T1 - Blueprint (Josh) Flashcards
1
Q
Skin Assessment:
How often does the epidermis regenerate?
A
q 28-45 days
2
Q
Skin Assessment:
Which layer of skin is responsible for temp regulation, homeostasis?
A
Epidermis
***also site of Vit D metabolism
3
Q
Skin Assessment:
What are petechiae a sign of?
A
increased capillary fragility and venous stasis
4
Q
Skin Assessment:
How are moles (lesions) assessed?
A
ABCDE
A - assymetry of shape B - border irregularity C - color variations within one lesion D - diameter greater than 6 mm E - evolving or changing features
5
Q
Skin Assessment:
Which diagnostic test tests for FUNGAL infections?
Which diagnostic test tests for BACTERIAL infections?
Which diagnostic test tests for VIRAL infections?
A
KOH (Potassium Chloride) - Fungal
C and S - Bacterial
Tzanck Smear - Viral
6
Q
Skin Problems:
When does the Proliferative Phase of wound healing begin and how long does it last?
A
day 4 to 2-3 wks
7
Q
Skin Problems:
Which type of wound closure has loss of tissue?
A
Second Intention (has a cavity)
8
Q
Skin Problems:
What is the characteristic appearance of Psoriasis?
A
silver appearance scaling or skin
9
Q
Skin Problems:
What are the medications used to treat Psoriasis?
A
Corticosteroids (Triamcinolone Acetonide)
Tar Prep
Anthralin
Calciptriene
Tazarotene
UV B Light Therapy
PUVA Therapy
Systemic Meds
10
Q
Skin Problems:
Which type of Keratosis is pre-cancerous?
A
Actininc Keratosis
***sebhorric keratosis is NOT pre-cancerous
11
Q
Skin Problems:
Which type of skin cancer is the following:
rough, scaly lesion with central ulceration and crusting
A
Squamous Cell Carcinoma
12
Q
Skin Problems:
Which type of skin cancer is the following:
small, waxy nodule with superficial blood vessels
has well-defined borders
A
Basal Cell Carcinomas
13
Q
Skin Problems:
Which type of skin cancer is most serious?
A
Melanomas
***Use ABCDE to self-examine
14
Q
Skin Problems:
What are some BACTERIAL skin infections?
A
Folliculitis
Furuncles
Cellulitis
MRSA
15
Q
Skin Problems:
What are some VIRAL skin infections?
A
Herpes Type 1 and 2 (genital)
Herpes Zoster (chickenpox and shingles)
16
Q
Skin Problems:
What are some FUNGAL skin infections?
A
Tinea Pedis
Tinea Cruris
Tinea Capitis
Tinea Corporis
Candidas Albacans (yeast infection)
17
Q
Burns:
Which type of burn blisters?
A
2nd Degree Superficial (Partial Thickness)
18
Q
Burns:
Which type of burns blanch?
A
1st Degree (Superficial)
2nd Degree Deep Dermal (Partial Thickness)
***if they blanch, they don’t blister
19
Q
Burns:
How long does it take a 1st Degree burn to heal?
A
2-7 days
20
Q
Burns:
Which type of burns are painful?
A
1st and 2nd Degree
21
Q
Burns:
Which burn fits this description:
- pale white, charred
- deep red, black, brown
- dry, leathery surface
- severe edema
- fat exposed
- tissue disrupted
- no blisters
A
3rd Degree (Full Thickness)
22
Q
Burns:
Why would someone with Full Thickness burns urinate blood?
A
hemolysis
23
Q
Burns:
Which full thickness burn has edema?
Which full thickness burn has NO edema?
A
Full Thickness (3rd Degree)
Deep Full Thickness
24
Q
Burns:
What are examples of thermal burns?
A
steam
scalds
fire
25
Burns:
What is main concern with electrical burns?
cardiac arrest
***depth of burn; Rule of 9's doesn't apply
26
Burns:
What are signs and symptoms of Inhalation Injury?
SOB; dyspnea
Hoarseness
Stridor
Flaring
Tachypnea
Burns to face, neck, mouth
Sooty sputum
Singed facial hair
Swelling of face, neck, trachea
27
Burns:
What is the patho of inhalation injury?
CO binds to Hgb and decreases O2 delivery and hypoxemia occurs
28
Burns:
What else does smoke do to lungs?
decreases surfactant and may cause ARDS, brochospasm, atelectasis, edema, and infections
29
Burns:
What is treatment regiment for Inhalation Injury?
100 percent FiO2 ASAP
Early Intubation
Rest
Maintain Airway
May need PEEP (expect them to get ARDS)
30
Burns:
What are the phases of Burn Care?
Resuscitation Phase
Acute Care Phase
Rehab Phase
31
Burns:
What are the labs like in the first 24 hrs of the Resuscitation Phase?
HCT and Hgb elevated (due to third spacing)
Na+ decreased (due to third spacing)
K+ increased (due to cell destruction)
WBC initial increase then left shift
Glucose elevated due to stress
ABG slight hypoxemia and metabolic acidosis
Protein and Albumin low due to fluid loss
Carboxyhemoglobin elevated
32
Burns:
What happens to labs after 48-72 hrs of the Resuscitation Phase
Hgb and HCT decreased (due to fluid shift back into vasscular space)
Na+ remains decreased( due to renal and wound loss)
K+ decreased (due to renal loss and mvmt back into cells)
33
Burns:
How long does the Resuscitation Phase last?
until plasma vol is restored
34
Burns:
What is circulation like during Resuscitation Phase?
Hypovolemia
Increase HR
Decrease CO
Decrease CVP
Decrease UOP
35
Burns:
What would be the GI assessment during the Resuscitation Phase?
SNS (Fight of Flight) Response
- slowing of motility
- ileus
- Curling's Ulcer (give H2 blockers)
36
Burns:
What would the Metabolic condition be during Resuscitation Phase?
Hypermetabolic (needs lots of calories)
***but you don't want to give if they have no motility
37
Burns:
What is the management goal during Resuscitation Phase?
Hemodynamic Stability
- keep UOP 0.5-1 mL per kg per hr
- keep SBP above 90
- large bore IV with LR Bolus (expect to gain 15% base weight in emergent phase)
38
Burns:
When is the Acute Care Phase?
36-72 hrs after injury
39
Burns:
What is the hallmark characteristic of the Acute Care Phase?
diuresis
40
Burns:
Which type is painful: Silver Sulfadiazine or Mefenide Aceetate?
Mefenide Aceetate
41
Burns:
If Mefenide Aceetate is more painful that Silver Sulfadiazine, what is the reason we would choose to give it?
it can penetrate the eschar better than S.S
42
Burns:
What is the DOC for electrical burns?
Mefenide Aceetate
***give 2 x's a day
43
Burns:
Silver Sulfadiazine is contraindicated in whom?
newborns and preganant
44
Burns:
During the Acute Phase, we want to promote nutrition. How much can their BMR change during this stage?
can increase by 40-100 percent
45
Burns:
What would the nitrogen balance be during Acute Phase?
negative levels due to loss of protein and albumen
46
Burns:
Because of their catabolic state, what type of calorie requirement does burn patient need?
8000 calories per day
47
Burns:
What is the physical assessment during the Acute Phase?
Hemodilution (diuresis)
Increased UOP
Decreased Na+
Decreased K+
Metabolic Acidosis
48
Burns:
During Rehab phase, if client is wearing splints, how often should they be removed?
2 hr per shift
49
Burns:
What position do we want a burned extremity?
elevated and extended
50
Burns:
Calculate how much fluid is needed during Resuscitation Phase.
4 mL x percent TBSA burned x weight in kg
- Give half in first 8 hrs
- Give other half over next 16 hrs
51
Burns:
What are the values associated with the Rule of 9s?
Head and Neck (9 percent)
Anterior Trunk (18 percent)
Posterior Trunk (18 percent)
Arms (9 percent each)
Legs (18 percent each)
Perineum (1 percent)
52
Burns:
What is protocol for a circumferential burn on an extremity?
elevated and extend above heart
check distal pulse q hr
***may have lateral incision to allow skin expansion
53
Burns:
For the first 48-72 hrs, how often are we measuring UOP?
q hr
54
Carboxyhemoglobin:
What is mild?
Moderate?
Severe?
Fatal?
Mild: 11-20 percent
Moderate: 21-40 percent
Severe: 41-60 percent
Fatal: 61-80 percent
55
Burns:
What is burn shock?
hypovolemic shock associated with major shift of fluids out of vascular space
***usually seen during resuscitation phase (but can happen in any phase)
56
Infection:
What type of precaution for Antrax?
What type of precaution for Botulism?
Anthrax - Standard
Botulism - Standard
57
Infection:
What are examples of Contact Precautions?
MRSA
Pediculosis (lice)
Scabies
RSV
C.diff
58
Infection:
What are examples of Droplet Precautions?
Flu
Mumps
Perussis
Meningitis
59
Infection:
What are examples of Airborne Precautions?
TB
Measles
Chickenpox
Smallpox
60
Infection:
What are the two Multi Drug Resistent Organisms (MRDO) that we talked about?
MRSA
VRE (Vancomycin Resistent Enterococcus)
61
Infection:
What is med treatment for MRSA?
Vanco
Linezolid
62
Infection:
What is best way to avoid MRSA?
avoid large crowds
practice good hand hygiene
63
Infection:
What is VRE?
Vancomycin Resistant Enteorcoccus
- normal flora that live in intestinal tract that can cause infection when outside of it
- can live on almost any surface
64
Bioterrorism:
Which type of precautions for the following..
- Anthrax
- Botulism
- Plague
- Smallpox
Anthrax - Standard
Botulism - Standard
Plague - Droptlet and Contact
Smallpox - Standard, Contact, and Airborne
65
Shock:
Hemorrhage will result in which type of Shock?
Hypovolemic Shock
66
Shock:
What are the different types of Shock?
Hypovolemic
Cardiogenic
Distributive
Obstructive
67
Shock:
What are signs and symptoms of Hypovolemic Shock?
Increased HR (compensating for low vol)
Decreased BP (due to low vol)
Narrow Pulse Pressure (due to low SBP)
Postural Hypotension
Decreased CO/CI (due to low vol)
Low CVP (due to low vol)
Decreased PAWP (due to low vol)
Increased SVR (compensating for low vol)
Increased RR (compensatory)
68
Shock:
With Hypovolemic Shock, what will be PaCO2 and PaO2?
both decreased
client will be in resp. alkalosis
69
Shock:
What is the most common cause of Cardiogenic Shock?
MI
70
Shock:
What is the patho of Cardiogenic Shock?
poor myocardial contractility leads to vasoconstriction
high venous pressure leads to extravasation and edema and poor tissue perfusion
71
Shock:
Symptoms of Cardiogenic Shock?
Weak, thready pulse
SBP less than 90
Acute drop in BP greater than 30 mmHg
Tachycardia
Diminished Heart Sounds
Decreased LOC
Pale, cool, moist skin
Decreased UOP
Chest Pain
Dysrhythmias
Increased RR
Crackles
Decreased CO and CI (CI less than 2.2 L per min)
72
Shock:
Why would Cardiogenic Shock cause the following...
- Increased PAWP
- Increased CVP
- Increased SVR
Increased PAWP - due to blood backing up from pump failure
Increased CVP - due to blood backing up from pump failure
Increased SVR - vasoconstriction as a compensatory reaction due to low BP
73
Shock:
With Cardiogenic Shock, pressure in Arteries is --- and in Veins is ---
Why?
low (due to pump failure and failure of blood to move fwd)
high (due to pump failure causing blood to pool in veins)
74
Shock:
What happens to fluid volume during Distributive Shock?
fluid shifts from vascular space to third spacing
75
Shock:
Distributive Shock can be Neural and Chemical Induced.
What are examples of Chemical Induced?
Anaphylaxis
Sepsis
Capillary Leak Syndrome
76
Shock:
What are the causes of Distributive Shock?
loss of sympathetic tone
blood vessel dilation
pooling of blood in venous and capillary beds
capillary leakage
77
Shock:
Which type of shock will have Hoarseness, Stridor, Wheezing, pruritis and angioedema?
Distributive (Anaphylactic)
78
Shock:
Which type of shock will have a bounding pulse and warm, dry skin due to dilation of vessels?
Distributive (Neurogenic)
79
Shock:
What is the only type of shock with decreased HR?
Distributive (Neurogenic)
80
Shock:
What change in BP is associated with all shock?
decrease in BP
81
Shock:
What would the SKIN be like for the following...
- Septic Shock
- Distributive (Neurogenic)
- Distributive (Anaphylactic)
- Cardiogenic
- Hypovolemic
- Obstructive
Septic - pink, warm, flushed
Distributive (Neuogenic) - warm, dry (due to dilation of vessels)
Distributive (Anaphylactic) - itching, redness, rash
Cardiogenic - pale, cool, moist
Hypovolemic - pale, cool, moist
Obstructive - cool, moist
82
Shock:
What does PULSE PRESSURE look like with the following...
- Septic Shock
- Hypovolemic
Septic - wide pp
Hypovolemic - narrow pp
83
Shock:
What does PULSE look like with the following...
- Septic Shock
- Distributive (Neurogenic)
- Cardiogenic
Septic - full, bounding pulse
Distributive (Neurogenic) - bounding pulse
Cardiogenic - weak, thready pulse
84
Shock:
What RR is seen in all shock?
increased
85
Shock:
What are some causes of Obstructive Shock?
Pericarditis
Cardiac Tamponade
Pulmonary Embolism
86
Shock:
Which types of shock decrease PAWP?
Which types increase PAWP?
Decrease PAWP:
- Septic
- Neurogenic
- Hypovolemic
Increase PAWP:
- Obstructive
- Cardiogenic
87
Shock:
Which types of shock decrease SVR?
Which types increase SVR?
Decrease SVR:
- Neurogenic
- Septic
Increase SVR:
- Hypovolemic (compensatory to low vol)
- Cardiogenic (compensatory to low BP)
88
Shock:
Which types of shock decrease CVP?
Which types increase CVP?
Decrease CVP:
- Septic
- Neurogenic
- Hypovolemic
Increase CVP:
- Cardiogenic
89
Shock:
Only one type of shock is associated with increased CO and CI. Which one?
Septic
**also has increased SVO2
90
Shock:
What are the stages of Shock?
Initial: MAP drops less than 10
Nonprogressive: MAP drops by 10-15
Progressive: MAP drops by 20 or more
Refractory: death
91
Shock:
Which stage of shock will be associated with hypoxia of NONVITAL organs?
Which stage of shock will be associated with hypoxia of VITAL organs?
Nonvital = Nonprogressive Stage (MAP falls by 10-15)
Vital = Progressive Stage (MAP falls by 20 or more)
92
Shock:
During the Nonprogressive Stage, what will acid-base balance and Potassium level look like?
Acidosis
Hyperkalemia (cell destruction)
93
SIRS:
SIRS (Systemic Inflammatory Reaction Syndrome) is diagnosed how?
When 2 or more of following are present:
- Temp greater than 38 or less than 36
- HR greater than 90
- RR greater than 20 or PaCO2 less than 32
- WBC greater than 12000 or less than 4000 or 10 percent bands
94
Septic Shock:
What are the Neuro and Endocrine symptoms?
SNS stimaled (release of ACTH)
Release of Epi, NE, glucocorticoids, aldosterone, glucagon, and renin
Hypermetabolic State
Relative Insulin Resistance (high glucose level)
Mitochondrial Dysfunction
- cannot receive O2 properly at cellular level
- reason they may not respond to increase in O2
95
Surviving Sepsis Guidelines:
What are the fluid resuscitation guidelines in initial stage?
more than 1 L crystalloid (LR or NS)
30 mL per kg NS in first 4-6 hrs
Incremental bolus dependent upon client response
96
Surviving Sepsis Guidelines:
What is the recommended vasopressor treatment?
NE is DOC
- 0.03 units per min
DA for clients with low HR
Dobutamine for clients with low CO
***Corticosteroids only if vasopressors are insufficient
97
Surviving Sepsis Guidelines:
What should be done within 3 hrs?
Within 6 hrs?
3 hrs:
- measure lactate
- obtain blood culture PRIOR to antibiotic
- 30 mL per kg NS or hypotension or lactate greater than 4
6 hrs:
- apply vasopressors to maintain MAP greater than or equal to 65
- reassess lactate and MAP
98
Cancer:
What foods should be avoided with cancer patients?
Fresh fruits and veggies
Undercooked meats
Fish or Eggs
Paprika
Raw Nuts
Yogurt
99
Cancer:
Carcinomas of the lung can lead to which oncological emergency?
Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
- water is reabsorbed to excess by kidneys
- client becomes water intoxicated
100
Cancer:
What are some symptoms of SVCS?
Superior Vena Cava Syndrome
- persistent cough or SOB
- hoarseness
- Stoke's Sign (visible vessels)
- periorbital swelling
- HA
- reddish face, cheeks, palms, mucous membranes
- vision changes
101
Cancer:
What is treatment for SVCS?
High dose radiation
Metal stint in SVC
Elevate HOB
O2
Diuretics
Steroid Therapy
102
Cancer:
Tumor Lysis Syndrome would be seen with which cancers?
Lymphoma
Leukemia
***usually after first dose or round of treatment
103
Cancer:
Tumor Lysis Syndrome causes an incrased in K+ due to cell destruction. What are symptoms of hyperkalemia?
tall T waves
flat P waves
bradycardia
GI hypermotility
104
Cancer:
What type of diuretics with Tumor Lysis Syndrome?
Osmotic (Mannitol)
105
Cancer:
What is treatment plan for Tumor Lysis Syndrome?
Prevent with oral fluid intake of 3000-5000 mL a day
NS (adequate hydration)
Diet restrictions
Seizure Precautions
Dialysis
