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Adult Health II - (Josh) > T1 - Blueprint (Josh) > Flashcards

T1 - Blueprint (Josh) Flashcards

1
Q

Skin Assessment:

How often does the epidermis regenerate?

A

q 28-45 days

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2
Q

Skin Assessment:

Which layer of skin is responsible for temp regulation, homeostasis?

A

Epidermis

***also site of Vit D metabolism

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3
Q

Skin Assessment:

What are petechiae a sign of?

A

increased capillary fragility and venous stasis

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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
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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

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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

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7
Q

Skin Problems:

Which type of wound closure has loss of tissue?

A

Second Intention (has a cavity)

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8
Q

Skin Problems:

What is the characteristic appearance of Psoriasis?

A

silver appearance scaling or skin

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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

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10
Q

Skin Problems:

Which type of Keratosis is pre-cancerous?

A

Actininc Keratosis

***sebhorric keratosis is NOT pre-cancerous

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11
Q

Skin Problems:

Which type of skin cancer is the following:

rough, scaly lesion with central ulceration and crusting

A

Squamous Cell Carcinoma

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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

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13
Q

Skin Problems:

Which type of skin cancer is most serious?

A

Melanomas

***Use ABCDE to self-examine

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14
Q

Skin Problems:

What are some BACTERIAL skin infections?

A

Folliculitis

Furuncles

Cellulitis

MRSA

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15
Q

Skin Problems:

What are some VIRAL skin infections?

A

Herpes Type 1 and 2 (genital)

Herpes Zoster (chickenpox and shingles)

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16
Q

Skin Problems:

What are some FUNGAL skin infections?

A

Tinea Pedis

Tinea Cruris

Tinea Capitis

Tinea Corporis

Candidas Albacans (yeast infection)

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17
Q

Burns:

Which type of burn blisters?

A

2nd Degree Superficial (Partial Thickness)

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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

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19
Q

Burns:

How long does it take a 1st Degree burn to heal?

A

2-7 days

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20
Q

Burns:

Which type of burns are painful?

A

1st and 2nd Degree

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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)

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22
Q

Burns:

Why would someone with Full Thickness burns urinate blood?

A

hemolysis

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23
Q

Burns:

Which full thickness burn has edema?

Which full thickness burn has NO edema?

A

Full Thickness (3rd Degree)

Deep Full Thickness

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24
Q

Burns:

What are examples of thermal burns?

A

steam

scalds

fire

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25
Q

Burns:

What is main concern with electrical burns?

A

cardiac arrest

***depth of burn; Rule of 9’s doesn’t apply

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26
Q

Burns:

What are signs and symptoms of Inhalation Injury?

A

SOB; dyspnea

Hoarseness

Stridor

Flaring

Tachypnea

Burns to face, neck, mouth

Sooty sputum

Singed facial hair

Swelling of face, neck, trachea

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27
Q

Burns:

What is the patho of inhalation injury?

A

CO binds to Hgb and decreases O2 delivery and hypoxemia occurs

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28
Q

Burns:

What else does smoke do to lungs?

A

decreases surfactant and may cause ARDS, brochospasm, atelectasis, edema, and infections

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29
Q

Burns:

What is treatment regiment for Inhalation Injury?

A

100 percent FiO2 ASAP

Early Intubation

Rest

Maintain Airway

May need PEEP (expect them to get ARDS)

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30
Q

Burns:

What are the phases of Burn Care?

A

Resuscitation Phase

Acute Care Phase

Rehab Phase

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31
Q

Burns:

What are the labs like in the first 24 hrs of the Resuscitation Phase?

A

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

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32
Q

Burns:

What happens to labs after 48-72 hrs of the Resuscitation Phase

A

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)

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33
Q

Burns:

How long does the Resuscitation Phase last?

A

until plasma vol is restored

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34
Q

Burns:

What is circulation like during Resuscitation Phase?

A

Hypovolemia

Increase HR

Decrease CO

Decrease CVP

Decrease UOP

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35
Q

Burns:

What would be the GI assessment during the Resuscitation Phase?

A

SNS (Fight of Flight) Response

  • slowing of motility
  • ileus
  • Curling’s Ulcer (give H2 blockers)
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36
Q

Burns:

What would the Metabolic condition be during Resuscitation Phase?

A

Hypermetabolic (needs lots of calories)

***but you don’t want to give if they have no motility

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37
Q

Burns:

What is the management goal during Resuscitation Phase?

A

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)
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38
Q

Burns:

When is the Acute Care Phase?

A

36-72 hrs after injury

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39
Q

Burns:

What is the hallmark characteristic of the Acute Care Phase?

A

diuresis

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40
Q

Burns:

Which type is painful: Silver Sulfadiazine or Mefenide Aceetate?

A

Mefenide Aceetate

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41
Q

Burns:

If Mefenide Aceetate is more painful that Silver Sulfadiazine, what is the reason we would choose to give it?

A

it can penetrate the eschar better than S.S

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42
Q

Burns:

What is the DOC for electrical burns?

A

Mefenide Aceetate

***give 2 x’s a day

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43
Q

Burns:

Silver Sulfadiazine is contraindicated in whom?

A

newborns and preganant

44
Q

Burns:

During the Acute Phase, we want to promote nutrition. How much can their BMR change during this stage?

A

can increase by 40-100 percent

45
Q

Burns:

What would the nitrogen balance be during Acute Phase?

A

negative levels due to loss of protein and albumen

46
Q

Burns:

Because of their catabolic state, what type of calorie requirement does burn patient need?

A

8000 calories per day

47
Q

Burns:

What is the physical assessment during the Acute Phase?

A

Hemodilution (diuresis)

Increased UOP

Decreased Na+

Decreased K+

Metabolic Acidosis

48
Q

Burns:

During Rehab phase, if client is wearing splints, how often should they be removed?

A

2 hr per shift

49
Q

Burns:

What position do we want a burned extremity?

A

elevated and extended

50
Q

Burns:

Calculate how much fluid is needed during Resuscitation Phase.

A

4 mL x percent TBSA burned x weight in kg

  • Give half in first 8 hrs
  • Give other half over next 16 hrs
51
Q

Burns:

What are the values associated with the Rule of 9s?

A

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
Q

Burns:

What is protocol for a circumferential burn on an extremity?

A

elevated and extend above heart

check distal pulse q hr

***may have lateral incision to allow skin expansion

53
Q

Burns:

For the first 48-72 hrs, how often are we measuring UOP?

A

q hr

54
Q

Carboxyhemoglobin:

What is mild?

Moderate?

Severe?

Fatal?

A

Mild: 11-20 percent

Moderate: 21-40 percent

Severe: 41-60 percent

Fatal: 61-80 percent

55
Q

Burns:

What is burn shock?

A

hypovolemic shock associated with major shift of fluids out of vascular space

***usually seen during resuscitation phase (but can happen in any phase)

56
Q

Infection:

What type of precaution for Antrax?

What type of precaution for Botulism?

A

Anthrax - Standard

Botulism - Standard

57
Q

Infection:

What are examples of Contact Precautions?

A

MRSA

Pediculosis (lice)

Scabies

RSV

C.diff

58
Q

Infection:

What are examples of Droplet Precautions?

A

Flu

Mumps

Perussis

Meningitis

59
Q

Infection:

What are examples of Airborne Precautions?

A

TB

Measles

Chickenpox

Smallpox

60
Q

Infection:

What are the two Multi Drug Resistent Organisms (MRDO) that we talked about?

A

MRSA

VRE (Vancomycin Resistent Enterococcus)

61
Q

Infection:

What is med treatment for MRSA?

A

Vanco

Linezolid

62
Q

Infection:

What is best way to avoid MRSA?

A

avoid large crowds

practice good hand hygiene

63
Q

Infection:

What is VRE?

A

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
Q

Bioterrorism:

Which type of precautions for the following..

  • Anthrax
  • Botulism
  • Plague
  • Smallpox
A

Anthrax - Standard

Botulism - Standard

Plague - Droptlet and Contact

Smallpox - Standard, Contact, and Airborne

65
Q

Shock:

Hemorrhage will result in which type of Shock?

A

Hypovolemic Shock

66
Q

Shock:

What are the different types of Shock?

A

Hypovolemic

Cardiogenic

Distributive

Obstructive

67
Q

Shock:

What are signs and symptoms of Hypovolemic Shock?

A

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
Q

Shock:

With Hypovolemic Shock, what will be PaCO2 and PaO2?

A

both decreased

client will be in resp. alkalosis

69
Q

Shock:

What is the most common cause of Cardiogenic Shock?

A

MI

70
Q

Shock:

What is the patho of Cardiogenic Shock?

A

poor myocardial contractility leads to vasoconstriction

high venous pressure leads to extravasation and edema and poor tissue perfusion

71
Q

Shock:

Symptoms of Cardiogenic Shock?

A

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
Q

Shock:

Why would Cardiogenic Shock cause the following…

  • Increased PAWP
  • Increased CVP
  • Increased SVR
A

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
Q

Shock:

With Cardiogenic Shock, pressure in Arteries is — and in Veins is —

Why?

A

low (due to pump failure and failure of blood to move fwd)

high (due to pump failure causing blood to pool in veins)

74
Q

Shock:

What happens to fluid volume during Distributive Shock?

A

fluid shifts from vascular space to third spacing

75
Q

Shock:

Distributive Shock can be Neural and Chemical Induced.

What are examples of Chemical Induced?

A

Anaphylaxis

Sepsis

Capillary Leak Syndrome

76
Q

Shock:

What are the causes of Distributive Shock?

A

loss of sympathetic tone

blood vessel dilation

pooling of blood in venous and capillary beds

capillary leakage

77
Q

Shock:

Which type of shock will have Hoarseness, Stridor, Wheezing, pruritis and angioedema?

A

Distributive (Anaphylactic)

78
Q

Shock:

Which type of shock will have a bounding pulse and warm, dry skin due to dilation of vessels?

A

Distributive (Neurogenic)

79
Q

Shock:

What is the only type of shock with decreased HR?

A

Distributive (Neurogenic)

80
Q

Shock:

What change in BP is associated with all shock?

A

decrease in BP

81
Q

Shock:

What would the SKIN be like for the following…

  • Septic Shock
  • Distributive (Neurogenic)
  • Distributive (Anaphylactic)
  • Cardiogenic
  • Hypovolemic
  • Obstructive
A

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
Q

Shock:

What does PULSE PRESSURE look like with the following…

  • Septic Shock
  • Hypovolemic
A

Septic - wide pp

Hypovolemic - narrow pp

83
Q

Shock:

What does PULSE look like with the following…

  • Septic Shock
  • Distributive (Neurogenic)
  • Cardiogenic
A

Septic - full, bounding pulse

Distributive (Neurogenic) - bounding pulse

Cardiogenic - weak, thready pulse

84
Q

Shock:

What RR is seen in all shock?

A

increased

85
Q

Shock:

What are some causes of Obstructive Shock?

A

Pericarditis

Cardiac Tamponade

Pulmonary Embolism

86
Q

Shock:

Which types of shock decrease PAWP?

Which types increase PAWP?

A

Decrease PAWP:

  • Septic
  • Neurogenic
  • Hypovolemic

Increase PAWP:

  • Obstructive
  • Cardiogenic
87
Q

Shock:

Which types of shock decrease SVR?

Which types increase SVR?

A

Decrease SVR:

  • Neurogenic
  • Septic

Increase SVR:

  • Hypovolemic (compensatory to low vol)
  • Cardiogenic (compensatory to low BP)
88
Q

Shock:

Which types of shock decrease CVP?

Which types increase CVP?

A

Decrease CVP:

  • Septic
  • Neurogenic
  • Hypovolemic

Increase CVP:
- Cardiogenic

89
Q

Shock:

Only one type of shock is associated with increased CO and CI. Which one?

A

Septic

**also has increased SVO2

90
Q

Shock:

What are the stages of Shock?

A

Initial: MAP drops less than 10

Nonprogressive: MAP drops by 10-15

Progressive: MAP drops by 20 or more

Refractory: death

91
Q

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?

A

Nonvital = Nonprogressive Stage (MAP falls by 10-15)

Vital = Progressive Stage (MAP falls by 20 or more)

92
Q

Shock:

During the Nonprogressive Stage, what will acid-base balance and Potassium level look like?

A

Acidosis

Hyperkalemia (cell destruction)

93
Q

SIRS:

SIRS (Systemic Inflammatory Reaction Syndrome) is diagnosed how?

A

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
Q

Septic Shock:

What are the Neuro and Endocrine symptoms?

A

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
Q

Surviving Sepsis Guidelines:

What are the fluid resuscitation guidelines in initial stage?

A

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
Q

Surviving Sepsis Guidelines:

What is the recommended vasopressor treatment?

A

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
Q

Surviving Sepsis Guidelines:

What should be done within 3 hrs?

Within 6 hrs?

A

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
Q

Cancer:

What foods should be avoided with cancer patients?

A

Fresh fruits and veggies

Undercooked meats

Fish or Eggs

Paprika

Raw Nuts

Yogurt

99
Q

Cancer:

Carcinomas of the lung can lead to which oncological emergency?

A

Syndrome of Inappropriate Antidiuretic Hormone (SIADH)

  • water is reabsorbed to excess by kidneys
  • client becomes water intoxicated
100
Q

Cancer:

What are some symptoms of SVCS?

A

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
Q

Cancer:

What is treatment for SVCS?

A

High dose radiation

Metal stint in SVC

Elevate HOB

O2

Diuretics

Steroid Therapy

102
Q

Cancer:

Tumor Lysis Syndrome would be seen with which cancers?

A

Lymphoma

Leukemia

***usually after first dose or round of treatment

103
Q

Cancer:

Tumor Lysis Syndrome causes an incrased in K+ due to cell destruction. What are symptoms of hyperkalemia?

A

tall T waves

flat P waves

bradycardia

GI hypermotility

104
Q

Cancer:

What type of diuretics with Tumor Lysis Syndrome?

A

Osmotic (Mannitol)

105
Q

Cancer:

What is treatment plan for Tumor Lysis Syndrome?

A

Prevent with oral fluid intake of 3000-5000 mL a day

NS (adequate hydration)

Diet restrictions

Seizure Precautions

Dialysis

Adult Health II - (Josh) (13 decks)

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