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Seminar Exam 2 Flashcards

1
Q

causes of SIADH

A
  • inappropriate, continued secretion or action of ADH despite normal or increased plasma volume
  • resulting in impaired water excretion
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2
Q

symptoms of SCC

A
  • pain
  • fatigue
  • SOB
  • loss of sensation
  • loss of motivation d/t treatment (high dose opioids)
  • anemia
    • injured RBCs hemolyzing, making new ones (taxing on bone marrow), RBCs don’t carry as much oxygen, doesn’t deliver well, doesn’t get to tissues as well
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3
Q

etiologies of HHS

A
  • pre-existing T2DM
    • esp. elderly
  • infection/sepsis
  • CVA, MI, pancreatitis, GI bleed
  • medication interactions
  • TPN or enteral
    • esp. elderly
  • dialysis
    • esp. elderly
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4
Q

cerebrospinal fluid

A
  • clear, colorless, odorless fluid that fills ventricles, subarachnoid space and spinal cord
  • cushions brain and spinal cord against injury (absorbs shock)
  • food and wate removal system of brain
  • 3rd circulation after blood and lymph
  • made up of
    • water, protein, oxygen, carbon dioxide
    • electrolytes: Na, K, Cl, glucose
  • 120-150 ml in circulation; 25 ml produced/hr, 500 ml/day
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5
Q

GI/other symtpoms suggesting adrenal insufficiency

A
  • N/V
  • abdominal pain
  • general weakness
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6
Q

thinking associated with dementia

A
  • cognitive decline with problems in memory plus one or more:
    • aphasia
    • apraxi
    • agnosia
    • executive functioning
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7
Q

define depression

A
  • cluster of depressive symptoms (via SIG E CAPS depression criteria) is present on most days, for most of the time, for at least 2 weeks
    • symptoms of such intensity they are out of the ordinary for individual
  • biologically based illness affecting a person’s thoughts, feelings, behavior, and physical health
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8
Q

positioning and stimuli for pt with increased ICP

A
  • positioning
    • 30 degrees
    • head and neck neutral for adquate venous draining
  • minimize stimuli
    • quite environment
    • lights dim
    • don’t cluster nursing interventions
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9
Q

symptoms of mild TBI

A
  • # 1: LOC lasting few sec to minutes
  • # 2: N/V - early symptom
  • headahce, lightheadedness, dizziness
  • confusion, tiredness, sleepiness
  • blurred vision, ringing in ears
  • bad taste in mouth
  • sleep changes, behavior/mood changes
  • trouble with memory, concentration, attention, thinking
  • sensitivity to light/sound
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10
Q

define Addison’s disease

A
  • adrenal insufficiency
    • deficiency of glucocorticoids
  • primary - issue with adrenal glands
  • secondary - issue with pituitary
  • tertiary - issue with hypothalamus
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11
Q

why high flow oxygen for croup?

A
  • open airway
  • improve oxygenation
  • blows of CO2
  • decreases inspiratory resistance by keeping nasopharyngeal area open
  • support oxygenation by increasing pressure
  • controlled by respiratory therapist or provider
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12
Q

sypmtoms of septic shock

A
  • fever
  • rigors
  • hypotension
  • tachycardia
  • tachypnea
  • oliguria
  • restlessness
  • N/V/D
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13
Q

cranial nerves

A
  1. olfactory
  2. optic
  3. oculomotor
  4. trochlear
  5. trigeminal
  6. abducen
  7. facial
  8. vestibular
  9. glossopharyngeal
  10. vagus
  11. accessory
  12. hypoglossal
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14
Q

management of neutropenia

A
  • granulocyte-colony stimulating factor
    • side effect: bone pain
  • chemotherapy dose adjustment for subsequent regimens
  • broad spectrum IV abx if sepsis suspected
  • PO prophylactic abx
  • patient education
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15
Q

paracrine hormone secretion

A

hormone acts locally by diffusing from source to target cells in neighborhood

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16
Q

overview of HHS

A
  • hyperglycemia hyperosmolar state
  • affects individuals with T2DM
  • severe hyperglycemia, hyperosmolarity, dehydration
  • absence of ketosis and acidosis
  • severe hyperglycemia causes osmotic diuresis
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17
Q

managing PTSD

A
  • not just a veteran’s disorder
  • any life/health threatening injury can result in PTSD
  • management is often overlooked
  • nurses play a role
    • treating a patient post injury
    • seeing them in a return capacity
    • assessing symptoms
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18
Q

nursing management of patient with increased ICP

A
  • ID early
  • airway
  • CPP 60-100
  • euvolemia
  • positioning
  • minimize stimuli
  • prevent increased metabolic demand
  • pharmacologics
  • ventricular drainage
  • monitor for complications
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19
Q

nursing interventions for HHS

A
  • vitals
  • insulin, monitor BG hourly
  • fluid replacement with NSS
  • I&O
  • monitor/treat electrolytes
  • monitor for thromboembolic event
    • formation promoted by dehydration, immobility, critical illness
  • education
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20
Q

medical interventions for HHS

A
  • restore fluid balance
    • 0.9%, D545% when BG = 250-300
    • 1-2 L in first 2 hours
    • may need upt o 12 L in first 24-36 hrs
  • insulin
    • SC or IV bolus
    • gtt not typically needed
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21
Q

define incretins

A

intestinal hormones releasedin response to meals which enhance insulin production

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22
Q

hypertonic saline to decrease ICP/metabolic demand

A
  • if mannitol is not effective
  • 3% continuous infusion or 5% bolus
  • to combat effects of inappropriate influx of sodium into cells
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23
Q

SCD overview

A
  • SCD vs SCA (anemia)
    • SCA = diagnosis; SCD = presentation; SCC = crisis
  • problems begin at 5-6 mo
  • average life expectancy 40-60 yrs
    • 90% to age 20; 50% to age 50
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24
Q

define TBI

A

nondegenerative, noncongenital insult to the brain from an external mechanical force, possibly leading to permanent or temporary impairment of cognitive, physical, and psychosocial functions, with an associated diminished or altered state of consciousness

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25
Q

managing Addisonian crisis

A
  • maintain hemodynamic stability and adequate tissue perfusion
  • restore normal levels of cortisol, fluid, electrolytes
  • hormone replacement w/ exogenous steroids - lifesaving
    • cortisol syring and ID bracelet for outpt
  • treat underlying cause
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26
Q

sequelae of vena cava syndrome

A
  • laryngeal edema
  • cerebral edema
  • decreased CO with hypotension
  • pulmonary embolus
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27
Q

delirium onset

A

sudden: hours to days

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28
Q

examples of prerenal kidney injury:

absolute decrease in effective blood volume

A
  • vascular: hemorrhage
  • skin: severe burns, diaphoresis
  • GI: V/D
  • renal: polyuria (diuretics, severe glycosuria)
  • endocrine: diabetes insipidus
  • fluid pooling (peritonitis, pancreatitis)
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29
Q

define superior vena cava syndrome

A
  • obstruction of blood flow thru superior vena cava
  • malginant mediastinal tumors cause approximately 80% of SVC cases
    • 70% from lung cancer
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30
Q

assessing cranial nerve XI

A

accessory - shrug shoulders, turn head

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31
Q

diagnosing thyroid storm

A
  • decreased TSH
  • increased T3, T4
  • elevated CPK (rhabdo) b/c everything activated
  • elevated alk phos, creatinine phosphokinase levels
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32
Q

treatment for hyperviscosity syndrome

A
  • plasmopheresis
    • symptom management
  • treatment of causative factor
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33
Q

onset of depression

A

recent unexplained changes in modd present for at least 2 weeks

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34
Q

delayed N/V

A

after 24 hours and up to 7 days after chemo administration

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35
Q

causes of pain for cancer patients

A
  • cancer
  • diagnostic procedures
  • cancer treatment
    • radiation can be painful
  • pre-existing conditions
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36
Q

mini mental status exam

A
  • orientation
  • attention and concentration
  • memory
    • long & short term
    • retention & immediate recall
  • calculations - count back from 10-1
  • abstract reasoning and judgment
    • “don’t count chickens before they hatch”
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37
Q

contraindications of using hypertonic saline in ICP

A
  • CHF (salt overload)
  • ICP < 20 mmHg
  • volume overload
    • CVP > 15 mmHg or PAOP > 12
  • serum sodium > 160 mEq/L
  • chronic hyponatremia
  • DI
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38
Q

endocrine glands

A
  • hypothalamus
  • pituitary
  • pineal
  • thyroid
  • parathyroid
  • adrenals
  • pancreas
  • intestines
  • ovaries, testes
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39
Q

management of spinal cord compression

A
  • high corticosteroids - immediate intervention
  • resection of tumor
  • radiation
  • chemotherapy - but not all chemos cross the BBB
  • pain management
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40
Q

nursing diagnoses for septic shock

A
  • infection - actual
  • imbalanced nutrition - less than body requirements
  • risk for electrolyte imbalance
  • risk for imablanced fluid volume
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41
Q

function of insuline

A

transports glucose into cells

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42
Q

S/Sx of hypoglycemia

A
  • shakiness, dizziness, sweating
  • hunger, headache
  • pale skin
  • moodiness, behavior changes
  • tingling around mouth
  • clumsiness
  • seizure, confusion, LOC, coma
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43
Q

how does low Hgb factor into resiratory distress?

A
  • diminishes oxygen-carrying capacity
  • could accelerate respiratory decompensation
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44
Q

unilateral hippus

A
  • rhythmic contraction/dilation of pupil not in response to or need for accomodation due to light change
  • can be normal but not if not baseline
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45
Q

identifying patient at risk for ICP

A
  • be aware of pt condition and complications
  • frequent neuro assessments q15min - 4h
  • vitals indicating increased ICP
  • changes can be subtle
    • need serial assessments
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46
Q

nursing interventions to decrease ICP

A
  • positioning
    • head in neutral position and HOB at 30 to facilitate venous return
  • decrease stimuli
    • avoid clustering care, lights off, quiet
  • avoid valsalva
    • suction when appropriate, not routinely; stool softeners/avoid constipation
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47
Q

sickle cell admission criteria

A
  • most patients can tell when they need to be admitted
    • still need to determine if it’s the right course of action
    • most will be followed by a specialist
  • most common cause of admission is intractable pain for more than 4 hours despite meds and supporting measures
  • beyond that:
    • vitals, performance based i.e. inability to maintain SpO2 > 95% w/o support, DOE above baseline, etc.
    • tend to be dyspneic anyway, but much worse during crisis
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48
Q

define hyperleukocytosis

A
  • elevated WBC > 4,500 - 10,000 cells/ul
  • when caused by malignancy:
    • frequently occurs in patients with AML experiencing acute leukemia
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49
Q

Broca’s area

A

verbal, expressive speech (in frontal lobe)

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50
Q

define neuropathic pain

A

caused by damage to peripheral or CNS - difficult to treat

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51
Q

define cancer-related refractory pain

A

when pain cannot be adequately controlled despite aggressive measures

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52
Q

AKI S/Sx

A
  • increased BUN/Cr, altered BUN/Cr ratio
  • decreased urine output (earliest sign)
  • decreased creat clearance (24 hr urine collection)
  • altered serum/urine osm as kidney cannot maintain appropriate systemic water balance
  • fluid overload, pulm edema, metabolic acidosis
    • d/t renal excretion of electrolytes and losing bicarb d/t decreased kidney fxn
  • thirst, weakness, confusion, N/V, dry skin, pruritis
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53
Q

incidence of diarrhea in cancer patients

A

50-90% when receiving chemo

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54
Q

hypophosphatemia

A
  • normals: 2.5-4.5 (critical = 1.0)
  • Sx: heart failure, N/V, seizures, coma, musc weakness, resp failure
    • needed for ATP production
  • causes: sepsis, DKA, malnutrition, alcoholism
  • Tx: PO or IV Na or K phos
  • caution: monitor for resp failure; use Na not K phos for repletion in renal failure
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55
Q

refractory N/V

A

occuring b/c of failure of prophylactic and breakthrough meds to control symptoms

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56
Q

treatment of Cushing’s syndrome

A
  • depends on cause
  • decrease/stop steroid use
  • pituitary tumor may require surgery
  • adrenalectomy - usually only for malignancy
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57
Q

preventing increased metabolic demand in patients with increased ICP

A
  • manage fever
    • antipyretics
    • cooling blanket
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58
Q

insulin types

A
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59
Q

pronator drift

A
  • one arm drifts down vs the other
  • sign of focal lesions causing motor deficit
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60
Q

treating thyroid storm

A
  • cardiac and respiratory stabilization
    • B-adrenergic antagonists to control BP
  • antithryoid meds
  • antipyretics, antibiotics if necessary
  • I/O, daily waits
  • cooling measures (avoid shivering)
  • intubation if necessary
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61
Q

what underlying conditions increase chances of subarachnoid bleed?

A

HTN and cardiac issues

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62
Q

definition of malignant pleural effusions

A
  • abnormal collection of fluid btwn pleural lining of lung and wall of chest cavity
  • fluid will re-accumulate if malignant
  • neoplasms of lung, breast, ovary, and lymphomas cause +75% of cases
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63
Q

ramifications of sickled RBCs

A
  • decreased oxygen flow to multiple organs
    • anoxic injury
  • edema
  • across the body
    • large areas affected
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64
Q

what withdrawal can kill you?

A
  • alcohol
  • benzos

die of seizures - status epilepticus

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65
Q

types of infectious oncologic emergencies

A
  • neutropenic fever
  • septic shock
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66
Q

MRI

A
  • most sensitive (neurological, radiological) but takes an hour
  • evaluates
    • tissue
    • vessel integrity
    • structural changes
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67
Q

sequelae of malignant pericardial effusion

A
  • pericarditis
  • cardiac tamponade
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68
Q

airway/breathing assessment of TBI patient

A
  • oxygenation and ventilation
  • hypercarbia may increase ICP
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69
Q

assessing cranial nerve I

A

olfactory - smell

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70
Q

most common causes of intranreal injury

A
  • ATN 2/2 ischemia (prerenal) (90%)
  • nephrotoxic agents
    • IV hydration before contrast and hold other nephrotoxic meds (glucophage, metformin)
  • rhabdo: aggressive hydration, bicarb administration to buffer kidneys
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71
Q

metabolic stress response r/t Addison’s disease

A
  • relative adrenal insufficiency d/t acute or critical illness
  • hyperglycemia d/t insulin resistance with cortisol production and increased glucagon production to provide energy for body
  • initial 24 hour “ebb” followed by hypercatablic “flow”
    • cold, low flow followed by breaking down of body to make energy
  • derangement in thyroid function d/t acute/critical illness
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72
Q

excitatory amino acids r/t TBI

A
  • mechanism of secondary injury
  • TBI leads to significantly elevated excitatory a.a.
    • particulalry glutamate and aspartate
  • leads to cell swelling and neuronal death
    • d/t inappropriate influx of Na and Cl depites neuronal salt wasting (against concentration)
  • may lead to decreased stores of ATP and increased free radical production
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73
Q

cancer-related causes of hypercalcemia

A
  • multiple myeloma
  • lung cancer
  • breast cancer
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74
Q

implication of using a sedating agent for ICP

A
  • hypotension which may decrease CPP > 60 mmHg
  • may need pressor support
    • propofol b/c it’s short acting
  • pain meds b/c propofol not a pain med
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75
Q

types of hallucinations

A
  • auditory
  • olfactory
  • tactile
  • visual
  • gustatory
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76
Q

define Cusing’s syndrome

A

excess of glucocorticoids

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77
Q

prevalence of TBI

A
  • 1.5 million people
  • 1/3 of all injury-r/t deaths
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78
Q

what to ensure if someone is having a hallucination?

A
  • safety of patient and others
  • explain behavior
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79
Q

Sx of Addisonian crisis

A
  • refractory hypotension
    • steroids to stabilize
    • fluids and pressors won’t work
  • syncope
  • confusion, severe lethargy
  • psychosis, slurred speech
  • convulsions
  • fever
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80
Q

define myxedema coma

A
  • life threatening disorder d/t severe hypothyroidism
  • more in women over 60
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81
Q

strain or deformation of tissue r/t TBI

A
  • due to primary injuries
  • three kinds
    • compressive: causing physical damage, ischemia, infarct
    • tensile: streching
    • shear: distortion produced by tissue sliding over tissue
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82
Q

do you need consent from parents to do an LP?

A

no, because it’s diagnostic (despite the fact that it’s invasive)

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83
Q

causes of intratubular obstruction (leading to intrarenal injury)

A
  • cellular debris
  • myoglobin casts
  • uric acid crystals
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84
Q

common cancer-related causes of anorexia-cachexia

A
  • chemotherapy/radiation
  • head & neck cancers - cannot eat
  • severe mucositis/esophagitis
    • mouth to rectum
  • intubation
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85
Q

secondary insut r/t TBI

A
  • after initial insult
  • reaction to insult
    • resulting in chain of events w/ ongoing sequelae
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86
Q

why woudl TBI cause SIADH?

A

injury to pituitary and hypothalamus

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87
Q

early signs of respiratory distress in children

A
  • nasal flaring
  • retractions
    • intercostal (mild); substernal/costal (moderate); supraclavicular/sternal (severe)
  • abdominal breathing
  • declining pulse ox
  • decreased breath sounds, shallow breathing
  • tachycardia, bradycardia
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88
Q

causes of TBI

A
  • MVA
  • assaults
  • repeat axonal shearing d/t sports impacts
  • any physical blow to or rapid movement of head
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89
Q

symptoms of tumor lysis syndrome

A
  • oliguria - cellular debris blocking renal tubules
  • cardiac arrhythmias - d/t electrolyte disturbances
  • seizures
  • volume overload, pulm edema - d/t treatment to flush contents out
  • hypertension
  • altered mental status
  • lethargy
  • weakness
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90
Q

circulation assessment in TBI patient

A
  • continuous hemodyanmic monitoring (art line, CVP)
  • facilitate maintenance of adequate CPP and necessary with vasoactive drugs
  • hypertonic/normotonic fluids, colloids, blood products if using pressors
  • otpimize hgb levels and monitor for coagulopathy
  • thromboprophylaxis with SCDs, no heparin until bleed stable
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91
Q

Cheyne-Stokes breathing

A
  • during ICP
  • like fish out of water
  • breathe fast, then slow, then shallow, then deep
    • losing autonomic control
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92
Q

pharmacologic management of cancer-related N/V

A
  • antiemetic regimen based on emetic potential of chemo
  • 5-HT3 receptor antagonist (ondansetron)
  • NK1 receptor antagonist (emend)
  • cannabis
  • benzodiazepines (for anticipatory)
  • corticosteorids (dronabinol)
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93
Q

common symptoms of dying

A
  • pain
  • extremity coolness
  • restlessness
  • somnolence
  • agonal or cheyne-stokes breathing
  • loss of appetite
  • gurgling
  • decreased urine or recal output
  • incontinence
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94
Q

lab studies r/t Addison’s disease

A
  • azotemia
  • low serum cortisol
  • low urinary 17-OH-steorids
  • failure to respond to various “stimulation tests” by icnreasing cortisol output
    • Cosyntropin stim test
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95
Q

conditions that affect cerebral blood flow and cerebral blood volume

A
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96
Q

common progression for addicts

A
  • PO opioids to heroin
  • dependence to addiction
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97
Q

top cancer new cases in 2016 by type

A
  • breat
  • lung and bronchus
  • prostate
  • colorectum
  • urinary
  • melanoma of skin
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98
Q

sickle cell trait

A
  • autosomal recessive - one copy of gene
  • does not cause SCD
  • generally a “benign” disease but rare reported cases of disease process becoming health threatening
    • lowered performance in athletes
    • potential sickling in high stress, low oxygen states, high altitude exposure, potential SCC in high acuity illness
  • patients should be alerted when SCT b/c can give it to children
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99
Q

define thrombocytopenia

A
  • decrease in circulating platelets
  • < 150,000/ul
  • goal for leukemia patients is 10,000
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100
Q

symptoms of neutropenia

A
  • fever
  • malaise
  • tachypnea
  • tachycardia
  • hypotension
  • mucositis/esophagitis
  • recurrent sinusitis and otisis
  • cough
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101
Q

PTSD trigger

A
  • severity is irrelevant
    • what matters is effect on patient
    • how nurse navigates patient through difficult and life-long injury
  • patients may be ashamed “this thing” “screwed them up”
    • not realizing its extended time under stress that did the damage, rather than the one trigger (which they usually blame)
  • self blame and shame are part of PTSD
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102
Q

cortisol r/ stress response

A
  • maintains homeostasis
    • cardiovascular
    • metabolic
    • immunologic
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103
Q

criteria for involuntary admission

A
  • harm to others
  • harm to self
  • self neglect
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104
Q

define caregiver role strain

A

difficulties assuming and functioning in caregiver role as well as associated alterations in caregiver’s emotional and phsyical health that can occur when care demands exceed resources

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105
Q

define nociceptive pain

A

injury to body tissues

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106
Q

causes of N/V in cancer patients

A
  • chemotherapy
  • radiation
  • infection
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107
Q

define anorexia-cachexia

A
  • anorexia - involuntary loss of appetite
  • cachexia - weakness and wasting d/t severe chronic illness
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108
Q

treating hypoglycemia

A
  • recognize early
  • IV dextrose, glucose tablet, simple sugar
    • followed by complex carb/protein, glucagon SC if severe
  • follow IV D50 with continuous D5 infusion
  • check serial glucose q15 min until stable
  • watch for long-acting agents that could cause drop in serum glucose
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109
Q

sequelae of hyperviscosity syndrome

A
  • congestive HF
  • ischemic acute tubular necrosis
  • pulm edema with multi-organ system failure
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110
Q

tests for hyperleukocytosis

A
  • CBC
    • elevated WBC count
    • can be > 100,000/ul in acute leukemia
  • bone marrow biopsy and aspiration
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111
Q

assessing cranial nerve VIII

A

vestibular - hearing and balance

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112
Q

CPP

A
  • cerebral perfusion pressure
  • CPP = MAP - ICP
  • optimatally, 60-70 mmHg in TBI patient
  • reflects that cerebral perfusion is impacted by interaction of systemic BP and ICP
    • may need pressors to optimize MAP/CPP while trying to maintain ICP as low as possible
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113
Q

pharmacologic management of diarrhea in cancer patients

A
  • rule out C.diff
  • imodium
  • psyllium
  • octreotide
  • lamotil
  • glutamine (for bone marrow pts to improve gut health)
  • vitamin E (bone marrow pts to improve gut health)
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114
Q

medulla

A
  • inside of adrenal glands
  • connected with sympathetic division of autonomic nervous system
  • produce catecholamines
    • epi, norepi, dopa
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115
Q

basal-bolus insulin concept

A
  • basal insulin to suppress hepatic glucose production between meals
  • bolus insulin to meet post-meal insulin requirement
  • may reduce hypoglycemia
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116
Q

sickle cell and critical care admission

A
  • acute chest with EKG changes / + trop or increasing trop
  • inability to maintain SpO2 >90% with significant oxygen support
  • declining mental status
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117
Q

how does agitation in a child with respiratory distress manifest?

A

low oxygen level

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118
Q

why does cancer occur?

A
  • when abnormal cells proliferate uncontrollably
  • malignant cells evade apoptosis
  • create own blood supply (angiogenesis)
    • greater than 1 cubic mm
  • internal or external factors
    • gene mutations vs radiation, chem exposure
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119
Q

breakthrough N/V

A

occuring despite prophylactic meds

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120
Q

adjuvant therapy for N/V in cancer patients

A
  • acupuncture/acupressure
  • aromatherapy & massage
  • guided imagery
  • music therapy
  • progressive muscle relaxation
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121
Q

PO opiods - the monster we created

A
  • pain as 5th vital sign
    • American Pain Society lobbies AMA and ANA in early 1990s for this recognition, adopts catchphrase in 1996
  • adopted by J.Co and CMS as standard of care
    • CMS uses in payment system
    • patients only give good reviews when NOT in pain
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122
Q

neuro assessment of TBI patient

A
  • cranial nerve assessment limited by sedation
  • cough/gag with yankauer
  • blink (saline drops)
  • pupil symmetry, reactivity, tracking
  • response to stimulus, localization of pain
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123
Q

ischemic vs hemorrhagic stroke on CT

A
  • bleeding looks dark on CT
  • immediate phase of ischemic stroke looks normal
    • absence of blood
    • ok for TPA
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124
Q

continuous renal replacement therapy - overview

A
  • sick, hemodynamically unstable patients
  • venous-venous access
  • methods vary
    • direction of flow
    • dialysate used
    • type of molecule or fluid removed
  • circuit can replace/balance electrolytes
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125
Q

tests for tumor lysis syndrome

A
  • BMP
    • hyperkalemia
    • hyperphosphatemia
    • hypocalcemia
    • hyperuricemia
    • elevated BUN, creat
  • ABG or VBG
    • metabolic acidosis
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126
Q

causes of spinal cord compression in cancer patients

A

tumor putting pressure on spinal cord

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127
Q

function and types of androgens

A
  • responsible for masculine characteristics (testosterone)
  • also precursors of estrogens
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128
Q

processes regulated by pituitary

A
  • growth
  • BP
  • pregnancy, childbirth, lactation
  • sex organ function
  • thyroid function
  • metabolism
  • water, osmolarity
  • thermoregulation
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129
Q

treatments for SCC

A
  • meds when reticulocyte count > 10
  • may have standing orders if followed by specialist
  • treatments:
    • oxygen (2L NC then titrate) for comfort
    • opioid pain meds
    • anti-inflammatory meds (toradol, ibuprofen)
      • for secondary inflammation processes, not pain - opens capillaries, slows crisis, decreases pain
    • fluids (NSS bolus, 1-2L) to move clumped blood vessels (dehdyration is a trigger)
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130
Q

PTSD symptoms

A
  • nightmares - flashbacks (invasive memories)
  • hypervigilance
  • inability to sleep
  • change in social dynamic to ensure you don’t get hurt again
  • avoiding triggers
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131
Q

what intubation changes need to be made based on arterial blood gas, and what does ABG show?

Vent settings: 100% FiO2; Rate 40; TV 120; PEEP 5

ABGs: pH 7.5; CO2 29; O2 104; HCO3 25; BE +1

A
  • slow down rate and decrease FiO2
  • respiratory alkalosis - hyperventilated
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132
Q

Wernicke’s area

A

reception and understanding of language (temporal lobe)

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133
Q

establishing/maintaining airway in patient with increased ICP

A
  • RR, depth, rhythm
  • cyanosis
  • intubate, less than 8
  • oxygenation
  • ABGs
    • PaO2 and PaCO2 WDL
    • correct acid/base
  • hyperventilate to lower ICP but ONLY temporarily - not standard practice b/c reduces perfusion d/t acidosis
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134
Q

tests for brain mets / increased ICP

A
  • CT - most common
  • PET - more in outpt
  • MRI
  • brain biopsy
  • BMP
    • electrolyte imbalances if mets to pituitary gland and meninges
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135
Q

symptoms of hyperleukocytosis

A
  • dyspnea
  • fatigue
  • mucosal bleeding
  • change in mental status
  • EKG changes
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136
Q

acute pain management for cancer patients

A
  • epidural anesthesia (rare)
  • local anesthetic infusion
  • gabapentin
  • paracoxib
  • opioids
  • tramodol
  • hypnotherapy
  • music therapy
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137
Q

patho of acute chest syndrome

A
  • multiple sickled RBC/emboli block pulmonary vasculature
    • pain and SOB and other SCC sx
  • elevated trop may be marker for pulm HTN
    • correlate more with indices of hemolytic burden (amount of RBC hemolysis, debris) like low Hct, elevated LDH, bili
      • not frequent indicator for SCD patients
    • correlate with EKG - anoxic injury to heart is a threat
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138
Q

estimating ET tube in children

A

size of pinky

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139
Q

motor assessment

A
  • 0 = no muscle contraction
  • 1 = trace contraction by palpating while pt attempts to contract
  • 2 = actively move muscle without gravity
  • 3 = actively move against gravity, not resistance
  • 4 = move against some reistance
  • 5 = overcomes resistance (normal)
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140
Q

is cranial nerve palsy contra- or ipsilateral?

A

contralateral - motor nerves cross over

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141
Q

presentation of acute chest syndrome

A
  • diffuse chest pain
  • non-reproducible
    • moving arms, deep breathing doesn’t make it hurt
    • pain is just always there
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142
Q

treatment for malignant pleural effusions

A
  • typically palliative in nature
  • thoracentesis
    • if life expectancy < 1 mo
  • pleurx catheter
  • tube thoracostomy
    • if life expectancy 1-3 mo
  • pleurodesis
    • after thoracostomy
    • if life expectancy > 3 mo w/ no contraindications
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143
Q

sickled cells

A
  • aren’t malleable
    • hard, get caught in capillaries, and block
  • don’t carry oxygen as well
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144
Q

populations at risk for TBI

A
  • young (15-30) with highest mortality 15-24
  • >57 years
  • low income
  • unmarried
  • ethnic minorities
  • inner cities
  • men
  • h/o substance abuse
  • pmh TBO
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145
Q

opioids during SCC

A
  • above what an opioid-naive person would take
  • usually on medium to high dose chronic opioids
  • in ED:
    • standard three course tx: 3 rounds IV pain meds with benadryl on dose #1 and #3
    • 2-6 mg dilaudid q2h, 4-10 mg q2h
  • PRN q2-4h push meds, but sometimes PCA
    • don’t ignore/forget the patient
    • double check dosing cap
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146
Q

symptoms of malignant pericardial effusion

A
  • chest pressur or pain
  • SOB
  • nausea
  • abdominal fullness
  • difficulty swallowing
  • change in mental status
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147
Q

static or quasistatic loading r/t TBI

A
  • mechanism of primary injury
  • occurs when slowly moving object traps head against rigid structure
    • injury occurs 2/2 squeezing resulting in skull fractures
    • speed not significant
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148
Q

additional management of cancer-related anorexia/cachexia

A
  • PO supplements - Ensure
  • nutrition consult
  • monitor “nutrition” labs (can affect wound healing)
    • albumin
    • pre-albumin
    • total protein
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149
Q

define Cushing’s Triad

A
  • widened pulse pressure
    • increased systolic and decreased diastolic
  • bradycardia
  • abrnoaml respiratory pattern
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150
Q

define cancer-related breakthrough pain

A

sudden, brief pain during period when chronic pain is generally well-controlled

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151
Q

Glasgow Coma Scale

A
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152
Q

hypernatremia

A
  • normals: 135-145 (critical above 160 - cerebral dehydration and coma)
  • Sx: confusion, N/V, hyperreflexia/twitching, seizures, peripheral edema
  • causes: bicarb, renal water loss (diuretics, Cushing’s syndrome, DKA/HHNK), GI loss, insensible loss
  • Tx: water repletion with hypotonic fluids, natriuresis with thiazide diuretics
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153
Q

pharmacologic management of cancer-related anorexia/cachexia

A
  • cannabis
  • corticosteroids
  • progestins - stimulate progesterone
  • total enteral nutrition
  • total parenteral nutrition
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154
Q

define neutropenia

A

decrease in circulating neutrophils via CBC differential

less than 2000 is technically neutropenic

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155
Q

nursing management of SCC

A
  • make pt comfortable
  • advocate for effective pain management while protecting patient
    • overmedication of patients and terrified interns (2mg morphine q4h is not effective)
  • watch patient for worsening Sx
    • acute chest, priapism, intractable pain at previously therapeutic med levels, decline in oxygenation and ability to sustain oxygenation
  • ensure comfortable, functional discharge
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156
Q

what elements of the CBC are concerning for NICU baby?

WBC: 30 Hgb: 14 Hct: 36 Plt: 200,000 6 bands 42 segs

A

WBC is elevated (should be 5-21)

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157
Q

hypermagnesemia

A
  • normals: 1.8-3.0 (critical = 9.0)
  • Sx: skeletal muscle weakness, neuromuscular blockade, cardiac and vascular relaxation –> asystole, hypotension
  • causes: renal failure, antacid or laxative abuse
  • tx: treat cause, HD may be required, calcium gluconate
  • caution: profound hypermagnesemia can cause cardiac arrest
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158
Q

define thyroid storm

A
  • aka thyrotoxicosis
  • life threatening disorder d/t excessive concentrations of T3 and T4
  • may be manifestation of hyperthyroidism
  • everything is “sped up”
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159
Q

causes of aneurysms

A
  • hereditary weakness of vessel wall
  • HTN
  • atherosclerosis
  • injury
  • infection
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160
Q

etiology of SCD

A
  • autosomal recessive
  • evolutionary protective mechanism against malaria
  • likely originated in sub-Saharan Africa (W. and central)
    • also in Indian subcontinent (S. Asia), Arabian Peninsula, Adriatic Sea nations (Turkey, Greece, Cyprus, Syria, N. Israel)
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161
Q

sensory assessment

A
  • superficial sensation
  • light touch
  • pain
  • deep sensation
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162
Q

common causes of cancer-related anemia

A
  • hemorrhage
  • leukemia
  • bone marow failure (where RBCs are made)
    • d/t chemo, radiation, infection, tumor
  • autoimmune dx
  • hepatitis
  • poor diet
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163
Q

nursing interventions for DKA

A
  • monitor ABGs
  • monitor BG q1-2h
  • monitor I&O
  • replace and monitor electrolytes
  • educational needs
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164
Q

classifying intracranial hematomas

A

where the bleed is located

  • epidural - rapid arterial, 10-15% mortality
  • subdual - venous, acute or chronic, 90% mortality
  • intracerebral
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165
Q

treatment for disseminated intravascular coagulation

A
  • blood product administration
  • pressure on sources of bleeding
    • rhinorocket for epistaxis
  • heparin if plt count high enough to break up clots
  • tx of causative factor
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166
Q

causes of tumor lysis syndrome

A
  • after irritation or treatment of malignancy
  • usually occurs with rapidly proliferating, treatment responsive diseases
  • can be spontaneous in high-grade hematologic malignancies
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167
Q

components of neuro exam

A
  • history
  • visually assess
  • prior neuro disease?
    • TIA’s, stroke, seizures
  • look appropriate?
    • dress, speech, posture
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168
Q

causes of disseminated intravascular coagulation

A
  • inappropriate activation of clotting cascade
  • thrombosis and hemorrhage
  • causes:
    • leukemia
    • transfusion rxn
    • pregnancy complications
    • injury/trauma
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169
Q

hyperphosphatemia

A
  • normals: 2.5-4.5 (critical = 5.0)
  • Sx: neuromuscular excitability, delirium, coma, prolonged QT, vent dysrrhythmias
  • causes: chronic kidney failure, severe catabolic states
  • Tx: phosphate binding agents (PO or NSS) to increase renal excretion
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4
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170
Q

hypokalemia

A
  • normals: 3.5-5.3 (critical = 2.5)
  • Sx: respiratory muscle weakness, EKG changes (ventricular irritability)
  • causes: GI or renal loss, shift to intracellular space, drugs (esp. loop diuretics)
  • Tx: IV or PO K chloride or gluconate (try to replete to 4.0)
  • caution: in DKA, true systemic levels will be deranged by an insulin drip
    • never replate more than 10 mEq/hr d/t arrhythmias
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171
Q

legal documents r/t death and dying

A
  • advanced directive
  • POLST
  • power of attorney
  • DNR/DNI
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172
Q

adverse effects from haloperidol (Haldol)

A

tardive dyskinesia

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173
Q

gateway to addiction for veterans

A
  • loss of job fears
  • effect on VA benefits
  • stigma in and out of VA/tricare system
    • have to sign papers that they have a psychiatric disorder
    • stigmatizes psych dx and veternas
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174
Q

symptoms of hyperviscosity syndrome

A
  • confusion / change in mental status
  • seizures
  • ataxia
  • parasthesias
  • retinal hemorrhages
  • SOB
  • hypoxemia
  • acute respiratory failure
  • hypotension
  • spontaneous gum bleeding
  • epistaxis
  • rectal bleeding
  • menorrhagia
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175
Q

sedation/analgesia to decrease ICP/metabolic demand

A
  • sedation should always be accompanied by analgesia
  • sedated patients can still feel pain
  • pain and agitation increase metabolic demand
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176
Q

what labs to draw during SCC?

A
  • CBC - H&H for anemia
  • BMP - acidosis, tissue lysis, hydration (AKI)
  • reticulocyte count - measure for SCD (usually called a “tic”)
  • troponin - justify why drawing a trop
  • coags, type&screen - if transfusion is necessary
    • usually 3-4 L blood
177
Q

recommendations for noxious stimuli

A
  • NOT
    • sternal rub
    • nailbed stimulation
  • YES
    • Vulcan death grip
    • angle of jaw pressure
178
Q

rhabdomyolysis overview

A
  • muscle cell breakdown
    • cellular debris too large to be filtered through kidneys
    • can cause permanent renal injury
  • diagnose with CK
  • hydrate so cells can pass through
  • bicarb to buffer kidneys and decrease tendency of myoglobin to precipitate into renal tubule
  • keep urine output high
    • monitor for dark urine - hallmark sign
179
Q

sickle cell crisis

A
  • pain in multiple areas
    • hips, legs
    • lower/mid back, abdomen
    • arms, shoulders, neck
    • chest
  • SCC may last 5-7 days
    • some patients present early, knowing it will be bad
    • some present late after trying to self manage
  • many patients can manage most of their crises at home
180
Q

subarachnoid hemorrhage

A
  • typically associated with aneurysmal rupture
    • may occur w/ TBI 2/2 lacerated microvessels in subarachnoid space
  • S/Sx: WHL, N/V, photosensitivty
  • may lead to hydrocephalus if bleed obstructs outflow of arachnoid villi or 3rd/4th ventricle
  • may lead to vasospasm
    • impedes circulation and deprives tissue of O2
    • accumulation of waste (lactate, free radicals)
  • classic “hanging chicken” sign via scan
181
Q

etiologies of DKA

A
  • usually in T1DM
  • sometimes in T2DM
    • infection, trauma, cardiovascular injury
    • most common is inadequate insulin and infection
    • others: pancreatitis, drugs
182
Q

treatment for malignant pericardial effusion

A
  • 9/10 is just hospice care
  • pericardiocentesis
  • systemic chemo to eliminate fluid
  • radiation
  • video-assisted thorascopic surgery (VATS)
  • pericardial window
183
Q

how many days should you do nothing after sustaining a concussion?

184
Q

community management of SCD

A
  • long term abx (amp) (esp. with splenectomy) for infection control
  • vaccines, including flu (can be trigger, though)
  • high PO fluid intake (water)
  • chronic PO opioids for home pain management
  • rarely home O2
  • hydroxyurea - antineoplastic agent
    • causative prevention of SCC
  • consider: travel, stressors, weather change, education
185
Q

change in how we think about pain

A
  • from a vital sign to a symptom
  • billing and compliance critera to exclude pain quanitifaction criteria
    • including surveys
186
Q

symptoms of spinal cord compression

A
  • pain and stiffness in neck, back, lower back
  • burnign pain spreading thru arms, buttocks, down into legs (sciatica)
  • numbness, cramping, weakness in arms, hands, legs
  • loss of sensation in feet
  • difficulty with hand coordination
  • foot drop
  • loss of sexual ability
  • incontinence
187
Q

treat Addison’s disease

A
  • hemodynamic stabilization
  • steroid hormone replacement
    • pred 60 mg PO qd (outpt)
    • hydrocortisone 50 mg IV q6h (gold standard)
    • florinef (fludrocortisone) 50 mcg PO qd
188
Q

what is the threat from priapism?

A
  • impotence
  • ischemia
  • clot can become thromboembolism
189
Q

symptoms of hypercalcemia

A
  • confusion - hallmark Sx
  • lethargy
  • weakness
  • restlessness
  • dysrhythmias - on tele
  • N/V/D
  • polyuria
  • constipation
190
Q

chronic pain management for cancer patients

A
  • ER and SR opioids
  • bone-modifying agents (prevent further bone loss from mets)
  • celiac plexus block
  • gabapentin combinations
  • methadone
  • NSAIDs
  • tramodol
  • cannabis
  • duloxetine
  • palliative radiation therapy to relieve pressure
191
Q

longer term SCD sequelae

A
  • avascular necrosis
    • hip replacements by age 30
    • vascular web in hips is narrow and turtuous
  • blindness
  • oragn damage (spleen particularly, but also kidneys, liver, bowel)
  • skin ulcers - skin not getting good blood flow
  • cognitive loss - disseminated microinfarcting
  • erectile dysfxn
  • jaundice
192
Q

course of depression

A
  • usually reversible with treatment
  • often worse in morning
193
Q

exocrine hormone secretion

A
  • seceretion of hormones into ducts that lead directly to external environment
    • salivary, sweat
194
Q

define hallucination

A

perception w/o objective stimulus

195
Q

treatment for superior vena cava syndrome

A
  • supplemental oxygen
  • corticosteroids
  • diuretics
  • radiation of mediastinal tumor
  • chemo
  • elevate HOB
196
Q

types of nephrotoxic agents causing intrarenal injury

A
  • aminoglycosides
  • contrast
  • ethylene glycol
  • NSAIDs
  • amphotericin B
197
Q

crystalloids

A
  • isotonic: same osm as serum, expand intravascular volume
    • NSS, LR, plasmalyte
  • hypotonic: lower osm than serum, shift fluid into intracellular space
    • 1/2, 1/4 NSS, D5W, 2.5% dextrose
  • hypertonic: higher concentrations of particles than serum, pull fliud from intracellular space to intravascular space
    • D10W, D5 1/2NSS, 3% NS
198
Q

types of behaviors seen in psych assessments

A
  • echolalia
  • flight of ideas
  • pressured speech
  • circular/tangential logic
  • nonsensical speech
199
Q

treatment of brain mets / increased ICP

A
  • high dose corticosteroids
    • dexamethasone most common
    • decreases vasogenic edema / ICP
  • seizure ppx
    • phenytoni, Keppra, valproate
  • chemo
  • radiation
  • steriotactic radiosurgery (cyberknife)
200
Q

pharm interventions for increased ICP

A
  • anticonvulsants - dilantin
  • sedation - fentanyl, propofol
  • neurmuscular blockade
  • vasoactive meds - neo
  • osmotic diuretics - mannitol
  • steroids - dexamethasone
  • barbiturate coma - phenobarbital
201
Q

treatment of hypercalcemia

A
  • goal is to flush out extra calcium
  • calcitonin injection - bind some of calcium
  • biphosphonates
  • loop diuretics
  • iotonic saline IV
202
Q

common lab values during SCC

A
  • Hgb 5-9 g/dL
  • Hct 17-29%
  • leukocyte 12,000-20,000
    • predominance of neutrophils - contributes to clumping
  • plt count increased
  • erythrocyte sedimentation rate is low
  • reticulocyte count elevated
    • but may vary depending on extent of baseline hemolysis
203
Q

complications of increased ICP

A
  • hydrocephalus - CSF exceeds absorption
    • noncommunicating - obstruction
    • communicating - nonfunctional arachnoid villi cannot reabsorb
  • herniation
    • cingulate - displaced towards opposite side
    • transtentorial - down
    • uncal - lateral
    • tonsillar
204
Q

hypomagnesemia

A
  • normals: 1.8-3.0 (critical = 1.0)
  • Sx: seizures, coma, ventricular ectopy, dysrrhythmias (torsades de pointes)
  • causes: GI or renal loss, sepsis, alcoholism, malnutrition
  • Tx: mag sulfate IV 1-5g at 1g/hr (replete to 2.0)
  • caution: monitor BUN/Cr prior to repleting Mg b/c renally cleared
205
Q

why do SCD patients have chest pain?

A
  • vascularized lungs
  • ischemic injury
    • reduced blood flow
  • anemia is causing cardiopulmonary injury
206
Q

types of delusions

A
  • paranoid
  • grandiose
  • somatic
    • ex: patient thinks they are pregnant
207
Q

mechanical causes of postrenal injury

A
  • blood clots
  • calculi
  • tumors
  • prostatic hypertrophy, prostate cancer
  • urethral strictures
208
Q

types of cancer-related N/V

A
  • anticipatory
  • acute
  • delayed
  • breakthrough
  • refractory
209
Q

uncal herniation

A

subset of transtentorial herniation

210
Q

S/Sx of thyroid storm

A
  • fever
  • change in mental status, over psychosis, coma
  • cardiac effects: irregular pulse, hypotension, shock
  • respiratory effects: pulm edema
  • GI effects: N, abd pain, hepatosplenomegaly
  • hyperreflexia
  • exopthalmus
211
Q

intracerebral hemorrhage

A
  • intraparenchymal bleed secondary to laceration or contusion
  • potentially involving large, deep vessels
212
Q

tests for hyperviscosity syndrome

A
  • serum viscosity > 5 units
  • no exact cut off for serum viscosity exists
    • diagnosis based partially on symptoms
213
Q

microtrauma

A
  • repeated
    • DAI
    • axonal shearing
    • concussion
214
Q

transtentorial herniation

A

descending herniation

215
Q

first response for NICU baby alarming for apnea and bradycardia

A
  • stimulate
  • unwarp to check airway and leads
  • try to feed
216
Q

primary insult in TBI

A

primary damage and mechanical damage - moment of trauma

217
Q

treatment for aneurysms

A
  • coiling - angio intervention
  • clipping - surgical intervention
  • monitor - assess for S/Sx of rupture
218
Q

other assessment findings in DKA

A
  • serum & urine ketones
  • serum osmolality > 300-350
  • azotemia (BUN, Cr)
  • increased Hct
  • hyperkalemia
  • hyponatremia
  • metabolic acidosis
  • decreased LOC
219
Q

hypothalamus and pituitary gland

A
  • control almost all of endocrine system
  • hypothalamus releases and inhibits hormones
    • act on anterior pituitary
    • which in turn targets organs on a systemic level
220
Q

define oncologic emergencies

A

clinical condition resulting from a metabolic, neurologic, cardiovascular, hematologic, and/or infectious change caused by cancer or its treatment that requires immediate intervention to prevent loss of life or quality of life

221
Q

how PTSD sufferers cope

A
  • self medication with alcohol or drugs
  • even when on supportive or prescribed psychiatric medications
222
Q

ICP

A
  • pressure exerted by CSF that circulates around brain and spinal cord
  • 0-10
  • < 20 in ICU
223
Q

functional causes of postrenal injury

A
  • diabetic neuropathy
  • neurogenic bladder
  • certain drugs
    • parasympathetics
    • causing urinary retention - antihistamines
224
Q

anticipatory N/V

A

conditioned response, because of prior CINV, which may be triggered when exposed to some stimuli

225
Q

IV access in SCD patients

A
  • usually accessed in ED - hard sticks
  • sometimes have port
    • increases infection w/ every access
  • ultrasound guided IV
    • watch for infiltration
    • esp. CAT scan dye - can necrotize tissue
  • EJ sometimes, but may not be acceptable
    • prone to infiltrate/extravasate
    • very close to central
    • not for contrast studies
    • infection risk
226
Q

assessing cranial nerves IX and X

A

glossopharyngeal and vagus - swallowing, gag, gustation

227
Q

hyponatremia

A
  • normals: 135-145 (critical: below 120 - risk of cerebral edema and seizure)
  • Sx: muscle weakness, confusion, seizure, coma
  • causes: SIADH (TBI, lung cancer, narcotic abuse), natriuresis with thiazide diuretics, excessive free water repletion, alcohol abuse (diuresis)
  • Tx: seizure and fall precautions, treat cause (fluid restriction vs sodium repletion)
228
Q

symptoms of malignant pleural effusions

A
  • SOB, dyspnea
  • cough
  • pleuritic pain
229
Q

therapeutic respones to patient with delusions/hallucinations

A
  • acknowledge feelings
  • state intentions to help
  • reinforce that you and others not experiencing the same thing
230
Q

causes of rhabdo

A
  • crush injuries, severe burns, compartment syndrome
  • severe exertion
  • seizure activity
  • drug side-effects
    • HMG Co-A reductase inhibitors for hypercholesterolemia
231
Q

tests for septic shock

A
  • blood cultures
  • lactic acid high
  • CXR
  • UA / C&S
  • ABG or VBG
  • c.diff sample
  • throat or wound culture - infection risk
232
Q

causes of septic shock

A
  • system-wide response to infection, icnluding organ dysfxn
  • risk factors
    • neutropenia
    • central lines
    • indwelling caths or drains
    • invasive tests or procedures
    • steroids
    • chronic abx use
233
Q

decortication

A
  • hyperflexion of upper extremities and hyperextension of lower
  • higher up injury
234
Q

causes of TBI

A
  • # 1 MVC
  • # 2 falls <4 and >75
  • # 3 GSW, penetrating trauma
  • blunt trauma
  • stab wound
  • anoxia 2/2 hemorrhage, arrest
235
Q

endogenous opioid peptites r/t TBI

A
  • mechanism of secondary injury
  • may modulate damage via icnreasing release of EAA
    • and via behavioral suppression
    • and decreased LOC
236
Q

severe sequelae of thrombocytopenia

A
  • GI bleed
  • cerebral bleed
237
Q

managing caregiver role strain

A
  • cognitive behavioral interventions
  • education
  • caregiver training and skill development
  • couples therapy
  • mindfulness-based stress reduction
  • respite care
  • exercise
  • journaling
238
Q

medical interventions for DKA

A
  • rehydrate and restore electrolyte balance
  • monitor acid-base balance
  • treat hyperglycemia but keep above 200
    • IV regular insulin drip, IV aspart/novolog bolus
    • decrease BG no faster than 75-100 mg/dL/hr
  • correct fluid volume deficit
    • 0.9% -> 0.45% -> D545% when BG = 250-300
    • some may need 6L fluid for adequate resuscitation
  • correct electrolyte imbalance
    • K replacement as levels decrease
    • controversial to treat with NaHCO3
239
Q

negative Sx of schizophrenia

A
  • flat affect (affective blunting)
  • anhedonia (lack of pleasure)
  • inattention (inability to begin/sustain planned activities)
  • avolition (lack of motivation to pursue meaningful goals)
  • alogia (speaking little, even when forced to interact
  • apathy
240
Q

pathophysiology of DKA

A
  • acute, life threatening condition d/t baseline insufficient or absent insulin
  • increase in circulating insulin-antagonist hormones (cortisol)
  • glucose can’t get into cells
    • exaggerated hepatic glucose production d/t insufficient intracellular glucose + insulin resistance
  • lipolysis to produce energy for cells
    • fatty acids in serum, ketone production (ketonemia)
  • metabolic acidosis d/t ketones and lactic acidosis
  • electrolyte imbalances
  • hyperglycemia –> osmotic diruesis
241
Q

examples of different aneurysms

242
Q

symptoms of superior vena cava syndrome

A
  • facial swelling
  • head fullness
  • headache
  • light-headedness
  • cough
  • upper extremity edema
  • chest pain
  • dysphagia
  • orthopnea
  • distorted vision
  • hoarseness
  • stridor
  • nasal stuffiness
  • nausea
  • pleural effusion
  • distended veins in chest wall and neck
  • change in mental status
243
Q

hypercalcemia

A
  • normals: 9-11 (critical = 13)
  • Sx: lethargy, anorexia, V, positive inotropy (increased contractility) w/ bradycardia
  • causes: primary hyperparathyroidism, malignancy, lithium, thiazide diuretics, associated w/ hypophosphatemia
  • Tx: diuresis, IV fluids, K phos, sodium phos
  • risk of pathologic fracture - fall precautions
244
Q

intraventricular hemorrhage

A

tends to occur in presence of very severe TBI and associated with poor prognosis

245
Q

stroke d/t SCD

A
  • sickled RBCs block small capillary beds
    • or can become emboli themselves, resulting in different types of stroke
  • rare occurence, but need to watch for S/Sx
  • age is not a limiting factor
246
Q

define croup

A
  • viral infection
  • common from 6 mo to 6 yrs with peak of 7-36 mo
  • children more prone b/c smaller airway, exposure
247
Q

symptoms of brain mets / increased ICP

A
  • headache
  • seizure
  • N/V
  • nuchal rigidity
  • photophobia
  • cognitive dysfxn
  • motor dysfxn
248
Q

cerebral angiogram

A

detects aneurysms and vasospasm

249
Q

common symptoms of anorexia/chachexia

A
  • fatigue
  • early satiety
  • taste changes
  • pallor
250
Q

why wouldn’t someone think they’re an addict?

A
  • job, not homeless
  • meds are legal, prescribed, not injecting
  • predisposed notion of what an addict is
251
Q

tests for hypercalcemi

A
  • BMP - hypokalemia, hyponatremia, hypophosphatemia
    • serum calcium > 11 mg/dl
  • ionized calcium - more accurate but more expensive
    • >5.6 mg/dl
252
Q

define malginant periardial effusion

A

abnormal collection of fluid in pericardial space

253
Q

symtoms of disseminated intravascular coagulation

A
  • bleeding that is difficult to stop
  • organ dysfxn
  • hypotension
  • bruising
  • hemoptysis
  • confusion - if bleeding into brains
254
Q

delirium and mortality

A

more episodes increases mortality

255
Q

benadryl in SCC

A

potentiates opiates to help with pain management

256
Q

types of cardiovascular oncologic emergencies

A
  • malignant pericardial or pleural effusion
  • superior vena cava syndrome
257
Q

nutrition in TBI patient

A
  • early initiation of enteral feeds (~48 hrs)
    • can be complicated by pressor administration
258
Q

define stroke

A
  • sudden neurological deficit d/t disturbance in cerebral perfusion
    • weakness to face or one side of body, HA, confusion, trouble speaking, abnormal gait
  • classification based on underlying problem of effected vessel
    • hemorrhagic or ischemic
259
Q

assessing cranial nerve V

A

trigeminal - facial sensation, corneal reflexes, jaw movement

260
Q

hyperventilation in ICP

A
  • blow of CO2
  • CO2 is potent vasodilator
    • body will blow off to vasoconstrict and try to compensate to decrease ICP
261
Q

function and types of glucocorticoids

A
  • glucose metabolism
  • prednisone, hydrocortisone, cortisol
262
Q

target cells

A

cells with receptors to certain hormones; hormones attracted to certain cells

263
Q

splenic infarct d/t SCD

A
  • very fine vasculature within spleen
  • quite often infarcted before puberty
  • removed d/t loss of tissue/necrosis
  • ramifications:
    • infection (almost always on chronic abx)
    • resistance (C.diff), GI issues, adherence
264
Q

what vitals are concerning for sepsis in NICU baby?

T: 38.6 HR: 180 RR: 92 BP:90/42

A
  • temp, HR, RR elevated
  • BP is normal
265
Q

acute N/V

A

w/in 24 hrs of chemo administration

266
Q

accessing PO opioids

A
  • easy to acquire
  • over prescription
    • dentists and orthos biggest violaters
    • huge scrips - 120+ pills
  • risks of buying on street
    • substitutions (w/ psych meds)
      • dystonic rxns
    • dealer running out + access to heroin
267
Q

brain temperature

A
  • 1 degree C higher than core temp
  • significant deviation may indicate change in perfusion
268
Q

mannitol to decrease ICP/metabolic demand

A
  • osmotic diuretic
  • increases plasma osmolality, pulling fluid to intravascular space
  • guided by ICP and serum osmolarity
    • overuse could result in hypovolemia and life threatening dysrrhythmias
  • don’t give mannitol with osm greater than 320 b/c blood is too concentrated and will suck too much water out of brain cells
  • also monitor I&O, EKG, BP, Na and K levels
269
Q

diffuse axonal injury

A
  • results in axonal damage from shearing forces d/t rapid acceleration-deceleration and rotation
  • presentation:
    • immediate coma
    • decortication
    • decerebration
270
Q

define cancer-related acute pain

A
  • no longer than 3 mo
  • most frequent cause is postop pain and oral mucositis
271
Q

sequelae of hyperleukocytosis

A
  • tumor lysis syndrome
  • disseminated intravascular coagulopathy
  • acute respiratory failure
  • pulm hemorrhage
  • CNS infarction
  • hemorrhage
  • splenic infarction
  • myocardial ischemia
  • renal failure d/t renal vessl leukostasis
  • priapism
272
Q

define hyperviscosity syndrome

A
  • triad of mucosal bleeding, visual changes, and neurologic symptoms
  • most commonly occurs in patients with plasma cell dyscracias (multiple myeloma)
273
Q

HHS S/Sx

A
  • neur: confusion, impaired sensorium, lethargy, blurry vision, weakness, coma
  • CV: tachy, hypotension, decreased CO
  • renal: polyuria
  • pulm: shallow, rapid respirations (NO Kussmaul)
  • GI: N/V, extreme thirst, hunger
  • skin: poor turgor, warm, flushed, dry mucous membranes
274
Q

non-thyroid illness syndrome (NTIS)

A
  • aka sick euthyroid syndrome
  • hypothyroid response to acute illness
  • possibly protective role
    • metabolic slowing to conserve energy during illness
  • synthroid not beneficial and may be harmful
  • TFTs difficult to interpret b/c of derangement in stress hormones
  • continue baseline synthroid if known hypothyroidism
275
Q

septic work-up

A
  • blood cultures
  • urine culture
  • lumbar puncture (LP)
  • CBC, BMP
276
Q

CT scan

A
  • identifies
    • hemorrhages
    • ventricular size
    • atrophy
    • lesions
277
Q

S/Sx of increased ICP

A
  • headache
  • N/V
  • visual disturbances
  • gait disturbances (ataxic - wide - cerebellar dysfunction)
  • altered LOC
  • confusion, change in character
  • pupillary dilation (late sign)
    • cranial nerve compression, herniation
278
Q

secondary complications of increased ICP

A
  • pneumonia
  • infection
  • skin breakdown
  • gastric ulcers
  • DVT/PE
  • bowel obstruction
279
Q

monitoring tumor lysis syndrome

A
  • continuous tele
  • EKG
  • strict I/O - Foley
  • frequent labs
280
Q

level of consciousness

281
Q

additional management of diarrhea in cancer patients

A
  • increase PO fluid intake
  • restrict dairy and/or fiber intake
  • fecal management system
282
Q

decompressing craniectomy to decrease ICP/metabolic demand

A
  • precautions r/t turning and patient care
  • helmet OOB until flap replaced
283
Q

regulation of blood glucose

A
  • insulin secreted by beta cells of pancreas in resonse to an increased blood sugar
  • glucagon produced by alpha cells of pancrease to stimulate gluconeogenesis by liver
284
Q

examples of prerenal kidney injury:

arterial occlusion

A

thromboembolism

285
Q

DSM-V PTSD

A
  • trigger: exposure to actual or threatened death, serious injury or sexual violation via:
    • direct experience
    • witnessing in person
    • learns it occurred to close family member or friend
    • experiences first-hand repeated or extreme exposure to aversive details of traumatic event
286
Q

symptom management during dying

A
  • oral liquid morphine
  • anxiolytics
  • glycogyrrolate or scopalamine
  • indwelling urinary cath
287
Q

causes of increased ICP

A
  • cerebral edema
  • mass lesions
  • trauma
  • increased blood volume
  • increased CSF volume
    • some type of outflow obstruction
  • combination
288
Q

adverse effects from olanzapine (Zyprexa)

A

weight gain

289
Q

colloids

A
  • large (proteinaceous or starchy) molecules that increase oncotic pressure in intravascular space
    • attracting fluid to intracellular space to expand blood volume
    • plasma and volume expander
  • technically hypertonic
  • hespan, albumin, blood products
290
Q

tests for malginant pleural effusions

A
  • chest CT
  • ultrasound of fluid collection
  • thoracentesis
    • diagnostic & therapeutic
291
Q

common causes of thrombocytopenia

A
  • disseminated intravascular coagulation
  • myelodysplastic syndrome
  • leukemia
  • cirrhosis
  • splenomegaly
  • infection
292
Q

temporal lobe functions

A
  • speech
  • memory
  • hearing
293
Q

treatment for hyperleukocytosis

A
  • hydrea for acute leukemia
  • leukopheresis
  • hydration
  • urine alkalinization
    • promotes uric acid excretion
294
Q

CBF

A
  • cerebral blood flow
  • r/t cerebral perfusion
  • may need to estimate via CPP
295
Q

course of delirium

A
  • often reversible with treatment
  • often fluctuates over 24 hour period and often worse at night
296
Q

refractory pain management for cancer patients

A
  • intraspinal techniques
    • intrathecal injections
    • implanted devices
      • reservoirs or pumps
297
Q

impulsive loading r/t TBI

A
  • mechansim of primary injury
  • sudden motion without significant physical contact
298
Q

government protections r/t financial burden of cancer care

A
  • family medical leave act
  • COBRA
299
Q

brain oxygenation

A
  • PbtO2
  • normal range 25-50 mmHg
  • <20 = cerebral hypoxia
300
Q

purpose of neurological examination

A
  • determine presence of nervous system dysfunction
  • establish neurological database- know baseline
  • systemic step by step approach
301
Q

etiologies of Cushing’s

A
  • iatrogenic via steroid administration
  • ACTH-producing pituitary lesion
  • adrenal cortical adenoma or carcinoma
  • ACTH or CRH producing cancers of other organs
  • true primary adrenal hyperplasia
  • Cushingism with burst of cortisol after eating
  • recurrent Cushingism of pregnancy
302
Q

thinking associated with depression

A

reduced memory, concentration and thinking, low self-esteem

303
Q

decerebration

A
  • hyperextension of both upper and lower extremities
  • lower down injury
304
Q

course of dementia

A
  • slow, chronic progression
  • irreversible
305
Q

common causes of neutropenia

A
  • congenital neutropenia
  • aplastic anemia
  • acute leukemia
  • myelodysplastic syndrome
  • bone marrow tumor infiltration
  • bone marrow fibrosis
  • radiation
  • infection
  • chemo - side effect or goal, depending on cancer
306
Q

overview of neutropenic fever

A
  • fever in setting of neutropenia
  • criteria:
    • oral temp > 100.4
    • WBC < 1,000/ul
  • can progress rapidly to septic shock d/t compromised immune system
307
Q

examples of prerenal kidney injury:

drugs altering renal perfusion, nephrotoxic

A
  • ACE inhibitors, ARBs
    • renal protective unless BP is too low
  • NSAIDs
  • ampotericin B - antifungal (IV)
  • contrast agents - need hydration, hold other nephrotoxic agents
  • cyclosporine
308
Q

clinical manifestations of Addison’s disease

A
  • weakness
  • GI Sx
  • dark pigmentation
  • hypotension, hypoglycemia
  • hyponatremia, hperkalemia, hypercalcemia
  • change in mental status
309
Q

skull fractures

A
  • type depends on speed, force of object and direct
  • classification:
    • linear
    • comminuted
    • depressed
    • basal
      • battle sign/racoon’s eyes
      • rhinorrhea/otorrhea
310
Q

cortex

A
  • outside of adrenal glands
  • mediates body’s stress response
  • produces
    • glucocorticoids
    • mineralcorticoids
    • androgens
311
Q

other interventions for brain mets / increased ICP

A
  • symptom management
    • pain
    • anti-emetics (extreme nausea)
  • fall precautions - gait is off
  • seizure precautions
  • initiate goals of care discussion if prognosis is poor
312
Q

causes of myxedema coma

A
  • autoimmune thyroditis
  • drug-induced hypothyroidism
    • lithium, amiodarone
  • precipitated by pneumonia, infections, cardiac events
  • non-adherence to thyroid-replacement regimen
313
Q

define dementia

A
  • gradual and progressive decline in mental processing ability that affects:
    • short-term memory
    • communication
    • language
    • judgment
    • reasoning
    • abstract thinking
  • eventually affects long-term memroy and ability to perform familiar tasks
  • sometimes changes in mood, behavior
314
Q

types of pain in cancer patients

A
  • acute
  • chronic
  • breakthrough
  • refractory
  • nociceptive
  • neuropathic
315
Q

assessment/diagnostic findings of HHS

A
  • serum glucose > 600
  • hyperosmolality > 320
  • pH > 7.30
  • ketones absent
  • hyperkalemia, hypernatremia
316
Q

pathophysiology of Cushing’s Triad

A
  • when MAP < ICP, hypothalamus increases sympathetic stimulation of heart
    • vasoconstriction
    • increased contractility
    • increased CO
  • increase in BP detected by baroreceptors in carotids, triggering parasympathetic response via vagal stimulation and bradycardia
  • indicates imminent herniation
317
Q

signs of basilar skull fracture

A
  • battle’s sign - ecchymosis of mastoid process
  • raccoon eyes
  • CSF rhinorrhea or otorrhea
  • cranial nerve palsy
  • bleeding from nose and ears
  • hemotympanum
318
Q

assessing cranial nerve II

A

optics - visual actuity, visual fields

319
Q

how to know if dependence/addiction or physiological

A
    • opioids and symptoms stop = dependence or addiction
    • opioids and symptoms return = likely physiological
320
Q

function and types of mineralcorticoids

A
  • Na-K metabolism
  • aldosterone
    • increases Na reabsorption by renal tubules
    • water follows sodium
321
Q

transcranial doppler

A

evaluates cerebral blood flow

322
Q

tests for superior vena cava syndrome

A
  • CXR
  • chest CT
  • MRI
  • venography
323
Q

ventricular drainage in increased ICP

A
  • drain small amounts to decrease ICP
    • <20 ml/hr
  • assess CSF
    • color, flow
  • aseptic technique
    • during dressing changes at cath site
    • during ventric-bag changes
324
Q

medications to intubate children

A

versed (midazolam) for sedation and anxiolytic

325
Q

incidence of N/V in cancer patients

A

70-80% of patients receiving chemo

326
Q

positive Sx of schizophrenia

A
  • delusions
  • thought disorders
  • hallucinations
  • movement disturbances
    • i.e. catatonia
327
Q

methadone

A
  • opioid, narcotic - difference is in dosage
  • when patients are addicted, seek detox and methadone clinic (~65 mg)
  • why on methadone?
    • stability, routine, eliminate risky behaviors, lower high, withdrawal management
  • 5-10 mg likely means chronic pain
328
Q

epidural hematoma

A
  • above the dura mater
  • impact loading results in damage to dural arteries or veins, ofen by fractured skull
329
Q

legislation/awareness re: TBI

A
  • Michelle Obama mandated the Nation study these
    • many sports players have asked the same
  • increasing awareness due to public figures
    • new weapons and tactics in current wars
      • IED combined with advanced trauam services produce surviving vets with brain damage
330
Q

endocrine hormone secretion

A

hormone distrubted in blood and binds to distant target cells

331
Q

licox

A
  • triple lumen catheter to monitor ICP, brain temp (bT), and brain oxyenation (PbtO2)
  • placed in white matter in penumbra (shadow) of injury to reflect oxygen and temp of involved tissue
    • place in at-risk tissue
332
Q

treatment for tumor lysis syndrome

A
  • aggressive IV hydration
  • allopurinol
  • febuxostat
  • rasburicase
  • IV glucose + insulin
    • for severe hyperkalemia
  • oral phosphate binder
  • hemodialysis
333
Q

percocet

A
  • opioid
    • Mu agonist
  • nerve forms more mu receptors - need more opiodis
  • if mu receptors are not hit, you experience pain and withdrawal
334
Q

hypocalcemia

A
  • normals: 9-11 (critical = 6.5)
    • total impacted by serum albumin
  • Sx: neuromuscular irritability, tetany, seizures, prolonged QT
  • causes: sepsis, acute or chronic kidney dx, hypomagnesemia, vit D deficiency, citrate administration
  • tx: calcium gluconate (continuous + bolus)
    • correct hypocalcemia before any acidosis b/c acid correction will further decrease ionized Ca levels
335
Q

symptoms of moderate to severe TBI

A
  • headache that won’t go away
  • repeat N/V
  • slurred speech
  • convulsions or seizures
  • inability to wake up from sleep
  • pupil dilation (one or both)
  • numbness/tingling of arms/legs (long term)
  • loss of coordination (long term)
  • increased confusion, restlessness, or agitation (long term)
  • LOC lasting few min to hours
336
Q

define anemia

A
  • decrease in circulating RBCs
  • < 12 gm/dl
337
Q

breakthrough pain management for cancer patients

A
  • opioids (almost exclusively)
    • 10-20% of total daily basal dose
  • do not usually use opioid/acetaminophen combos (percocet) b/c of fever masking
338
Q

tests for spinal cord compression

A
  • x-ray
  • MRI
  • CT
  • myelogram
  • electromyelogram (EMG)
339
Q

S/Sx of Cushing’s

A
  • truncal obesity with buffalo hump and moon face
  • thin extremities
  • thin fragile skin, bruising, slow healing
  • hyperglycemia, hypernatremia
  • water retention, edema, HTN, cardiac failure
  • incrased appetite
  • insomnia, mental status changes
  • osteoporosis
  • loss of normal circadian rhythm
340
Q

monitoring devices for ICP

A
  • intraventricular catheter - can drain CSF to manipulate ICP
  • subarachnoid bolt
  • epidural/subdural cath
  • fiberoptic transducer-tipped cath
341
Q

assessing cranial nerve VII

A

facial - facial movements and gustation

342
Q

clinical manifestations of myxedmea coma

A
  • hypothermia
  • mental status depression
  • bradycardia, hypotension
  • hypoventilation and resp failure
  • adrenal insufficiencies (everything slowing down)
  • nonpitting peripheral edema
  • periorbital edema
  • delayed DTRs
343
Q

resources for financial burden of cancer care

A
  • government entitlements
    • low income, elderly, disabilities
  • pharmaceutical patient assistance programs
  • cancer organizations
  • faith-based organizations
344
Q

conjunctive in SCD

A
  • washed out - looks like clay
  • hands and nail beds
  • b/c of low H&H and anemia
    • not getting enough blood flow
345
Q

why tight glycemic control?

A
  • decrease morbidity and mortality
  • frequent blood glucose monitoring and titration of IV insulin
  • protocols institution specific
  • benefits:
    • decreased LOS, infection, operative mortality
    • improved long-term prognosis
  • most helpful in CT surgery population, possibly harmful in MICU population
346
Q

treatment of septic shock

A
  • broad spectrum IV abx
  • tylenol (not for pain b/c fever masking)
  • IV fluid resuscitation
  • vasopressors
  • oxygen
347
Q

contracoup injury

A

occurs on opposite side of direct impact from rapid acceleration-deceleration

348
Q

incidence of pain in cancer patients

A

20-75% report pain

349
Q

causes of Addisonian crisis

A
  • acute injury or infection of adrenals
  • critical illness in pt with chronic adrenal insufficiency
  • abrupt cessation of corticosteroid therapy
  • ketoconazole and etomidate
    • interfere with steorid biosynthesis
  • rifampin
    • increases corticosteroid clearance (seen in HIV)
350
Q

blast injury

A
  • special TBI
  • pressure wave causes trauma in addition to coup/ contracoup
351
Q

diagnostic findings in DKA

A
  • BG: mild 250-300; severe >300-900
  • pH: mild < 7.30; severe < 7.20
  • hCO3: <15
  • anion gap: >17
    • indicates accumulation of fixed acids in serum (ketone) leading to acidosis
352
Q

ideal glucose levels on different floors

A
  • ICU: 80-100
  • floors: 140-180
  • glycoslyated hemoglobin (A1c): <6.5%
353
Q

SCC triggers

A
  • stress
  • weather change
  • infection
  • acidosis
    • exercise, stress, infection
  • mostly idiopathic
354
Q

thinking associated with dementia

A

fluctuations in alertness, cognition, perceptions, thinking

355
Q

hyperkalemia

A
  • normals: 3.5-5.3 (critical = 6)
  • Sx: EKG changes (peak T, prolonged intervals, bradycardia, cardiac arrest), weakness, N/V/D
  • cause: kidney injury, acidosis (shift from intracellular space), tissue breakdown, skipped dialysis
  • Tx: treat cause, kayexelate, calcium gluconate (cardioprotective), insulin/D50 to temporarily move K intracellular
  • caution: monitor BUN/Cr b/c acute renal failure puts pt at risk for hyperkalemia
356
Q

define delusion

A

idiosyncratic belief or impression that is firmly maintained despite being contradicted by what is generally accepted as reality or rational argument

357
Q

managing delirium

A
  • abx for infection, remove unnecessary invasive lines
  • IV fluids, oxygen therapy
  • use meds that cause delirium with caution
  • manage pain
  • remove restraints
  • toilet frequently
  • encourage pt to wear glasses, hearing aids
  • calm, quiet environment, familiar objects
  • call bell, environmental interventions
358
Q

S/Sx DKA

A
  • neuro: impaired sensorium, confusion, lethargy, blurry vision
  • CV: hypotension, tachy, peak T, wide QRS
  • pulm: rapid shallow breathing, fruity breath –> Kussmaul
  • gen: weakness, S/Sx dehydration, elevated BG (as low as 250 in T1DM)
  • GI: N/V/D, abd pain, thirst, hunger, absent bowel sounds
  • renal: polyuria
  • skin: warm, flushed, dry mucous membranes
359
Q

diagnosing myxedema coma

A
  • increased TSH, decreased T3, T3
  • hyponatremia, hypoglycemia
  • resp acidosis
  • ECG changes
    • sinus brady, t-wave depression, st changes, prolonged RT and QT intervals
360
Q

symptoms of thrombocytopenia

A
  • purpura
  • petechiae
  • prolonged or unusual bleeding
    • mouth bleeding after brushing in undiagnosed pts
  • fatigue
  • enlarged spleen
  • jaundice
  • change in mental status - esp. with head bleed (can be spontaneous)
361
Q

top cancer deaths in 2016 by type

A
  • lung and bronchus
  • colorectum
  • pancreas
  • breast
  • liver and intrahepatic bile duct
  • prostate
362
Q

top 3 differential diagnoses:

barky cough, intercostal and suprasternal retractions, + hoarseness when crying, + stridor at rest

VS: T 38.5, HR 150, RR 45, BP 117/77, ox 95% on RA

A
  • croup - edema in upper airway
  • epiglottitis
  • upper airway obstruction - constriction or foreign body
363
Q

pathophysiology of tumor lysis syndrome

A
  • tumor cells break open d/t chemo
  • release intracellular contents
  • causes metabolic disturbances (electrolyte)
364
Q

correction of fluid / Na++ balance after hyponatremia

A
  • slow to avoid permanent neurological injury
    • central pontine myelinolysis (locked in syndrome)
    • breakdown of myelin sheath (specifically in pons)
      • loss of voluntary motor fxn with preservation of cognitive fxn
  • sodium deficit:
    • formula based on weight, gender, actual, desired Na levels
    • should not exceed 1-2 mEq/L q24 hr or 8-12 mEq/L/day
365
Q

haloperidol (Haldol) and olanzapine (Zyprexa) interaction

A
  • increase antidopamine effects
    • severe muscle stiffness or spasms
    • difficulty speaking or swallowing
    • restlessness, tremor
    • uncontrollable muscle or facial movements
366
Q

questions to ask after TBI discharge

A
  • who do you live with?
  • how well do they take cae of you?
  • will they be comfortable if you stay with them?
  • do you have a job?
367
Q

increased intracranial pressure r/t mechanism of TBI

A
  • mechanism of secondary injury
  • Monro-Kellie hypothesis: if volume of one (brain, CSF, blood) increases, the others must decrease or ICP will rise
  • may lead to:
    • hypoxia, ischemia
    • edema (loss of vasomotor autoregulation and dilation of vessels - hyperemia)
    • hydrocephalus (d/t outflow obstruction)
    • herniation
368
Q

define Addisonian crisis

A

acute event which may result in hypotension, circulatory collapse, and shock

369
Q

causes of intracranial hematomas

A
  • head injury
  • ruptured blood vessel
370
Q

why would hyponatremia cause cerebral edema?

A
  • responding to osmotic pressure that is too low
  • body sends water to intracellular space to compensate
    • cerebral edema
371
Q

team interventions to decrease ICP/metabolic demand

A
  • mannitol
  • seizure management
  • maintaining normothermia
  • sedation/analgesia
  • hypertonic saline
  • decompressing craniectomy
372
Q

types of neurologic oncologic emergencies

A
  • spinal cord compression
  • brain mets / increased ICP
373
Q

define craniocerebral trauma

A

injury to skull and or brain that is severe enough to interfere with normal brain function and will need treatment

374
Q

priapism r/t SCD

A
  • extended erection > 4 hrs
  • treatments:
    • PO pseudoephedrine (60 mg)
    • terbutaline 0.25 mcg SQ
    • phenylephrine 0.5 mg IV intracorporeal (into penis)
    • cavernous aspiration - draining (urology)
      • 14 g needles to get thick blood out
375
Q

assessing cranial nerves III, IV, VI

A
  • oculomotor, trochlear, abducens - extra-ocular movements
  • ptosis - III nerve palsy
  • nystagmus
376
Q

define aneurysm

A

weakened section of cerebral artery that develops outpouching filled with blood

377
Q

frontal lobe functions

A
  • recognize future consequences resulting from current actions
  • choose between good and bad actions
  • override, suppress unacceptable social responses
  • determine similarities and differences between things and events
378
Q

Romberg sign

A
  • patient standing and circulating around trying to maintain balance
  • cerebellar injury
379
Q

psych assessment

A
  • presenting problem, cheif complaint, patient persepctive
  • medical - head/brain injuries, surgeris, admissions, where they get care
  • surgical, psychiatric history
  • social hx - living situation, family, friends, caregivers
  • med reconcilitation (past and present) - on/off meds, combo meds, too many/few meds
  • mental status:
    • appearance, behavior, mood, speech, affect, through process, insight, judgment
380
Q

define cancer-related chronic pain

A
  • 3 or more months
  • most frequent cause is bone mets
381
Q

common causes/factors of cancer-related diarrhea

A
  • tumors
  • chemotherapy
    • can be a dose limiting side effect for certain chemos d/t electrolyte/fluid imbalances
  • raditaton to abdomen or pelvic region
  • graft vs host disease in patients who received allogeneic stem cell transplant
382
Q

plan of care for croup

A
  • bronchodilator
  • antipyretic
  • steroid (anti-inflammatory)
  • fluids (decrease in PO, fever increases metabolic rate to lead to dehydration)
  • warm/moist air to thin secretions
    • or cold air to reduce inflammation
    • whatever works for patient
383
Q

early and late signs of increased ICP

384
Q

hypo/hyperchloremia

A
  • normals: 95-105
    • derangements rarely seen in absence of other electrolyte problems
  • chloride follows sodium, competes with bicarb for sodium ions
    • most common cause of hypochloremia is bicarb administration for pH correction
    • also in CF patients b/c inappropriate salt excretion via sweating
  • hyperchloremia may cause Sx similar to hypernatremia
385
Q

define dependence

A

physiological need for a substance, in this case, unfilled and overabundant mu opioid receptors

386
Q

pathophysiology of hypercalcemia

A
  • osteolytic metastasis with local release of cytokines
  • tumor secretion of parathyroid hormone-related protein
  • tumor production of colcitriol
387
Q

symptoms of SIADH

A
  • confusion / disorientation
  • generalized muscle weakness
  • myoclonus
  • tremor
  • hyporeflexia
  • ataxia
  • dysarthria
  • Cheyne-Stokes respiration
  • seizures
  • coma
388
Q

most common cause(s) of renal injury

A
  • pre-renal
  • interfering with blood flow to kidneys
    • absolute or relative hypovolemia
    • arterial occlusion
  • alteration of glomerlar hemodynamics due to drugs
389
Q

lab values suggesting adrenal insufficiency

A
  • hyponatremia, hyperkalmia
  • acidosis
  • hypoglycemia
  • eosinophilia
  • increased serum cr and BUN
390
Q

types of metabolic oncologic emergencies

A
  • hypercalcemia (most common)
  • tumor lysis syndrome
  • SIADH
391
Q

issues with financial burden r/t cancer

A
  • some meds not covered by insurance
  • lost income
  • out of pocket tx or related care
392
Q

define delirium

A
  • medical emergency characterized by acute and fluctuating onset of:
    • confusion
    • attention disturbances
    • disorganized thinking
    • and/or decline in LOC
  • cannot be accounted for by preexisting dementia
    • but can coexist with dementia
393
Q

what does this blood gas show?

  • ph: 7.20
  • CO2: 64.2
  • HCO3: 24.8
  • BE: -3.8
  • Hgb: 7.8
  • Hct: 24%
A

uncompensated respiratory acidosis with hypoxemia

394
Q

nursing care of acute chest

A
  • assume all CP in SCD is acute chest
  • assessments:
    • assess patient
    • oxygen
    • EKG
    • call medical team
    • telemetry
  • consider rapid response if on medical floor and pt becomes unstable or has change in vitals or status
395
Q

ataxic breathing

A
  • common in ICP
  • dysregulated breathing
396
Q

vital signs suggesting adrenal insufficiency

A
  • fever
  • tachycardia
  • orthostatic hypotension
  • hypotension refractory to volume or vasopressor agents
397
Q

treatment for SIADH

A
  • caution in correct hyponatremia
    • rapid correction can cause neuro complications
  • hypertonic saline IV
  • loop diuretics w/ saline
  • vasopressin-2 receptor antagonists
  • water restriction
398
Q

nurses’s role in an LP on a NICU patient

A

hold patient in lateral decubitus

399
Q

define hypoglycemia

A

blood glucose <70 mg/dl

400
Q

autocrine hormone secretion

A

hormone acts on same cell that produced it

401
Q

“transient” Cushing’s syndrome

A
  • metabolic stress response 2/2 acute illness
  • dramatic increase in cortisol production
  • undesirable effect on serum glucose
    • insulin resistance
    • risk of stress ulcers
    • loss of normal circadian rhythm (sundowning)
    • loss of lean muscle mass
402
Q

types of primary injuries r/t TBI

A
  • skull fracture: leading to hematoma, cranial nerve damage, incresed brain injury
  • auditory/vestibular dysfxn: trauma to temporal region resulting in hearing loss or vertigo
  • intracranial hemorrhage
  • coup and contracoup contusions
  • concussion: deformity of deep structures, mild DAI
  • diffuse axonal injury
  • penetrating injury
403
Q

tests for malignant pericardial effusion

A
  • CXR
  • echo
  • chest CT
  • pericardiocentesis - to diagnose
404
Q

common causes of delirium

A
  • meds - benzo, narcotics, anticholinergics, beta blockers, steroids, NSAIDs, digoxin
  • alcohol or benzo withdrawal
  • infection, inflammation
  • metabolic - kidney, liver, thryoid disease; hypo/erglycemia
  • stress - surgery, sleep, pain, hypoxia, environmental changes
  • fluids, electrolytes, nutrition - dehydration, electrolyte alterations
  • brain disorder - CNS infection, head injury
405
Q

adverse effects of anticholinergics

A
  • hot as a hare
  • blind as a bat
  • dry as a bone
  • red as a beet
  • mad as a hatter

extra pyramidal Sx

  • can’t see, can’t pee
  • can’t spit, can’t shit
406
Q

hospice care

A
  • life expectancy > 6 mo
  • cessation of treatment
  • quality of life, comfort care
  • not a death setnence
  • in patient or home
407
Q

coup injury

A

occurs right under area of impact

408
Q

tests for disseminated intravascular coagulation

A
  • PT/PTT - high
  • fibrinogen - low
  • d-dimer - high
  • CBC - platelets and hemoglobin low
409
Q

postrenal kidney injury

A
  • blockage of urine outflow from kidney
  • usually reversible if obstruction is removed
  • hydronephrosis shown on imaging
410
Q

assessing cranial nerve XII

A

hypoglossal - tongue protrusion

411
Q

treating myxedema coma

A
  • cardiac, resp stabilization
  • rapid thyroid hormone replacement
    • possibly exogenous steroids too
  • rewarming
  • infection control
412
Q

onset of dementia

A

gradual deterioration over months to years

413
Q

types of hematologic oncologic emergencies

A
  • hyperviscosity syndrome
  • hyperleukocytosis
  • disseminated intravascular coagulation
414
Q

moderate-late signs of respiratory distress in children

A
  • cyanosis
  • tripod (more moderate)
  • stupor/unconscious
415
Q

contents of skull

A
  • brain matter 80%
  • intravascular blood 10%
  • CSF 10%

if derangement of fluid or pressure exceeds capacity to compensate, tissue starts dying

if brain has nowhere to go, will herniate through spinal cord

416
Q

stridor

A
  • comes from upper airway
  • when at rest:
    • not giving effort
    • patient should be in state of relaxation and not working to breathe
417
Q

major categories of cancer

A
  • carcinoma - skin, tissue lining internal organs
  • sarcoma - bone, cartilage, fat, muscle, blood vessels, connective/supportive tissue
  • leukemia - blood, bone marrow
  • lymphoma & myeloma - immune system
  • CNS cancers - brain and spinal cord
418
Q

pathophysiology of HHS

A
  • insulin deficiency initiates
  • small amounts of insulin prevents ketosis by inhibiting lipolysis
  • decreased glucose utilization –> increased hepatic glucose output
  • fluid shifts intracellular to extracellular to offest hyperosmolarity
  • severe dehydration may cause renal insufficiency
    • further increases serum glucose
  • slower onset than DKA
419
Q

treatment for thrombocytopenia

A
  • platelet transfusions
  • cessation of injurious agent
420
Q

prioritize: blood culture, urine culture, CBC, LP on a NICU baby

A

do the LP last - will stress them out and the other tests can run in the meantime

421
Q

monitoring hypercalcemia

A
  • continuous tele
  • EKG
  • strict I/O
  • frequent labs (3x/day depending on severity)
422
Q

tests for SIADH

A
  • BMP
    • hyponatremia
    • BUN/creat
  • 24 hr urine collection
    • hypo-osmolality
423
Q

Cosyntropin stim test

A
  • basline ACTH and cortisol levels drawn
  • administer exogenous ACTH
  • levels of cortisol checked at 3o and 60 min post administration
  • normal adrenal function should bump cortisol levels with ACTH
    • Addison’s won’t bump
424
Q

hormones

A

chemical messengers

425
Q

impact loading r/t TBI

A
  • mechanism for primary injury
  • collision of head with a solid object at tangible speed
426
Q

S/Sx of sepsis in neonate

A
  • elevated vitals
  • difficult to arouse
427
Q

types of secondary injuries r/t craniocerebral trauma

A
  • hypoxemia - delayed ischemia, infarct
  • hypotension - low CPP
  • sustained increased ICP - alterations in flow and balance of skull contents
  • acid-base balance - many body processes require enzymatic control with optimal pH range
  • hyperthermia - increases metabolic demand
428
Q

classifying craniocerebral trauma

A
  • location
  • GCS
  • type of injury
  • mechanism of injury
429
Q

define addiction

A

violation of social boundaries to feed the dependence and acquire drugs

430
Q

managing neutropenic fever

A
  • broad spectrum abx
  • vanco if the following is suspected:
    • catheter-related infections
    • known conolization with penicillin/cephalosporing resistant pneumoccoci or MRSA
    • blood cultures for gram+ bacteria
    • hypotension
    • severe mucositis
  • tx for neutropenia can help resolve fevers
    • granulocyte colony stimulating actors (neupogen)
431
Q

ionized vs total calcium

A
  • ionized is free, bioavailable calcium (has a charge)
  • ionized more accurate in critical illness
    • represents bioavailable Ca
  • binds strongly (esp. to proteins aka albumin) but also to other molecules
  • ionized is the clinical concern - need nutrition panel (albumin) to calculate ionized calcium
    • usually from arterial draw
432
Q

interventions when herniation is imminent

A

OR and mannitol (need huge needle b/c it’s thick)

433
Q

prevalance of brain mets / increase ICP in cancer patients

A
  • 24-45% of cancers metastaize to brain
  • can lead to increased ICP
434
Q

what is a TBI

A
  • brain insult that results from mechanical disruption of brain tissue from external impact or injury to head
  • term “closed-head injury” not preferred b/c brain is the focus of injury and treatment
435
Q

seizure and normothermia management in decreasing ICP/metabolic demand

A
  • seizures and shivering increase metabolic demand
  • dilantin and ativan to manage sz
  • antipyretics to manage normothermia
    • cooling blanket PRN
    • paralytics to control shivering
436
Q

gentamicin

A
  • requires peak/trough levels
    • d/t ototoxicity or nephrotoxicity
  • nurse responsibility
    • dont between 3rd and 4th dose (peak right after 3, trough right before 4)
437
Q

examples of prerenal kidney injury:

relative decrease in blood volume (ineffective blood volume)

A
  • decreased CO:
    • heart failure
    • MI
  • sepsis
  • shock states

Leadership (6 decks)

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