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Critical Care I > Test 1 misc 2 > Flashcards

Test 1 misc 2 Flashcards

1
Q

submersion injury timeline to poor outcome in normal water temp

A

4-5 min

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2
Q

severe resp complication of submersion injury

A

ARDS

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3
Q

Post Submersion Neuro Class

Alert, fully conscious

A

A

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4
Q

Post Submersion Neuro Class

Obtunded, stuporous but arousable; purposeful response to pain; normal respiration

A

B

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5
Q

Post Submersion Neuro Class

Comatose; not arousable; abnormal response to pain; abnormal resp

A

C

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6
Q

Post Submersion Neuro Class

flexor to pain, cheyne stokes

A

C1

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7
Q

Post Submersion Neuro Class

Extensor response to pain; central hyperventilation

A

C2

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8
Q

Post Submersion Neuro Class

Flaccid; apneic

A

C3

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9
Q

initial chest x ray expectation for submersion injury

A

Initial Chest x-ray can be normal, show patchy infiltrates (frequently in the periphery or bibasilar regions) or show pulmonary edema.

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10
Q

what pH imbalance do you expect in submersion injury

A

resp acidosis that leads to metabolic acidosis due to lactic acid buildup

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11
Q

Treating submersion injury

A

Some patients require positive pressure for 48-72 hours,
§ Antibiotics and steroids are not indicated unless the pt becomes febrile
§ Hypovolemia should be treated with isotonic crystalloids (10-20 mL/kg). inotropic support with dopamine, dobutamine or epi can be required if continued hypertension or poor perfusion are ongoing.
Abnormal CT= most likely death
§ Is the patient is symptomatic evaluation via arterial BG, and chest x-ray should be done. Also consider a CBC, coag studies, and electrolyte panel.

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12
Q

submersion injury obs time and necessary orders if well appearing

A

prolonged time frame after submersion incident because even mild hypoxia can increase permeability of pulm capillaries with alveolar fluid leak and surfactant damage

Pulse oximetry monitoring
ABG if resp distress
Chest x ray (all submersion victims)

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13
Q

symptoms commonly seen with submersion injury

A

anxiety, vomiting, cough, wheezing, hypothermia, altered mental status, metabolic acidosis, respiratory failure, and finally respiratory/cardiac arrest.

Kline, Andrea M.; Haut, Catherine. Lippincott Certification Review: Pediatric Acute Care Nurse Practitioner (p. 1031). Wolters Kluwer Health. Kindle Edition.

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14
Q

______ should be used to prevent atelectasis and overcome intrapulmonary shunting

A

Positive end expiratory pressure

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15
Q

CN impairment initially in Botulism

A 
Bulbar Palsy
IX
X
XI
XII
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16
Q

Treatment in Infant Botulism

A

mostly supportive by assisting in breathing

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17
Q

Presentation of Infant Botulism

A

§ Usually starts from the head down, with oculobulbar muscle weakness, blurring of vision, dipoplia, ptosis, ophthalmoplegia, dysarthria, and dysphagia.

§ Infants usually present listless, feeding poorly, have a weak cry, and are constipated. This is followed by a descending pattern of weakness with the upper limbs, lower limbs, and ultimately the respiratory muscles.

§ Occurs more frequently in infants less than 6 months of age but can occur up to 1 year of age.

§ S&S- constipation, lethargy, poor feeding, excessive drooling, and increasing weakness.

§ On physical exam, general hypotonia and symmetrical cranial nerve palsies are present. Infants appear to have expressionless face. CRANIAL NERVE PALSIES ARE ALWAYS PRESENT, and part of the definitive diagnosis.

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18
Q

management for infant botulism

A

§ There is an infant botulism antitoxin (BIG-IV) -Administration of human botulism immune globulin intravenous (BIG-IV).

available and if used early markedly shortens the intensive care course. Abx are not usually recommended because they will lyse bacteria and release more toxin into the circulation.
§ Feed via NG tube or NJ tube.

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19
Q

bacteria that causes botulism

A

bacteria,

Kline, Andrea M.; Haut, Catherine. Lippincott Certification Review: Pediatric Acute Care Nurse Practitioner (p. 572). Wolters Kluwer Health. Kindle Edition.

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20
Q

•Infants have weak cry, expressionless face, ptosis, and sluggish pupillary responses. Gag, suck, and swallow reflexes are diminished or may be absent.

A

Botulism

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21
Q

causes of meningitis in Neonates

A

Group B Strep,
E. Coli
Listeria monocytogenes
Klebsiella species

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22
Q

causes of meningitis in infants 3 months-9mos

A 
Strep Pneumoniae
Nesseria meningitidis (group B strep is responsible for small amounts of meningitis
H. influenzae type B
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23
Q

causes of meningitis in children 10-18 yrs

A

N. meningitidis is responsible for the majority of bacterial meningitis cases.

streptococcus pneumonia

H. influenzae

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24
Q

meningitis in unvaccinated children, what etiology to consider

A

IF CHILDREN ARE UNVACCINATED!!! Think possibly H. influenzae type B, also if in an underdeveloped countries.

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25
Q

most common cause of viral meningoencephalitis

A

Enterovirus

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26
Q

Bacterial meningitis usually involves the fluid in the ______ space

A

subarachnoid

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27
Q

causes of Meningitis in 5 yr old

A

N. Meningitis

Strep pneumoniae

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28
Q

Meningeal signs of meningitis

A

Severe throbbing headache
Photophobia
nuchal rigidity
Kernig sign: Passive extension of the knee in supine position, resulting in back pain and resistance. • Brudzinski sign: • Passive flexion of the neck, resulting in involuntary flexion of the knees and hips.

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29
Q

csf changes associated with bacterial meningitis

A 
Increased WBC 
increased protein
decreased glucose
increase pressure
increased lactate (>25 is indicative of bacterial meningitis
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30
Q

abx for meningitis with recent neurosurgery or ventricular shunt

A

vancomycin + cefepime; vancomycin + ceftazidime; or vancomycin + meropenem. •

31
Q

abx for meningitis with basilar skull fx

A

vancomycin + 3rd-generation cephalosporin.

32
Q

abx for meningitis older than 1 mos

A

empirical broad-spectrum antimicrobial coverage with VANCOMYCIN, and either cefotaxime or ceftriaxone should be started.
§ ACYCLOVIR should be initiated for all infants and children with suspected HSV encephalitis.

33
Q

most common cause of meningitis in children

A

viral meningitis - specific agent not usually specified but (Enterovirus >80% of cases)

other echovirus, coxsackievirus, arbovirus, mumps, EBV, Cytomegalovirus, Varicella, adenovirus, HSV

34
Q

csf changes in viral meningitis

A

glucose normal, slightly decreased

Protein slightly increased

WBC - mildly increased

35
Q

what is the gold standard for diagnosis of HSV meningitis

A

CSF PCR for HSV

36
Q

management of viral meningitis

A

self limiting - resolves in 7-10 days

control seizures

acyclovir if HSV meningitis is suspected

37
Q

differences/additional symptoms in HSV meningitis

A

function: ataxia, focal neurologic signs, acute encephalopathy (high suspicion).

Kline, Andrea M.; Haut, Catherine. Lippincott Certification Review: Pediatric Acute Care Nurse Practitioner (p. 604). Wolters Kluwer Health. Kindle Edition.

38
Q

GBS has what shape bacteria (ie: gram neg, gram pos…)

A

gram positive cocci

39
Q

what is the gold standard test for determining if a case of meningitis is bacterial in etiology

A

CSF bacterial culture

40
Q

steroid injections make you more at risk for what kind of meningitis

A

fungal infection

41
Q

what csf test tests for fungal meningitis

A

beta-D-glucan

42
Q

suspect viral meningitis over bacterial when you see what in csf

A

normal glucose and protein levels along with a lower WBC with a monocytic predominance

43
Q

if pathogens make it into the brain parenchyma itself, the response is

A

Encephalitis

44
Q

most common cause of pure encephalitis

A

enterovirus

45
Q

temporal lobe enhancement on CT is a symptom of

A

HSV encephalitis

46
Q

presence of RBCs in CSF is suggestive of

A

Herpes Simplex encephalitis

47
Q

Ampicillin covers what type of meningitis

A

Listeria monocytogenes

48
Q

Medications to avoid with eating disorders

A

TCAs - cardiotoxicity in malnourished individuals

Bupropion - increased risk of seizures in individuals with eating disorders

49
Q

complications of Bulimia nervosa

A

erotion of enamil
sialadenosis (swelling of parotid gland)
bad breath
Russels sign - calleouses on knuckles from making yourself vomit
Tears in distal esophagus or stomach itself (Mallory Weiss syndrome - abd pain and hematemesis)

Amenorrhea
type 2 DM

50
Q

Russels sign

A

sign of Bulimia nervosa - callous on knuckles

51
Q

Mallory weiss syndrome

A

associated with Bulimia nervosa - tears in distal esophagus or stomach resulting in abd pain and hematemesis

52
Q 
Bulimia Nervosa:
What does BP
HR:
Electrolytes:
Ph:
A

Dehydration causes
Hypotension (<90/50)
Tachycardia HR >100

Electrolytes low
NA
Cl
Mg
phosphorous
K+

General Metabolic Alkalosis

53
Q

Lab tests to order in Bulimia nervosa

A 
Serum electrolytes
serum creatinine
BUN
CBC with diff
LFTs
Urinalysis
54
Q

Pharm for Bulimia Nervosa

A

SSRI
choice is Fluoxetine

If they dont respond, try diff SSRI - Sertraline

If dont respond or tolerate ->
Either tricyclic antidepressant
Trazodone
MAOIs
Topiramate
55
Q

Med you cant describe for a pt with Bulimia nervosa

A

Bupropion - increased risk of seizures in individuals with eating disorders

56
Q

Binge Eating disorder treatment

A

Psychotherapy is first line
second line is
SSRI s
third line is Topiramate

Mod severe cases may benefit from Lisdexamfetamine

57
Q

what is the unintentional Food regurgitation disorder

A

called: Rumination Disorder
nor due to a medical disorder
not purposeful
associated with mood disorders

58
Q

What diagnostics rule out other differentials for Rumination disorder

A

High resolution impedance manometry testing

upper GI endoscopy

59
Q

initial management for rumination disorder

A

Education and treatment of mood disorder

Diaphragmatic abd breathing immediately after a meal and for 10-15 min after

60
Q

if initial mgmt of rumination disorder doesnt work, what meds can you try

A

Baclofen

increases LES tone
decreases LES relaxation

61
Q

diagnostic criterion for PICA

A

strong cravings to eat non-food items >= month
has to be culturally inappropriate

should not happen in the context of another health condition such as schizophrenia, autism or another eating disorder

62
Q

what is PICA associated with

A

anemia (esp iron deficiency)
emotional trauma
malnutrition
comorbid psychiatric disorders

63
Q

complications with PICA

A 
nutritional deprivation
anemia
toxicity
constipation
intestinal obstruction
parasitic infections
jaw or tooth injury
weight changes
64
Q

treatment for PICA

A

1) Nutritional rehab and psychotherapy

Identify substance -> decrease exposure -> healthier alt to decrease cravings

If comorbid psych disorders -> SSRIs

65
Q

significant food restrictions at least once a week for 3 months with fear of gaining weight and BMI below 18.5

A

Anorexia

66
Q

cycles of binging and purging once a week for 3 months with normal weight or over weight (BMI >18.5)

A

Bulimia

67
Q

large amounts of food that causes lots of insulin to be released which leads to cellular intake of electrolytes and produces arrhythmias

A

Refeeding syndrome

68
Q

expected weight gain in anorexia in hospitalized vs outpatient patients

A

2-3 lbs/week (hospitalized)

0.5-1lb/week (outpatients)

69
Q

how many kcal/kg/day in anorexia treatment

A

30-40 kcal/kg/day

70
Q

in bulimia, what acid base disorder is seen

A

metabolic alkalosis

71
Q 
Salicylate intoxication 
Hyperventilation
Hyperthyroidism
Interstitial pulmonary disease
CNS diseases

causes what acid base imbalance

A

Resp alkalosis
High pH
low CO2

72
Q

diarrhea will cause what acid base imbalance

A

metabolic acidosis
low pH
low HCO3

73
Q 
Methanol
Uremia
DKA
Paraldehyde
Isoniazid and iron
lactic acid
ethanol glycol
ethanol induced
ketoacidosis
salicylates

All do what do your anion gap and give you what kind of a acid base imbalance

A

increased anion gap metabolic acidosis

low pH
low HCO3

74
Q 
Loss of gastric acid due to vomiting
NG suctioning
Diuretic use
Alterations to parenteral nutrition
Excessive bicarb administration

all put you at risk for what kind of acid base balance

A

metabolic alkalosis

high pH
High bicarb

Critical Care I (27 decks)

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