UWORLD stuff Flashcards
malignant hyperthermia cause and s/s
- rare but life threatening inherited muscle abnormality that is triggered by specific, inhaled anesthetic agents and the depolarizing muscle relaxant succinylocholine used to induce general anethesia
Severe muscle rigidity or spasms.
Rapid, shallow breathing and problems with low oxygen and high carbon dioxide.
Rapid heart rate.
Irregular heart rhythm.
Dangerously high body temperature.
Excessive sweating.
Patchy, irregular skin color (mottled skin)
cause of tumor lysis syndrome
Tumor lysis syndrome is caused by the massive release of intracellular ions such as potassium, phosphorus, and nucleic acids that have been metabolized to uric acid. The main organ responsible for the excretions of these substances is the kidney.
** allopurinal = med to decrease uric acid levels
where to give immunizations for infant
anterolateral thigh with 1 in needle
** ventrogluteal area does not have enough muscle mass till at least age 3
medications that cannot be combined
MAOIs (segeline) and SSRIs –> serotonin syndrome, NMS and hypertensive crisis
MAOIs need to be discontinued for at least 2 weeks before starting a new medication
concerning assessment of neonate
**ptosis (Drooping of eyelid) could be indicative of paralysis of a cranial nerve
** remember that fluid heard in lungs should clear on its own with transition into real life, testes should decend by 6 months
sickle cell anemia
at risk for dehydration
hemophilia a
abnormal/inability to blood to clot
**not at risk for dehydration, no need for special diet
concerns with “sulfa” drugs
dehydration
IBD
common to have lower hemoglobin
common to have elevated c-reactive protein, ESR, and WBCs
- *black tarry stools require followup but not immediate priority
- *at risk for dehydration
how often should a peripheral IV be changed
72-96 hours
tachyarrhythmias intervention
cardioversion
s/s of an asthma attack
rapid breathing
chest tightness
wheezing on expiratory
use of accessory muscles
cough from airway inflamation and increased mucus production
diminished breath sounds d/t hyperinflation
IM injections
muscular area, 1 in to 1.5 inches for adults
graves disease s/s
fever
excessive autonomic activity
AMS
*** condition occurs when the thyroid gland secretes excessive amount of hormone during stress, trauma, surgery, infection, etc
botulism
life threatening condition with different causes… all stem from bacteria which could lead to paralysis
(from eating honey… young infants are unable to breakdown the bacteria in it)
–> improperly canned foods
early s/s –> can’t hold head up, constipation, diminished DTR, difficulty feeding
breast engorgement treatment for woman who is exclusively using formula
cabbage leaves until they wilt
analgesic
ice packs for 15-20 mins every 3-4 hours
EA/TEF
frothy saliva coughing choking drooling distended abdomen
care of ascending colostomy
identify foods that are gassy/cause odor, avoid
clarify medications that are enteric coated with doctor
need sufficient fluid intake
clozapine (clozaril)
atypical antipsychotic
at risk for agranulocytosis, cardiac disease (myocarditis) and seizures
**common side effects: weight gain, hypersalivation
valsalva manuver
vagus nerve is stimulated
this slows down heart rate and decreases CO which could lead to cardiac complications
straining increases intra-abdominal and intrathoracic pressure and ICP
remember contraindicted in liver cirrhosis, eye surgery, heart disease, head injury, stroke, etc
pts that should not use the valsalva manuver
vagus nerve is stimulated
this slows down heart rate and decreases CO which could lead to cardiac complications
straining increases intra-abdominal and intrathoracic pressure and ICP
remember contraindicted in liver cirrhosis, eye surgery, heart disease, head injury, stroke, etc
ACE inhibitors
increase serum potassium, so always assess BP and K+ prior to administration
SBFT
imaging study to assess the function of the small bowel
non-invasive
fast for 8 hours prior to administration
stools may be chalky for 72 hours
complications of PEEP
barotrauma –> pneumothorax and subcutaneous emphysema … decreased venous return which can lead to hypotension
raynaud phenomenon
vasospastic disorder resulting in an episodic vascular response related to cold temp or emotional stress
s/s
color change in appendages
white in color from decreased perfusion followed by bluish-purple appearance d/t cyanosis
numbness/coldness
pt should immerse hands in warm watter
may also be prescribed CCB
avoid COLD water
fifth disease “slapped face” or erythema infectiosum
viral illness caused by human parvovirus and affects mainly school aged children
- spread thru resp secretions and period of communicability occurs before onset of symptoms
- distinct red rash on cheeks then spreads to extremities and a maculopapular rash develops then goes to proximal and distal surfaces
- malaise
- joint pain
- can take NSAIDS
- typically recover within 7-10 days
- once they develop symptoms THEY ARE NO LONGER INFECTIOUS …. ISOLATION NOT REQUIRED
transplant pts
likely immunosuppressed by steroids and anti-rejection drugs
- organ transplant clients will have blunted response to infection, such as a low-grade fever
- *SYSTEMIC SYMPTOMS may indicate serious underlying infection**
- may develop fulminant sepsis w/in a few hours if antibiotics are delayed
- *IN PRIORITIZING PTS SYSTEMIC > LOCALIZED S/S**
position for prolapsed cord
knee-chest position or trendelenburg
nurse can also use sterile, gloved hand to lift the presenting part off the cord
other –> o2 and IV fluids
otherwise –> cord compression and impaired fetal oxygenation occurs
emergency c-section ususally required unless vag birth is imminent and safe
shoulder dystocia
mcroberts maneuver
leopold maneuver
systematic approach to palpating the pregnant abdomen to identify fetal presentation
Kawasaki disease
mucocutaneous lymph node syndrome
- >/= 5 days of fever, bilateral nonexudative conjunctivitis, mucositis, cervical luymphadenopathy, rash and extremity swelling
CORONARY ARTERY ANEURYSMS are the most serious possible sequelae in untreated clients.. need EKG
IVIG and aspirin therapy… parents cautioned about risk of reye syndrome… also teach CPR
scope of practice RN
clinical assessment intitial client education discharge education clinical judgement initiating blood transfusion
scope of LPN/LVN
monitor RN findingd reinforce education routine procedures (cath insertion) most med administrations ostomy care tube patency & enteral feeding specific assessments (lung sounds, bowel, neuro checks)
scope of UAP
activities of daily living hygiene linen change routine, stable VS documenting i/o positioning
catatonic schizophrenia
immbolity, remaining mute, bizarre postures, extreme postures, extreme negativism, staring
- unable to meet basic needs so at high risk for dehydration and malnutrition
myelomeningocele
- occurs as result of neural tube failing to fuse properly during fetal development
high risk for infection, priority is to cover the area with sterile moise dressing - at risk for hydrocephalus
- place newborn in prone position, with face turned to side to prevent rupture
therapeutic aPTT for heparin pt
between 46-70 seconds (1.5-2.0x baseline)
protamine is reversal agent for heparin
autonomic dysreflexia
occur in any individual with a spinal cord injury at or above T6
- leads to exaggerated sympathetic nervous system response resulting in uncontrolled hypertension
- common triggers include bladder or rectum distension and pressure ulcers
MANIFESTATIONS:
acute onset of throbbing h/a, nausea, blurred vision; hypertension and bradycardia; diaphoresis and skin flushing above level of injury
MED EMERGENCY –> need bladder cath to remove precipitating trigger
GBS
acute immune-mediated polyneuropathy
- ascending muscle paralysis
- absence of reflexes
- autonomic dysfunction is common (orthostatic hypotension, paralytic ileus, urinary retention, diaphoresis)
- NM respiratory failure is the most life-threatening complication monitor rate and depth of resp
GOLD STANDARD FOR ASSESSING EARLY VENTILATION FAILURE: measurement of serial bedside forced vital capacity (spirometry)
active pulmonary TB
- airborne precaution (N95, hand hygiene) clinical manifestations: - cough - night sweats - fever - hemoptysis - unintended weight loss - fatigue **negative pressure room**
ectopic pregnancy
fertilized egg implants and begins to grow outside the uterine cavity
- may report a positive pregnancy test
- abdominal pain
vaginal spotting/bleeding
** can result in hemorrhage if left untreated and hemodynamic compromise**
reaction to MMRV vax
- within 5-12 days after 1st dose
- low-grade fever, mild rash, swelling and erythema, irritability and restlessness
- rare but fever after MMRV cax can lead to febrile seizures
toxoplasmosis
parasitic infection… acquired from exposure to infected cat feces or ingestion of undercooked meat or soil contaminated fruits/veggies
can cause serious fetal harm
SE of statins
hepatotoxicity
muscle aches
**assess LFT prior to starting med
manifestations of airway obstruction
snoring
use of accessory muscles
decr o2 saturations
cyanosis
head tilt and chin lift is a maneuver used to open the airway
risk factors of postpartum hemorrhage + extras
risk factors: grand multiparity (ie >/ 5 births), intrauterine infection, prolonged labor, use of oxytocin during labor, and coagulopathy
perineal pad that is saturated in 1 hour indicates heavy/excessive bleeding –> hemodynamic compromise
** assess fundal tone, lochia amount and VS and notify HCP IMMEDIATELY!**
burn injuries
cause cellular destruction, capillary leaking and fluid shifts
fluids are lost during the emergent phase (first 24-72 hours), resulting in hypovolemia and hyponatremia… blood is more viscous and incr hematocrit and hemoglobin values
also releases potassium so hyperkalemia tall, peaked T waves, shortened QT interval and cardiac arrhythmias
mature minors
adolescents 14-18, deemed able to understand treatment risks
allowed to give independent consent to receive/refuse treatment for some conditions (STIs, family planning, drug and alcohol abuse, blood donation and mental health care)
mild-to-moderate dementia
may need frequent reality reorientation to promote appropriate behaviors
advanced dementia –> reality orientation may not be effective and might lead to anxiety, inappropriate behaviors and aggression, then use validation therapy
cirrhosis
leads to elevated bilirubin, ammonia and coagulation studies (PT/INR and aPTT)
hyponatremia and hypoalbuminemia are expected
polycythemia vera
requires periodic therapeutic phlebotomy treatments to reduce RBC count + risk of blood clotting associated with increased blood viscosity
** this can also occur secondary in someone w chronic hypoxemia (such as COPD) **
sluggish blood means decr tissue perfusion
thrombocytopenic purpura
autoimmune condition in which antibodies bind to and cause destruction of platelets
increased risk for bleeding
- *remember better to use electric razors, not safety razors**
- low impact activity**
somatic symptom disorder
psychological disorder that develops from stress –> medically unexplainable physical symtpoms
- *redirect somatic complaints to unrelated, neutral topics
- limit time spent discussing physical symptoms
- secondary gains –> factors that intensify symptoms and coping strategies
IV narcotics *pregnancy
nalbuphine, butorphanol, meperidine
give during the peak of contractions… can help decrease the sedation of the fetus and subsequent NB resp distress at birth
less med passes the placental barrier
autonomic dysfunction + causes
dysfunction of the nerves that regulate nonvoluntary body functions, HR, BP and sweating *also affects BR, digestion, sensation
** can be sudden and severe but also reversible… typically irreversible
causes: uncontrolled diabetes, irregulat protein build up in organs (amyloidosis), autodimmune diseases, some meds (cancer drugs), viruses and bacteria (HIV, botulism, lyme) and some inherited disorders (hypothyrodism)
