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CEN > Things I Should Probably Know > Flashcards

Things I Should Probably Know Flashcards

1
Q

What abnormal lab values confirm the diagnosis of HELLP?

A
  1. Urine protein consistent with pre-e
  2. Schistocytes on blood smear
  3. Platelets less than 100k
  4. TBili greater than 1.2
  5. AST greater than 70
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2
Q

What is HELLP?

A

Believed to be a form of pre-E

Hemolysis (H)
Elevated liver enzymes (EL)
Low platelet count (LP)

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3
Q

APGAR assesses which 5 things?

A 
Neonatal HR
Resp effort
Muscle tone
Reflex irritability
Color

0-2 points per each category, 10 is best score

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4
Q

Abruptio placentae

A

Onset of symptoms: sudden and intense bleeding with pain

Bleeding may be vaginal or concealed

Uterine tone is FIRM

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5
Q

Placenta Previa

A

Onset of symptoms: asymptomatic or painless bleeding

Vaginal bleeding

Uterine tone is soft and relaxed

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6
Q

Metformin is contraindicated with?

A

IV contrast (hold metformin for at least 48 hours after receiving IV contrast)

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7
Q

Cranial nerve 1

A

Olfactory

Controls sense of smell

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8
Q

Cranial nerve 2

A

Optic

Central and peripheral vision

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9
Q

Cranial nerve 3

A

Oculomotor

Constriction of pupils

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10
Q

Cranial nerve 4

A

Trochlear

Downward eye movement

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11
Q

Cranial nerve 5

A

Trigeminal

Face

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12
Q

Cranial nerve 6

A

Abducens

Sideways eye movement

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13
Q

Cranial nerve 7

A

Facial

Movement and expression

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14
Q

Cranial nerve 8

A

Vestibulocochlear

Controls hearing

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15
Q

Cranial nerve 9

A

Glossopharyngeal

Tongue and throat

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16
Q

Cranial nerve 10

A

Vagus

Sensory and motor

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17
Q

Cranial nerve 11

A

Accessory

Head and shoulder movement

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18
Q

Cranial nerve 12

A

Hypoglossal

Tongue position

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19
Q

Nasal fracture

A

Most common of all facial fractures and least likely to need specialist consult

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20
Q

Orbit rim and blowout fracture

A

Fractures of orbital floor or lateral and medial orbital walls; occur from direct blow to orbit such as from a baseball or fist

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21
Q

Mandibular fractures of the lower jaw

A

May be singular or multiple

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22
Q

Maxillary fractures

A

Fractures of the upper jaw

Le Fort 1, 2, and 3

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23
Q

Le Fort I

A

Horizontal fracture, separates teeth from upper structures

“Floating palate”

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24
Q

Le Fort II

A

Pyramidal fracture; teeth are at the base of the pyramid, fracture passes diagonally along the lateral wall of the maxillae sinuses, apex of pyramid is the nasofrontal junction

“Floating maxilla”

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25
Q

Le Fort III

A

Craniofacial disjunction transverse fracture line passes through the nasofrontal junction, maxillofrontal suture, orbital wall, zygomatic arch, and zygomaticofrontal suture

“Floating face”

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26
Q

“Floating palate”

A

Le Fort I

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27
Q

“Floating maxilla”

A

Le Fort II

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28
Q

“Floating face”

A

Le Fort III

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29
Q

Zygomaticomaxillary complex (tripod) fractures

A

Simultaneous fracture of the lateral and inferior orbital rim, the zygomatic arch, and lateral maxillary sinus wall

Occurs from direct blow to the lateral cheek

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30
Q

Blast lung injuries (BLI): clinical triad

A

Apnea
Hypotension
Bradycardia

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31
Q

The 6 P’s

A 
Pain
Paresthesia
Pallor
Paralysis
Pulselessness
Poikilothermia
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32
Q

Compartment syndrome: compartment pressure

A

Within 20-30mmHg of mean arterial pressure

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33
Q

Non displaced fracture

A

Broken area of bone remains in alignment

Optimal condition for reduction and healing

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34
Q

Displaced fracture

A

Broken areas of bones are not aligned

May require manual or surgical reduction including hardware for fixation

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35
Q

Transverse fracture

A

Horizontal break in a straight line across the bone occurs from a force perpendicular to the break

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36
Q

Oblique fracture

A

Diagonal break occurs from a force higher or lower than the break

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37
Q

Spiral fracture

A

Torsion or twisting break around the circumference of the bone

Common in sports injuries and abuse

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38
Q

Comminuted fracture

A

Break is fragmented into 3 or more pieces.

More common in people older than 65 and those with brittle bones

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39
Q

Compression fracture

A

Break is crushed or compressed, creating a wide, flattened appearance

Frequently occurs with crush injuries

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40
Q

Segmental fracture

A

Two or more areas of the bone are fractured, creating a segmented area of “floating” bone

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41
Q

Greenstick fracture

A

Type of incomplete break

Bone is not completely separated and bends to one side; common in children due to softer bones

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42
Q

Avulsed fracture

A

A “chip” fracture displaced small segments of bone from the main bone at the area of tendon/ligament attachment. Results from tension/pulling of the tendons/ligaments away from the bone

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43
Q

Torus/buckle fracture

A

Incomplete fracture with bulging of cortex, common in children

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44
Q

Impacted fracture

A

Ends of the bone are impacted or “jammed” into each other from forceful impact

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45
Q

Salter-Harris fracture

A

Growth plate fracture

Classified as I-V

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46
Q

Estimated blood loss from pelvic fractures

A

1.5-4.5L

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47
Q

Estimated blood loss from hip fracture

A

1.5-2.5L

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48
Q

Estimated blood loss from femur fracture

A

1-2L

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49
Q

Estimated blood loss from humerus fracture

A

1-2L

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50
Q

Fractures with risk for fat emboli (4)?

A

Comminuted fractures of femur or tibia

Fractures of ribs or pelvis

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51
Q

Trephination

A

Boring of hole into the nail bed to relieve the underlying pressure

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52
Q

Rule of 9’s

A

For calculating TBSA for burns

Face: 9% (4.5% front, 4.5% back)
Chest/abd front: 18%
Back: 18%
Arm: 9% EACH (4.5% front, 4.5% back)
Groin: 1%
Legs: 18% EACH (9% front, 9% back)
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53
Q

1st degree burn

A

Affects DERMIS only

Reddened area

Blanches easily with light pressure

Think sunburns

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54
Q

2nd degree burns: superficial partial thickness

A

Blanches with pressure

Development of vesicles or bullae in 24 hours

Often appear wet

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55
Q

2nd degree burns: deep partial thickness

A

Color is white or red

Does NOT blanch

Often appears dry

Development of vesicles or bullae

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56
Q

3rd degree burns

A

Vary in appearance: white, red, black and charred, brown and leathery

No pain or reduced pain d/t nerve damage

No development of vesicles or bullae

Hypovolemia (hypotension or whole body edema)

Metabolic acidosis

Rhabdo

Hemolysis

AKI

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57
Q

Parkland formula

A

Calculates fluid resuscitation for burns

2-4mL x TBSA (%) x weight in kg

Give 50% in first 8 hours, remaining in next 16 hours
—formula time starts at the time the burn happened

USE LACTATED RINGERS NOT NS

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58
Q

What kind of salve should be used on burns?

A

Silver salve

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59
Q

Patient sustained burns. Burns are eschar and constricting. What procedure is indicated?

A

Escharotomy

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60
Q

Which form of intubation is to be avoided in ingestion & inhalation burns?

A

Nasotracheal intubation

Consider cricothyrotomy

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61
Q

What should not be administered before antivenom in snake bites?

A

Blood products

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62
Q

Keraunoparalysis

A

Weakness in limbs following a lightning strike

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63
Q

Lightning strike differs from generated electric energy in that it does not usually cause which 3 things?

A

Burns

Rhabdo

Internal organ/tissue damage

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64
Q

Decon: radiation

A

Use radiation meter to monitor progress
Remove clothing and debris
Decon skin
Clean wounds before intact skin using NS

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65
Q

Internal decon for radiation: which 3 drugs are used?

A 
Potassium iodine (KI)
Prussian blue
Diethylenetriamine pentaacetate (DTPA)
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66
Q

Prussian blue

A

Used for internal radiation decon

Removes radioactive cesium and thallium from body.

Radioactive material is passed in the feces

Oral med

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67
Q

Diethylenetriamine pentaacetate (DTPA)

A

Removes radioactive plutonium, americium, and curium from the body

Radioactive material is passed in the urine

Can be given IV or as an inhalant for those who have inhaled radiation

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68
Q

ABG analysis in submersion injuries reveals?

A

Significant metabolic acidosis (pH < 7.35 and HCO3 < 22)

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69
Q

Resuscitation in drowning victims starts with _________ _________ and not ________________.

A

Rescue breathing; compressions

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70
Q

Treatment of __________ is the main concern in submersion injuries.

A

Hypoxemia

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71
Q

Hypoxemia treatment in submersion injuries

A

Intubate

Start patient on 100% O2, titrate down based on serial ABGs

Use PEEP

Administer nebulized bronchodilators to relieve bronchospams or wheezing

CXR

72
Q

Hypothermia occurs when core body temp drops below ____.

A

35°C (95°F)

73
Q

When body temperature drops below _____, thermoregulation ceases.

A

30°C (86°C)

74
Q

Ekg readings in hypothermia

A

Very important

Shows prolonged intervals

Will read as injury due to MI, but will show a J wave or Osborn wave

75
Q

Treatment of mild hypothermia

A

Passively rewarm patients at a rate of 1°C per hour with an insulated blanket and rewarmed fluids

Use active rewarming with forced hot air in an enclosure

It’s better to apply the heat to the core of the body. Heat applied to the extremities may increase metabolic demand, which can strain the depressed cardiovascular system

76
Q

Treatment of severe hypothermia

A

Treat with active core warming

Inhalation: O2 should be heated to 40°C-45°C (104-113°F) and delivered via oxygen mask or ET tube

Infusion: IVF or blood products should be heated to 40-42°C (104-107.6°F)

Lavage: closed thoracic lavage can be administered through 2 thoracic tubes; the peritoneal lavage should be heated 40-45°C

Extracorporeal core rewarming: not often performed

Fluid resuscitation: administer 1-2L for adults or 20mL/kg for peds of NS heated to 40-42°C

77
Q

Moderate hypothermia temps

A

28-32°C (82.4-89.6°F)

78
Q

Severe hypothermia temps

A

Less than 28°C (82.4°F)

79
Q

Cardiovascular involvement of hypothermia

A

CPR is only administered in patients with a perfuming rhythm when true cardiac arrest is confirmed

Patients who have VF or asystole require CPR

Defib is only recommended once body temp reaches about 30°C (86°F)

Administration of ACLS drugs should not be expected

80
Q

Defib (in hypothermia) is only recommended once body temp reaches about ______.

A

30°C

81
Q

Examples of anticholinergic meds (and one plant for bonus points)

A

Antihistamines

Antipsychotics such as haldol, seroquel, and zyprexa

TCAs such as amitriptyline

Benztropine

Scopolamine

Atropine

Atropa belladonna (deadly nightshade)

82
Q

S/s anticholinergic toxicity

A 
Hyperthermia (“hot as a hare”)
Flushing (“red as a beet”)
Mydriasis, blurred vision (“blind as a bat”)
Dry skin (“dry as a bone”)
Agitation, delirium, hallucinations, memory loss (“mad as a hatter”)
Urinary retention (“full as a flask”)
Tachy
HTN
Ileus
83
Q

Treatment for anticholinergic toxicity

A

Physostigmine salicylate

Supportive care for s/s (benzos for seizures, Valium for agitation, catheter for retention, cooling measures for hyperthermia)

84
Q

Cholinergic crisis

A

Result of excess acetylcholine, which causes overstimulation of muscarinic and nicotinic receptors

85
Q

Most common causes of cholinergic crisis

A

Anticholinesterase (patients with MG, patients who have received neostigmine after gen. anesthesia)

Insecticides and pesticides

Nerve agents (ex: sarin)

86
Q

S/s cholinergic crisis: generalized

A

HR, BP, and RR may be increased or decreased

Increased bowel sounds

Constructed pupils

Diaphoresis

87
Q

Muscarinic s/s (cholinergic): SLUDGE

A 
Salivation
Lacrimation
Urination
Defecation
GI cramps
Emesis
88
Q

Muscarinic s/s (cholinergic): DUMBELS

A 
Diarrhea
Urination
Miosis
Bronchorrhea, bradycardia, bronchoconstriction
Emesis
Lacrimation
Salivation
89
Q

Nicotinic s/s (cholinergic): MTW(T)hFS

A 
Mydriasis
Tachycardia
Weakness
HTN, hyperglycemia
Fasciculations
Sweating

(Also abd pain, paresis)

90
Q

Treatment and management of cholinergic crisis

A

Decon patient if needed (pesticides)

Maintain airway and breathing

IVF

Antidote (atropine, oximes like pralidoxime)

Supportive care for symptoms (like benzos for seizures)

91
Q

Antidotes for cholinergics

A

Atropine

Oximes (ex: pralidoxime)

92
Q

Sympathomimetic agents: how do they work?

A

Mimic endogenous sympathetic nervous system agonists (like epi and dopamine), causing direct stimulation of the alpha and beta adrenergic receptors

93
Q

Examples of sympathomimetics

A 
Cocaine
Amphetamines
Methamphetamines
MDMA
Bath salts
Cold meds (like Sudafed)
Diet supplements containing ephedrine
94
Q

Ingestion of acids will cause?

A

Injuries to the upper resp. tract as the pain and sour taste prompt gagging or spitting, which may lead to aspiration

May also cause coagulative necrosis in the stomach

95
Q

Alkali ingestion causes?

A

Liquefactive necrosis in the esophagus and will continue to cause damage until it has been neutralized

96
Q

S/s acid/alkali ingestion

A 
Drooling
Dysphagia
Visual oral burns
Emesis (can appear brown)
Bleeding in mouth, throat, or stomach
Excessive thirst

Esophageal perf.

Airway injury

97
Q

Treatment of acid/alkali burns in first few minutes after ingestion?

A

Dilute with milk or water

98
Q

Treatments contraindicated with acid/alkali ingestion

A 
Gastric emptying by emesis*
Activated charcoal
Neutralizing agents
Gastric lavage
NG tube

*This is because the acid/alkali is a caustic agent and causing regurgitation will re-expose the upper GI tract to the caustic agent

99
Q

Valium dosing for CIWA score of 8-14

A

5-10mg or equivalent Ativan (0.5-1mg)

100
Q

Valium dosing for CIWA score of 15-19

A

10-15mg Valium or equivalent

101
Q

Valium dosing for CIWA score of 20-25

A

20mg Valium or equivalent

102
Q

Valium dosing for CIWA score of 25-30

A

25-30mg Valium or equivalent

103
Q

Cyanide antidotes (4)

A

Hydroxocobalamin
Amyl nitrite
Sodium nitrate
Sodium thiosulfate

104
Q

Sources of cyanide

A

Smoke from fires
Meds (sodium nitroprusside)
Pits/seeds from bitter almonds, apricots, peaches, and apples

105
Q

S/s cyanide poisoning

A 
Bitter almond smell on breath
HA
Confusion
Bloody emesis
Diarrhea
Flushed, red skin
Tachy
HTN
Tachypnea
Hypovolemic shock
Coma
106
Q

Which diseases require the use of airborne precautions (4)?

A

Measles
Chicken pox
Herpes zoster BEFORE blisters are completely dry and crusted
TB

107
Q

Which diseases require the use of droplet precautions (5)?

A 
Measles
Mumps
Pertussis
Chicken pox
Diphtheria
108
Q

Which diseases require the use of contact precautions (7)?

A 
C.diff
Chicken pox
Diphtheria
Mono
Herpes zoster BEFORE blisters are completely dry and crusted
MRSA
VRE
109
Q

s/s opioid OD

A 
resp depression
shallow breathing
pinpoint pupils
cyanosis
bradycardia
change in LOC
110
Q

treatment/management of opioid OD

A

narcan (naloxone) is reversal agent

intubate for airway protection if indicated

mechanical ventilations

111
Q

s/s acetaminophen OD

A

Gastroenteritis
Renal failure
pancreatitis
hepatotoxicity leading to multiple organ failure

112
Q

treatment/management of acetaminophen OD

A

n-acetylcysteine (mucomyst) is treatment for OD

activated charcoal if in window for administration

113
Q

nursing considerations for acetaminophen OD

A

monitor serum acetaminophen levels in labs (dosing for mucomyst is based on these serial results)

114
Q

s/s salicylate OD

A 
N/v
tinnitus
fever
confusion
seizures
rhabdo
acute renal failure
hyperventilation &amp; resp alkalosis (EARLY)
hypoventilation and resp acidosis (LATE)
resp failure
hyperactivity that can turn into lethargy
115
Q

treatment/management of salicylate OD

A

activated charcoal
alkaline diuresis with extra KCl
ETT if indicated
mechanical ventilation if needed

116
Q

nursing considerations for salicylate OD

A

draw salicylate levels & ABGs

117
Q

examples of salicylates

A

aspirin (ASA)
ibuprofen
other NSAIDS

118
Q

s/s calcium channel blocker OD

A 
Hyperglycemia
Hypotension
Bradycardia
Heart block
peripheral edema
reflexive tachycardia
119
Q

treatment/management of calcium channel blocker OD

A

High dose insulin
Vasopressors
Inotrope

120
Q

nursing considerations for calcium channel blocker OD

A

ekg
frequent monitoring of BP
monitor BG

121
Q

examples of calcium channel blockers

A 
amlodipine
diltiazem
nicardipine
nifedipine
verapamil
122
Q

s/s beta blocker OD

A

cardiac:

  • bradycardia
  • hypotension
  • prolonged QT interval
  • prolonged QRS complex
  • ventricular dysrhythmias
  • AV block

GI:

  • esophageal spasms
  • hyperkalemia
  • hypoglycemia
123
Q

treatment/management of beta blocker OD

A

glucagon
dopamine, norephinephrine

ipratropium for pts with esophageal spasms

124
Q

examples of beta blockers

A

the “-olols”
metoprolol
atenolol
propranolol

125
Q

s/s digitalis OD

A 
n/v
abd pain
HA
dizziness
confusion
HALO VISION
bradycardia
tachydysrhythmias (paroxysmal atrial tachycardia with block most common)
126
Q

treatment/management of digitalis OD

A

digoxin immune fab

potassium supplementation

atropine in case of AV block or severe bradycardia

lidocaine or phenytoin to prevent cardioversion

127
Q

nursing considerations for digitalis OD

A

continuous telemetry monitoring as hyperkalemia could lead to AV block

128
Q

s/s heavy metal OD

A 
altered LOC
fatigue
muscle and joint pain
HTN
constipation
numbness &amp; pain in extremities
dark eye circles
hearing loss

Mees’ lines

  • white lines running across the entire nail bed
  • but can also be indicative of other conditions
129
Q

severe lead toxicity will lead to?

A

wrist drop
encephalopathy
colic
Burton’s lines (blue-black line on gums)

130
Q

mercury poisoning can lead to?

A

“mad hatters disease” with s/s including slurred speech, irritability, and depression

131
Q

treatment/management of heavy metal OD

A

chelation therapy

dialysis

132
Q

most common metals in heavy metal OD?

A

arsenic
cadmium
lead
mercury

133
Q

s/s iron OD (5 stages)

A

stage 1: GI upset, n/v, pain
stage 2: latent phase; milder GI upset
stage 3: shock and metabolic acidosis, dehydration, lactic acid
stage 4: hepatotoxicity, necrosis
stage 5: bowel obstruction from GI healing leading to scarring

134
Q

treatment/management of iron OD

A

deferoxamine mesylate (DFO) for acute iron toxicity

intermittent phlebotomy for chronic iron toxicity from hemochromatosis
-this helps lower ferritin and may reduce s/s too much iron

135
Q

nursing considerations for iron OD

A

especially toxic in children (consuming chewable vitamins)

can be seen in patients who have had repeated blood transfusions

136
Q

s/s oral hypoglycemic OD

A

mild: dizziness, nausea, lightheadedness
severe: altered LOC, CNS depression, seizures, coma, hypokalemia, hypomagnesemia

137
Q

treatment/management of oral hypoglycemic OD

A

sulfonylurea supplemented with octreotide if needed for GI symptoms

IV dextrose bolus followed by D10 continuous infusion

138
Q

s/s warfarin OD

A

bloody, red, or black tarry stool

pink, red, or dark urine

spitting up or coughing up blood

“coffee ground” emesis

hemorrhage

139
Q

treatment of warfarin OD (think of reversal agent)

A

vitamin K

140
Q

s/s TCA OD

A

blurred vision, dilated pupils, lethargy, change in LOC, hallucinations, hyperthermia, seizures, resp. distress, hypotension, tachycardia, cardiac arrest

141
Q

treatment/management of TCA OD

A

sodium bicarb
metoprolol as needed to correct cardiac dysrhythmias
benzos for seizure treatment

142
Q

Airborne precautions

A

Private room with negative pressure air system

Door kept closed

N95 required

143
Q

Droplet precautions

A

Private room, door may be open

Appropriate PPE within 3 feet of patient

Wash hands with antimicrobial soap after removing gloves and mask, before leaving the patient’s room

Surgical mask

144
Q

Contact precautions

A

Private room, door may be open

Wear gloves, gown

Hand hygiene

145
Q

Which diseases require the use of airborne precautions (4)?

A

Measles
Chicken pox
Herpes zoster BEFORE blisters are completely dry and crusted
TB

146
Q

Which diseases require the use of droplet precautions (5)?

A 
Measles
Mumps
Pertussis
Chicken pox
Diphtheria
147
Q

Which diseases require the use of contact precautions (8)?

A 
C.diff
Measles
Chicken pox
Diphtheria
Mono
Herpes zoster BEFORE blisters are completely dry and crusted
MRSA
VRE
148
Q

Meds to treat cdiff

A

Metronidazole (flagyl)
Vancomycin
Fidaxomicin (Dificid)

149
Q

In refractory or severe cases of cdiff, which 2 procedures may be used?

A

Fecal transplant

Colectomy

150
Q

Measles

A

Infection caused by a paramyxovirus

Virus enters through upper resp react or conjunctiva and spreads systemically through lymph nodes, triggering a systemic inflammatory response

Spread through resp droplets (like coughing/sneezing)

S/s: sore throats, fever, cough, runny nose, Koplik spots, rash

Dx: swab, saliva, or blood samples tested for measles specific immunoglobulin (IgM)

Tx: supportive care, give vitamin A

151
Q

Mumps

A

Acute inf caused by a paramyxovirus. Virus enters the nose or mouth and replicates in resp tract, GI tract, or eyes. Inflamm response results in swelling of salivary glands (usually parotid gland)

Spread through resp droplets in close proximity

S/s: HA, salivary gland edema, parotitis, fever, anorexia

Dx: serological assay on blood sample to detect IgM

Tx: supportive care, isolate until glandular swelling is gone, soft diet, avoid acidic substances

152
Q

Complications of measles

A 
Subacute sclerosing panencephalitis
Encephalitis
Acute thrombocytopenia purpura
Bacterial superinfection
Transient hepatitis
153
Q

Complications of mumps

A

Orchitis or oophoritis
Meningitis or encephalitis
Pancreatitis

154
Q

Pertussis

A

Caused by bacterium borderella pertussis. Inf causes mucopurulent sanguineous exudate that can compromise resp tract. Initially starts with nonspecific URI s/s and progresses to a hallmark paroxysmal it’s spasmodic cough that ends in a prolonged high pitched inspiration (the “whoop”)

Spread through close contact resp droplets

S/s: cough increasing in severity, increase in mucus, n/v, nocturnal cough, hoarseness, “whooping cough”, choking spells in infants

Dx: nose/throat swab; PCR rest run on swab is most sensitive

Tx: abx (erythromycin, azithromycin); supportive care

155
Q

Chicken pox

A

Caused by varicella zoster virus. Inhaled droplets infect conjunctiva or mucus membranes of upper resp tract. Viral inf then spreads, causing hallmark rash

Spread through direct contact and airborne droplets

S/s: itchy rash that forms small fluid-filled blisters they eventually scab; rash starts on face and trunk and spreads; fever, HA, fatigue

Dx: varicella titer test; Tzanck test (swab of lesion)

Tx: symptomatic treatment aimed at stopping itching

Tx in immunocompromised or severe cases: antivirals (valcyclovir, acyclovir)

156
Q

Diphtheria

A

Caused by bacterium corynebacterium diphtheriae. Bacteria gains entry through pharynx or skin and releases a toxin that causes inflamm and necrosis of infected area.

Spread through resp droplets and skin contact

S/s:

  • pharyngeal inf: white or gray glossy exudate in the back of the throat, edema/visibly swollen neck, stridor, serosanguinous or purulent discharge
  • skin inf: often indistinguishable from symptoms that look like a variety of chronic skin inf; pain and tenderness

Dx: pharyngeal swab shows gram+ bacilli; skin swab/biopsy shows gram+ bacilli

Tx:

  • pharyngeal inf: abx (PCN, erythromycin)
  • skin inf: clean w/ soap and water, abx (PCN, erythromycin)
157
Q

Diphtheria complications

A 
Severe prostration
Pallor
Tachy
Acute renal failure
Stupor
Coma

Main critical s/s that can develop:

  • myocarditis
  • nervous system toxicity
158
Q

What should be administered once a patient has recovered from diphtheria?

A

Diphtheria vaccine

159
Q

Should close contacts in diphtheria receive antibiotics?

A

Yes

160
Q

Herpes zoster

A

Aka shingles

Acute viral inf that is the result of the varicella zoster virus reactivating in a posterior dorsal root ganglion

Spread through contact with fluid from blisters caused by rash

S/s: redness and rash of blisters

  • usually occur in a linear fashion on one side of the body, usually appear in truncal area
  • pain, itching

Dx: based on symptoms; Tzanck test from swab of lesion

Tx: antivirals (acyclovir, famciclovir, valcyclovir)

161
Q

What can be used to treat the pain from shingles?

A

Systemic pain treated with gabapentin

Local pain treated with capsaicin or lidocaine ointment

162
Q

Mononucleosis (mono)

A

Infection caused by Epstein Barr virus. Virus replicated in epithelial cells of pharynx and in B lymphocytes, triggering a response from the body’s immune system.

Spread through body secretions, most commonly though saliva when kissing

S/s: fatigue lasting weeks to months, fever, pharyngitis, palatal petechiae, splenic rupture, airway obstruction

Dx: blood test

Tx: supportive care, corticosteroids for severe s/s like airway obstruction

163
Q

Specific teaching for mono at d/c?

A

Rest

Avoid heavy lifting and contact sports for 1 month or until splenomegaly resolves

164
Q

Due to risk of splenic rupture, avoid _____ ________ _________ of the abd in mono.

A

Deep pressure palpation

165
Q

MRSA is resistant to which family of abx? Give 5 examples

A

Beta-lactam abx

Ampicillin
Amoxicillin
Methicillin
PCN
Cephalosporin
166
Q

Which abx can be used for MRSA infections (4)?

A

Trimethoprim (Primsol)
Sulfamethoxazole (Bactrim)
Clindamycin (Cleocin)
Linezolid (Zyvox)

167
Q

VRE is resistant to which abx?

A

Vancomycin

168
Q

VRE that can be used to treat VRE infections (6)?

A 
Amoxicillin
Amoxicillin
Gentamicin
PCN
Piperacillin
Streptomycin
169
Q

Diagnostic test for TB?

A

Skin test (Mantoux skin test)

  • positive results indicate pt is infected
  • tests do not distinguish patent TB inf from active TB disease

CXR shows multinodular infiltrates near clavicle

Sputum sample shows acid fast bacilli

170
Q

Treatment for TB?

A

2 months of tx with:

  • isoniazid (INH)
  • rifampin (RIF)
  • pyrazinamide (PZA)
  • ethambutol (EMB)

After 2 months of tx, PZA and EMB are discontinued. INH and RIF are continued for another 4-7 months or longer, depending on clinical findings and symptoms.

171
Q

4 steps to disaster management and preparedness

A
  1. Mitigation
  2. Preparedness
  3. Response
  4. Recovery
172
Q

Mitigation

A

Identify vulnerabilities to threats or weaknesses in current plan

173
Q

Preparedness

A

Develop mutual aid agreements, create disaster management plans, determine supply thresholds and needs, consider stockpiles, and establish a command and control structure

174
Q

Response

A

Warn (notify), isolate (during the disaster), and rescue (following the disaster)

175
Q

Recovery

A

Inventory supplies and resources, relieve staff members present during the isolation phase, incorporate records into the EMR, implement CISM program if needed, and activate employee assistance programs if needed.

176
Q

Which 4 elements must be present in order to prove negligence?

A
  1. duty
  2. breach of duty
  3. proximate cause
  4. damages

CEN (5 decks)

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