Term
| Indications & contraindications for injections |
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Definition
INdications:
1. improve, treat, and maintain a pts condition
2. vaccinations for disease prevention
Contraindicatins:
1. allergy to med
2. lack of suitable site
3. coagulopathy
4. occlusive PVD
5. shock
6. impaired peripheral absorption
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Term
| Potential complications of injections |
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Definition
1. anaphylactic or toxic reaction
2. medication errors - five rights
3. infection or abscess at site
4. lipodystrophy or atrophy at sc site
5. pain |
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Term
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Definition
Right:
1. drug
2. pt
3. dose
4. route
5. time |
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Term
intradermal injections:
1. primarily ___ effect
2. ___ is most common site
3. slow absorption
4. small amounts only |
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Definition
1. local
2. ventral forearm |
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Term
| subcu injections go in what 4 spots? |
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Definition
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Term
| doing an IM injection into deltoid can produce injury to what 3 structures? |
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Definition
radial nerve
ulnar nerve
brachial artery |
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Term
| landmarks for dorsogluteal injections |
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Definition
| PSIS and greater trochanter. draw an imaginary linebetween them and inject above = upper outer quadrant of buttocks |
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Term
the ___ is the preferred IM injection site for infants, children, and adults
what nerve is in danger of injury? |
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Definition
vastus lateralis
lateral femoral cutaneous nerve |
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Term
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Definition
explain: drug, site, sensation
obtain verbal consent
question allergies and reaction |
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Term
| Gauge needles for each injection |
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Definition
ID: 26-27g, 1/2-5/8" - 15 deg angle. do NOT rub site
SC: 2-3 ml, 24-33g, 5/16" - 45-90 deg angle
IM: 2-5 ml, 18-22g, 1-2", 90 deg |
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Term
| things to document after injection |
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Definition
drug
dose
route
lot #
expiration date
where
when
whom |
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Term
heparin administration:
1. site
2. always do what?
3. never do what 3 things?
4. apply ___ if pt bruises easily |
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Definition
1. 2" below umbilicus, 1" away from umbilicus and between ASIS's
2. always rotate site from one side to the other
3. do not: inject w/in 2 in of scar, bruise, or umbilicus; aspirate for blood, rub or massage site
4. ice |
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Term
Z track IM injections:
1. done to prevent __ & __
2. only given in ___ site
3. __-__ ml syringe w/ 2 __g needles at __" long |
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Definition
1. leakage into sq tissue
2. dorsogluteal
3. 3-5 ml, 20g, 2"
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Term
Special considerations for injections:
1. never use gluteal muscle for kids <__ y/o or who are walking <__ year
2. preferred site for sc injections is __ in infants and __ in older kids
3. preferred site for IM injections AND multiple injections: ___ is #1 and __ is #2 |
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Definition
1. <3 y/o, 1 year
2. thighs, deltoid
3. vastus lateralis, deltoid |
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Term
| things to have pts report after an injection |
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Definition
fever
joint pain
injection site pain
SOB
rash
pain
erythema
ecchymosis |
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Term
| indications and contraindications for IVs |
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Definition
indications:
1. administration of fluids
2. deliver meds
3. administration of blood
contraindications:
1. avoid venipuncture at site of an active skin infection
2. do not insert distal to any area of preexisting thrombophlebitis
3. avoid lower extremity ventipunctures in elderly or those w/ pvd |
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Term
| potential complications of IVs |
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Definition
Local:
- thrombosis or thrombophlebiti
- infection
systemic:
- catheter embolization
- septicemia
- PE
- air embolism
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Term
| 2 most frequently utilized spots for IV |
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Definition
metacarpal vein
cephalic vein |
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Term
| Use Butterfly IV for what 2 populations? |
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Definition
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Term
| indications & contraindications for venipuncture |
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Definition
indications: blood sample larger than finger stick
contraindications:
1. infection, rash, recent tattoo
2. scars, surgery, injuries, repeated puncture, trauma
3. side of mastectomy
4. hematoma
5. arm w/ iv for fluids or blood products
6. arm w/ fistula or cannula |
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Term
| 4 conditions associated wtih prolonged bleeding |
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Definition
DIC
hyperfibrinolysis
thrombocytopenia
platelet disorder |
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Term
| potential complications of venipuncture |
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Definition
cellulitis
phlebitis
vein laceration
thrombosis
hemorrhage or hematoma = most common
vasovagal syncope |
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Term
| 3 best veins for venipuncture |
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Definition
1. median cubital
2. cephalic |
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Term
| techniques for finding difficult veins |
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Definition
keep arm below heart level
apply warm towel
use BP cuff as tourniquet
rub or tap venipuncture site
have pt increase fluid intake 24-48 hours ahead |
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Term
| indications & contraindications for blood cultures |
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Definition
indications:
1. suspicion of bacteremia
2. monitor efficacy of drug treatment
3. severely ill and febrile - suspected infective endocarditis, catheter site infection, meningitis, osteomyelitis, septic arthritis, bacterial pneumonia, FUO
contraindications:
1. warfarin or coumadin
2. site of active skin infection
3. failed prior blood culture |
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Term
| complications of blood draw |
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Definition
hematoma
bleeding
localized skin infection or phlebitis
contaminated blood samples |
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Term
| what do you draw for an episode of sepsis? |
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Definition
| 2 sets of blood cultures from 2 separate venipunctures at 2 separate sites |
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Term
blood culture:
1. __ ml syringe w/ __g needle |
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Definition
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Term
| indications and contraindications for art stick |
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Definition
indications:
1. dx of an acute CO2/O2 exchage dysfunction or acid-base balance
2. monitor severity and progression of COPD
3. quantify pt response to therapeutic intervention
4. when IV access not available
5. specific tests: ammonia levels, CO, lactate
contraindications:
1. ABSOLUTE: no pulse
2. invisible surface landmarks
3. atherosclerosis, arterial inflammation, aneurysm
4. coagulopathy, thrombocytopenia, anticoagulants
5. ESRD w/ shunt
6. skin infections, rashes, scars |
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Term
| complications of art stick |
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Definition
MOST COMMON in femoral and brachial: hemmorrhage and hematoma
MOST COMMON in radial: thrombosis
arterial spasm
nerve damage
infection |
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Term
art stick:
1. most frequent site of art stick?
2. two sites in danger of injury from a brachial stick?
3. __ ml syringe w/ __g needle
4. ___ can occur if sample is not analyzed quickly
5. excess heparin in syringe can do what? |
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Definition
radial
basilic vein and median nerve
3-5 ml, 21-25g
pseduoacidosis
decrease pH |
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Term
| INdicaions and contraindications for intubation |
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Definition
indications:
failure to oxygenate, ventilate, or protect airway
resp or cardiopulmonary arrest
trauma
anticipated clinical course
contraindications:
relative only - unstable C spine, severe facial trauma |
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Term
| systematic process where deep sedation and muscle paralysis are used to expedite intubation |
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Definition
| rapid sequence intubation procedure (RSI) |
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Term
| desired depth of intubation tube |
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Definition
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Term
| complications of intubation |
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Definition
right mainstem bronchus intubation
esophageal intubation
vocal cord trauma
oral truama
tracheal perforation
aspiration
pneumo
arrhythmia |
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Term
| indications and contraindications for joint injections |
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Definition
indications:
arthritis, bursitis, synovitis, tendonitis, ligament sprain, muscle strain, trauma
contraindications:
carcot joint, infectin, tumor, immunosuppression, neurogenic disease, skin dz, total joint arthroplasty, anticoagulation, burns |
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Term
knee injections:
1. preparation of hyaluronic acid that is injected into the joint. done to decrease inflammation, improve mobility & pain, provide lubrication to knee joint. watch for ___ allergies. synovitis.
2. anti=inflammatory. side effects: tissue atrophy, osteoporosis, AVN, hyperglycemia, tendon rupture, infection, skin depigmentation
use a __-__ g needle and __-__ ml syringe |
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Definition
1. viscosupplementation - no bird allergies
2. steroid
20-23, 6-12 ml |
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Term
under what circumstances should you aspirate a joint?
__-__ ml syringe, __g needle
things to evaluate aspirate for? |
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Definition
1. diagnostic - fluid analysis
2. therapeutic
effusion, septic arthritis, gout, inflammation, injury
20-35 ml, 18-20 g
aspirate for viscosity, cell count, culture, gram stain, crystals |
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Term
| indications & contraindications for shoulder injections |
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Definition
indications: arthritis, bursitis, tendonitis, rotator cuff tear, muscle strain, arm pain, scapular pain
contraindications: infection, tumor, immunosupression, neurogenic, skin disease, total joint arthroplasty, anticoagulation, burns |
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Term
| general precauitions for steroid injections |
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Definition
| will raise a diabetics blood glucose levels |
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Term
pt complains of lateral hip pain that at times radiates to the knee and is generally worse by laying on that side
contraindications |
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Definition
greater trochanteric bursitis - needs injection
contras: infection, immunosuppression, neurogenic disease, skin infection, THA, anticoagulation, burns |
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Term
NG tube indications and contraindicatins
best way to check tube placement?
complications? |
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Definition
indications: GI tract decompression (ileus, pancreatitis), adminsitration of oral agnets, GI hemorrhage
contraindication: maxillofacial trauma, AMS, esophageal trauma
inject air and listen for borborygmi over stomach
complications: sinusitis, epistaxis, sore throat, esophageal perforation, aspiration, pneumo, intracranial placement |
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Term
Catheterization:
1. best size for women and men
2. complications? |
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Definition
1. women: 14-16 french. men: 16-18 french
2. complications: trauma and infection
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Term
| indications for chest tube |
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Definition
| indications: pneumo, hemopenumothorax, malignant pleural effusion, tx w/ sclerosing agents or pleurodesis, chylothorax, postop after coronary bypass, thoracotomy, r lobectomy |
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Term
indications and contras for thoracentesis
1. never insert needle below the __ rib
complications? |
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Definition
indications:
diagnostic for pleural effusion of unknown cause - transudate or exudate, cell count, gram, hct, gu, cytologic, pH, trigs, amylase. ALSO - reduces resp distress
contra:
may need to use reversal agent w/ severe coaguloapthy
mechanical ventilation
infection at site
1. 9th
complications: pneumo, pain, cogh, infection, hemothorax, organ injury, air embolism, poste expansion pulmonary edema (avoid by not taking >1500 ml at a time) |
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Term
What is ALT?
When would it be elevated? |
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Definition
used to ID hepatocellular diseases of the liver and monitor those diseases
jaundice pt with increased ALT --> liver is cause
Sensitive and mostly specific to liver
elevated: mainly liver disease, also MI, pancreatitis, shock, myositis, burns |
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Term
AST:
1. indicated in pts wtih suspected __ or __
2. Found in high concentration in what 6 tissues?
3. what disease processes could cause elevations?
4. what disease proceses could cause a decrease? |
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Definition
1. CAD or hepatocellular disease
2. liver, myocardium, skeletal muscle, kidneys, pancreas, RBC
3. MI, cardio surgery or cath, angioplasty, liver disease, skeletal disease, hemolytic anemia, pancreatitis
4. decrease: ARD, DKA, pregnancy, chronic renal dialysis
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Term
55yo male with history of CAD and DM presents with myalgias and nausea. He is currently taking Zocor, gemfibrozil and metformin.
AST is high
ALT is high
CK is normal
most likely cuase of this? |
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Definition
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Term
PSA:
1. differences with age and race?
2. 3 causes of elevated PSA?
3. what would cause a falsely elevated PSA?
4. limitations? |
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Definition
1. older pts: wider range of normal, japs and blacks: narrower range of normal
2. cancer, BPH, prostatitis
3. rectal exam, prostatitc manipulation, ejaculation w/in last 24 hours, recent UTI/prostatitis, finasteride
4. limitations: "diagnostic gray zone" from 4-10 ng/ml |
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Term
What is PT, INR, and PTT?
what are some foods that can affect PT/INR? |
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Definition
1. PT: protime. measures clotting ability of factors I, II, V, VII, and X - extrinsic system. PT is prolonged when these are deficient
INR: international normalized ratio. more sensitive for oral anticoagulation
PTT: partial thromboplastin time. screens for defects in intrinsic clotting system (VIII, X, XI, XII)
Foods that affect PT/INR: abx (increase, oral contraceptives, HRT, vit K (decrease)
foods such as beef, pork, green tea, broccoli, chickpeas, kale, turnip greens, soybeans have lots of vit k - decrease PT/INR |
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Term
65yo female S/P total hip arthroplasty is being treated with Coumadin for DVT prophylaxis. She is currently taking 2.5mg of Coumadin daily and had a blood draw today.
PT and INR are elevate
why? |
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Definition
pt is on coumadin to prevent DVT which should elevate PT and INR
desired INR is 2-3 |
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Term
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Definition
| interferes with production of vit K dependent clotting factors which results in a prolonged PT |
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Term
| how do you reverse the effects of coumadin? |
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Definition
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Term
Henrietta F., a 42 yoF, had her lipid profile results forwarded to the clinic after attending a local health fair. Her nonfasting results are shown below. She follows a reasonable, low-fat diet, and hikes for exercise often. She has a 20pack/year history of smoking but rarely drinks alcohol. She takes vitamins, calcium, and an antihistamine for seasonal allergies. She does not have a family history of diabetes, hyperlipidemia, pancreatitis, or coronary heart disease. At her office visit, she has a normal physical exam. She is 5’8”, 150 lobs, and premenopausal. Her fasting glucose was 90 mg/dL; electrolyte, hematology, liver, renal, and thyroid tests are all normal.
Total: 232
HDL: 52
1. What should be done now?
Fasting lipid profile:
Total: 224
HDL: 45
LDL: 158
Trigs: 165
2. How should this be interpreted?
3. What now?
4. how does exercise work to help cholesterol?
5. what are some foods that affect trigs?
6. what are some foods that affect cholesterol? |
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Definition
1. fasting lipid profile
2. borderline high
3. Calculate framingham score
4. converts trigs to HDL - lowers trigs and increases HDL
5. carbs, sugars, tobacco, etoh- increase. fish oils decrease
6. cholesterol-rich increase, plant sterols decrease |
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Term
Chief Complaint: Exertional "heartburns"
History of Present Illness: The patient is a 63-year-old man with hypertension and dyslipidemia who was recently diagnosed with type 2 diabetes. He reports moderate to severe “heartburns” intermittently over the past few months, which have been getting more frequent of late and do not seem to respond to antacids. The nagging burning sensation across his lower chest is sometimes accompanied by numbness of his jaw and left shoulder, and occurs whenever he walks briskly for a few blocks or whenever he climbs two flights of stairs. Symptoms persist as long as he is exerting, often associated with shortness of breath, and go away slowly after several minutes of rest. This morning he had an episode that started 45 minutes ago and seems to be worsening instead of resolving after he stopped the provoking activity.
Age: 63
Gender: Male
Race: Hispanic
Height: Height 5’4” (163 cm)
Weight: Weight 190 lbs (86 kg)
Blood Pressure: 142/88 mm Hg
Pulse: 86 bpm
Head and Neck: No jugular venous distention at 30 degrees
Chest and Lungs: Chest is clear to auscultation
Cardiac Exam: Regular cardiac rhythm, normal S1 and S2, positive S4 but no S3 gallop, no murmurs
Abdomen: Abdomen is unremarkable
Extremities: Full and equal distal pulses, no edema
Patient proceeds with cardiac enzyme testing with the results shown below:
Troponins high
CK-MB high
EKG: NSSTT changes
1. What does this tell you?
2. is CK or troponins more specific to cardiac?
3. how long does it take for these to be pos? how long do they remain elevated?
4. what can cause false elevated troponins?
5. what can case falsely elveated CK levels? |
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Definition
1. he's had an MI
2. troponin
3. troponin: 2-6 hr, peak at 12-24h, stay elevated for 7-10 hours
CK-MB: 4-6 hr, peaks at 12-24, stays elevated for 2-3 days
4. trauma, CHF, renal failure, HTN< hypotension, drug tox, vasospasm, sepsis, burns, PE, pulmonary HTN
5. prolonged vigorous exercise, increased muscle mass, IM injetions, drugs, myopathies
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Term
| HDL, LDL< and trig goals for "high risk" pts? |
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Definition
HDL: >40
LDL <70
trigs <150 |
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Term
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Definition
| inhibit production of cholesterol in the liver |
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Term
Liver panel contents:
1. enzyme mainly in liver. best for detecting hep.
2. enzyme w/ highest concentration in liver, biliary tract and bone. increased in liver dz, pregnancy, fxs, bone cancer, paget disease, RA, MI. decreased in hypophosphatemia, malnutrition, pernicious anemia, scurvy
3. found in high concentraiton in highly metabolic tissue - liver, heart, skeletal muscle, kidney's pancreas, RBC
4. measures the bilirubin that is conjugated in the liver which can be excreted. increased in gallstones, extrahepatic duct obstruction, liver metastasis, cholestasis frm drugs
5. increased in erythroblastoma fetalis, transfusionreaction, sickle cell, hemolytic jaundice, hemolytic anemia, pernicious anemia, large volume blood transfusion, hepatitis, cirrhosis, sepsis, neonatal hypervilirubinemia
6. main protein made in the liver that tells whether or not liver is making an adequate amount of protein
7. measures albumin, prealbumin, and globulins
8. enzyme found in liver cells - indicator of heavy alcohol use
9. intracellular enzyme used to support diagnosis of injury or disease involving heart, liver, RBC, kidneys, skeletal muscle, brain, and lungs. not specific to any disease or organ.
10. liver produced protein involved in the clotting of blood |
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Definition
1.ALT
2. AST
3. Alk phos
4. direct bilirubin
5. indirect bilirubin
6. albumin
7. total protein
8. GGT
9. LDH
10. PT |
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