS q15min until stable
25
Q

HHNKS

(hyperglycemia hyperosmolar nonkeotic syndrome)

A
  • glucose > 800
  • associated with type 2 DM
  • hypotension
  • dry mucous membranes
  • seizures
  • ketosis, acidosis don’t occur b/c pt has some insulin (unlike type 1 DM patients)
26
Q

Care of pt with Hiatal Hernia

A

small, frequent feedings

do not lie down 1h after eating

elevate head when sleeping

Meds: antacids, h2 receptor blockers, cytoprotective agents

CARAFATE: coats the stomach (SO GIVE ON EMPTY STOMACH prior to ingestion of food)

27
Q

Chronic duodenal ulcer

A

male, 30-60yo

low gastric pH, hypersecretion

pain 2-3h after or at night (b/c stomach empty!)

food intake relieves pain

rarely malignant

28
Q

chronic gastric ulcer

A

age 50 and older (no difference in male/female)

normal gastric pH

pain 30min to 1h after meals or when fasting

pain relieved by vomiting (eating makes worse)

tendency to be malignant

29
Q

Change in diet for ulcers

A

eat 3 meals per day

avoid coffee, alcohol, caffeine, milk, cream

avoid food extremes in temperature

reduce stress and stop smoking

30
Q

Ulcer medications

A
  • Antacids 1h before or after meals
  • Histamine receptor blockers (Tagamet): Take with meals
  • Anticholinergics: give 30min before meals
  • Cytoprotectives: Carafate will coat ulcer
  • Proton pump inhibitors
31
Q

Billroth I & II

A

Removal of part of the stomach

II is more complicated

32
Q

Crohn’s dz versus Ulcerative Colitis

A

Crohn’s disease (affects ileum)

  • slowly progressive, lesions separated by normal tissue (regional)
  • age 20-30 and 50-80
  • steathorrhea
  • colicky abdominal pain after meals
  • have 5-6 unformed stools/day (diarrhea rare)
  • weight loss, anemia, dehydration
  • fistula formation common

Ulcerative Colitis

  • begins in rectum w/ continuous segments involving mucosa layer
  • age 30-50
  • no fat in stool
  • rectal bleeding is common
  • abdominal pain pre-defecation
  • diarrhea 10-20 liquid stools/day, often bloody
  • weight loss, anemia, dehydration
  • fistual formation RARE
  • remission and relapses
33
Q

Diverticular disease

A
  • pain in LLQ
  • relieved by passage of stool, flatus
  • constipation alternating with diarrhea
  • dietary deficiency of fiber
    • avoid food w/ seeds
    • need high fiber diet to promote bowel movement
34
Q

Appendicitis

A
  • pre-umbilical abdominal pain shifts to RLQ (McBurney’s point)
  • localized tenderness
  • anorexia, N/V
  • muscle guarding, low grade fever, WBC is 15-20k

Implementation:

  • no analgesics to mask the pain b/c when it ruptures pain is suddenly relieved (which can cause peritonitis)
  • no heating pads, enema, or laxative
  • NPO
  • Fowler’s position post-op
35
Q

Peritonitis

A

inflammation of part or all of abdominal cavity

  • severe abdominal pain
  • abdominal rigidity, rebound tenderness
  • N/V
  • ascites
  • fever, leukocytosis
  • decreased bowel sounds –> paralytic ileus
36
Q

Hirschsprung’s dz

A

missing nerve cells in the muscles of part or all of the intestine, no peristalsis

newborn: failure to pass meconium, refusal to suck
child: failure to gain weight, foul stools, constipation

abdominal distention

37
Q

Intestinal Ostomies

A

Postop: Intestinal ostomies for fecal diversion

  • NG tube, NPO until peristalsis
  • Clear liquids progressing to solid, low-residue diet first 6-8wks
  • Monitor I&O and F&E balance
  • Condition of stoma
    • first few days: beefy red, swelling should go down
    • notify HCP if dark blue or purple
  • Drainage is usually mucous for first few days and will start to function about 3-6 days after surgery
38
Q

poop consistency in colostomy

A

Upper intestinal:

  • lots of liquid stool, and gastric and pancreatic gas secretions
  • Ileostomy: liquid, odorous, highly corrosive drainage (don’t want to touch skin), remove contents 2-4x day w/ catheter; low-residue diet, no corn or nuts
    • pt has no control over when BM will occur

Colon:

  • water is pulled out so softer stool
  • Transverse colostomy: soft to fairly firm, very foul smelling and corrosive drainage, pouch should always be worn, diet not restricted after 6wks

Sigmoid colon:

  • more formed
  • Descending or Sigmoid colostomy: firm stool, foul smelling, fairly corrosive; may wear pouch and control with colostomy irrigation; diet not restricted after 6wks
  • irrigation begins 5-7d postop, warm water infused 5-10min and drained 10-15min. (irrigation cone used and inserted 3inches)
39
Q

manifestations and complications

of cirrhosis

A

Manifestations

  • indigestions, N/V
  • flatulence, constipation, diarrhea
  • anorexia, weight loss
  • esophageal varices
  • ascites, anemia
  • jaundice, pruritus
  • dark urine (tea colored), clay-colored (light) stool

Complications

  • Peripheral edema and ascites- dehydration and hypokalemia
  • Hepatic encephalopathy- accumulation of ammonia
    • asterixis- flapping tremor of hand
    • disoriented–> comatose
  • Hepatorenal syndrome
    • azotemia
    • renal failure
40
Q

Types of cirrhosis

A
  1. Laennec’s - due to alcoholism and poor nutrition
  2. Biliary - due to chronic biliary obstruction and infection
  3. Post-necrotic - due to previous viral hepatitis
41
Q

Cirrhosis: dietary needs

A

Early: high protein, high carbohydrate diet

Advanced stage: restrict fiber, protein, fat, sodium

avoid alcohol

sodium and fluid restrictions

monitor for bleeding

42
Q

Reye’s Syndrome

A

no aspirin for child with URI or gastroenteritis

Assessment:

fever, increased ICP, decreased LOC, decreased hepatic fxn

dx by liver biopsy

43
Q

Pancreatitis

A

Assessment

  • severe abdominal pain
  • N/V 24-48h after a heavy meal/alcohol
  • hypotension, acute renal failure
  • elevated serum amylase
  • hyperglycemia
44
Q

acute glomerular nephritis

A

caused by antigen reaction to the strep bacteria

45
Q

Scabies

Manifestations and tx

A

assessment:

  • minute, reddened, itchy lesions
  • severe itching, especially at night

implementation:

  • topical antipruritic
  • skin precautions necessary
  • isolate the laundry b/c mites could be on it
  • rash may continue 2-3 weeks
46
Q

Eczema

A

In children: dry, red skin lesions that weep and crust

In adults: hard, dry, scaling patches

Need to eliminate to prevent exacerbations:

  • milk, eggs, wheat, citrus
  • cotton clothing
  • soap

Apply lotion, topical steroids

KAPLAN (13 decks)

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