Shared Flashcard Set

Details

Emergency Nursing
CEN review
436
Medical
Graduate
06/18/2020

Additional Medical Flashcards

 


 

Cards

Term

What is the criteria for firinolytic therapy?

Definition
  • No stroke in 3m.
  • Onset of s/s within 180 min.
  • SBP < 185 mm Hg
  • Platelet count < 100,000 mm3
Term

What are the s/s of organophosphate poisoning?

Definition

SLUDGE

  • S  salivation
  • L  lacrimation
  • U urination
  • D diarrhea
  • G GI upset
  • E emesis
Term

Name the types of MIs according to ST elevation in corresponding leads.

Definition

SALI

  • S  septal:  V1 & V2
  • A  anterior:  V3 & V4
  • L  lateral:  V5,V6, I, AVL
  • inFerior:  II, III, AVF
Term

What are the s/s & stages of ethylene glycol poisoning?

Definition

Pts with ethylene glycol (anti-freeze) poisoning pass thru 3 stages of toxicity. metabolic & neuro effects occur in the 1st stage & are normally seen in the ED.  Neuro effects incl: inebriation, SEIZURES, & coma.  Metabolic effects incl: hypoglycemia (esp. in kids), hypocalcemia, & acidosis. Stage 2 effects the cardiopulmonary system & may incl: pulmonary edema & heart failure. Stage 3: kidney failure.

Term

In what position would you place the crushed arm of a pt that is dx with compartment syndrome?

Definition

At body level.  the extremity should not be positioned above the level of the heart because this may compromise arterial blood flow.  A dependent position will compromise venous return.

Term

What sense is lost after the patching of one eye?

Definition

Depth perception.

Pts may have difficulty climbing stairs.  All driving & operating of machinery should be avoided.

Term
Sutures on the face are removed after how many days?
Definition
Sutures on the face should be removed after 3-5d to prevent scarring.  The pt can shower & drsgs usually are not need after the first 24h.
Term
What assessment finding would help the RN to determine if the pt with an acute scrotum has a testicular tortion?
Definition
Elevated testis and absent cremasteric reflex on affected side.
Term
What activity would the nurse as the pt to perform to assess the radial nerve after a hand injury?
Definition
Thumbs up.
Term
What activity would the RN ask the pt. to perform to assess the ulnar nerve after a hand injury?
Definition
Abduct little finger.
Term
What activity would the RN ask the pt. to perform to assess the median nerve after a hand injury?
Definition
Touch thumb to every other finger.
Term
What is the current reccomendation for post-exposure rabies vaccine administration?
Definition

Days 0,3,7,14,28.

Never administered in gluteal area of adult and older children due to decreased efficacy.

 

Term
What is the current reccomendations for the administration of HRIG in post-exposure?
Definition
The total dose of HRIG be infiltrated in and around the bite site.  Dosing is 20 IU/kg with a total of 5 rabies vaccines.  HRIG is only for persons who have not received rabies vaccine. HRIG can be given up to 7d after bite.
Term
What precautions need to be instituted by the RN for the pt with RSV?
Definition
Respiratory & contact precautions. The virus can survive for hours on surfaces for hours and enters the body via the eyes, mouth, and nose.
Term
How is a biphasic defibrillator different than a monophasic defibrillator?
Definition
Biphasic defibrillators deliver current that flows through the heart in 2 directions-first in the same direction as the monophasic defibrillator and then the current reverses direction.
Term
A pt with CA who is receiving radiation tx to the chest presents to the ED with c/o CP and SOB. What assessment finding is consistant with pericardial effusion?
Definition

CA pts are at risk for pericardial effusion. Pts with pericardial effusion may exhibit symptoms of cardiac tamponade, incl. HTN, muffled heart sounds, and JVD. Also, pulsus paradoxus and  a drop in BP of > 10 mm Hg on inpiration.

Term

Which of the following is true regarding s/s of copperhead snake bite:

  • numbness @ site
  • C/O diplopia
  • Increased platelet count
  • Increased INR
Definition

Increased INR

Copperhead snakes are pit vipers, and their venom has a hemotoxin that injures blood vessels, causes tissue necrosis, and affects blood clotting. Copperheads are the least venomous of the pit vipers and do not cause systemic symptoms in adults. Kids however are more vulnerable to the effects of envenomation due to size.

Term

Which of the following s/s is associated with acute pancreatitis in the adult pt?

  • N/V
  • HTN
  • Hyperglyemia
  • Epigastic pain radiating to back
Definition

Epigastic pain radiating to back

 

Term
How long should an IO infusion be used for?
Definition
IOs are placed in the bone & are designed to be used no longer than 24h. IOs should flow by gravity although the rate can be increased by pressure bag or pump.
Term

Which of the following tests is most important for the pt with Addison's disease?

  • electrolyes
  • bedside glucose
  • head CT
  • plasma cortisol level

 

Definition

plasma cortisol level

Addison's disease (adrenal crisis) is a condition in which the adrenal cortex does not product enough glucocorticoid & mineralocortcoid hormones. Plasma cortisol levels are diagnostic of this condition.

Term
What electrolyte imbalance is associated with rhabdomyolysis?
Definition

Hyperkalemia

Rhabdomyolysis is caused by a breakdown in muscle tissue and subsequent release of myoglobin, causing the urine to become dark brown. this accumulation of myoglobin causes a fluid shift into the interstitial space.

Term

During a hazmat situation, the RN can deliver complete medical care in which zone of decon?

  • Hot zone
  • Warm zone
  • Cold zone
  • Any zone
Definition

Cold zone

Pts in the cold zone are properly decontaminated and can receive full medical tx. Pts in the hot zone are considered highly contaminated & minimal control such as airway control, antidotes, hemorhage control are provided. Pts in the warm zone are considered to have some contamination and stabilization is provided.

Term

Croup is classified as a(n):

  • upper airway obstruction
  • lower airway obstruction
  • lung tissue (parenchymal) disease
  • disordered control of breathing
Definition

Croup is classified as an upper airway obstruction, a blockage of the extrathoracic, large airways. Other disorders in this category incl: anaphylaxis, FB obstruction, & retropharyngeal abscess.

Term

Which of the following s/s are consistant with serotonin syndrome?

  • Hyporeflexia
  • Hallucinations
  • Bradycardia
  • Flat affect
Definition

Hallucinations

s/s of serotonin syndrome incl: restlessness, tachycardia, hyperthermia, hyperreflexia, & hallucinations.

Term

A young man with a snake bite to the hand comes to the ED. You notice 2 fang marks on the dorsal aspect of the left hand. There is eccymosis & swelling. He states a pain level 5. Your priority intervention is:

  • measure circumference of extremity
  • remove his rings
  • start IV of NS
  • get PT/aPTT samples
Definition

Remove rings

Copperheads are pit vipers.  Their venom contains proteoltyic enzymes, toxic protiens, & cytolytic enzymes. When envenomization occurs pts have pain at the site & develop ecchymosis & swelling that spreads; if the bite is on an extremity, there is a > risk of compartment syndrome developing.

Term

A peace corps volunteer returns home & goes to the ED c/o flu-like s/s x8d that are getting worse. The pt has a fever; T: 104 F, shaking chills, & orthostatic changes in v/s. Additional questions should focus on assessment of risk for:

  • toxic shock syndrome
  • meningitis
  • malaria
  • rabies

 

Definition
The pt's s/s are typical of malaria: low-grade fever, malise, myalgia, & H/A progressing through several days to high fevers with rigors and increased weakness. Other s/s incl: n/v/d, tachycardia, tachypnea, orthostatic dizzyness, arthralgia, chest discomfort, & cough.
Term

Your pt has a chest tube inserted to tx a pneumothorax. While assessing the function of the tube, you notice bubbling in the water seal chamber on exhalation. You should:

  • increase amount of suction
  • clamp drainage system and check for leaks.
  • decrease the amount of suction.
  • continue to monitor the system
Definition
Bubbling in the water seal chamber on exhalation is normal after chest tube insertion. On exhalation, intrathoracic pressure increases forcing air out through the chest tube. Only if the bubbling is continuous should the system be checked for leaks. However, if there should always be bubbling in the suction control chamber of the system
Term

Your pt arrives to the ED with a crushed black widow spider in a bag & a bite mark on LLE & has s/s of envenomization. The MD orders Valium. You will know that the drug has been effective when:

  • seizure activity stops
  • pt is sedated
  • wound erythemia is reduced
  • abdominal pain is relieved
Definition

s/s of a black widow bite may incl: pain at the site, chest, back, & shoulder pain or abdominal pain w/rigidity. Although antivenom maybe needed in severe cases, tx is often for symptomatic relief.  

Term

Your pt is dx w/deep frostbite to both feet. Your intial plan of care would incl:

  • scrub both feet with antiseptic solution.
  • place both feet in a dependent position
  • place both feet in a pan of 105-115 F water
  • administer analgesics for severe pain.
Definition
Rewarming measures should begin ASAP. A pan of warm water kept at a constant temp will rewarm the tissue during a 20-30 min. period. If a whirlpool is avail. it maybe used. The feet should not be rubbed, massages or scrubbed before rewarming.
Term
What is the reference range for blood urea nitrogen (BUN)?
Definition
10-20
Term
What is the reference range for serum creatine?
Definition
0.5-1.1
Term

For every 1 liter increase in oxygen, what is the increased % of oxygen?

 

i.e. if a pt is put on 2L nasal cannula what % of oxygen are they receiving?

Definition

For every 1 liter of oxygen the % of oxygen increases 4%.

 

If a pt is on 2L of oxygen they will be receiving 29% oxygen.  (RA 21% + 8% from the 2L =29%)

Term
If the anaphlactic pt is on beta blockers, what is the drug of choice to reverse anaphlyaxis?
Definition
Glucagon.
Term
What are the effects of alpha adrenergic stimulation on the body during hypovolemic shock?
Definition
  1. peripheral vasoconstriction
  2. increased capillary permiability
  3. release of glucocorticoids
  4. diaphoresis
  5. decreased gastric motility
Term
What are the effects of Beta 1 adrenergic stimulation during hypovolemic shock?
Definition
  1. increased heart rate
  2. increased contractility & automaticity
Term
What are the effects of Beta 2 adrenergic stimulation in the hypovolemic pt?
Definition
  1. increased respiratory rate
  2. bronchodialation
Term
If O-neg blood (universal donor) is not available, what pts may recieve O-pos blood?
Definition
Males of all ages and females that do not intend to have children in the future (i.e. post-menopausal women).
Term
What is the definition of neurogenic shock &  what is its relationship to hypovolemic shock?
Definition
Neurogenic shock, a form of distribuative shock, is the complete absence of sympathetic nervous system involvement & total parasympathetic control of the body caused by spinal injury, anesthesia, etc.. This is the compete opposite physiological state of hypovolemic shock.
Term
What is the cure for obstructive shock?
Definition

Correction of the obstruction. Examples:

  • have preganant lady roll from belly to lt side.
  • needle decompression  & chest tube for pneumo.
  • fibrinolytic tx for PE.
Term

True or False:

 

PRBCs contain clotting factors.

Definition

False.

 

FFP & platelets need to be given with PRBCs to provide clotting.

Term
At what ratio are isotonic crystaloid solutions given to the hypovolemic pt?
Definition

3:1 ratio because due to the osmolarity of the solution, as much as 75% of the volume will leak into surrounding tissue.  Blood products & colloids are given at a 1:1 ratio.

The isotonic solutions should be warmed to prevent hypothermia.

Term
In the hypovolemic pt, the increase in DBP is caused by what physiological effect?
Definition
Diastolic BP is increased due to the alpha adrenergic response of peripheral vasoconstriction causing an increase in peripheral vascular resistance.
Term

In the average adult male pt., what % of blood volume must be lost to begin to see s/s of hypovolemia?

  • 5%
  • 10%
  • 20%
  • 40%
Definition
15-30% of blood volume must be lost in the adult male pt to begin to see s/s of hypovolemic shock
Term

True or False

Hypotension is a late finding in the pediatric hypovolemic pt.

Definition
True.
Term
When treating the cardiogenic shock pt., the ED nurse knows that the following drugs decrease preload:
Definition
  1. Lasix
  2. Nitrates
  3. MSO4
Term
What drugs are given to the cardiogenic shock pt to increase contractility?
Definition
  • Dopamine (inotropin)
  • Dobutamine (Doburex)
  • Inamrione (Inocor)
Milrinone (Primacor)
Term
In the cardiogenic shock pt, what is the deciding factor to decrease afterload or to increase afterload?
Definition

Blood pressure.

If the pt is hypotensive afterload needs to be

Term
In the average lab, what is the wait time for a type & crossmatch?
Definition
30-45 min.
Term
In the average lab, what is the wait time for a type and screen?
Definition
30-35 min.
Term
What is done is a type & crossmatch that is NOT done in a type & screen?
Definition
A sample of the donor's blood & a sample of the reciptients blood are mixed and studied under a microscope to observe for clumping. Both T & S and TCM are screened for ABO, Rh, and antibodies.
Term

What electrolyte imbalance is caused by multiple blood transfusions?

Definition

Hypocalcemia

 

Assess for Chvostek’s sign (facial spasm)

Assess for Trousseau's sign (BP cuff)

 

Term

True or False

 

Generally, pts that have had an MI and have damaged > 40% of their left ventricle are at risk of developing cardiogenic shock.

Definition
True
Term
Name 6 s/s of cardiogenic shock.
Definition
  • S3/S4 heart sounds
  • Dysrhymias
  • Decreased peripheral pulses
  • Peripheral edema
  • Poor cap. Refill
Cool, clammy skin
Term
What drugs can the ED nurse expect to give to increase afterload, such as in the neurogenic shock pt?
Definition
  1. ACE inhibitors
  2. Nitrites
  3. Nitroprusside (Nipride)
Term
What are the most important initial interventions concerning the hypotensive septic shock pt?
Definition
  1. Volume
  2. Volume

   and yes:

 

  3. Volume

Term

What is the definative difference between mild anaphlaxis and severe anaphylaxis?

 

Definition

Mild:  Normal BP & Minimal respiratory distress

Severe:  Hypotensive & severe respiratory distress

Term
What is the first line tx for a adult pt in mild anaphlaxis?
Definition
0.2-0.3 ml of 1:1000 Epi SQ
Term
You have been giving 0.3 ml q 5-10 min x 3 doses of 1:1000 Epi SQ to your anaphylatic pt when his symptoms suddenly worsen.  What is the next pharmacological intervention the ED nurse can expect to administer?
Definition
0.1-0.5 ml of 1:10,000 Epi IV.
Term
What secondary treatments can the ED nurse expect to administer (after Epi) to the anaphylactic pt?
Definition
  1. O2
  2. Benadryl (antihistamines)
  3. Corticosteroids
  4. Albuterol
  5. Beta 2 agonists
  6. Zantac
Term
Your pt has had a severe anaphylactic reaction & has been intubated. She needs Epi now but her IV is not working (of course). You know that SQ administration is used only in mild cases & is not appropriate at this time. What is your next course of action?
Definition
3-5 ml of Epi 1:10,000 down the ET.
Term
When discussing septic shock, what is Xigris and how/when is it used?
Definition

Dotrocogin Alpha (Xigris) is a FDA approved drug used to combat the vasoconstrictive effects of septic shock. Ideally, it needs to be given in the first 24h of sepsis and is run over a 96h period.  It is very  expensive.

Term
At what location on the spine must damage occur to cause cardiogenic shock?
Definition
T4-T6 or above
Term
What is the physiological reason that neurogenic shock occurs in the SCI pt?
Definition

Sympathetic nerve tracts run down along the spinal column. Parasympathetic nerve tracts run down the anterior neck. When the spine is damaged & SNS influence is discontinued, the PNS takes over compete unrestrained control.

Term
Define Obstructive shock.
Definition
Obstructive shock results from inadequate circulating blood volume because of an obstruction, compression of a vessel,  PE, pericardial tamponade, or  tension pneumothorax can lead to obstructive shock.  Blood in the pericardial sac can compress the heart as well leading to obstructive shock. When this occurs, the pt becomes hypotensive, bradycardic, and hypoxic despite adequate blood supply
Term
What is the hallmark sign of Abruptio Placentae?
Definition
The hallmark of abruption is dark red vaginal bleeding with intense uterine tenderness or pain.
Term
Define mild Pre-Eclampsia
Definition

Mild preeclampsia is indicated by an increase in SBP of 30mm or more and an increase in DBP of 15mm or more, on two occasions at least 6h a part.

Term
Define PIH.
Definition
 PIH is synonymous w/preeclampsia-eclampsia.  Preeclampsia is characterized by HTN, protienuria, and nondependent edema, which occurs after the 20th week of pregnancy.  Eclampsia is an extension of preeclampsia characterized by convulsions, coma, or both; it can occur during pregnancy but also in the post-partum period.  A severe form of preeclampsia is characterized by hemolysis, elevated liver enzymes and low platelets is the HELLP syndrome. 
Term
What is hyperemesis gravidarium?
Definition
.  The primary clinical manifestation of hyperemesis gravidarum is frequent sustained vomiting often lasting 4-8w
Term
What are the 5 criteria assessed in the APGAR?
Definition
  1. Heart rate
  2. Color
  3. Respiratory Effort
  4. Muscle tone
  5. Reflex irratibility
Term
What is the most common causative agent of chronic gastritis?
Definition
Chronic gastritis may be caused by H. pylori, which is present in 30-50% of the population
Term
What is the most common time for an infant to be Dx with pyloric stenosis?
Definition
It is diagnosed 95% of the time during the first 3-12w of life
Term
What is the hallmark positive assessment for an AP?
Definition
RLQ rebound tenderness over McBurney’s point
Term

In the pt with cold septic shock. What would be an indicator that current interventional tx is sucessful?

  • urine output 20 ml/h
  • rise in serum pH
  • positive Babinski sign
  • core temp of 99.0 F
Definition

Rise in serum pH to a more alkaline state.  Remember that in cold (late) septic shock Acid-based values turn from a Respiratory alkalosis (in warm shock) to a combined metabolic/respiratory acidosis in cold shock. So, if the serum pH is returning to > alkaline state it would indicate that tx is working.

Term

Which of the following assessment findings is indicative of hypovolemic shock?

  • pulsus paradoxus
  • hemoglobin of 10 mg/dl & hemocrit of 38%
  • widening of pulse pressure
  • central venous pressue of 4 mm Hg
Definition

Pulses pardoxus is indicative of hypovolemic shock.  It is characterized by an abnormal drop (> 10 mm Hg) in SBP on inspiration.

Term

The ED nurse would expect a pt in early shock to have:

  • metabolic acidosis
  • metabolic alkalosis
  • respiratory acidosis
  • respiratory alkalosis
Definition

Respiratory alkalosis develops in the intial phase of shock. A compensatory mechanism of tachypnea is initated as a decrease in peripheral tissue perfusion occurs resulting in hypoxia. In early shock the pt hyperventilates to increase oxygenation, thus blowing off carbon dioxide.

Term

Which assessment finding indicates that the compensatory response mechanisms for shock are failing?

  • increase in cap refill time
  • cool, clammy skin
  • pale, moist skin
  • mottled skin
Definition

Mottled skin would indicate that compensatory mechanisms for shock are failing. During the compensatory stage of shock, the skin is typically cool, pale, & clammy as a result of peripheral vasoconstriction & increased sweat gland activity. If the cause of shock is not corrected, and compensatory mechanisms continue, the sme physiologic events that were initiated t compensate for a decreased CO will lead to detremental effects.  Impaired cellular function leads to acidosis. the resultant decrease in cardiac contractility and loss of vasomotor tone produce mottled skin.

Term

The nurse would expect a pt who is admitted to the ED in the early stages of septic shock to present with:

  • weak, thready pulses & low BP
  • decreased urine output
  • warm, flushed, & moist skin
  • hyperventilation & pulmonary congestion

 

Definition

The nurse would expect a pt who is admitted in the early (hyperdynamic, aka warm shock) stages of septic shock to present with warm, flushed, & moist skin; tachycardia with full, bounding pulses; tachypnea; confusion; normal or slightly decreased BP.

Term

In the pt with early septic shock, which respirator symptom would the ED nurse expect to note?

  • increased mucus production
  • bilateral crackles
  • hyperpnea
  • respiratory acidosis
Definition

Hyperpnea is common in early sepsis.

Term
What is the normal serum osmolarity?
Definition

275-295 mOsm/liter

A hyperosmolar state (>295) could cause brain cells to become dehydrated, thereby causing a change in level of consiousness.

Term
State the rule of nines.
Definition
[image]
Term
What is the Parkland burn formula?
Definition

4ml of LR x pt's wt in kg x % of BSA burned.

  • First 1/2 of this volume over first 8h.
  • Second 1/2 of this volume over the next 16h.
Term
What co-morbidities are closely asssociated with IBS?
Definition

More than half of those with IBS have underlying depression or anxiety.

Term
What is considered adequate urine output in the burn victim?
Definition
A urine output of 30-50 ml/h is a commonly used parameter for adequate fluid replacement in the burn victim.
Term
What 2 electrolyte imbalances should the ED nurse assess for in the early stages of a burn victim?
Definition
After the initial shock phase of burn injury, the nurse should assess for hypernatremia and hypokalemia.

·        Hypernatremia can result because the interstitial fluid, with its high sodium content, now shifts intravascularly, resulting in evaporative losses at the wound site.  Hypokalemia occurs because potassium losses incurred from damaged tissue and destroyed RBCs along with selective renal excretion of potassium that occurs with high aldosterone levels.

Term
What GI problems are associated with the massive burn pt?
Definition

·        Pts with massive burns frequently develop gastric distention and paralytic ileus form the stress of the injury, therefore must be kept NPO while in the ED.  An NG tube should be placed and gastric output should be measured and recorded. Aspirate should be checked for occult blood and pH should be checked every 2 hours.  Tagamet or Zantac may be ordered. 

Term
What effect does hypothermia have on insulin production?
Definition
Insulin secretion is decreased.  As a result, serum glucose levels may be elevated to 500-600 mg/dl.  Glucose uptake and insulin secretion will return to normal with rewarming.
Term
What is the temperature range that is compatable with human life?
Definition
The extreme degrees of 77-113 F are compatible with human life.
Term
When caring for the hypothermic pt, the ED nurse must be mindful of afterdrop.  What is afterdrop?
Definition

·        Afterdrop is a common phenomenon in hypothermic pts (also postop pts) in whom the core temperature continues to drop after the cause of hypothermia is removed. Usually about 2 degrees F. This occurs because of vasodialation causing peripherally sequestered cold blood returning to central circulation.

Term

True or False

 

The elderly are more at risk for hypothermia.

Definition

True 

The elderly are more at risk for hypothermia due to an impaired hypothalamic function

Term
What nutritional support is unique to massive burn pts?
Definition
Nutritional support for the burn pt requires large amounts of protein. Extensive burns produce a hypermetabolic response, which increases caloric and protein requirements to two to two and a half of the preburn state. A positive nitrogen balance is maintained by an intake of 6000-10,000 calories a day.  Sodium maybe replace as needed.  Lipids are usually given once per day to maintain adequate fat intake.  Glucose is necessary for caloric intake and to prevent further protein breakdown
Term
What are the expected assessment finding for a pt with heatstroke?
Definition

·        When assessing a pt for heatstroke, the nurse would expect to find a temp > 106 F. In addition: tachhypnea, hypotension, lethargy, or coma.

Term
What is the difference  between exertional and non-exertional heatstroke?
Definition

·        Exertional heatstroke, which is common in athletes, occurs with exercise during periods of high heat or humidity. Nonexertional heatstroke, which is not associated with activity may also occur in high heat or humidity but also in saunas, hot tubs.  Since exertional heatstroke manifests differently that nonexertional heatstroke, the nurse would expect to find that the pt with exertional heatstroke will have to continue to sweat and have moist and clammy skin. The pt with nonexertional heatstroke will have hot and flushed skin and will not sweat.  Both forms of heatstroke will cause variations in pulse rate.

Term
What lab findings are common in the pt with heatstroke?
Definition
The nurse would expect to find the heatstroke pt to have an elevated Hct and BUN from hemoconcentration.  Other labs typically include decreased glucose, respiratory alkalosis from hyperventilation which occurs to help the body eliminate heat
Term
At what temperature would the ED nurse expect to discontinue cooling measures in the pt with heatstroke?
Definition

·        The nurse should expect to stop all cooling measures when the pts body temperature reaches 102 F.  This is because the pts body temp will continue to drop after the measures have been removed.

Term
What is the effect of radiation exposure on a pt's WBC & platelet count?
Definition

·        A decreased WBC (leucopenia) and a decreased platelet count (thrombocytopenia) always occur in pts with radiation exposure and manifest anywhere form 1-5w from the incident, depending on the amount of exposure. In cases of mild exposure (100 rads) these symptoms usually manifest 4-5w later.  In moderate exposure (300-600 rads)  3w later. In high exposure (>600 rads) 1-3w later.  Such a pt would have a decreased protection against infection, anemia, and decreased coagulation. 

Term
For how long after a burn accident should the RN evaluate the pt's airway & why?
Definition

·        Frequent airway assessments are vital during the first 48 hours after burn injury.  Although the victim may not suffer mechanical airway obstruction as a result of the burn, the pt. will have edema as fluid shift from plasma to the interstitial spaces.  The large fluid replacement can add to this edema.  After 48 hours the burn pt enters the diuretic phase , characterized by an increase in urine output and decreased edema, the danger of airway obstruction decreases at this point.  If burn injuries occur in an enclosed environment, the toxic products of combustion can cause deterioration of pulmonary function.

Term
What initial treatment for frostbite of digits can the ED nurse expect to deliver?
Definition
The tx for frostbitten digits is rapid rewarming in bath water no warmer than 106 F. No mechanical friction, rubbing such be used.
Term
What causes the red, burned appearance of frostbite?
Definition
  • The red, burned appearance of frostbite is caused as ice crystals enlarge, and cells rupture, enzymatic and metabolic activity becomes interrupted.  Such interruption results in histamine release and increased capillary permeability with resultant red blood cell aggregation and microvascular occlusion.
Term
Why is it important to gently move the hypothermic pt?
Definition

·        Extreme caution must be used while moving, transporting, manipulating, or intubating a hypothermic pt. in order to prevent ventricular fibrillation.  Also, at temperatures at or below 85 degrees, defibrillation and drug therapy are ineffective.

Term
What is the age relationship concerning gastric & duodenal ulcers?
Definition
Duodenal ulcers occur most frequently in persons between the ages of 30-55 years, whereas gastric ulcers are more common n those ages 55-70 years
Term
What animals carry rabies?  Of these which are most common?
Definition
Any mammal can get rabies. The most common wild reservoirs of rabies are raccoons, skunks, bats, foxes, and coyotes. Domestic mammals can also get rabies. Cats, cattle, and dogs are the most frequently reported rabid domestic animals in the United States.
Term

A 6m old infant in brought to the ED with sudden onset of severe colicky pain & vomiting. The nurse should assess for:

  • blood or mucus in stool
  • relationship of feeding to onset of s/s.
  • a palpable olive-shaped mass in the epigastrium.
  • projectile vomiting.
Definition
Severe colicky pain combined with vomiting is a significant sign of intussusception. Intussusception is hte telescoping of one portion of the intestine into another. It most commonly occurs between the ages of 3m-2y. Stools maybe described as "currant jelly" in appearance.
Term
The most common tx for methemoglobinemia

(Methemoglobinemia is a disorder characterized by the presence of a higher than normal level of methemoglobin (metHb) in the blood. Methemoglobin is a form of hemoglobin that does not bind oxygen. When its concentration is elevated in red blood cells, anemia and tissue hypoxia can occur.)

is:
  • 100% oxygen
  • hyperbaric oxygen
  • ascorbic acid IV
  • methylene blue IV
Definition
In rare situations, topical agents such as benzocaine and lidocaine may cause methemoglobinemia.  Methylene blue converts Fe+3 back to Fe+2.
Term

GI upset, diaphoresis, fever, & tinnitus are common s/s of which of the following conditions?

  • GERD
  • Acute salicylate tox.
  • appendicitis
  • Acute acetaminophen tox.
Definition
These s/s are most commonly associated with acute salicylate tox. a condition that affects the CNS. Salicylate poisoning causes an accumulation of pyruvic & lactic acids, which lead to hyperthermia & metabolic acidosis.
Term

Assess the cerebellum by:

  • asking pt to swallow.
  • asking pt to read a statement & do what it says.
  • instruct pt to close his eyes, hold his arms out, & alternate touching his nose with each finger.
  • instruct pt to close his eyes & extend his arms straight out with palms up.
Definition
The cerebellum organizes & controlls movement. If there is normal functioning, there would be smooth & coordinated movements of the arms. The answer is C.
Term
adenosine (Adenocard) is used in the tx of narrow complex tachycardia. What S/Es should the ED nurse tell the pt he/she might experience?
Definition

Advise pts that they may experience:

  • irregular heartbeat
  • facial flushing
  • headache
  • lightheadedness
  • dizziness
  • nausea
  • SOB
  • CP
Term
What is a typical dose of Narcan?
Definition
0.4-2mg IV. Use higher doses for complete narcotic reversal. Can administer up to 6-10mg over short period (<10 min).  IM/SQ 0.4-0.8 mg. Can be give via ET route if IV/IO access not avail.
Term
What is the dosing of Succinylcholine (Anectine), a neuromuscular blocking agent, used in tracheal intubation during cardiac arrest?
Definition

1 to 2 mg/kg IV

or 

2 to 4 mg/kg IM

Comments: rapid onset, short duration (3-5 min). S/E: muscle fasciculations, rise in IOP & ICP.

Term
What meds are used in the RSI pre-medication phase?
Definition
  1. Fentanyl: 2-3 ug/kg given at at rate of 1-2 ug/kg per minute IV for analgesia in awake pts.
  2. Atropine: 0.02 mg/kg IV push
  3. Lidocaine:  1.5-2 mg/kg IV over 30-60s.
Term
What is the pediatric dosing for Narcan?
Definition
0.1 mg/kg IV or IM preferred route.  ET route not recommended.
Term
What is the compression-ventilation ratio for 1&2 rescuers in the adult?
Definition
30:2
Term
What is the criteria for the Glasgow coma scale?
Definition
Glasgow Coma Score
Eye Opening (E)Verbal Response (V)Motor Response (M)
4=Spontaneous
3=To voice
2=To pain
1=None
5=Normal conversation
4=Disoriented conversation
3=Words, but not coherent
2=No words......only sounds
1=None
6=Normal
5=Localizes to pain
4=Withdraws to pain
3=Decorticate posture
2=Decerebrate
1=None
Term

What EKG changes might the ED nurse see in a pt with ischemia?

Definition
ST segment depression & T wave inversion. These changes are transient and will revert to normal when oxygen is returned to the cell.
Term
In the pt having chest pain,  what is Levine's sign?
Definition
A clutched fist or open hand on the left chest when a pt is asked where their chest discomfort is. 80% of pts having an MI will demonstrate Levine's sign.
Term

True or False:

 

20% of pts having an MI will not experience chest discomfort.

Definition

True

The following pt populations are less likely to experience chest discomfort:

  • Diabetics
  • Elderly pts >85y (most common s/s is SOB)
  • Pts who have had a cardiac transplant will NOT experience chest pain.
  • Women
Term
When considering tx for MI, what does the mneumonic MONA stand for?
Definition

M  morphine

O  oxygen

N  nitro

A aspirin

Term
What is Prinzmetal's Angina?
Definition
Angina pain secondary to coronary artery spasm.  Usually occurs between the hours of midnight and 8am.  It is not associated with CAD. Tx with Ca channel blockers. Often occurs in younger people.
Term
What are some clinical manifestations of RIGHT sided heart failure?
Definition
  • peripheral edema
  • hepatomegaly
  • splenomegaly
  • ascites
  • JVD
  • increased central venous pressure
Term
What are some clinical manifestations of LEFT sided heart failure?
Definition
  • tachypnea
  • tachycardia
  • cough
  • rales
  • basilar crackles
  • gallop rhythm
  • increased pulmonary artery pressures.
  • hemoptysis
  • cyanosis
  • pulmonary edema
Term
What is Beck's triad?
Definition

Beck's triad is a collection of three medical signs associated with acute cardiac tamponade, an emergency condition wherein fluid accumulates around the heart and impairs its ability to pump blood. The result is the triad of low arterial blood pressure, increased central venous pressure, and distant heart sounds.[1]

Term
What is Pericardiac tamponade?
Definition
Accumulation of fluid in the pericardial sac. The fluid then increases the pressure on the heart & prevents the heart's ventricles from filling properly.This in turn leads to low stroke volume which can result in shock and often death.
Term
Which IV solution is always used for burn pts?
Definition
Lactated Ringers
Term

True or False

In septic shock, the very old & the very young may not respond to the pyrogens given off by the cells and may present without a fever.

Definition
True.
Term

True or False

Hypodynamic (late/cold) septic shock occurs when the BP goes so low that the SNS & RAS is activated.  At this late point, cold shock looks just like hypovolemic shock.

Definition
True.
Term

True or False

A very low glucose level or an overdose of insulin could cause neurogenic shock.

Definition
True.
Term

True or False

 

A Q wave in lead III alone is not diagnostic of infarction, even if it is otherwise “significant” in size and width. Qs in III are ignored unless other abnormalities are seen.

Definition

True

Term

True or False

Q waves are “significant” if they are greater than 1 box in width (longer than 0.04 msec) OR are larger than 1/4 of the R wave. Significant Q waves indicate either myocardial infarction or obstructive septal hypertrophy (IHSS).

Definition
True
Term

When is a Q wave significant?

  • Only in lead III
  • If it is 0.04s or greater or 25 % as deep as the R wave is high
  • In septal, anterior, & inferior infarcts.
  • During Ischemia
Definition
If it is 0.04s or more or 25% as deep as the R wave is high.
Term

True or False

A pt with unstable angina with have a positive troponin level.

Definition

False.

Troponin will only be positive when there is actually infarction of the myocardium.

Term
Define unstable angina
Definition
angina at rest for > 20 min.
Term
What are the reasons that Morphine is given during an MI or in the pt exerienceing severe angina?
Definition
  • analgesia
  • sedation
  • decrease preload
  • decrease afterload (cause it vasodialates)
  • reduces apprehension
Term

What can the ED nurse expect to give the MI pt that is allergic to ASA?

Definition
Plavix
Term
What preparations must the ED RN expect to accomplish in order to send the MI pt to the cath lab?
Definition
  • Page interventional attending
  • V/S & continuous monitoring
  • Establish IV
  • Oxygen
  • STAT labs: troponin, CBC, CMP, lipid panel, PT/INR, Mag.
  • H&P
  • ASA or Plavix
  • Metroprolol 5mg IV up to 3 doses (5 min apart)
  • Nitrates if pain continues after Bb.
  • MSO4
  • Hospital gown on pt, monitor & portable oxygen placed on pt/transfer to lab.
Term
How often are the troponin level & EKG repeated in the NSTEMI pt admited to cardiology?
Definition
q 6h.
Term
What is the time goal for the pt to get to the cath lab?
Definition
door to balloon <90 min.
Term
What is the time goal of the pt presenting to the ED with CP to get an EKG?
Definition
door to EKG < 10 min.
Term
What indicators are assessed in the TIMI risk score for NSTEMI/Unstable Angina pts?
Definition
  • age > or = 65y
  • > or = 3 CAD risk factors (incr. chol., family hx, HTN, DM, smoking)
  • Prior CAD (cath stenosis > or = 50%)
  • ASA in last 7d.
  • > or = 2 anginal events at rest in < or = 24h.
  • ST deviation > or = 0.5mm
  • Elevated Troponin

low risk: <3

intermediate risk:  3 or 4

High risk: > 4

 

Term

True or false:

The incidence of asymptomatic MI in persons 75-84y is > 40%.

Definition

True

Among the elderly assess for acute change in mental status, SOB,new onset weakness

Term
Provocative factors of acute coronary syndromes may include:
Definition
  • physical activity
  • emotional stress
  • cold weather
  • after meals
  • sex
  • may occur at rest
Term

True or False

EKG changes may not be apparent initally in the MI pt.  Especially shortly after the occlusion.

Definition
True.
Term
What distinguishes unstable angina from an MI?
Definition
Absence of troponin level.
Term

True or False

Troponin levels elevate 3-12h after MI onset, peak in 24h and return to normal in 5-12d.

Definition
True.
Term

True or False

The pt with an MI may have an normal temp that changes to an elevated temp that begins to rise 4-8h after MI onset as a nonspecific response to tissue necrosis.

Definition
You betcha.
Term

Which EKG finding is consistant with myocardia ischemia?

  • ST segment elevation
  • ST segment depression
  • T wave elevation
  • U wave appearance
Definition
ST segment depression
Term

Which abnormality would the RN be able to detect during an angina attack?

  • transient diastolic murmur
  • transient abnormal point of maximal impulse
  • pulsus paradoxus
  • pericardial friction rub
Definition
Transient abnormal point of maximal impulse.
Term
What is the optimal door to drug time for fibrinolytic tx of the MI pt?
Definition
< or = 30 min.
Term

A pt sustained a femur fx 4d ago and now presents to the ED with c/o petechial skin rash. You suspect:

  • rhabdomyolysis
  • compartment syndrome
  • fat embolism syndrome
  • pulmonary embolism
Definition
a petechial skin rash is a common presentation of a fat embolism that can progress into acute respirator distess or DIC.
Term

Which of the following would you expect to see in a PEDIATRIC pt in compensated shock? The child will:

  • remain normotensive up until 10% of blood volume is lost.
  • increase stroke volume to maintain BP.
  • have a fluid shift from the plasma to the iterstitial spaces.
  • increase heart rate to maintain BP.
Definition

increase HR to maintain BP & continue perfusion to theheart,  brain and kidneys. Tachycardia is an early sign in compensated shock. The child may stay normotensive up until 25% of blood volume is lost.

 

Term

The highest priority intervention for the pt with near drowning is directed at:

  • removing water from the lungs
  • preventing hypothermia
  • correcting hypoxia
  • correcting metabolic acidosis
Definition

correcting hypoxia

Damage to surfactant from both fresh and saltwater can lead to ventilation and perfusion missmatching.

Term

A jockey is brought to the ED after a horse fell on top of her and rolled on top of her.  The jockey is awake and c/o severe pain below the protective vest that extends below her waist. Initial xrays reveal an unstable pelvic fx. The highest priority nursing dx for this pt is:

  • altered tissue perfusion
  • fluid volume deficit
  • imparied gas exchange
  • acute pain
Definition

Fluid volume deficit.

Hemorrhage is a frequent complication of pelvix fxs, particularly when the fx is unstable, because the pelvic region is very vascular and receives a rich blood supply.

Term

A pt with traumatic brain injury arrives at the ER receiving O2 via NRM & has IV access. Which of the following findings in the inital resuscitation phase indicates that additional intervention is needed?

  • drainage from left ear
  • SBP of 100 mm Hg
  • SaO2 95%
  • Glasgow Coma Scale Score: 7
Definition
As with all trauma pts,the goals of initial resuscitation in the pt with traumatic brain injury are to establish a patent airway, maintain SaO2 >90%, SBP > 90mm Hg. Pts with a Glascow Coma Scale Score of <9 need RSI.
Term

True or False

Compartmental syndrome may develop more quickly in kids because fascial tissue is tighter and the compartment size is smaller than adults.

Definition

True.

Needles as small as 25 guage can be used to measure compartment pressure accurately.

Term

True or False

Normal tissue pressure is 10mm Hg or lower.

Definition
True.
Term

Which of the following labs would be performed in an attempt to R/O a PE or DVT?

  • brain-type natruretic peptide
  • BMP
  • ESR
  • D-dimer
Definition

D-dimer

D-dimer is a circulating marker indicating the presence of a thombus. As the fibrin clot breaks down, and elevated D-dimer indicates ongoing coagulation activation and reactive fibrinolysis.

Term

When caring for a victim of radiation exposure, which of the following procedures would be the priority intervention after  proper disposal of the pt's clothes?

  • Insert foley to contain contaminated urine
  • cleanse contaminated area with alcohol
  • decontaminate wounds with saline solution
  • wash pt's hair with soap & water

 

Definition
Decontaminate wounds with saline solution.
Term

When administerint Methotrexate to a pt dx with etopic pregnancy, the RN should:

  • mix the med just prior to administration
  • wear a nonpermeable gown & thick nitrile or other nonpermeable gloves.
  • take the usual precautions when preparing meds.
  • recap the needle to avoid aerosolized particles.
Definition

Methotrexate is a cytotoxic drug and should be considered hazardous.  OSHA mandates special saftey precautions. the usual precautions are not enough. It is important to wear PPE such as thick nitrile or other nonpermeable gloves and a nonpermeable gown. Pharmacy staff should mix this drug under controlled conditions at the pharmacy.

Term

When assessing pain in a child who is preverbal or noncommunicative, you would use which of the following scales:

  • FACES
  • Numeric
  • Oucher
  • Faces, legs,activity, cry, consolability(FLACC)
Definition
The FLACC scale is an objective scale that measures 5 categories of behaviors in children and is helpful in quantifying pain in a preverbal or noncommunicative child.
Term

Which of the following interventions has the highest priority for a pt that comes to the ED with HTN & signs of a dissecting aortic aneurysm?

  • give meperidine for pain relief
  • give labetalol to lower BP
  • give hydralazine to lower BP
  • Give lorazepam to reduce anxiety
Definition
Labetalol, a Bb, reduces BP & cardiac contractility and may slow the progression of the dissection.
Term

Nesiritide (Natrecor) is ordered for a pt dx with heart failure.  Which of following outcomes should the ED RN expect after administration?

  • increase HR
  • increase preload
  • increase BP
  • decrease BP

 

Definition
decrease BP
Term

A 47 y.o. pt with a hx of ETOH abuse comes to the ED with a medical complaint. In addition to monitoring the pt for s/s of withdrawl, the RN should expect to administer which of the following in order to prevent development of Wernicke-Korsakoff syndrome?

  • Folic acid
  • lorazepam
  • thiamine
  • magnesium
Definition
Wernicke-Korsakoff syndrome is a degenerative brain disorder that is caused by thiamine deficiency. Symptoms incl: severe cognitive impairment, delirium, & ataxia.
Term

A 25 y.o. man comes to the ED with c/o general malaise, nausea, weakness, & "brown urine". The pt states that he was "jumped" & "beaten up" 2d ago. Which of the following lab results indicates the pt has rhabdomyolysis?

  • K: 3.0 mEq/L
  • Serum Bicarb: 29 mEq/L
  • CK: 25,000 u/L
  • BUN to creatine ratio > 10:1
Definition
Creatine kinase (CK) levels are extremely elevated in rhabdo because of the release of myoglobin from injured muscles.
Term

One minute after being delivered in the ED, a newborn has a HR of 120, is actively crying while flexing arms and legs, and is pink in color except for cyanotic extremities. What is the child's Apgar score:

  • 10
  • 9
  • 8
  • 7
Definition
The Apgar score is based on the child's HR, respiratory effort, muscle tone, reflex irritability, & color. Each area assessed has a maximum possible score of 2. An infant with a pink trunk & cyanotic extremities would loose 1 pt.for color.  The answer is 9.
Term

A 70 y.o. diabetic pt with an increasing amount of confusion is admited to the ED.  The pt's FS is 700mg/dl, and serum ketones are absent. On the basis of these findings, interventions for hyperosmolar, hyperglycemic state (HHS) are started. The highest priority nursing intervention for this pt is:

  • fluid replacement
  • insulin administration
  • electrolyte replacement
  • correction of acidosis
Definition
Pts with HHS present with severe dehydration. Because the pancreas produces some insulin, pts with HHS do not have ketosis and the accompanying s/s of acidosis. Pts with HHS tend to have more profound dehydration than do pts with ketoacidosis. Insulin tx will be considered after pt is rehydrated.
Term

A 40 y.o. man collapsed after spraying pesticide to control insects in his garden. The day was hot & the pt was wearing shorts & sandals. Assessment of the pt revealed constricted pupils, weakness, and excessive salivation. The ED RN would prepare to administer which of the following antidotes to this pt?

  • N-acetylcysteine
  • ethanol
  • physostigmine
  • atropine

 

Definition
Atropine. The pt is showing s/s of organophospahte poisoning. organophosphates are easily absorbed through the skin & mucus membranes.
Term
What is the antidote for ethylene glycol poisoning?
Definition
Ethanol
Term

Which of the following statements about d/c inst. suggest the need to provide further instructions to the pt with severe dematitis on hands & dx with scabies:

  • I should wash my hands with warm soapy water
  • I should apply the med while my skin is still warm from the water.
  • I should not apply the med to inflamed or open areas.
  • I should not apply the med to my face.
Definition
In the pt that has scabies, the female mite burrows into the skin where it lays eggs, resulting in signs of dermatitis in the form of pimple-like sores. In a severe form of the disease called crusted scabies, the pt maay have plaques on the hands and feet or scales on the scalp and trunk. Pts should thoroughly dry their skin and allow it to cool before applying a scabicide, such as permethrin cream (5%) because warm skin may absorb the scabicide and cause CNS damage. :)
Term

A friend brought a 25 y.o. man to the ED. Upon arrival at the triage desk, the pt is having difficulty standing, is slow to respond to questions, and vomits (nice). The friend states that the pt had spoken to him on the phone an hour ago and he had been well. The pt called the friend back 30 min. later & stated that he suddenly felt very ill & needed to go to the hospital. Upon further assessment you discover that this pt has an occipital H/A & neck pain, his HR 60, and his BP 130/90. Based on your brief initial assessment, the ED RN should institute immediate interventions for the pt with possible:

  • food poisoning
  • meningitis
  • subarachnoid bleed
  • migraine h/a
Definition
The pt is exhibiting s/s of acute subarachnoid hemorrhage. The sudden onset of severe h/a & meningeal signs (nuchal rigidity) in a previously healthy person suggests intracranial bleeding. Blood in the subarachnoid space acts as an irritant producing meningeal s/s.
Term

A pt with CA who has a central line device for chemo comes to the triage desk with c/o hoarseness, a sense of fullness in the head, and tightness in the fingers. Based on the pts hx and s/s, the RN would assess for additional s/s associated with:

  • CHF
  • hyponatremia
  • superior vena cava syndrome
  • thoracic outlet syndrome
Definition
Superior vena cava syndrome results from blockage of drainage from above the superior vena cava. The severity of s/s is determined by the level and extent of blockage and the rapidity of s/s onset.
Term

True or False

Studying too much for the CEN can make your brain hurt.

Definition
True.
Term
What lab values need to be checked on a 48 y.o. man that is going over to radiology for an IVP?
Definition
BUN & Creatinine.
Term

A 35 y.o. primagravida woman who is at 28w gestation comes to the ED c/o severe ab pain & vaginal bleeding. Her uterus is rigid and boardlike. After you complete your primary assessment & interventions, the next priority would be to:

  • draw pt/aptt, fibrinogen levels, platelet levels, & fibrin split products.
  • attach fetal monitor
  • administer mag sulfate IV.
  • prepare pt for pelvic exam
Definition
Fetal monitoring is essential when treating a pt with suspected abruptio placentae & is an accurate way to determine if the fetus is in distress and an emergency C-section is indicated.
Term

Which of the following interventions would be the most appropriate for the pt located in the ED waiting room who is behaving in a bizarre manner, shuting obscenities?

  • Thorazine 50mg IM  :)
  • Prepare the pt for head CT
  • 4 point restraints
  • Perform finger stick for blood glucose level.
Definition

Any pt with AMS should be tested for hypoglycemia initially. A FS is a rapid tool to r/o hypoglycemia which would cause confusion, combativeness, and/or lethargy.

Term

A pt being tx for ab pain suddenly becomes tremulous, tachycardic, & hypertensive. It is suspected that he is going into ETOH withdrawl. Which of the following med orders should be anticipated:

  • compazine
  • librium
  • paral
  • phenobarbital sodium
Definition
Benzos such as librium are effective in suppresing s/s of ETOH withdrawl.
Term

A 60 y.o. A/A woman arrives at the ED via EMS with c/o weakness, fatigue, and dyspnea. She denies CP. She gives a PMH of IDDM but states her sugars are within range. The pt is placed on a stretcher and triage is done. The primary diagnostic study for this pt would be:

  • chem panel
  • ABG
  • CT of head
  • EKG
Definition
Pts with acute MIs who present w/o c/o CP tend to be older, female, nonwhite, or have a hx of diabetes or heart failure. The answer is EKG.
Term

True or False

When drawing blood cultures fill the aerobic (likes air) before the anaerobic (doesn't like air) bottle.

Definition

True

This is because there is usually air in the tubing prior to drawing.

Term
What are the hallmark signs of intesinal obstruction?
Definition
  • Ab pain
  • vomiting
  • prolonged constipation (obstipation)
  • distention
Term
What is Rosving's sign?
Definition
considered positive if the patient experiences RLQ pain as you apply LLQ pressure - suggests appendicitis.
Term
What is Murphy's sign?
Definition
inspiratory pain on subcostal RUQ (right upper quadrant) palpation, suggestive of gallbladder disease.
Term
What is a obturator sign?
Definition
considered positive if the patient experiences RLQ pain while you flex the hip and knee and internally rotate the leg - suggests appendicitis.
Term

True or False

Perforated ulcers most commonly occur in the duodenum.

Definition

True.

Constitutes 80% of all ulcers.

Term

True or False

Lower GI bleeding is characterized by bleeding from any source below the ligament of Treitz.

Definition
True.
Term

In a pt with prolonged bleeding, anemia is a potential complication. The ED RN assesses anemia by noting signs of pallor in the pt's:

  • lips
  • gums
  • sclera
  • nail beds
Definition
When the amount of hemoglobin has been significantly reduced, the nail beds or palms will reveal anemia.
Term
What is the most common cause of lower GI bleeding?
Definition
Hemorrhoids.
Term

True or False

Abdominal distention is a common finding in a pt with a AAA.

Definition
Yup.
Term

After initial stabilization in the ED, a pt with 50% total partial-thickness burns and full-thickness burns is prepared for immediate transfrer to a local burn center. Prep for the transfer would include:

  • debriding loose tissuue
  • cleaning wounds with mild soap and water
  • covering wounds with moist compresses
  • maintaining NPO status.
Definition
Maintain NPO due to risk of parlytic ileus & inceased chance of asipiration of vomit during transport.
Term

True or False

The following would be expected in the pt with an orbital blowout fx:

Photophobia, blurred vision, & blood in the anterior chamber of the eye.

Definition
True.
Term

True or False

Sorbitol is no longer routinly administered because it can cause vomiting, abdominal cramping & diarrhea. Activated charcoal is considered to be the most effective agent in preventing toxins from entering the bloodstream. It expels them in the stool.

Definition
True.
Term

True or False

Antidiuretic hormone (ADH) is released by the posterior pituitary gland & causes the reabsorption of sodium and water to increase circulating volume in the shock pt.

 

Definition
Yup.
Term
What is the reversal agent for Heparin?
Definition
protamine sulfate
Term
What allergy would prevent the ED RN from administering low molecular wt heparin?
Definition
pork
Term

True or False

Albumin deactivates large molecule heparin 

Definition
True
Term

True or False

Prinzmetal angina has a 50% mortality rate w/i the 1st year of dx. 

Definition
True
Term

True or False

A right sides MI has s/s of parasympatetic nervous system stimulation.

  • low BP
  • bradycardia
  • dry skin
  • AMS 
Definition
True
Term

True or False

A left sides MI has s/s of sympathetic nervous system stimulation.

  • tachycardia
  • HTN
  • diaphoresis
  • tachypnea 
Definition
True
Term
Name & describe the most common types of bone fx.
Definition
{image:|}
Term

True or False

EKG changes in pericarditis include PR depression as well as ST elevation.

Definition
True
Term

True or False

Osler's nodes (warm painful nodules on the pads of the fingers & toes) & Janeway legions are signs of endocarditis.

Definition
True.
Term

True or False

The most common cause of Infective Endocarditis is IVDA.

Definition
Yup.
Term

True or False

The most common cause of Pericarditis is infection of cardiac tissue 2-3d after an MI.

Definition
True.
Term
Define Osler's Nodes
Definition
Tender sub-Q nodules, often in the pulp of the digits. S/s of endocarditis.
Term
Define Janeway legions
Definition
non tender erythematous, hemorrhagic, or pustular lesions on the palms or soles of feet. s/s of endocarditis.
Term
Clinical manifestations of Pericarditis incl:
Definition
  • Lt sides chest pain that may radiate to neck/jaw/arm.
  • Associated with inspiration, lying down
  • Aggrevated by cough, sneeze, swallowing
  • Pain relieved by leaning forward.
  • Pericardial friction rub after MI.
Term
What is Beck's Triad as it relates to Pericardial Tamponade?
Definition
  1. marked hypotension
  2. diminished heart sounds
  3. JVD
Term
Define Pulsus Paradoxus.
Definition
Drop in SBP of > 10mm Hg when comparing inspiratory SBP to expiratory SBP. Often seen in Pericardial Tamponade.
Term
What EKG finding is indicative of myocardia ischemia?
Definition
ST seg. depression
Term

True or False

Any chest pain lasting longer than 45 min., is probally an MI.

Definition
True, CP usually only lasts 30 min. when r/t angina but is usually relieved by rest.
Term

A 12 lead EKG shows ST elevation in leads V1 through V3. The ED RN suspects the acute MI involves the:

  • inferior wall
  • anteroseptal wall
  • lateral wall
  • posterior wall
Definition
anteroseptal wall
Term

In the pt having an MI, MSO4 is ordered because:

  • it is a powerful analgestic & decreases myocardial work load.
  • it dialates coronary arteries when used with nitro.
  • it produces sedation
  • it is an effective & nonaddicting when given in small doses.
Definition
its a powerful analgesic and decreases myocardial workload.
Term

The MD orders Lidocaine: a 50mg bolus q 5 min x 2. followed by an infusion of 2mg/min. Lidocaine is ordered in the MI pt because it:

  • lowers fibrillation threshold
  • decreases heart's oxygen demand
  • eliminates irritability within the necrotic areas
  • eradicates potentially dangerous PVCs
Definition
PVCs, which result from myocardial irritability, are dangeoous in a pt with AMI because they are precursors to life threatening arrhythmias.
Term

As your post-MI pt waits for transfer to CCU, the pt becomes tachycardic but the BP remains stable. Which nursing action is most appropriate now?

  • Give morphine and reassure pt.
  • notify MD
  • auscultate the pts lungs
  • place pt in low fowler's position.
Definition
auscultate pts lungs. tachycardia is frequently the first s/s of heart failure in the pt with an MI. It is a compensatory mechanism for low stroke volume.
Term

Upon auscultatin, the RN detects a crescendo-decrescendo systolic murmur in the post MI pt. this is idicative of:

  • aortic insufficiency
  • papillary muscle dysfunction
  • ventricular aneurysm
  • early pericarditis
Definition
the murmur is characteristic of a papillary muscle dysfunction, namely mitral valve. when a papillary muscle becomes infarcted, improper valve closure results in regurgiation of blood from the left ventricle to the left atrium.
Term

The ED RN would expect a lateral wall MI in pts demonstrating:

  • Q waves in leads II,III, and aVF.
  • Q waves in leads I, aVL, V5, and V6
  • Q waves in leads V1 through V3.
  • Tall R waves in leads V1 & V2.
Definition
Q waves are indicative of myocardial necrosis. Q waves in leads I, aVL, V5, and V6 represent lateral wall of left ventricle.
Term

which intervention would be inappropriate for the pt with left ventricular failure?

  • assess fluid intake and electrolyte balance
  • restrict fluid intake
  • maintain infusion of NS
  • maintaining the pts intake of dietary sodium to 2g/day
Definition
maintain infusion of NS
Term

True or False

The ED RN understands that the rationale for administering inotropic and vasodilatative drugs to a pt with CHF is to:

 

Decrease preload, decrease afterload, & increase contractability.

Definition
True
Term

True or False

 

Digoxin is ordered in the CHF pt because it is an Positive inotrope and negative chronotrope.

Definition
True
Term
What are the signs of Digoxin toxicity?
Definition
  • Drowsiness, lethargy, fatigue, neuralgia, headache, dizziness, and confusion
  • Shortness of breath
  • Syncope
  • Swelling of lower extremities
  • Bradycardia
  • Hypotension
Term
What is the theraputic range for Digoxin?
Definition
0.8-2.0 ng/ml
Term
Define Electrical Alternans.
Definition
alternating strengths of pulses with each cardiac cycle.
Term
What is the most important test for dx endocarditis?
Definition
Blood cultures
Term
What are some risk factors in endocarditis?
Definition
  • cardiac sx
  • valve disease
  • rheumatic heart disease
  • pacemaker insertion
  • recent GI or GU disorder
  • IVDA
  • body piercings, tattoo.
  • pts with valve disease that underwent dental proceedures without ABs
Term

True or False

Endocarditis may cause rupture of the chordae tendineae, form abscesses or fistulas through cardiac vessels/chambers & embolize into blood,lungs, brain, kidney, spleen, bone, or joints.

Definition
True
Term
What EKG changes might the RN expect to see in the pt with a potassium of 6 mEq/liter?
Definition
Peaked T waves. (also prolonged PR intervals & widened QRSs)
Term
[image]
Definition
Atrial Fib
Term
[image]
Definition
A flutter
Term
[image]
Definition
V fib
Term
[image]
Definition
V tach
Term
[image]
Definition
WPW
Term
[image]
Definition
A Fib
Term
[image]
Definition
Junctional Rhythm
Term
[image]
Definition
Supraventricular tachycardia
Term
[image]
Definition
Agonal rhythm
Term
[image]
Definition
3rd degree HB (complete)
Term
[image]
Definition
PVCs trigemeny
Term
[image]
Definition
Sinus Brady: A heart rate less than 60 beats per minute (BPM). This in a healthy athletic person may be 'normal', but other causes may be due to increased vagal tone from drug abuse, hypoglycaemia and brain injury with increase intracranial pressure (ICP) as examples

Looking at the ECG you'll see that:

Rhythm - Regular
Rate - less than 60 beats per minute
QRS Duration - Normal
P Wave - Visible before each QRS complex
P-R Interval - Normal
Usually benign and often caused by patients on beta blockers
Term
[image]
Definition
Sinus Tach: An excessive heart rate above 100 beats per minute (BPM) which originates from the SA node. Causes include stress, fright, illness and exercise. Not usually a surprise if it is triggered in response to regulatory changes e.g. shock. But if their is no apparent trigger then medications may be required to suppress the rhythm

Looking at the ECG you'll see that:

Rhythm - Regular
Rate - More than 100 beats per minute
QRS Duration - Normal
P Wave - Visible before each QRS complex
P-R Interval - Normal
The impulse generating the heart beats are normal, but they are occurring at a faster pace than normal. Seen during exercise
Term
[image]
Definition
SVT: A narrow complex tachycardia or atrial tachycardia which originates in the 'atria' but is not under direct control from the SA node. SVT can occur in all age groups

Looking at the ECG you'll see that:

Rhythm - Regular
Rate - 140-220 beats per minute
QRS Duration - Usually normal
P Wave - Often buried in preceding T wave
P-R Interval - Depends on site of supraventricular pacemaker
Impulses stimulating the heart are not being generated by the sinus node, but instead are coming from a collection of tissue around and involving the atrioventricular (AV) node
Term
[image]
Definition
Atrial Flutter: Rhythm - Regular
Rate - Around 110 beats per minute
QRS Duration - Usually normal
P Wave - Replaced with multiple F (flutter) waves, usually at a ratio of 2:1 (2F - 1QRS) but sometimes 3:1
P Wave rate - 300 beats per minute
P-R Interval - Not measurable
As with SVT the abnormal tissue generating the rapid heart rate is also in the atria, however, the atrioventricular node is not involved in this case.
Term
[image]
Definition
1st degree HB: 1st Degree AV block is caused by a conduction delay through the AV node but all electrical signals reach the ventricles. This rarely causes any problems by itself and often trained athletes can be seen to have it. The normal P-R interval is between 0.12s to 0.20s in length, or 3-5 small squares on the ECG.

Looking at the ECG you'll see that:

Rhythm - Regular
Rate - Normal
QRS Duration - Normal
P Wave - Ratio 1:1
P Wave rate - Normal
P-R Interval - Prolonged (>5 small squares)
Term
[image]
Definition
2nd degree HB type 1: Another condition whereby a conduction block of some, but not all atrial beats getting through to the ventricles. There is progressive lengthening of the PR interval and then failure of conduction of an atrial beat, this is seen by a dropped QRS complex.

Looking at the ECG you'll see that:

Rhythm - Regularly irregular
Rate - Normal or Slow
QRS Duration - Normal
P Wave - Ratio 1:1 for 2,3 or 4 cycles then 1:0.
P Wave rate - Normal but faster than QRS rate
P-R Interval - Progressive lengthening of P-R interval until a QRS complex is dropped
Term
[image]
Definition
2nd degree type 2: When electrical excitation sometimes fails to pass through the A-V node or bundle of His, this intermittent occurance is said to be called second degree heart block. Electrical conduction usually has a constant P-R interval, in the case of type 2 block atrial contractions are not regularly followed by ventricular contraction

Looking at the ECG you'll see that:

Rhythm - Regular
Rate - Normal or Slow
QRS Duration - Prolonged
P Wave - Ratio 2:1, 3:1
P Wave rate - Normal but faster than QRS rate
P-R Interval - Normal or prolonged but constant
Term
[image]
Definition
3rd degree HB: 3rd degree block or complete heart block occurs when atrial contractions are 'normal' but no electrical conduction is conveyed to the ventricles. The ventricles then generate their own signal through an 'escape mechanism' from a focus somewhere within the ventricle. The ventricular escape beats are usually 'slow'

Looking at the ECG you'll see that:

Rhythm - Regular
Rate - Slow
QRS Duration - Prolonged
P Wave - Unrelated
P Wave rate - Normal but faster than QRS rate
P-R Interval - Variation
Complete AV block. No atrial impulses pass through the atrioventricular node and the ventricles generate their own rhythm
Term
[image]
Definition
BBB: Abnormal conduction through the bundle branches will cause a depolarization delay through the ventricular muscle, this delay shows as a widening of the QRS complex. Right Bundle Branch Block (RBBB) indicates problems in the right side of the heart. Whereas Left Bundle Branch Block (LBBB) is an indication of heart disease. If LBBB is present then further interpretation of the ECG cannot be carried out.

Looking at the ECG you'll see that:

Rhythm - Regular
Rate - Normal
QRS Duration - Prolonged
P Wave - Ratio 1:1
P Wave rate - Normal and same as QRS rate
P-R Interval - Normal
Term

True or False 

A first degree heart block (one in which the PR interval is >.20s) is indicative of all of the following:

  • Inferior wall MI (because of AV node ischemia)
  • Hyperkalemia
  • Digoxin use
  • organic heart disease
Definition
True
Term
[image]
Definition
Ventricular bigeminy, one of several arrhythmias associated with dig. toxicity, in which a PVC occurs every other beat.
Term

what is the tx for VTach?

Definition
Defibrillate at 200 j
Term
What is the definition of a Second Degree Heart Block Type I (Wenchebach)?
Definition
PR intervals become progressively wider until a QRS complex is finally dropped.
Term

True or False

In the pt with a temportary pacemaker, there should be a ventricular complex after each pacemaker spike.

 

Definition

True, if this does not happen, it is called loss of capture. Also, it would be very dangerous to increase the pacemaker rate during loss of capture.

Term
In terms of pacemakers, define loss of sensing.
Definition
loss of sensing is when the pacemaker continues to fire at at preset rate that is consistantly lower than the pts ventricular rate.
Term
In terms of pacemakers, define loss of capture.
Definition
Ventricular noncapture. Rhythm strip showing atrial (P wave) sensing followed by ventricular pacemaker spike, which failed to capture the ventricle.
Term

Why does the cardiologist mix the blood aspirated from a pericardial centesis in an emesis basin after it is drawn out?

Definition
Because pericardial blood will not clot, he wants to make certain that he did not aspirate from the Lt ventricle.
Term

True or False

A ligament attaches bone to bone

Definition
True
Term

True or False

A tendon attaches bone to muscle

Definition

True

Term

True or False

Wounds should not be sutured after being open for 8 hours (except face)

Definition
True
Term

True or False

It is OK to shower after having sutures.

Definition
True
Term

True or False

A SPRAIN is an injury to a ligament

Definition
True
Term

True or False

A STRAIN is an injury to a Tendon

Definition
True
Term
What is the difference between a stable and unstable pelvic fx?
Definition
The ability to ambulate
Term
What is Buerger's Disease?
Definition
is an acute inflammation and thrombosis (clotting) of arteries and veins of the hands and feet. It is strongly associated with use of tobacco products,[1] primarily from smoking, but also from smokeless tobacco. Most common in young males.
Term
What are the crutchwalking instructions for going UP stairs?
Definition

Up:

1. Step up with the strong leg

weight should be on the

hand grips. The

weak/operated leg follows.

2. Put no weight on the

weak/operated leg.

3. The crutches are brought up

last. If you are casted, be sure

your toes clear the steps

before proceeding to the next step.

Term
What are the crutchwalking instructions to go DOWN stairs?
Definition

Place both crutches on the stair below.

2. Step down with the weak/operated leg (or just

lower if no weight allowed).

3. Push down on the hand grips and step down

with the stronger leg.

4. Place the crutches down again and proceed.

Term

True or False

An Aortic Disection is defined as a tear in the intimal layer of the aorta, which exposes the degenerated medial layer to the forces of BP. These forces cleave or dissect the two layers of the arterial wall.

Definition
Yup.
Term

True or False

An Ascending Dissection is the most common & most lethal type of dissection.

Definition
True
Term

True or False

The Tx for AAA is :

  • negative inotropes
  • Bb
  • Ca channel blockers
  • Sx
Definition
True
Term
What is Nail trephination?
Definition
creating a hole in a nail to release underlying blood.
Term

True or False

Puncture wounds in to joint spaces can lead to septic arthritis & puncture wounds into cartilage, bone, & periosteum can cause osteomyeltis.

Definition
True
Term

True or False

Puncture wounds caused by high pressure mechanisms such as paint or grease guns can inject foreign substances into hard to reach places.  These substances will follow tissue planes and can travel down tendon sheaths causing widespread damage. Therefore, immediate surgical intervention is required to preserve tissue.

Definition
True
Term
What are some factors that can delay wound healing?
Definition
  • diabetes
  • long term steroid use
  • host immunocompromise
  • poor tissue perfusion (Buerger's disease)
Term

True or False

Because of wt. bearing, wounds to the plantar surface of the foot carry a much higher rate of penetration to bone with potential for osteomylelitis.

Definition
True
Term

True or False

Regarding Skin Avulsions:

  • Do not use Epi with Lido because of vasoconstriction
  • Wound edges should be approximated, NOT trimmed; even gray or dusky areas may heal suprisingly well.
Definition
True
Term

True or False

aprophylactic antibiotis are recommended for

  • obvously contaminated wounds
  • wounds to the plantar surface of the foot
  • immunocompromised pts.
  • ABs are NOT recommended for uncomplicated puncture wounds in healthy individuals anymore.
Definition
True
Term

True or False

Suturing of wounds older than 8h have a much higher risk of infection and often may heal better if left open.

But

The face has a richer blood suppy decreasing the risk of infection, therefore, closure of facial wounds after the 8h mark is usually considered.

Definition
True
Term

True or False

Bites, puncture wounds, and contaminated wounds carry a much higher rate of infection. Therefore, debridement & prophylactic ABs may take priority over closure.

Definition
True
Term

What is the difference between Subluxation & Dislocation?

Definition

Subluxation: joint injury where some of the articular surfaces of the joint remain intact but are incomplete.

 

Dislocation: Injury to the joint where the articular surfaces of the bones are no longer in contact.

Term

True or False

Pelvic Fxs carry a high risk for disruptoin of vasculature & nerves in the area. Average blood loss is 2 units with a potential for up to 4000 ml. Nerves at risk are the iliac artery, venous plexus, and sciatic nerve.

Definition
True
Term

True or False

Pelvic Fxs carry a mortality rate of 8-10% (open fxs carry a mortality rate of 40-60%)

Definition
True
Term
What is the Tx for Pelvic Fx?
Definition
  • Pelvic wrap
  • flexing the kness may decrease discomfort
  • external fixators
  • sx internal fixation
Term
What is an Avulstion Fx?
Definition
Fragment of bone connected to ligament breaks off.
Term

True or False

When an effused joint is aspirated, if the lab results of the fluid show a WBC count of <60,000 the cause of effusion is likely inflammatory (gout). But if the WBCs are >100,000 it is likely infection.

Definition
True
Term

True or False

Joint effusions most commonly affect the knee.

Definition
True
Term
What are some common causes of joint effusion?
Definition
  • Trauma/Sx
  • recent infections
  • substance abuse
  • use of diuretics
  • repetitive use of the joint
  • arthritis, gout, stds, bleeding disorders.
Term

True or False

After aspiration of a Joint Effusion, the RN should hold pressure to the site for 2-5 min. with a sterile drsg.

Definition
True
Term

True or False

Key points to crutch walking are:

  • Fit crutches to pt while wearing shoe on unaffected side.
  • The arm pieces should be 2" below axilla
  • The crutch should be at a 25 degree angle with the tips at 6-8" to the side & in front of the foot.
  • Place crutches 12" forward & approx 6" to the side.
  • Adjust crutch hand pieces so that the elbow has a 30 degree angle of flexion.
Definition
True
Term

Compound Fx Tx: true or false

  • initiate IV antibiotics early
  • If pt goes to sx immediately, cover wound with sterile saline drsgs.
  • If pt is delayed going to sx, flush the wound with 1-2 liters sterile saline & apply dry sterile drsg.
  • Tetnus
  • avoid the use of antibiotic creams & other bacteriostatic solutions as it may inhibit healing if it reaches the bone.
Definition
True
Term

True or False

Carpal Tunnel Syndrome is the entrapment of the Median nerve

Definition
True
Term
What is Tinel's sign?
Definition
Tingling when affected nerve is tapped. It is an indication of a nerve entrapement syndrome)
Term
What is Phalen's sign?
Definition
acute flexon of the wrist for 1 minute causes exacerbation of parasthesia along distribution of median nerve. It is an indication of carpal tunnel syndrome.
Term

True or False

Common causes of Compartment Syndrome incl:

  • FXs
  • crush injuries
  • high pressure injections
  • burns (electrical)
  • hypothermia/frostbite
  • snake/spider bites
  • prolonged overuse (forced march, long distance runners)
  • recent sx
  • casts, wraps, splints, MAST pants
Definition
True
Term

What early complication should the ED RN assess for in the pt with a femoral shaft fx?

  • delayed union
  • nonunion
  • fat emboli
  • infection
Definition
fat emboli
Term

True or False

Volkmann's Ischemia of nerves and muscles is the most serious complication of a femoral fx in a child.

Definition

True: this condition is caused by femoral artery spasm secondary to an intimal tear. s/s incl: pain, pallor, puffiness, pulselessness,paresthesia & paralysis.

Term

The primary tx for a child between the ages of 2-9y with an uncomplicated femoral shaft fx would be?

  1. Bryant's skin traction
  2. Fixed skeletal traction
  3. A double hip spica cast
  4. Intrameduallary nailing
Definition
double hip spica cast
Term

Which pelivc fx is considered stable (minor)?

  • Straddle fx
  • Malgaigne's hemipelvis fracture-dislocation
  • combined hemipelvis fx
  • fx of the ipsilateral rami
Definition
A fx of the ipsilateral rami is considered a stable pelvic fx. Stable fx of the pelvis usually result from low energy or well localized injury to the pelvis.
Term

The RN would prepare all of the following pts for sx except:

  • bilateral pelvic fx
  • open pelvic fx
  • major vessel injury
  • hypovolemic shock
Definition

Bilateral pelvic fx: because this type of fx is usually reduced by skeletal traction of both legs.

Term

True or False

When the RN notes blood at the urethral meatus while assessing a male pt with a pelvic fx foley caths would be contraindicated.

Definition
True
Term

The pricipal of the MAST trousers for a pt with multiple injuries including a pelvic fx include all of the following except:

  • Hemostasis (tamponade)
  • Autotransfusion
  • Decreased venous return
  • Increased peripheral vascular resistance
Definition
Decreased venous return is NOT one of the clinical effects of the MAST trousers. The volume of autotransfusion with MAST trousers has been estimated at 250-1000ml.
Term

As the RN begins to deflate the MAST trousers on her pt, she knows that further deflation is contraindicated when:

  • 5 mm Hg drop in SBP
  • 10 mm Hg drop in SBP
  • 5mm rise in DBP
  • 10 mm rise in DBP
Definition

The nurse knows that further deflation of the MAST trousers would be contraindicated once the pt experiences  a 10 mm Hg drop in SBP. Continuous BP & gradual deflation are essential during MAST removal.

The usual procedure for removing MAST is to deflate the abdomen first then the leg compartments.

Term

Which statement best describes a fx hip?

  • the affected leg is shortened & externally rotated
  • the affected leg is shortened & internally rotated
  • the affected leg is shortened & not rotated.
  • the pt has no deformity but has pain on affected side

 

Definition
A pt with a fx hip usually has an affected leg that is shortened & externally rotated.
Term

True or False

In a pt with an impacte femoral neck fx, the RN would expect to see: Groin pain on the affected side & limited ROM in the affected leg.

Definition
True
Term

True or False

The following assessment is characteristic of an anterior shoulder dislocation: after trauma:development of a sudden, severe sholder pain. the pt resists passive movement & has loss of shoulder symmetry.

Definition
True
Term

A pt with a hx of IVDA comes to the ED with c/o fever, general malaise, and night sweats. Which of the following assessment findings in this pt is specific for endocarditis?

  • Heart murmur
  • SOB
  • CP
  • Splenomegaly
Definition
infective endocarditis results in inflammation of the endocardium, especially the heart valves. The answer is heart murmur
Term

True or False

pts with lap belt injuries are at particular risk for mesenteric and bowel injuries when rapid decelleration forces suddenly trap the viscera against the spine..

Definition
Yup.
Term

A 35 y.o. man comes to the ED with c/o severe scrotal pain, fever, pyuria, & urethral discharge. You suspect:

  • syphillis
  • chlamydia
  • trichomonas
  • asotemia
Definition
these s/s are definative of epididymitis, a condition that results from inflammation secondary to stds. The causative factors are usually chlamydia or gonorrhea.
Term

A contraindication for the use of GP llb/lla inhibitor tx would be:

  • platelet count > 150,000
  • unstable angina that is being managed
  • NSTEMI
  • Arterioveous malformation
Definition
AV malformation
Term
The exam of a pt dx with pleural effusion will reveal decreased or absent breath sounds because of the collection of tluid in the pleeural space between the bisceral and parietal pleurae.
Definition
True.
Term

True or False

Many tattoo pigments contain metallic compounds, such as iron oxide. These pigments can result in MRI images with artifacts that can preclude an accurate dx as well as increase skin temp. high enough to cause burns.

Definition
True
Term

Which of the following assessment findings in a 2 y.o. child with diarrhea is consistant with moderate dehydration?

  • alert and restless
  • dry skin & mucous membranes
  • absent tears
  • decreased skin elasticity
Definition
children with moderate dehydration hve dry skin and mucous membranes, tenting, reduced tears, deep set eyes, increased HR, decreased urine output, and are restless and lethargic.
Term

True or false:

Lasix, increases venous capacitance & decreases left ventricle filling pressure

Definition
True
Term

A pt is brought to the ED after being struck by lightning wihle working outdoors. The pt is conscious. Which of the following would be a usual or expected finding in this pt?

  • full thickness burns
  • retrograde amnesia
  • fx extremity
  • ruptured TM
Definition
More than 50% of lightning strike victims have at least on TM ruptured. Burns are usually superficial due to flash over phenomenon.
Term

True or False

Lumbar vertebral fxs are often associated with calcaneus fxs.

 

Definition
True
Term

A child's tooth was knocked out duringa softball game. Proper care to clean the tooth would include:

  • scrubbing the tooth
  • drying the tooth with a clean cloth
  • placing the tooth in a isotonic solution
  • placing the tooth in water
Definition
The best way to care for the tooth would be to place it in a container of isotonic solution, such as cold milk, saliva, or 0.9% saline & gently move it back and forth. Ultimately, an attempt should be made to replace the tooth back in its socket if the the child is able to tolerate it, becasuse this step improves the chance that the tooth will survive.
Term

True or False

Phenytoin (dilantin) is a chemical irritant that can cause pain when administered because of the alkalinity of the solution. It is important to assure a patent IV line for administration.

Dilantin should be administered at a rate not exceedin 50mg/minute. It may not be mixed with D5W.

Definition
True
Term

True or False

Most deaths in the US related to tetanus infections occur in persons older than 60y.

Definition
True, because they are inadequately vaccinated.
Term
Define Trigeminal neuralgia
Definition
Brief, recurrent paroxysms of excruciating unilateral facial pain of UK etiology but typically affects females >40y. Attacks usually become more frequent with time. CN V affected. Tx with carfbamazeqin, phenytoin, or sx.
Term

Define Bell's Palsy

 

Definition
paralysis of facial muscles due to emotional stress, herpes, prolong exposure to drafts or cold. CN VII. Self limiting & resolves within 3w in 80-90% of cases. Tx with analgesics & steroids.
Term
What are the d/c instructions for a pt with Bell's Palsy?
Definition
  • Use artificial tears to prevent corneal ulcerations
  • Manually close affected eye or wear a patch.
  • Wear sunglasses when in the sun.
  • Avoid cold drafts to the face
  • Do facial exercises as directed
  • Moist heat & facial massage.
Term

True or False

For optimum success, a tooth should be repaced within 30m of avulsion & no more than 6h.

Definition
True.
Term
If RSI is unsuccessful due to large tumors, what can the RN expect to do next?
Definition
Obtain a cricothyroidotomy tray. this proceedure is indicated when the pts edema or tumor is so great that an ET tube cannot passed initially & subsequent attempts would cause further swelling.
Term
In terms of dental infections, what is Ludwig's angina?
Definition

Secondary dental infection involving the lower 2nd and 3rd molar which results in  bilateral diffuse swelling of the submandibular, submental, & sublingual areas.  Tx: Inraoral I&D, IV antibiotics

Term
Vincent's angina (aka Trenchmouth or Acute Necrotizing Ulcerative Gingivitis) is what type of dental infection?
Definition
This is trench mouth, a progressive painful infection with ulceration, swelling and sloughing off of dead tissue from the mouth and throat due to the spread of infection from the gums.

Certain germs (including fusiform bacteria and spirochetes) are thought to be involved. Vincent's angina is best treated with the antibiotic penicillin.

This condition is also called Vincent (or Vincent's) angina after the French physician Henri Vincent (1862-1950). The word "angina" comes from the Latin "angere" meaning "to choke or throttle."

As with most poorly understood diseases, Vincent angina goes by many other names including acute necrotizing ulcerative gingivitis (ANUG), acute membranous gingivitis, fusospirillary gingivitis, fusospirillosis, fusospirochetal gingivitis, necrotizing gingivitis, phagedenic gingivitis, ulcerative gingivitis, Vincent stomatitis, Vincent gingivitis, and Vincent infection.

Term

What is the Tx for Vincent's Angina (Trenchmouth)?

Definition
  • PCN
  • local debridement
  • good mouth care & nutrition
  • half strength H2O2 rinses
Term
What is the Ellis Classifications of Dental Trauma?
Definition
 

Ellis class I

Ellis class II

Ellis class III

Extent of Fx

Enamel of tooth

Enamel & Dentin of tooth

Enamel, dentin, & pulp of tooth.

Appearance of Tooth

Chalky white

Ivory yellow

Pink or bloody

Treatment

Non-Emergent

Calcium hydroxide or nailpolish & see DDS in 24h.

Cover tooth with tin foil or dry gauze & see DDS  STAT.

 
Term
What is the D/C teaching for a pt with Ludwig's Angina?
Definition
  • Rinse mouth with warm NS 2-3 times an hour while awake.
  • Hot moist compresses  to jaw and neck.
Term
What are some clinical manifestations of Vincent's angina?
Definition
  • Painfull bleeding gums
  • Ulcerations
  • Gray membrane that bleeds with pressure when touched
  • Fetid breath
  • Fever
Term
Define Diphtheria.
Definition

A bacterial infection of the mucous membranes spread by respiratory droplets. A thick gray membranous covering over the tonsils & pharynx is hallmark. In rare cases, the membrane may extend or fall over the larynx, causing an airway obstruction. Removal of this membrane will cause bleeding. Infection may spread to CNS, Cardiovascular, renal, or hemo systems. Tx: Diptheria antitoxin & Erythromycin 20-25 mg/kg q 12h x 7-14d.

Dx is made by throat culture: notify lab as the specimen requires special media & handllling.

Term
What is the definition of Croup?
Definition

Acute viral syndrome characterized by barking cough, hoarse voice, inspiratory stridor, & variable degrees of respiratory distress. The causative virus enters throug the nasopharynx & spreads to the laryns & trachea causing erthema & edema of tracheal walls.  An inflammatory exudate is produced that causes the vocal cords to swell resulting in the characteristic barking cough.

Term
What is the tx for Croup?
Definition
  • cool, humidified air
  • supplemental O2
  • racemic Epi
  • encourage hydration
Term
What is the definition of Epiglottitis?
Definition

Edema of the epiglottis & epiglottic folds that does not extend below the vocal cords. Most common in male children. If it strikes adults, it is likely to strike between the ages of 20-40y. Characteristic s/s incl: high fever, severe sore throat, DROOLING, and respirtory difficulties.

Term
What is the tx for Epiglottitis?
Definition
  • Minimize stimulation-do not upset child
  • Allow family to stay with child
  • Delay all dx proceedures except xray of neck
  • Have tracheotomy or cricothyrotomy kit avail.
  • blow by O2
  • Antibiotics
Term
What is Hyphema as it relates to the eye?
Definition

Hyphema is blood in the front (anterior) chamber of the eye. It may appear as a reddish tinge, or it may appear as a small pool of blood at the bottom of the iris or in the cornea.Often caused by blunt trauma. Patching the pts eye during the acute phase is part of the tx. Bedrest, BRP. Usually clears in 5 or 6d.

Term

True or False

  • Alkaline burns to the eye are more destructive
  • Acid burns are extremely irritating
  • The principals of acid or alkaline burn tx are similar
Definition
True
Term
What is the best indication that irriagation and tx of a pts eye that has had lye thrown in it has been sucessful?
Definition
A pH value of 7 on a litmus paper reading
Term
What is the most serious s/e of the drug Tamoxifen?
Definition
Retroperitoneal fibrosis
Term
What is the most serious s/e of ASA?
Definition
Retrobulbar neuritis
Term
What is one of the most serious risk factors related to Parkinson's disease?
Definition
 Phenothiazines
Term
A 60 year man suffering from COPD has developed a productive cough that has green phlegm over the last 24 hours comes to ED.  What  microorganism is mostly likely the cause?
Definition
Streptococcus pneumoniae
Term
 A 28 year female enters the ED with copious vaginal discharge that has a pungent odor.  What STD  is most likely occurring?
Definition
Gonorrhea
Term
You are instructing a patient about the risk factors about Huntington’s chorea.  What  is the most serious risk factor related to Huntington's chorea?
Definition
  Familial inheritance
Term
Define the following signs/symptoms: Right upper quadrant pain, fever (chills), and jaundice associated with cholangitis.

A. Bouchard's Nodes
B. Chandelier's Sign
C. Charcot's Triad
D. Chvostek's Sign

Definition
Charcot's Triad
Term
Define the following signs/symptoms: Calf pain with forcible dorsiflexion of the foot, associated with venous thrombosis.

A. Hegar's Sign
B. Hoffmann's Sign/Reflex
C. Homans' Sign
D. Horner's Syndrome

Definition
C. Homans' Sign
Term

4. Which of the following is not a characteristic of Beck's triad?

A. Rising jugular venous pressure is evidenced by distended jugular veins while in a non-supine position.
B. The fall in systolic pressure results when the fluid in the pericardial cavity accumulates to a degree that it impairs ventricular stretch.
C. The suppressed heart sounds occur due to the muffling effects of the sounds passing through the fluid surrounding the heart.
D. Pain and tingling in fingers after exposure to cold.

Definition
D
Term

7. Which of the following changes is not found with hypokalaemia?

A. Small or absent T waves
B. Wide QRS
C. First or second degree AV block
D. Slight depression of the ST segment

Definition
B. Wide QRS
Term
. Describe the Green Color of Triage?

A. Delayed care / can delay up to three hours
B. Urgent care / can delay up to one hour
C. Immediate care / life-threatening
D. Victim is dead / no care required

Definition
 Delayed care / can delay up to three hours
Term
Which of the following matches the definition: minute, pinpoint hemorrhages into the skin, mucosal or serosal surfaces?

A. Purpura
B. Ecchymoses
C. Petechiae
D. Fibrinolytic

Definition
Petechiae
Term
What is Addison's disease?
Definition
Addison's disease (also known as chronic adrenal insufficiency, hypocortisolism or hypocorticism) is a rare endocrine disorder in which the adrenal gland produces insufficient amounts of steroid hormones (glucocorticoids and often mineralocorticoids). It may develop in children as well as adults, and may occur as the result of a large number of underlying causes
Term
What are the s/s of Addison's disease?
Definition
The symptoms of Addison's disease develop insidiously, and it may take some time to be recognized. The most common symptoms are fatigue, muscle weakness, weight loss, vomiting, diarrhea, headache, sweating, changes in mood and personality and joint and muscle pains. Some have marked cravings for salt or salty foods due to the urinary losses of sodium.[
Term
What are the s/s of an Addisonian crisis?
Definition
  • severe abdominal & back pain
  • leg pain
  • vomitting
  • diarrhea leading to hypovolemic shock
  • hyponatriemia
  • hyperkalemia
  • metabolic acidosis
Term

True or False

According to the American Burn Assoc., pts with burns that overlay major joints should be referred to a burn center.

Definition
True
Term

True or False

Pts with burns to their face, hands, feet, genitalia, peri area, or those with partial thickness burns that cover 10% or more of their bodies or any 3rd degree burns should be refered to a burn center.

Definition
True
Term
What is the dosing of  a amiodarone drip that is started after your pt was defibrillated with a bolus dose of 300 mg?
Definition
1mg/minute
Term
What is the preferred volume & IV solution for a 2 y.o. child with hypoglycemia?
Definition

2-4 mL/kg of D25.   Neonates should be given 2ml/kg of D10.

Term

True or false

Pts dx with urinary calculi should avoid:

  • chocolate
  • spinach
  • rhubarb
  • parlsey
  • cocoa
  • instant coffee
  • tea
Definition
True
Term

True or False

Venturi Masks are considered high flow systems that can deliver a fixed FiO2 ranging from 24-50%

Definition
True
Term

True or False

If a PICC line does not flush, having the pt cough,deep breathe, or raise arm over head may help revove a mechanical obstruction.

Definition
True
Term

True or False

The goal of tx in the hyponatremic pt is to raise Na from 0.5 to 1 mEq/hr until sodium level has reached 125 mEq/hr using an isotonic solution. The RN knows that raising Na too quickly can cause rhabdomyolitis.

Definition
True
Term
What is Charcot's Triad as it relates to cholangitis (inflammation of the bile duct)?
Definition
  1. Jaundice
  2. Fever, usually with rigors
  3. RUQ pain
Term

What is CN I?

hint: remember the baking mneumonic.

Definition

Olfactory.

 

Term
What is CN II?
Definition

Optic. 

responsible for vision.

Term

What do CN III,IV, & VI have in common?

hint: crainial nerves 3, 4, & 6 make eyes do:

Definition

oculomtor.

cranial nerves, 3,4, & 6 make the eyes do tricks.

Term
What is CN V?
Definition

Trigeminal.

chewing & face sensation.

Term

What is CN VII?

hint: this is the one affected in Bell's palsy.

Definition

Facial motor.

Term
What is CN VIII?
Definition

Acustic-hearing.

Term
What is CN X?
Definition

Vagus.

responsible for swallowing, gag, ab viscera.

Term
What is CN XII?
Definition
hypoglossal-tounge movement.
Term
What drug class is associated with causing Parkinson's Disease?
Definition
The term "phenothiazines" is used to describe the largest of the five main classes of neuroleptic antipsychotic drugs. These drugs have antipsychotic and, often, antiemetic properties, although they may also cause severe side effects such as akathisia, tardive dyskinesia, extrapyramidal symptoms, and the rare but potentially fatal neuroleptic malignant syndrome as well as substantial weight gain.
Term
Your pt has had severe midfacial trauma r/t MVA. The MD orders a Water's view xray to determine:
Definition
The presence of orbital floor fxs.
Term
The radiologist reports that your pt with severe midfacial trauma has a Le Fort II fx which involves:
Definition
the maxillary segments of the sygomatic and orbital portions of the face.
Term
What assessment findings are consistant with a zygomatic fx?
Definition
periorbial ecchymosis & inferior orbit rim tenderness
Term
Your pt has been hit in the face with a baseball bat , the RN documents that he also has trismus, which is characterized by:
Definition
toxic contractions of the mastication muscles.
Term
The RN informs the pt that his nasal packing will be removed in 24-48h. The purpose of removing the packing at that time would be to:
Definition
Prevent infection & the possibility of compression necrosis.
Term
When caring for a pt with a zygomatic fx, the RN should assess for a possible orbital floor fx which is indicated by:
Definition

Vertical diplopia:  the imposition of one image above another, occurs when a pt suffers a blowout fx of the orbital floor.

Term
What is the drug of choice in the ED for a pt in hypertensive crisis with a SBP>220 or DBP 121-140?
Definition

labetalol 10-20 mg IV over 1-2 min

May repeat or double every 10 min. (max dose 300 mg)

Term
What is Digibind?
Definition
  • Digoxin specific Antibody tx: used for dig. tox. in the following: life threatening arrhythmias. Shock or CHF, hyperkalemia with potassium level >5.
  • IV dose varies according to amount of dig. ingested. A 40mg vial of Digibind binds about 0.6mg of digoxin. Average dose is 10 vials, may require up to 20 vials.
  • Serum digoxin levels rise after Digibind tx & should not be used to guide continuing tx.
Term
Your pt has unstable Tachycardia with pulses. EKG shows narrow QRS complexes, regular rhythm. What drug do you expect to administer?
Definition

Adenosine 6mg rapid IV push.

If no conversion, give 12mg rapid IV push.

may repeat 12mg dose once.

Term
Your pt is bradycardic. EKG shows 3rd degree AV block & the pt is poorly perfusing. What is your first step?
Definition
  • prepare for transcutaneous pacing
  • consider atropine 0.5mg IV while awaiting pacer. May repeat to a total dose of 3mg. If ineffective begin pacing.
Term
What are the indications for Transcutaneous Pacing?
Definition
  • hemodynamiclly unstable bradycardia (AMS, decreased BP, angina, pulmonary edema)
  • For pacing readiness in the setting of AMI as follows:
  • symptomatic bradycardia
  • Mobits type II second degree AV block
  • 3rd degree AV block
  • New left or right BBB.
  • bradycardia with symptomatic ventricular escape rhythms.
Term
What is the setup proceedure for transcutaneous pacing?
Definition
  • place electrodes on chest as per instructions.
  • turn the pacer ON>
  • set the demand rate to approx. 60/min.
  • set the milliamperes (mA) output to 2mA above the dose at which consisant capture is observed (saftey margin)
Term
What are the rhythms for unstable tachycardia?
Definition
  • A fib
  • A flutter
  • SVTs
  • Monomorphic/Polymorphic VT
  • wide complex tachycardia of uncertain type.
Term
A fib, A flutter, SVT, VT are all unstable tachycardia rhythms. How are they tx in the ED?
Definition

Cardioversion of the unstable pt.

Term
After traumatic injury the RN knows to continue to assess for s/s of compartment syndrome for up to how many days?
Definition
6
Term

True or False:

Reliable s/s of compartment syndrome include: pain, weakness, hypoesthesia, & tenseness of the compartment on palpation

Definition
True
Term
The RN is aware that in  compartment syndrome, irreversible damage to nerves and muscles typically occur after how many hrs of impaired perfusion?
Definition
4-12h
Term
What is considered a late sign of compartment syndrome?
Definition
loss of distal pulses.
Term

True or False

When pressure within the compartment exceeds 40mmHg, sx fasciotomy is indicated to relieve pressure before irreversable necrosis develops.

Definition
yes.
Term

The RN is aware that after amputation of body parts, the prognosis for successful reattachment is poor when warm muscle ischemia time exceeds:

  • 1h
  • 2h
  • 4h
  • 6h
Definition

6h: because muscle tissue is most sensative to anoxia, amputated parts that have not been cooled to decrease metabolism sustain damage.

Connective tissue, bone, tendons, nerves, & skin can survive up to 12h.

Term
What is the proper care for an amputated part?
Definition
Wrap body part in gauze soaked in physiologic solution, place in plastic bag or sterile container & immurse in ice bath 35-39 F.
Term
What is the pH level that needs to be reached after the irriation of the eye that has been exposed to acid/alkaline?
Definition
7.4
Term

True or False

It is important to tx pharyngitis caused by Group A beta-hemolytic streptocooci, because it can lead to infections such as peritonsillar abscess, retropharyngeal abscess, rheumatic fever, or glomerulonephritis.

Definition
True
Term
What is the tx for a peritonsillar abscess (aka Quincy)
Definition
  • antibiotics
  • warm saline throat irrigations
  • incision and drainage
Term

True or False

Diptheria, while rare in the US, can spread beyond the respiratory system to the:

  • CV system-myocarditis
  • Hematological- thrombocytopenia
  • Renal-kidney disease
  • Nervous-Guillian-Barre like syndrome
  • Soft tissues of neck-bull neck
Definition
True
Term
What is the tx for Anterior Epitaxis (bleeding from in front of the nasal bones)?
Definition
  • pinch nose for 10 min w/o peeking
  • topical anesthetic & vasoconstrictors (lidocaine,cocaine,tetracaine)
  • cauterization (silver nitrite,diathermy,electrocautery)
  • nasal packing (surgicel strips, petroleum gauze)
Term
What is the tx for Posterior Epitaxis?
Definition
  • foley cath in the nasopharynx
  • placement of gauze packs
  • nasostat to tamponade bleeding
  • reversal of known coagulopathies
Term
How do you remove a flying insect from the ear canal?
Definition
shine light into ear as insects fly out to the light.
Term

True or False

Cockroaches & spiders lack the ability to walk backwards.

Definition
True, if in the ear canal, kill with mineral oil or 2% lido then flush from canal.
Term
What is the difference between labryinthitis and Meniere's Disease?
Definition
 

Labryinthitis

Meniere’s Disease

Cause

Bacteria or Virus

Fluctuations of Endolymph in the inner ear.

S/S

  • Tinnitus
  • N/V
  • Sensitivity to noise
  • Lateral dizziness
  • Tinnitus
  • Mild to severe hearing loss.
  • Rotational vertigo
  • N/V

Tx

Bacterial-antibiotics

Viral-supportive

Meclizine

Antihistamines

Diuretics

Avoid caffeine, ETOH, smoking.

Sx

 
Term
What is Keratitis and how is it tx?
Definition

Keratitis is an infection or inflammation of the cornea almost always caused by exposure to ultraviolet light. It is a painful condition that often begins 6-10h after this exposure.

It is tx with topical ABs, cycloplegics (dialate &paralize pupil) & patching for 24h.

Term
What is the definition of Glaucoma?
Definition
Fluid in the anterior chamber of the eye collects when the canal of Schlemm is blocked. Pressure can cause damage to the optic nerve & decrease circulation to the retina leading to loss of vision.
Term
What are some s/s of Glaucoma?
Definition
  • Deep, severe, unilateral eye pain often initiated when pt is in a dark room.
  • H/A
  • Decreased vision
  • HALOS AROUND LIGHTS
  • Photophobia
  • N/V
  • IOP > 20mm Hg
Term
What is the tx for Glaucoma?
Definition
  • Analgesics
  • Antiemetics
  • Pilocarpine eye gtts
  • Osmotic diuretics
  • Sx
Term
What is Central Retinal Artery Occlusion & how is it tx?
Definition

Sudden, painless, UNILATERAL loss of vision caused by a blockage of the artery by a thrombus or emboli. Must be promptly tx w/i 1-2h to preserve vision.  Tx:

  • Digital massage of globe.
  • Carbogen gas(95% O2 & 5% CO2) given in 3-10m increments at 2h intervals.
  • Anticoagulants, Thrombolytics, low molecular wt heparin.
Term
Pilocarpine eye drops are used to tx Glaucoma. How do they work?
Definition

Glaucoma is an eye disease where the eye pressure is too high for the eye nerve (optic nerve) to function. There are two ways to lower eye pressure: either slow the rate of fluid produced inside of the eye (turn down the faucet) or, increase the rate fluid leaves the eye (open the drain). Pilocarpine eye drops function by increasing the rate fluid exits the eye. They do this by encouraging the small muscles inside your eye to work harder. This stimulates the muscles which pull on the drainage channels that help fluid leave the eye quicker, thus decreasing the pressure inside the eye.

Term
What is a Leforte I maxillary fx?
Definition
transverse detachment of the entire maxilla above the teeth at the level of the nasal floor.[image]
Term
What is a Leforte II maxillary fx?
Definition

Midface fx that involves a triangular segment of the midportion of the face & nasal bones.

[image]

Term
What is a Leforte III maxillary fx?
Definition

Complete separation of the cranial attachments from the facial bones.

[image]

Term
What are the nursing interventions for Leforte maxillary fxs?
Definition

Maxillary fxs carry a high risk of airway obstruction.

  • consider ice to face
  • elevate HOB if cervical injury has been r/o.
  • suction prn
  • consider early intubation or surgical airway

Maxillary fxs carry a risk for basilar skull fx & intracrainial injury, perform meticulous neurological assessments.

Term
Your pt has been splashed in the eye with an acidic substance. What is your first course of action?
Definition
Immediate flushing with NS, usually for a minimum of 30m with 2L of NS (may require more) continue to flush until pH is around 7.4
Term
What is 1% methylcellulose solution used for?
Definition
artificial tears.
Term
What is the tx for hemorrhagic complications ffrom oral anticoagulants (Coumadin)?
Definition
  • Vitamin K
  • fluid volume replacement
  • FFP
  • transfusion of whole blood
Term
What Obstetric incident leads to DIC?
Definition
Activation of clotting mechanism caused by placental & fetal tissue
Term
What assessment finding is most significant in the pt with DIC
Definition
Abnormal bleeding
Term
Acute lymphocytic leukemia (ALL), a malignant disease of the bone marrow and lymphatic system that affects the hematological cells and causes a proliferation of nonfuctional WBCs primarily affects the young & is not seen after what age?
Definition
20y.  Approx. 80% of all pts with ALL are between the ages of 2-5y.
Term

True or False

Hemophila A is much more common than Hemophila B

Definition
True
Term

Hemophila A is a deficiency of Factor VIII

True or False

Definition
True
Term

Hemophila B is a deficiencyof Factor IX

True or False

Definition
True
Term

Hemophila A is 5x more common than Hemophila B. Both types are inherited as X-linked traits; therefore, almost all individuals affected are male.The mothers and some sisters of hemophiliacs maybe asymptomatic carriers of this disorder.

True or False?

Definition
True
Term
Define Retinal Detachment
Definition
Sensory layer spearates for the retinal pigment epithilium leading to a decreased blood supply to the retina.
Term
what are some s/s of retinal detachment?
Definition
  • painless
  • gradual or sudden deterioration of vision unilaterally.
  • photopsia (flashing lights in visual field)
  • cloudy, smoky vision
  • curtain or veil over visual field
Term
What is the tx for retinal detachment?
Definition
  • patch both eyes to reduce bilateral movement
  • rest
  • scleral buckling
  • laser repair
Term
Define Hyphema
Definition
Bleeding from the iris that causes a collection of blood in the anterior chamber of the eye resulting in pain, photophobia & blurred vision.
Term
Define Malar eminence
Definition
highest point of the cheek bone, this feature is lost in an orbital fx
Term
define Ptosis
Definition
drooping of the eyelid
Term
What d/c teaching does a pt with a ruptured TM receive?
Definition
  • The TM will heal itself & it should be kept dry during the healing process.
Term
D/C inst. for pt with OE:
Definition
  • protect external canal from moisture when bathing
  • No swimming until infection resolves
  • No Q-tips until infection resloves
  • leave otowick in place until it falls out on its own
  • apply heat to ear with heating pad or compresses
Term
What are the warning signs of Hyperosmolar Hyperglycemic Nonketotic Syndrome (HHNS)?
Definition
  • Blood sugar level over 600 mg/dl
  • Dry, parched mouth
  • Extreme thirst (although this may gradually disappear)
  • Warm, dry skin that does not sweat
  • High fever (over 101 degrees Fahrenheit, for example)
  • Sleepiness or confusion
  • Loss of vision
  • Hallucinations (seeing or hearing things that are not there)
  • Weakness on one side of the body
  • Term

    What is Hyperosmolar Hyperglycemic Nonketotic Syndrome (HHNS)?

    Definition

    Hyperosmolar Hyperglycemic Nonketotic Syndrome, or HHNS, is a serious condition most frequently seen in older persons. HHNS can happen to people with either type 1 or type 2 diabetes, but it occurs more often in people with type 2. HHNS is usually brought on by something else, such as an illness or infection.

    In HHNS, blood sugar levels rise, and your body tries to get rid of the excess sugar by passing it into your urine. You make lots of urine at first, and you have to go to the bathroom more often. Later you may not have to go to the bathroom as often, and your urine becomes very dark. Also, you may be very thirsty. Even if you are not thirsty, you need to drink liquids. If you don't drink enough liquids at this point, you can get dehydrated.

    Term
    What is DKA?
    Definition

    Diabetic ketoacidosis (DKA) is an acute metabolic complication of diabetes characterized by hyperglycemia, hyperketonemia, and metabolic acidosis. DKA occurs mostly in type 1 diabetes. It causes nausea, vomiting, and abdominal pain and can progress to cerebral edema, coma, and death. DKA is diagnosed by detection of hyperketonemia and anion gap metabolic acidosis in the presence of hyperglycemia. Treatment involves volume expansion, insulin replacement, and prevention of hypokalemia.

    Term
    How is DKA diagnosed?
    Definition
    A diagnosis of diabetic ketoacidosis requires the patient's plasma glucose concentration to be above 250 mg per dL (although it usually is much higher), the pH level to be less than 7.30, and the bicarbonate level to be 18 mEq per L or less. Beta-hydroxybutyrate is a better measurement of the degree of ketosis than serum ketones. Intravenous insulin and fluid replacement are the mainstays of therapy, with careful monitoring of potassium levels. Phosphorous and magnesium also may need to be replaced. Bicarbonate therapy rarely is needed. Infection, insulin omission, and other problems that may have precipitated ketoacidosis should be treated. Myocardial infarction is a precipitating cause of diabetic ketoacidosis that is especially important to look for in older patients with diabetes. Cerebral edema is a major complication that occurs primarily in children.
    Term
    What is SIADH secretion?
    Definition

    The syndrome of inappropriate antidiuretic hormone (SIADH) is a condition commonly found in the hospital population, especially in patients being hospitalized for central nervous system (CNS) injury. This is a syndrome characterized by excessive release of antidiuretic hormone (ADH or vasopressin) from the posterior pituitary gland or another source. The result is hyponatremia, and sometimes fluid overload. It should be noted that vasopressin has other important functions, addressed in the appropriate articles.

    Term
    What are some s/s of SIADH secretion?
    Definition
    Signs and symptoms of hyponatremia are primarily related to the dysfunction of the central nervous system and correlate with severity and rapidity of development of hyponatremia. Anorexia, nausea, and malaise are the earliest findings, followed by headache, irritability, confusion, muscle cramps, weakness, obtundation, seizures, and coma. These occur as osmotic fluid shifts result in cerebral edema and increased intracranial pressure. Whereas most patients with serum sodium concentration above 125 mEq/L are asymptomatic, those with lower levels typically have symptoms, especially in the setting of a rapid decrease. When sodium concentration drops below 105 mEq/L, life-threatening complications are likely to occur.
    Term

    Pts at risk for developing SIADH secretion include those with lung carcinomas, as oat-cell carcinom accounts for 80% of al cses of SIADH.

    True or False

    Definition
    True
    Term

    List risk factors of SIADH.

    Definition
    • Lung carcinomas #1
    • tuberculous meningitis
    • extracranial malignant tumor
    • bronchogenic tumors
    • pancreatic tumors
    • head trauma
    • meds such as thiazides, chlorpropamide.
    • viral respiratory infections
    Term

    Preventing seizures is the primary goal of nursing care for the pt dx with SIADH.

    True or False

    Definition
    True
    Term
    . Causes of digoxin toxicity include:A. hypermagnesemia.B. hypercalcemia.C. hyperthyroidism.D. hyperkalemia.
    Definition
    Hypercalcemia causes digoxing toxiciy because calcium has a similar effect as digoxin
    Term
    . Which of the following would be the earliest indicationthat there is a complication from the administrationof thrombolytic medication to a patientwho had an acute stroke?
    • A. Change in the level of consciousness
    • B. Hypotension
    • C. Increased paralysis
    • D. Dizziness
    Definition
    A A subtle change in the level of consciousnessis the earliest indication of an intracranial bleed,which is the most feared complication of thrombolytic
    Term
    5. After completion of central venous cannulationvia the subclavian vein, your patient becomesanxious and dyspneic and complains of chestpain. You suspect a:A. tracheal injury.B. pneumothorax.C. cardiac tamponade.D. pulmonary contusion.
    Definition
    5. Correct answer: B Whereas all of these conditions may presentwith the symptom complex of chest pain, anxiety, anddyspnea, pneumothorax is the most common complicationof central venous cannulation because of the close proximityof the apex of the lung.
    Term
    What is the length of time that sutures are left in place on various body parts?
    Definition

    Body Part

    Length of Time (days)
    Face3-4
    Neck5
    Scalp6-7
    Arms/back of hands7
    Chest/Abdomen7
    Legs/top of feet10
    Back10-12
    Palms of hands, soles of feet14
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