Term
| potent complex immunologic cascade |
|
Definition
| normal inflammatory immune response |
|
|
Term
| prompt protective response to microorganism invasion |
|
Definition
| normal inflammatory immune response |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| excessive or poorly regulated response may lead to maladaptive release of inflammatory compounds |
|
Definition
| systemic inflammatory response syndrome (SIRS) |
|
|
Term
| toll like receptors on cells |
|
Definition
|
|
Term
| make contact with pathogens and initiate the immune response |
|
Definition
|
|
Term
| activate the complement system |
|
Definition
|
|
Term
|
Definition
|
|
Term
| what kind of receptor is a scavenger receptor? |
|
Definition
|
|
Term
| what do mast cells release? |
|
Definition
histamine
eosinophil and neutrophil chemotaxic factors |
|
|
Term
| constriction of large vessels and dilation of post capillary venules; increased permeability |
|
Definition
|
|
Term
| attracts neutrophils eosinophils |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| ingestion and disposal of antigen |
|
Definition
|
|
Term
| phagocyte and complement system activation |
|
Definition
|
|
Term
| arrive later but live longer and reproduce |
|
Definition
| monocytes and macrophages |
|
|
Term
|
Definition
|
|
Term
| modulate the histamine from mast cells |
|
Definition
|
|
Term
| recognize and eliminate cells infected with viruses |
|
Definition
|
|
Term
| key in recognizing differentiation in cells |
|
Definition
|
|
Term
| activate by antigen/antibody complexes and initiate coagulation |
|
Definition
|
|
Term
| activate fibrinogen and Factor V |
|
Definition
|
|
Term
| tissue factor expression; hypercoagulability |
|
Definition
|
|
Term
| production of pro-inflammatory cytokines |
|
Definition
|
|
Term
| neutrophil dysfunction; defective clearance of bacteria |
|
Definition
|
|
Term
| increased apoptosis; immunideficiency |
|
Definition
|
|
Term
| increased apoptosis; adrenergic insufficiency |
|
Definition
|
|
Term
|
Definition
|
|
Term
| cellular products of inflammation |
|
Definition
leukotriene
platelet activating factor
prostaglandins
cytokines
chemokines |
|
|
Term
| increase vascular permeability |
|
Definition
|
|
Term
| platelet activation, increase vascular permeability, and increased leukocyte adhesion |
|
Definition
| platelet activating factor |
|
|
Term
| increased vascular permeability, attract neutrophils, and cause pain |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| increase cellular respiration |
|
Definition
|
|
Term
| increase lysosomal activity |
|
Definition
|
|
Term
|
Definition
|
|
Term
| enhance the immune response |
|
Definition
|
|
Term
| produce antiviral proteins |
|
Definition
|
|
Term
| interferes with viral reproduction |
|
Definition
|
|
Term
| tumor necrosis factor alpha |
|
Definition
|
|
Term
|
Definition
|
|
Term
| synthesizes inflammatory serum proteins by the liver |
|
Definition
|
|
Term
| cause muscle wasting and intravascular thrombosis |
|
Definition
|
|
Term
| The inflammatory process begins with tissue injury from: |
|
Definition
Infection
Mechanical damage
Ischemia
Nutrient deprivation
Genetic or immune defects
Chemical agents
Temperature extremes
Ionizing radiation |
|
|
Term
| Where do inflammatory changes begin? |
|
Definition
|
|
Term
|
Definition
Blood vessel dilation
Increased vascular permeability & leakage of fluid out of vessel
WBC adheres to inner vessel wall & migrate through the wall to the site of injury |
|
|
Term
| What biochemical mediators are released that cause space between the cells to allow leakage? |
|
Definition
histamine
bradykinins
leukotrienes
substance P
prostaglandins |
|
|
Term
| Step 1 of inflammatory process |
|
Definition
| Limit inflammation by activating clotting, enzymes, and eosinophils to limit the spread of inflammation |
|
|
Term
| Step 2 of inflammatory process |
|
Definition
| Prevent further damage by diluting the toxins and destroying bacteria through the complement system and macrophage and neutrophil phagocytosis |
|
|
Term
| Step 3 of inflammatory process |
|
Definition
| Elicit a more specific response through influx of lymphocytes |
|
|
Term
| Step 4 of inflammatory process |
|
Definition
| Prepare the area for healing by removing dead cells and products of inflammation through lymph and epithelial cells |
|
|
Term
| nonspecific, ischemia, inflammation |
|
Definition
| systemic inflammatory response |
|
|
Term
| a body wide response to cytokine release and their effects on the receptors |
|
Definition
|
|
Term
| cause of chemical and biochemical changes |
|
Definition
|
|
Term
| SIRS: body wide response following any of a variety of clinical insults: |
|
Definition
Infection
Pancreatitis
Ischemia
Multiple trauma
Tissue injury - MI, burns
Hemorrhagic shock
Immune mediated organ injury |
|
|
Term
| SIRS is defined by presence of 2 or more of the following: |
|
Definition
Temperature greater than 38.0 C(100.4F) or less than 36.0 C (96.8F)
HR higher than 90 bpm
RR higher than 20 breaths/min
Arterial carbon dioxide tension below 32 mmHg
WBC higher than 12,000 L or lower than 4000/uL
More than 10% bands |
|
|
Term
| a systemic response to infection |
|
Definition
|
|
Term
| Sepsis is identical to SIRS except: |
|
Definition
| that it must result specifically from infection rather than from any of the noninfectious insults that may also cause SIRS |
|
|
Term
| Sepsis is a documented or suspected infection with one or more of the following: |
|
Definition
Fever - core temp > 38.3 C (100.9F)
Hypothermia - core temp < 36.0 C
HR > 90 bpm
Tachypnea
Altered mental status
Significant edema or positive fluid balance > 20 ml/kg over 24 hours
Hyperglycemia in the absence of diabetes > 120
Leukocytosis - WBC > 12,000
Leukopenia WBC < 4000
Normal WBC count with > 10% immature forms, bands
Plasma C-reactive protein increased
Plasma procalcitonin increased |
|
|
Term
|
Definition
|
|
Term
| extension of the normal pathophysiologic response to infection |
|
Definition
|
|
Term
| the first clinical sign of sepsis |
|
Definition
|
|
Term
| unchecked, it results in MODS which may be the first clinical sign |
|
Definition
|
|
Term
| In sepsis, vasoactive mediators cause ________ and increase ___________ at the site of infection. |
|
Definition
vasodilation
microvascular permeability |
|
|
Term
| plays a central role in the vasodilation and resistance to vasopressors in septic shock |
|
Definition
|
|
Term
| In sepsis, impaired secretion of ________ may occur. |
|
Definition
|
|
Term
| mortality increases as organ failure increases |
|
Definition
|
|
Term
|
Definition
Extremes of age - old/young
Patients with developmental delay, CP
Recent surgery, invasive procedure, illness, childbirth, pregnancy termination, miscarriage
Reduce immunity |
|
|
Term
| What are some examples of reduced immunity that could cause sepsis? |
|
Definition
Diabetes
Liver cirrhosis
Autoimmune diseases - SLE, RA
HIV/AIDS
Para/quadraplegics
Sickle cell disease
Splenectomy patients
Compromised skin from chronic wounds, burns, ulcers
Chemotherapy
Post organ transplant - bone marrow, solid organ
Chronic steroid use
Recent antibiotic use
Indwelling catheters of any kind - dialysis, foley, IV, PICC, PEG tubes |
|
|
Term
|
Definition
Fever
Chills
Sweating
Altered mental function
Hyperventilation with respiratory alkalosis
Fatigue
Malaise
Anxiety |
|
|
Term
| occurs from resetting the hypothalamus so that heat production and heat loss are balanced to maintain a higher temperature |
|
Definition
|
|
Term
| In sepsis, an abrupt onset of fever is usually associated with what? |
|
Definition
|
|
Term
| a secondary symptoms associated with fever and results from increased muscular activity in an attempt to produce heat and thereby raise the body temperature to the level required to reset the hypothalamus |
|
Definition
|
|
Term
| occurs when the hypothalamus returns to its normal set point and senses that the body temperature is above the desired level |
|
Definition
|
|
Term
| is stimulated to offload excess body heat through evaporative cooling |
|
Definition
|
|
Term
| What is a common manifestation of sepsis in elderly individuals? |
|
Definition
| mild disorientation or confusion |
|
|
Term
| What is commonly the only symptoms of sepsis in the elderly? |
|
Definition
|
|
Term
| What are some more severe manifestations of altered mental status in sepsis? |
|
Definition
apprehension
anxiety
agitation
coma |
|
|
Term
| altered amino acid metabolism has been proposed as a cause of metabolic encephalopathy |
|
Definition
| altered mental status in sepsis |
|
|
Term
| In sepsis, stimulation of the medulla center by endotoxins is the cause of _____________. |
|
Definition
|
|
Term
| Symptoms may be absent in patients with serious infections |
|
Definition
|
|
Term
|
Definition
Shivering, fever, or very cold
Extreme pain or general discomfort
Pale or discolored skin
Sleepy, difficult to arouse, confused
"I feel like I might die"
Short of breath |
|
|
Term
| What happens to cardiac output in the early stages of sepsis? |
|
Definition
| It is well maintained or even increased |
|
|
Term
| In sepsis, the presence of vasodilatory mediators may result in: |
|
Definition
warm skin
warm extremities
normal capillary refill |
|
|
Term
| As sepsis progresses, _______ and __________ fall. |
|
Definition
stroke volume
cardiac output |
|
|
Term
| In sepsis, patients begin to manifest signs of poor distal perfusion including: |
|
Definition
cool skin
cool extremities
delayed capillary refill |
|
|
Term
| necessary for oxygen delivery |
|
Definition
|
|
Term
| In sepsis, hemoglobin should be maintained at a level of __________. |
|
Definition
|
|
Term
| What happens to the platelet count in sepsis? |
|
Definition
|
|
Term
| may predict the existence of a bacterial infection |
|
Definition
|
|
Term
| common source of sepsis especially in elderly |
|
Definition
|
|
Term
| Diagnostic testing for sepsis |
|
Definition
CBC
Blood cultures
UA/culture
Gram stain/culture from site
Metabolic panel, electrolytes
Reanl/hepatic function
ABGs
Serum lactate
PT/aPTT
Clotting products
US, CT, Chest x-ray |
|
|
Term
| In sepsis, elevated serum lactate indicts what? |
|
Definition
| significant tissue hypoperfusion and shift from aerobic to anaerobic metabolism |
|
|
Term
| Used to identify clotting dysfucntion |
|
Definition
|
|
Term
| Used to detect the presence of DIC |
|
Definition
| Clotting products such as fibrin, fibrinogen, thrombin, D-dimer |
|
|
Term
| Used to identify pneumonia and the development of ARDS |
|
Definition
|
|
Term
| defined as sepsis associated with organ dysfunction |
|
Definition
|
|
Term
| Characteristics of severe sepsis |
|
Definition
Arterial hypoxemia
Acute oliguria (<0.5 ml/kg/hour)
Creatinine > 2.0 mg/dL
Decreased cap refill or mottling
Arterial hypotension - systolic < 90mmHg
Mean arterial BP < 65mmHg or SBP decreased > 40mm
Coagulation abnormalities - INR > 1.5 or aPTT > 60 seconds without anticoagulation
Thrombocytopenia - platelets < 100,000
Hyperbilirubinemia
Hyperlactatemia |
|
|
Term
| How to calculate mean blood pressure |
|
Definition
| diastolic + 1/3(systolic-diastolic) |
|
|
Term
|
Definition
Avoid invasive catheters or remove them ASAP
Prophylactic antibiotics in the perioperative phase particularly after GI surgery
Use of topical antibiotics around invasive catheters for patients with burns
Maintenance of adequate nutrition
Administration of pneumococcal vaccine to patients who have undergone splenectomy
Early enteral feedings
Proper asepsis and use of PPE
Hand washing |
|
|
Term
| Defined as sepsis with hypotension despite adequate fluid resuscitation |
|
Definition
|
|
Term
| Concomitant organ dysfunction or perfusion abnormalities are present in the absence of other known causes |
|
Definition
|
|
Term
| Early symptoms of septic shock |
|
Definition
|
|
Term
| Late symptoms of septic shock |
|
Definition
| Pale, cold, clammy, mottled, subnormal body temperature, pulmonary congestion, drowsiness, stupor, coma |
|
|
Term
| What is the difference with septic shock from other shock conditions? |
|
Definition
| Initially the skin and temperature presentation |
|
|
Term
| 3 major goals of septic shock |
|
Definition
1. Resuscitate the patent from septic shock - supportive measures to correct hypoxia, hypotension, and impaired tissue oxygenation
2. Identify the source of infection and treat it with antimicrobial therapy, surgery, or both
3. Maintain adequate organs system function to interrupt the pathogenesis of MODS |
|
|
Term
| Treatment of septic shock |
|
Definition
Early recognition
Early hemodynamic resuscitation and CVP line
Early ventilatory resuscitation - O2 therapy, intubation, CPAP
Source ID and control
Early and adequate antibiotic therapy
Continued hemodynamic support - Swan Ganz, hemodynamic lines
Corticosteroid controversial
Tight glycemic control |
|
|
Term
| Are medical emergencies that require treatment and resuscitation immediately |
|
Definition
|
|
Term
| Fluid resuscitation for sepsis |
|
Definition
| Give at least 30 ml/kg of IV crystalloids within the first 3 hours |
|
|
Term
|
Definition
|
|
Term
| Reassessment of fluid resuscitation should include evaluation of available physiologic variables: |
|
Definition
HR
BP
Arterial oxygen saturation
RR
Temperature
Urine output
CVP |
|
|
Term
| In treatment of septic shock, initial target MAP of _______ in patients with septic shock requiring ___________. |
|
Definition
|
|
Term
| a marker of tissue perfusion |
|
Definition
|
|
Term
| Treatment of septic shock: guiding fluid resuscitation to normalize ________ in patients with elevated levels. |
|
Definition
|
|
Term
| In treatment of septic shock, assessment of _____ and ____________ status guides amount and rate of infusion. Give fluids as long as __________. |
|
Definition
volume
cardiovascular status
improving |
|
|
Term
| Isotonic crystalloid solutions |
|
Definition
Sodium chloride 0.9%
LR solution |
|
|
Term
| In septic shock treatment, repeat boluses until adequate restored - _______ may be required. |
|
Definition
|
|
Term
| What should be monitored in fluid resuscitation in septic shock? |
|
Definition
|
|
Term
| In treatment of septic shock, ____ in addition to _______ may be used for initial resuscitation and subsequent intravascular volume replacement. |
|
Definition
|
|
Term
| What indicates adequate volume of fluid replacement in treatment of septic shock? |
|
Definition
| Improvement in mental status, HR, BP, MAP (> 60-65), capillary refill, and urine output |
|
|
Term
| What values might indicate adequate volume if heart is functioning appropriately? |
|
Definition
CVP 8-15 mmHg
PAP > 18 mmHg |
|
|
Term
| When should aerobic and anaerobic blood cultures be taken in septic shock? |
|
Definition
|
|
Term
| Rule of obtaining cultures in septic shock |
|
Definition
| Blood cultures within 45 minutes. Two sites, other cultures as suspected to isolate the source, urine, spinal fluid, wound, sputum |
|
|
Term
| What antibiotics should be started in septic shock until the source of infection is identified? |
|
Definition
| broad spectrum antibiotics |
|
|
Term
| When should antibiotics begin in septic shock? |
|
Definition
|
|
Term
| In treatment of septic shock, ________ may be ordered as needed, but don't delay fluids and antibiotics because of these. |
|
Definition
|
|
Term
| Hospitals and hospital systems should have sepsis screening protocols for who? |
|
Definition
| Acutely ill high risk patients |
|
|
Term
| When should appropriate routine microbiologic cultures (including blood) be obtained? |
|
Definition
| before starting antimicrobial therapy |
|
|
Term
| Administration of IV antimicrobials initiated as within _________ for both sepsis and septic shock. |
|
Definition
|
|
Term
| What is indicated for patients presenting with sepsis or septic shock to cover all likely pathogens? |
|
Definition
| broad spectrum therapy with one or more antimicrobials |
|
|
Term
| What is the first choice vasopressor for septic shock? |
|
Definition
|
|
Term
| In septic shock, add ________ (dosage) to Norepinephrine with the intent of raising MAP to target or to decrease norepinephrine dosage. |
|
Definition
Vasopressin
up to 0.03 U/min |
|
|
Term
| In septic shock, what can be used as an alternative vasopressor agent to Norepinephrine but only in highly selected patients? |
|
Definition
|
|
Term
| In septic shock, what should be used in patients who show evidence of persistent hypo-perfusion despite adequate fluid loading and the use of vasopressor agents? |
|
Definition
|
|
Term
| Treats hypotension after fluid resuscitation |
|
Definition
|
|
Term
| Stimulates beta 1 adrenergic and alpha adrenergic receptors, which increases arterial tone and cardiac contractility |
|
Definition
|
|
Term
| What increases with Norepinephrine? |
|
Definition
Systemic blood pressure
Coronary blood flow
Myocardial oxygen demand |
|
|
Term
| Examples of regional perfusion |
|
Definition
urine flow
lactate concentration |
|
|
Term
| What improves after Norepinephrine infusion? |
|
Definition
|
|
Term
| When should Norepinephrine be used? |
|
Definition
|
|
Term
| Norepinephrine therapy appears to have no effects on _______________ and _____________ provided that adequate cardiac output is maintained. |
|
Definition
Splanchnic oxygen consumption
hepatic glucose production |
|
|
Term
| All patients requiring vasopressors have __________________ placed as soon as practical if resources are available. |
|
Definition
|
|
Term
| Used to treat hypotension in fluid resuscitated patients |
|
Definition
|
|
Term
| It stimulates both adrenergic and dopaminergic receptors |
|
Definition
|
|
Term
|
Definition
| depends on the hemodynamic effect |
|
|
Term
| Lower doses stimulate mainly dopaminergic receptors that produce renal and mesenteric vasodilation |
|
Definition
|
|
Term
| What do higher doses of Dopamine produce? |
|
Definition
cardiac stimulation
tachycardia
vasoconstriction |
|
|
Term
| The blood pressure increases in Dopamine therapy primarily as a result of what? |
|
Definition
|
|
Term
| Undesirable effects of Dopamine |
|
Definition
Tachycardia
increased pulmonary shunting
increased pulmonary artery pressure |
|
|
Term
| a selective alpha 1 adrenergic recepetor agonist |
|
Definition
|
|
Term
| Primarily used in anesthesia to increase blood pressure |
|
Definition
|
|
Term
| Has been found to increase MAP in patients with sepsis who are hypotensive with an increase in oxygen consumption and reduced cardiac output |
|
Definition
|
|
Term
| Should be used if Norepinephrine causes myocardial arrhythmias |
|
Definition
|
|
Term
| Contains anti-inflammatory actions that stop the systemic inflammatory reaction and breaks the cycle of sepsis but it slows healing and immune suppresses |
|
Definition
|
|
Term
| When should Corticosteroid use be stopped? |
|
Definition
| ASAP, when the patient is hemodynamically able to wean from pressors |
|
|
Term
| What patients should corticosteroid use be used in? |
|
Definition
Patients with vasopressor dependent shock
Those with adrenal insufficiency |
|
|
Term
|
Definition
|
|
Term
| Epinephrine can increase MAP by increasing what? |
|
Definition
cardiac index
stroke volume
systemic vascular resistance
heart rate |
|
|
Term
| Increases oxygen deliver and consumption |
|
Definition
|
|
Term
| The use of Epinephrine is recommended in what patients? |
|
Definition
| those unresponsive to traditional agents |
|
|
Term
| Undesirable effects of Epinephrine |
|
Definition
Increased lactate concentration
Potential production of myocardial ischemia and arrhythmias
Reduced splanchnic flow |
|
|
Term
| Conditions for RBC transfusion in septic shock |
|
Definition
| Hgb < 7.0 in adults in the absence of extenuating circumstances such as myocardial ischemia, severe hypoxemia, or acute hemorrhage |
|
|
Term
| Conditions of prophylactic platelet transfusion in septic shock |
|
Definition
< 10,000 in the absence of apparent bleeding
< 20,000 if the patient has a significant risk of bleeding |
|
|
Term
| What can be given in septic shock to protect against VTE in the absence of contraindications? |
|
Definition
Unfractionated Heparin
Low molecular weight Heparin |
|
|
Term
| Use __________ rather that UFH for VTE prophylaxis in the absence of contraindications. |
|
Definition
|
|
Term
| What should be used when pharmacologic VTE is contraindicated in septic shock? |
|
Definition
| mechanical VTE prophylaxis |
|
|
Term
|
Definition
Progressive or Sequential Systems Failure
Multiple organ system failure |
|
|
Term
| Progressive and potentially reversible dysfunction in 2 or more organ systems |
|
Definition
|
|
Term
| Induced by a variety of acute insults |
|
Definition
|
|
Term
|
Definition
|
|
Term
| Clinical trials have demonstrated a mortality ranging from 40-75% in these patients |
|
Definition
|
|
Term
|
Definition
|
|
Term
| Homeostasis cannot be maintained without intervention |
|
Definition
|
|
Term
| The direct result of well defined insult in which organ dysfunction occurs early and can be directly attributable to the insult itself |
|
Definition
|
|
Term
| Hypotensive episode precedes the damage |
|
Definition
|
|
Term
| The inflammatory response of the body causes the clinical manifestations of sepsis which leads to organ hypo-perfusion and systemic dysfunction |
|
Definition
|
|
Term
| 4 proposed mechanisms of MODS |
|
Definition
Hypoxia
Direct cytotoxicity from endotoxins
Apoptosis
Immunosuppression |
|
|
Term
| MODS exists in multiple organs: |
|
Definition
Hemodynamic
Hematologic
Pulmonary
GI
Renal
CNS |
|
|
Term
| In MODS, there are changes in both ______ and _______ ventricular performance. |
|
Definition
|
|
Term
| In MODS, cardiac output is often ____________ initially to maintain blood pressure in the presence of systemic vasodilation. |
|
Definition
|
|
Term
| Patients with pre-existing cardiac disease are unable to their cardiac output appropriately. |
|
Definition
|
|
Term
| ________ interferes with the normal distribution of systemic blood flow to organ systems. |
|
Definition
|
|
Term
| Core organs may not receive appropriate oxygen delivery causing regional hypo-perfusion |
|
Definition
|
|
Term
| the key target organ for sepsis |
|
Definition
|
|
Term
| A decrease in the number of functional capillaries causes an inability to extract oxygen and plugging of the capillary lumen by blood cells |
|
Definition
|
|
Term
| Increased endothelial permeability leads to widespread ___________ involving protein rich fluid and loss of intravascular volume and protein. |
|
Definition
|
|
Term
| Produced by ischemic pancreas |
|
Definition
| myocardial depressant factor |
|
|
Term
| decreases contractility of the heart and impairs phagocytosis |
|
Definition
| myocardial depressant factor |
|
|
Term
| Causes reversible myocardial depression resistance to catecholamine and fluid administration |
|
Definition
| myocardial depressant factor |
|
|
Term
| oxygen need is not matched by supply |
|
Definition
|
|
Term
| What causes a redistribution of intravascular fluid volume in MODS? |
|
Definition
Reduced arterial vascular tone
Diminished venous return
Venous dilation
Release of more myocardial depressant substances |
|
|
Term
| What are some pulmonary causes of MODS? |
|
Definition
Endothelial injury in the pulmonary vasculature
Enhanced microvascular permeability
Interstitial and alveolar edema
Neutrophil entrapment initiates injury to alveolar capillary membranes
Collapsed or fluid filled alveoli cannot exchange gas |
|
|
Term
| What are the earliest and most frequent manifestations of MODS? |
|
Definition
acute lung injury
acute respiratory distress syndrome |
|
|
Term
| Damaged lung tissue produces less ___________ which decreases lung compliance and __________ causing alveoli to ____________. |
|
Definition
surfactant
elasticity
collapse |
|
|
Term
| Schizophrenia: Neurobiochemical |
|
Definition
Dopamine hypothesis
Serotonin
Glutamate |
|
|
Term
| Schizophrenia: Neuroanatomical |
|
Definition
| structural cerebral abnormalities |
|
|
Term
|
Definition
| several genes on different chromosomes interact with environment |
|
|
Term
| Schizophrenia: Nongenetic risk factors |
|
Definition
Complications of pregnancy and birth
Stress |
|
|
Term
| Schizophrenia: Psychological and environmental factors |
|
Definition
Prenatal stressors
Psychological stressors
Environmental stressors |
|
|
Term
| Schizophrenia statistics in adults |
|
Definition
|
|
Term
| Schizophrenia statistics in children |
|
Definition
|
|
Term
| Onset of schizophrenia in men |
|
Definition
|
|
Term
| Onset of schizophrenia in women |
|
Definition
|
|
Term
| Schizophrenia: No difference related to what? |
|
Definition
|
|
Term
| Comorbidity: schizophrenia |
|
Definition
Substance abuse disorders
Nicotine dependence
Anxiety, depression, suicide
Physical health or illness
Polydipsia |
|
|
Term
| Eugen Bleuler's 4 A's of Schizophrenia |
|
Definition
Affect
Associative looseness
Autism
Ambivalence |
|
|
Term
|
Definition
Recurrent acute exacerbations of psychosis
Increase in residual dysfunction and deterioration with each relapse |
|
|
Term
|
Definition
|
|
Term
| Onset or exacerbation of symptoms in schizophrenia |
|
Definition
| Acute phase of schizophrenia |
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|
Term
| Delusions and hallucinations prominent |
|
Definition
| Acute phase of schizophrenia |
|
|
Term
|
Definition
| Acute phase of schizophrenia |
|
|
Term
|
Definition
| Acute phase of schizophrenia |
|
|
Term
|
Definition
| Acute phase of schizophrenia |
|
|
Term
|
Definition
| Acute phase of schizophrenia |
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|
Term
|
Definition
|
|
Term
| Symptoms diminishing, schizophrenia |
|
Definition
| Stabilization phase of schizophrenia |
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|
Term
| Movement towards previous level of functioning |
|
Definition
| Stabilization phase of schizophrenia |
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|
Term
|
Definition
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|
Term
| At or near baseline functioning, schizophrenia |
|
Definition
| Maintenance phase of schizophrenia |
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|
Term
| Subtypes of schizophrenia |
|
Definition
Paranoid
Catatonic
Disorganized
Undifferentiated
Residual |
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|
Term
| Signs and symptoms categories of schizophrenia |
|
Definition
Positive symptoms
Negative symptoms
Cognitive symptoms
Mood symptoms |
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|
Term
| Potential early symptoms of schizophrenia (Pre-psychotic) |
|
Definition
Withdrawn from others
Depressed
Anxious
Phobias
Obsessions and compulsions
Difficulty concentrating
Preoccupation with religion or self
Symbolism - colors/items |
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|
Term
| General assessment in pre-psychotic phase of schizophrenia |
|
Definition
Positive symptoms
Negative symptoms
Cognitive symptoms
Affective/mood symptoms |
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|
Term
| Dimensions altered in individuals with schizophrenia |
|
Definition
Ability to work
Interpersonal relationships
Self care abilities
Social functioning
Quality of life |
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|
Term
| False, fixed beliefs that cannot be corrected by reasoning |
|
Definition
|
|
Term
| Positive symptoms of schizophrenia |
|
Definition
Delusions
Concrete thinking
Alterations in speech
Alterations in perception
Alterations in behaviour |
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|
Term
| Examples of delusions in schizophrenia |
|
Definition
Ideas of reference
Persecution
Gradiosity
Somatic sensations
Jealousy
Control
Though broadcasting
Thought insertion
Thought withdrawal
Delusions of being controlled |
|
|
Term
| Alterations in speech in schizophrenia |
|
Definition
Neologisms
Echolalia
Echopraxia
Clang associations
Word salad
Loose associations
Flight of ideas
Pressured speech |
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|
Term
| Thought disorders affecting speech and communication in schizophrenia |
|
Definition
Concrete thinking
Religiosity
Magical thinking
Circumstantiality
Tangentiality
Cognitive retardation
Alogia
Thought blocking
Thought insertion
Thought deletion |
|
|
Term
| What kind of hallucinations might be present in schizophrenia? |
|
Definition
|
|
Term
| Alterations in perception in schizophrenia |
|
Definition
Depersonalization
Derealization
Hallucinations
Boundary impairment |
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|
Term
| Alterations in behavior in schizophrenia |
|
Definition
Catatonia
Motor retardation
Motor agitation
Stereotyped behaviors
Automatic obedience
Wavy flexibility
Negativism
Impaired impulse control |
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|
Term
| Negative symptoms of schizophrenia |
|
Definition
Affective blunting
Anergia
Anhedonia
Avolition
Poverty of content of speech
Poverty of thought/thought blocking
Flat affect/inappropriate affect |
|
|
Term
| Cognitive symptoms of schizophrenia |
|
Definition
Inattention, easily distracted
Impaired memory
Executive function: poor decision making skills, poor problem solving skills
Illogical thinking
Impaired judgement |
|
|
Term
| Depression and other mood affective symptoms, schizophrenia: |
|
Definition
Dysphoria
Suicidal ideation
Hopelessness |
|
|
Term
| What assessment is crucial in affective symptoms of schizophrenia? |
|
Definition
| assessment for depression |
|
|
Term
| Affective symptoms of schizophrenia, assessment for depression crucial: |
|
Definition
May herald impending relapse
Increases substance abuse
Increases suicide risk
Further impairs functioning |
|
|
Term
| Assessment guidelines: schizophrenia |
|
Definition
1. Any medical problems
2. Abuse of or dependence on alcohol or drugs
3. Risk to self or others
4. Command hallucinations
5. Belief system
6. Suicide risk
7. Ability to ensure self safety
8. Co-morbidity disorders/dual diagnosis
9. Medications
10. Presence and severity of positive and negative symptoms
11. Patient's insight into illness
12. Family's knowledge of patient's illness and symptoms |
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|
Term
| Nursing diagnosis for positive symptoms in schizophrenia |
|
Definition
Disturbed sensory perception
Risk for self-directed or other directed violence
Disturbed thought processes |
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|
Term
| Nursing diagnosis for negative symptoms in schizophrenia |
|
Definition
Social isolation
Chronic low self esteem |
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|
Term
| Outcome identification: Phase 1 Acute (Schizophrenia) |
|
Definition
| Patient safety and medical stabilization |
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|
Term
| Outcome identification: Phase 2 Stabilization (Schizophrenia) |
|
Definition
Adhere to treatment
Stabilize medications
Control or cope with symptoms |
|
|
Term
| Outcome identification: Phase 3 Maintenance (Schizophrenia) |
|
Definition
Maintain achievement
Prevent relapse
Achieve independence, satisfactory quality of life |
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|
Term
| Planning: Phase 1 Acute schizophrenia |
|
Definition
| Best strategies to ensure patient safety and provide symptom stabilization |
|
|
Term
| Planning: Phase 3 Maintenance schizophrenia |
|
Definition
Provide patient and family education
Relapse prevention skills are vital |
|
|
Term
| Acute settings of phase 1 schizophrenia |
|
Definition
Partial hospitalization
Residential crisis centers
Halfway houses
Day treatment programs |
|
|
Term
| Interventions: acute phase of schizophrenia |
|
Definition
Psychiatric, medical, neurological evaluation
Psychopharmacological treatment
Support, psychoeducation, and guidance
Supervision and limit setting in the milieu |
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|
Term
| Interventions: stabilization phase of schizophrenia |
|
Definition
Milieu management
Personal responsibility and ADL
Activities and groups
Counseling and communication techniques |
|
|
Term
| Interventions: stabilization and maintenance phase of schizophrenia |
|
Definition
Hallucinations
Delusions
Associative looseness
Health teaching and health promotion |
|
|
Term
| The Maintenance phase of schizophrenia is about: |
|
Definition
Home maintenance
Prevention of relapse
Medication compliance |
|
|
Term
| In milieu therapy of schizophrenia, there is a potential for physical violence due to ___________ or ____________. |
|
Definition
|
|
Term
| In milieu therapy, the priority is the least restrictive safety technique: |
|
Definition
Verbal de-escalation
Medications
Seclusions or restraints |
|
|
Term
| Provide support and structure in schizophrenia |
|
Definition
|
|
Term
| Encourage development of social skills and friendships in schizophrenia |
|
Definition
|
|
Term
| What is the most common hallucination of schizophrenia? |
|
Definition
|
|
Term
| How to approach a client dealing with hallucinations |
|
Definition
| in a nonthreatening and nonjudgmental manner |
|
|
Term
| What to assess in hallucinations |
|
Definition
| if messages are suicidal or homicidal |
|
|
Term
| Client is anxious, fearful, lonely, and the brain is not processing stimuli accurately |
|
Definition
|
|
Term
| How to address delusions in a client with schizophrenia |
|
Definition
| Be open, honest, matter of fact, and calm |
|
|
Term
| Avoid arguing about content |
|
Definition
|
|
Term
|
Definition
|
|
Term
| In delusions, what are we validating? |
|
Definition
| the part of the delusion that is real |
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|
Term
| Do not pretend that you understand |
|
Definition
|
|
Term
| Place difficulty of understanding on yourself |
|
Definition
|
|
Term
| Look for reoccurring topics and themes |
|
Definition
|
|
Term
| Emphasize what is going on in the client's environment |
|
Definition
|
|
Term
| Involve client in simple, reality based activies |
|
Definition
|
|
Term
| Reinforce clear communication of needs, feelings, and thoughts |
|
Definition
|
|
Term
| Coping techniques for schizophrenia |
|
Definition
Distraction
Interaction
Activity
Social action
Physical action |
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|
Term
| Client and family teaching for schizophrenia |
|
Definition
Learn all you can about the illness
Develop a relapse prevention plan
Avoid alcohol and drugs
Learn ways to address fears/losses
Learn new ways of coping
Comply with treatment
Maintain communication with supportive people
Stay healthy by managing illness, sleep, and diet |
|
|
Term
| For long term treatment and compliance of schizophrenia |
|
Definition
|
|
Term
| Typical or first generation treatment for schizophrenia |
|
Definition
| conventional antiosychotics |
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|
Term
| Second generation treatment for schizophenia |
|
Definition
|
|
Term
| Treat both positive and negative symptoms |
|
Definition
|
|
Term
| Minimal to no extrapyramidal side effects or tardive dyskinesia |
|
Definition
|
|
Term
| What is a disadvantage to atypical antipsychotics? |
|
Definition
| tendency to cause significant weight gain |
|
|
Term
| Examples of atypical antipsychotics |
|
Definition
Clozapine
Risperidone
Olanzapine
Quetiapine
Ziprasidone
Aripiprazole |
|
|
Term
| Use is declining due to neurtopenia |
|
Definition
|
|
Term
| Anticholinergic side effects of atypical antipsychotics |
|
Definition
Dry mouth
Urinary retention and hesitancy
Constipation
Blurred vision
Photosensitivity
Dry eyes
Inhibition of ejaculation or impotence |
|
|
Term
| Extrapyramidal side effects of atypical antipsychotics |
|
Definition
Pseudo Parkinsonism
Acute dystonic reactions
Akathisia
Tardive dyskinesia |
|
|
Term
|
Definition
Opisthotonos
Oculogyric crisis |
|
|
Term
| Where can tardive dyskinesia occur? |
|
Definition
|
|
Term
| Nonrhythmic jerky rapid not suppressible involuntary movement, mostly of the distal muscles and faces |
|
Definition
|
|
Term
| slow involuntary convoluted writhing movements of the fingers, hands, toes, and feet, arms, legs, neck, and tongue |
|
Definition
|
|
Term
| Cardiovascular side effects of a2 blocks |
|
Definition
Hypotension
Postural hypotension
Tachycardia |
|
|
Term
| Rare and toxic effects of alpha 2 blockers |
|
Definition
Agranulocytosis
Cholestatic jaundice
Neuroleptic malignant syndrome |
|
|
Term
| Symptoms of neuroleptic malignant syndrome |
|
Definition
Muscle rigidity
Hyperpyrexia
Autonomic dysfunction - tachycardia, tachypnea |
|
|
Term
| In schizophrenia pharmacotherapy, high potency = |
|
Definition
|
|
Term
| High potency antipsychotic medications |
|
Definition
Trifluoperazine
Fluphenazine
Thiothixene |
|
|
Term
| Medium potency antipsychotic medications |
|
Definition
Loxapine
Molindone
Perphenazine |
|
|
Term
| In schizophrenia pharmacotherapy, low potency = |
|
Definition
|
|
Term
| Low potency antipsychotic medications |
|
Definition
Chlorpromazine
Thioridazine
Mesoridazine |
|
|
Term
|
Definition
|
|
Term
| Long acting antipsychotic medications |
|
Definition
Haloperidol decanoate
Fluphenazine decanoate |
|
|
Term
| Adjuncts to antipsychotic drug therapy |
|
Definition
Antidepressants
Antimanic agents |
|
|
Term
| What communication guidelines are there for paranoia? |
|
Definition
Don't fight or support delusion
Help find acceptable alternatives |
|
|
Term
| Predominantly positive symptom of schizophrenia |
|
Definition
|
|
Term
| Can include delusions, hallucinations, and unreasonable suspicisions |
|
Definition
|
|
Term
| dramatic reduction in activity to the point that voluntary movement stops |
|
Definition
|
|
Term
| activity can dramatically increase |
|
Definition
|
|
Term
| stuporous/withdrawn phase |
|
Definition
|
|
Term
|
Definition
|
|
Term
| incoherent and illogical thoughts and behaviors |
|
Definition
| disorganized schizophrenia |
|
|
Term
| People who do not fit into the three previous categories |
|
Definition
| undifferentiated schizophrenia |
|
|
Term
| While such individuals do not experience significant delusions, hallucinations, disorganized speech, or disorganized catatonic behavior, their symptoms are not predominantly positive, disorganized, or movement disordered |
|
Definition
| undifferentiated schizophrenia |
|
|
Term
| Active signs of undifferentiated schizophrenia |
|
Definition
positive symptoms
negative symptoms |
|
|
Term
| individual does not meet criteria for any other subtype |
|
Definition
| undifferentiated schizophrenia |
|
|
Term
| Not experiencing prominent delusions, hallucinations, disorganized speech, disorganized or catatonic behaviors but are experiencing at least 2 of those symptoms to a lesser extent or they experience the negative symptoms of schizophrenia |
|
Definition
|
|
Term
| Negative symptoms of schizophrenia |
|
Definition
Difficulty paying attention
Social withdrawal
Apathy
Reduction in speech |
|
|
Term
| Evidence of two or more residual symptoms persists: |
|
Definition
Reduced initiative, interests, or energy
Social withdrawal
Impaired role function
Speech deficits
Odd beliefs |
|
|
Term
| Different from the residual phase where they are no longer experiencing positive symptoms, but negative symptoms remain |
|
Definition
|
|
Term
| Advanced practice interventions: schizophrenia |
|
Definition
Psychotherapy
Cognitive behavioral therapy
Group therapy
Medication
Social skills training
Cognitive remediation
Family therapy |
|
|
Term
| Client's intense emotions produce similar emotions in the nurse |
|
Definition
|
|
Term
| Willingness for nurse to discuss feelings and behaviors with supervisors decreases defensive behaviors |
|
Definition
|
|
Term
| Self assessment: working with clients with schizophrenia: periodic reassessment: |
|
Definition
Treatment outcomes
Client's strengths and weaknesses |
|
|
Term
| Although rare, this is a psychiatric emergency due to the potential for suicide or infanticide |
|
Definition
|
|
Term
| an overt presentation of bipolar disorder after delivery |
|
Definition
|
|
Term
| psychosis and poor insight and judgement in the mother produce a serious safety risk to infant and mother |
|
Definition
|
|
Term
|
Definition
|
|
Term
| When does postpartum psychosis most often occur? |
|
Definition
| within 2 weeks after birth |
|
|
Term
| abrupt hormonal loss at birth is implicated as well as family history of bipolar disorder and other related disorders |
|
Definition
|
|
Term
| with acute onset and lack of premorbid debility, the prognosis is positive with treatment |
|
Definition
|
|
Term
| delusions and hallucinations commonly revolved around the infant |
|
Definition
|
|
Term
| Treatment of postpartum psychosis |
|
Definition
Antipsychotics
Mood stabilizers - Lithium
Benzodiazepines - Lorazepam, Diazepam |
|
|
Term
| In postpartum psychosis, why is timely remission of symptoms important? |
|
Definition
| so the mother can bond with the infant |
|
|
Term
| Timely remission of symptoms is important |
|
Definition
|
|
Term
| Frequent outpatient follow up care is critical as well as support and supervision post discharge |
|
Definition
|
|
Term
| Antecedents that may be impaired with postpartum psychosis |
|
Definition
Intact neurological function
Opportunities for growth through education
Nutrition |
|
|
Term
| Attributes altered with postpartum psychosis |
|
Definition
Ability to interpret the environment accurately
Ability to send and receive information or communicate
Ability to remember and learn |
|
|
Term
| Risk factors for postpartum psychosis |
|
Definition
Previous bipolar episodes, psychosis, or postpartum psychosis
Family history of bipolar disorder or postpartum psychosis
Discontinuation of a mood stabilizer
Being pregnant for the first time
Sleep deprivation
Increased environmental stress
Lack of partner support |
|
|
Term
| Purpose is to obtain evidence of signs and symptoms of mental disorders including danger to self or others that are present during the time of the interview |
|
Definition
| postpartum psychosis assessment |
|
|
Term
| postpartum psychosis assessment |
|
Definition
Behavior during interview
Motor activity - increased/decreased
Speech - may be illogical/bizarre
Concentration/attention span
Memory
Thought content - fear of child being destroyed, in danged, influence or hurt by Satan or evil spirts
Presence of command hallucinations
Thought process
Mood/affect
Insight
Judgement
Motivation for treatment |
|
|
Term
| Negative consequences for postpartum psychosis |
|
Definition
Frequent injuries
Institutionalized/dependence
Poor health outcomes
Unexpected consequences for actions/victimization
Inability to form/maintain relationships |
|
|
Term
| Interventions for postpartum psychosis |
|
Definition
Assess for homicidal/suicidal ideation
Verify content of delusions/hallucinations
Pharmacotherapy
Careful discharge planning before patient leaves hospital
Informed consent obtained if mother is breastfeeding and on antipsychotic medications
Referral to intensive outpatient therapy
Arrangements for support system
Psycho education
Monitoring for medication side effects |
|
|
Term
| an option for patients who do not respond to medications or have intolerable side effects related to postpartum psychosis |
|
Definition
|
|
Term
| any trauma to the skull, scalp, or brain |
|
Definition
|
|
Term
| a serious form of head injury |
|
Definition
|
|
Term
| The most common causes of head injuries |
|
Definition
|
|
Term
| twice as likely to sustain a TBI |
|
Definition
|
|
Term
|
Definition
MVA's
Falls
Fire arm related injuries
Assaults
Sports related injuries
Recreational accidents
War related injuries |
|
|
Term
| has a high potential for a poor outcome |
|
Definition
|
|
Term
| Deaths from head injuries occur at three points in time after the injury: |
|
Definition
Immediately after the injury
Within 2 hours after the injury
3 weeks after the injury |
|
|
Term
| When do the majority of deaths after a head injury occur? |
|
Definition
| immediately after the injury |
|
|
Term
| The majority of deaths after a head injury occur immediately after the injury, either from: |
|
Definition
direct head trauma
massive hemorrhage and shock |
|
|
Term
| Deaths occurring within a few hours of the trauma are caused by what? |
|
Definition
| progressive worsening of the head injury or bleeding |
|
|
Term
| Critical in the prevention of deaths in head trauma |
|
Definition
| Immediately recognizing changes in neurologic status and rapid surgical intervention |
|
|
Term
| Deaths occurring 3 weeks or more after the head injury result from what? |
|
Definition
|
|
Term
|
Definition
Scalp lacerations
Skull fractures |
|
|
Term
|
Definition
|
|
Term
| The scalp is highly __________ which causes ________________. |
|
Definition
|
|
Term
| Major complications of scalp lacerations |
|
Definition
|
|
Term
| an easily recognized type of external head trauma |
|
Definition
|
|
Term
|
Definition
Linear or depressed
Simple, comminuted, or compound
Closed or open |
|
|
Term
| occurs when there is a break in continuity of bone without alteration of relationship of parts |
|
Definition
|
|
Term
| Linear fractures are associated with what? |
|
Definition
|
|
Term
| an inward indentation of skull and is associated with a powerful blow |
|
Definition
|
|
Term
| is without fragmentation or communicating lacerations |
|
Definition
| a simple linear or depressed skull fracture |
|
|
Term
| it is caused by low to moderate impact |
|
Definition
| a simple linear or depressed skull fracture |
|
|
Term
| occurs when there are multiple linear fractures with fragmentation of bone into many pieces |
|
Definition
|
|
Term
| It is associated with direct, high-momentum impact |
|
Definition
|
|
Term
| is a depressed skull fracture and scalp laceration with communicating pathway to intracranial cavity |
|
Definition
|
|
Term
| associated with severe head injury |
|
Definition
|
|
Term
| Fractures may be closed or open, depending on the presence of a ______________ or extension of the fracture into the _________ or _______. |
|
Definition
scalp laceration
air sinuses
dura |
|
|
Term
| Location determines manifestations |
|
Definition
|
|
Term
| Complications of a skull fracture |
|
Definition
Infection
Hematoma
Tissue damage |
|
|
Term
| It is also important to note that in cases where a basal skull fracture is suspected, a ____________________ should be inserted under fluoroscopy. |
|
Definition
| nasogastric or oral gastric tube |
|
|
Term
| is a specialized type of linear fracture that occurs when the fracture involves the base of the skull |
|
Definition
|
|
Term
| Manifestations can evolve over the course of several hours, vary with the location and severity of fracture, and may include cranial nerve deficits, Battle’s sign, and periorbital ecchymosis. |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| This fracture generally is associated with a tear in the dura and subsequent leakage of CSF. |
|
Definition
|
|
Term
| CSF leakage from the nose |
|
Definition
|
|
Term
|
Definition
|
|
Term
| What generally confirms that the fracture has traversed the dura? |
|
Definition
|
|
Term
| Rhinorrhea may also manifest as what? |
|
Definition
|
|
Term
| This risk of ___________ is high with a CSF leak. |
|
Definition
|
|
Term
| 2 methods of determining if there is a CSF leak in the nose or ear |
|
Definition
| a Dextrostix or Tes-Tape strip to determine whether glucose is present |
|
|
Term
| Gives a positive reading for glucose |
|
Definition
|
|
Term
| What should you do if blood is present in the CSF? |
|
Definition
|
|
Term
|
Definition
Diffuse (Generalized)
Focal (localized)
Minor (GCS 13-15)
Moderate (GCS 9-12)
Sever (GCS 3-8) |
|
|
Term
| damage to the brain cannot be localized to one particular area of the brain |
|
Definition
|
|
Term
| damage can be localized to a specific area of the brain |
|
Definition
|
|
Term
| Examples of diffuse injuries |
|
Definition
|
|
Term
| Examples of focal injuries |
|
Definition
|
|
Term
| a sudden transient mechanical head injury with disruption of neural activity and a change in the LOC |
|
Definition
|
|
Term
| considered a minor diffuse head injury |
|
Definition
|
|
Term
| Manifestations of a concussion |
|
Definition
Brief disruption in LOC
Retrograde amnesia
Headache |
|
|
Term
|
Definition
|
|
Term
| May result in post concussion syndrome |
|
Definition
|
|
Term
| When does post concussion syndrome develop? |
|
Definition
| anywhere from 2 weeks to 2 months after the injury |
|
|
Term
| This syndrome can significantly affect the patient’s abilities to perform activities of daily living |
|
Definition
|
|
Term
| Post concussion syndrome manifestations |
|
Definition
Persistent headache
Lethargy
Personality and behavior changes
Shortened attention span
Decreased short term memory
Changes in intellectual ability |
|
|
Term
| is widespread axonal damage occurring after a mild, moderate, or severe TBI |
|
Definition
|
|
Term
| Where does the damage occur in a diffuse axonal injury? |
|
Definition
| Primarily around axons in the subcortical white matter of the cerebral hemispheres, basal ganglia, thalamus, and brainstem |
|
|
Term
| axonal damage is not preceded by an immediate tearing of the axon from the traumatic impact, but rather the trauma changes the function of the axon, resulting in axon swelling and disconnection |
|
Definition
|
|
Term
| How long does it take diffuse axonal damage to occur? |
|
Definition
|
|
Term
| Clinical manifestations of a diffuse axonal injury |
|
Definition
Decreased LOC
Increased ICP
Decoritcation or decerebration
Global cerebral edema |
|
|
Term
| Approximately ____ of patients with diffuse axonal injury remain in a persistent vegetative state. |
|
Definition
|
|
Term
| Can be minor to severe and cam be localized to an area of injury |
|
Definition
|
|
Term
| Focal injuries consist of: |
|
Definition
Lacerations
Contusions
Hematomas
Cranial nerve injuries |
|
|
Term
| Involve tearing of the brain tissue |
|
Definition
|
|
Term
| Often occur in associated with depressed and open fractures and penetrating injuries |
|
Definition
|
|
Term
| Tissue damage is severe and surgical repair of the laceration is impossible due to the nature of the brain tissue |
|
Definition
|
|
Term
|
Definition
Tearing of brain tissue
Intracerebral hemorrhage
Subarachnoid hemorrhage
Intraventricular hemorrhage |
|
|
Term
| If bleeding is deep into the brain tissue, ________ and ________ signs develop. |
|
Definition
|
|
Term
| generally associated with cerebral laceration |
|
Definition
|
|
Term
| Manifests as a space occupying lesion |
|
Definition
|
|
Term
| Symptoms of intracerebral hemorrhage |
|
Definition
Unconsciousness
Hemiplegia on the contralateral side
Dilated pupil on the ipsilateral side |
|
|
Term
| ________________ and _______________ can also occur secondary to head trama. |
|
Definition
Subarachnoid hemorrhage
Intraventricular hemorrhage |
|
|
Term
| The bruising of brain tissue within a focal area |
|
Definition
|
|
Term
| Associated with a closed head injury |
|
Definition
|
|
Term
| Frequently occurs at a fracture site |
|
Definition
|
|
Term
|
Definition
Hemorrhage
Infarction
Necrosis
Edema |
|
|
Term
| With contusion, the phenomenon of _______________ is often noted and can range from minor to severe. |
|
Definition
|
|
Term
| Occurs when the brain moves inside the skull due to high energy or high impact injury mechanisms |
|
Definition
|
|
Term
| Occur both at the site of the direct impact on the brain on the skull |
|
Definition
|
|
Term
| Occur both at the site of the direct impact on the brain on the skull and at a secondary area of damage of the opposite side away from the injury leading to multiple contused areas |
|
Definition
|
|
Term
| a secondary area of damage on the opposite side away from the injury |
|
Definition
|
|
Term
| These injuries tend to be more severe and overall patient prognosis depends on the amount of bleeding around the contusion site |
|
Definition
|
|
Term
| May continue to bleed or rebleed and appear to "blossom" on subsequent CT scans of the brain, which worsens neurologic outcome. |
|
Definition
|
|
Term
| Neurologic assessment may demonstrate focal as well as generalized manifestations, depending on the size and location |
|
Definition
|
|
Term
| A common complication of brain contusions |
|
Definition
|
|
Term
| When do seizures usually occur following contusions? |
|
Definition
| in the first 7 days of injury |
|
|
Term
| In contusions, there is an potential for _____________ if anticoagulants are used. |
|
Definition
|
|
Term
| In contusions, anticoagulant use and coagulopathy are associated with what? |
|
Definition
Increased hemorrhage
More severe head injury
Higher mortality rate |
|
|
Term
| Results from bleeding between the dura and the inner surface of the skull |
|
Definition
|
|
Term
|
Definition
|
|
Term
| Is usually associated with a linear fracture crossing a major artery in the dura causing a tear |
|
Definition
|
|
Term
| It can have a venous or arterial origin |
|
Definition
|
|
Term
| Are associated with a tear of the dural venous sinus and develop slowly |
|
Definition
|
|
Term
| The middle meningeal artery lying under the temporal bone is often torn |
|
Definition
|
|
Term
| Hemorrhage occurs into the epidural space which lies between the dura and the inner surface of the skull |
|
Definition
|
|
Term
|
Definition
|
|
Term
| What are the classic signs of an epidural hematoma? |
|
Definition
Initial period of unconsciousness
Brief lucid interval followed by a decreased in LOC
Headache
N/V
Focal findings |
|
|
Term
| Treatment for epidural hematoma |
|
Definition
Rapid surgical intervention to evacuate the hematoma
Prevent cerebral herniation
Medical management for increasing ICP |
|
|
Term
| Occurs from bleeding between the dura mater and the arachnoid layer of the meninges |
|
Definition
|
|
Term
| Usually results from injury to the brain tissue and the blood vessels |
|
Definition
|
|
Term
| The veins that drain from the surface of the brain into the sagittal sinus are the source of most __________________. |
|
Definition
|
|
Term
| Because a subdural hematoma is usually ________ in origin, the hematoma may be __________ to develop. |
|
Definition
|
|
Term
| Can be caused by an arterial hemorrhage in which case it develops more rapidly |
|
Definition
|
|
Term
| Classifications of subdural hematoma |
|
Definition
|
|
Term
| When does an acute subdural hematoma manifest? |
|
Definition
| within 24-48 hours of the injury |
|
|
Term
| The signs and symptoms of an acute subdural hematoma are similar to those associated with brain compression in increased ICP and include: |
|
Definition
|
|
Term
| The patient's appearance may range from drowsy to confused to unconscious |
|
Definition
|
|
Term
| The ipsilateral pupil dilates and becomes fixed if ICP is elevated |
|
Definition
|
|
Term
| When does a subacute subdural hematoma usually occur? |
|
Definition
| Within 2-14 days of the injury |
|
|
Term
| After the initial bleeding, it may appear to enlarge over time, as the breakdown products of the blood draw fluid into the subdural space |
|
Definition
| subacute subdural hematoma |
|
|
Term
| Develops over weeks or months after a seemingly minor hear injury |
|
Definition
| chronic subdural hematoma |
|
|
Term
| are more common in older adults due to a potentially larger subdural space as a result of brain atrophy |
|
Definition
| chronic subdural hematoma |
|
|
Term
| With _________, the brain remains attached to the supportive structures, but tension is increased, and it is subject to tearing. |
|
Definition
|
|
Term
| The larger the size of the subdural space also accounts for the presenting complain of chronic subdural hematomas to be ___________, rather than the signs of increased ICP. |
|
Definition
|
|
Term
| Are prone to cerebral atrophy and subsequent development of subdural hematomas due to an increased incidence of falls |
|
Definition
|
|
Term
| Delay in diagnosis of a subdural hematoma in the older adult can be attributed to symptoms that mimic other health problems in persons of this age group such as: |
|
Definition
somnolence
confusion
lethargy
memory loss |
|
|
Term
| The manifestations of a subdural hematoma are often misinterpreted as what? |
|
Definition
|
|
Term
| Occurs from bleeding within the brain tissue and occurs in approximately 16% of head injuries |
|
Definition
|
|
Term
| where do intracerebral hematomas usually occur? |
|
Definition
| frontal and temporal lobes |
|
|
Term
| the best diagnostic test to evaluate for head trauma because it allows rapid diagnosis and intervention in the acute care setting |
|
Definition
|
|
Term
| What studies may also be used in the diagnosis and differentiation of head injuries? |
|
Definition
MRI
PET
Evoked potential studies |
|
|
Term
| More sensitive than a CT scan in detection small lesions |
|
Definition
|
|
Term
| Allow for the measurement of CBF velocity |
|
Definition
| transcranial doppler studies |
|
|
Term
| May also be indicated since cervical spine trauma often occurs at the same time as a head injury |
|
Definition
Cervical spine x-ray
CT scan
MRI |
|
|
Term
| Emergency treatment of head injuries |
|
Definition
Ensure patent airway
Stabilize cervical spine
Oxygen via non-rebreather mask
IV access - 2 large bore catheters to infuse NS or LR
Intubate if < 8 GCS
Control external bleeding
Remove patient's clothing
Maintain patient warmth
Ongoing monitoring
Assume neck injury
Administer fluids cautiously |
|
|
Term
| How to maintain patient warmth following head injury |
|
Definition
Blankets
Warm IV fluids
Overhead warming lights
Warm humidified O2 |
|
|
Term
| Ongoing monitoring following head injury |
|
Definition
VS
LOC
O2 sat
Cardiac rhythm
GCS
Pupil size/reactivity
Rhinorrhea, otorrhea, scalp wounds |
|
|
Term
| Following a head injury, anticipate need for ____________ if gag reflex is impaired or absent. |
|
Definition
|
|
Term
| Assume ___________ with head injury. |
|
Definition
|
|
Term
| Following a head injury, administer fluids cautiously to prevent what? |
|
Definition
fluid overload
increasing ICP |
|
|
Term
| Principles in caring for patients with a head injury |
|
Definition
Measures to prevent secondary injury by treating cerebral edema and managing increased ICP
Timely diagnosis
Surgery if necessary |
|
|
Term
| What are the primary management strategies for patients with concussions and contusions? |
|
Definition
Observation and management of increased ICP
CPP and MAP |
|
|
Term
| The treatment of skull fractures is usually ______________. |
|
Definition
|
|
Term
| For depressed fractures and fractures with loose fragments, a ___________ is necessary to elevate the depressed bone and remove the free fragments. ___________ and _____________ will be needed at a later time. |
|
Definition
craniotomy
craniectomy
cranioplasty |
|
|
Term
| In cases of large acute subdural and epidural hematomas, or those associated with significant neurologic impairment, the _________ must be removed through surgical evacuation. |
|
Definition
|
|
Term
| Is generally performed to visualize and allow control of the bleeding vessels |
|
Definition
|
|
Term
| May be used in an extreme emergency for a more rapid decompression, followed by a craniotomy |
|
Definition
|
|
Term
| May be placed postoperatively for several days to prevent reaccumulation of blood |
|
Definition
|
|
Term
| In cases were extreme swelling is expected, a ____________ may be performed where a piece of the skull is removed to reduce the pressure inside the cranial vault, this reducing the risk of herniation. |
|
Definition
|
|
Term
| Treatment of subdural and epidural hematomas |
|
Definition
Craniotomy, burr holes
Craniectomy if extreme swelling |
|
|
Term
| Nursing assessment: subjective data: head injury |
|
Definition
Past medical history
Mechanism of injury
Medications
Alcohol/drug use
Risk taking behaviors
Headaches
Mood or behavioral changes
Mentation changes; impaired judgement
Aphasia, dysphagia
Fear, denial, anger, aggression, depression |
|
|
Term
| Mechanisms of head injuries |
|
Definition
MVA
sports injury
industrial incident
assault
falls |
|
|
Term
| Nursing assessment: head injury: objective data |
|
Definition
Altered mental status
Lacerations
Contusions
Abrasions
Hematoma
Battle's sign
Periorbital edema and ecchymosis
Otorrhea
Exposed brain
Rhinorrhea
Impaired gag reflex
Altered/irregular respirations
Cushing's Triad
Vomiting
Bowel and bladder incontinence
Uninhibited sexual expression
Altered LOC
Seizures
Pupil dysfunction
Cranial nerve deficits |
|
|
Term
|
Definition
Systolic hypertension with widening pulse pressure
Bradycardia with full, bounding pulse
Irregular respirations |
|
|
Term
| Possible diagnostic findings: head injury |
|
Definition
Location and type of hematoma
Edema
Skull fracture/foreign body on CT scan
MRI
Abnormal EEG
Positive toxicology screen or alcohol level
Abnormal glucose level
Increased ICP |
|
|
Term
| Nursing assessment: MSK: head injury |
|
Definition
Motor deficit
Palmar drift
Paralysis
Spasticity
Decorticate or decerebrate posturing
Muscular rigidity/Increased tone
Flaccidity
Ataxia |
|
|
Term
| Nursing diagnoses: head injury |
|
Definition
Risk for ineffective cerebral tissue perfusion
Hyperthermia
Impaired physical mobility
Anxiety
Potential complication: increased ICP |
|
|
Term
| Overall goals: head injury |
|
Definition
1. Maintain adequate cerebral oxygenation and perfusion
2. Remain normothermic
3. Achieve control of pain and discomfort
4. Be free from infection
5. Have adequate nutrition
6. Attain maximal cognition, motor, and sensory function |
|
|
Term
| What is the one of the best ways to prevent head injuries? |
|
Definition
| To prevent car and motorcycle collisions |
|
|
Term
| The use of ______ by cyclists has led to fewer TBI's. |
|
Definition
|
|
Term
| The use of __________ and ____________ are also associated with reduced TBI mortality rates. |
|
Definition
car seat belts
child car seats |
|
|
Term
| The second leading cause of head injuries |
|
Definition
|
|
Term
| The goal of nursing management of the head-injured patient is to maintain ___________ and _________ and prevent secondary cerebral ischemia. |
|
Definition
cerebral oxygenation
perfusion |
|
|
Term
| Nursing acute intervention: head injuries |
|
Definition
Maintain cerebral perfusion
Prevent secondary cerebral ischemia
Monitor for changes in neurologic status
Patient and family teaching
Measures for immobilized patients
Antiemetics
Analgesics
Pre-op if needed |
|
|
Term
| Major focus of nursing care in head injuries related to ______________. |
|
Definition
|
|
Term
| What eye problems can occur after a head injury? |
|
Definition
Loss of the corneal reflex
Periorbital ecchymosis and edema
Diplopia |
|
|
Term
| May occur from injury to or inflammation of the hypothalamus in head injuries |
|
Definition
|
|
Term
| In head injuries, elevations in body temperature can result in: |
|
Definition
Increased CBF
Cerebral blood volume
ICP |
|
|
Term
| In head injuries, increased metabolism secondary to hyperthermia increases ____________, which in turn produces further cerebral vasodilation. |
|
Definition
|
|
Term
| Goal temp in head injuries |
|
Definition
|
|
Term
| Measures for patients leaking CSF: |
|
Definition
HOB elevated
Loose collection pad
No sneezing or blowing nose
No NG tube
No nasotracheal suctioning |
|
|
Term
| In head injuries, nursing measures specific to the care of the immobilized patient such as those related to: |
|
Definition
bladder/bowel function
skin care
infection |
|
|
Term
| Nursing implementation: acute rehab in head injuries |
|
Definition
Motor and sensory deficits
Communication issues
Memory and intellectual functioning
Nutrition
Bowel and bladder management |
|
|
Term
| Conditions that may require nursing and collaborative management includ: |
|
Definition
poor nutritional status
bowel/bladder management
spasticity
dysphagia
DVT
hydrocephalus |
|
|
Term
| Expected outcomes: head injury |
|
Definition
Maintain normal cerebral perfusion pressure
Achieve maximal cognitive, motor, and sensory function
Experience no infection or hyperthermia
Achieve pain control |
|
|
Term
| Treatment based on primary cause |
|
Definition
|
|
Term
| Interventions focus primarily on alterations in mental status |
|
Definition
|
|
Term
| Antecedents for encephalopathy |
|
Definition
Adequate cerebral oxygenation
Tissue perfusion
Nutrition
Intact neurological function
Opportunities for growth through education |
|
|
Term
| Attributes for encephalopathy |
|
Definition
Ability to interpret the environment accurately
Ability to send and receive information/communicate
Ability to remember/learn |
|
|
Term
| Sub concepts for encephalopathy |
|
Definition
Brain injury/disease
Language/communication skills
Intelligence
Cognitive development |
|
|
Term
| Encephalopathy risk factors |
|
Definition
Infection - bacterial, viral
Anoxic injury
Alcoholism
Liver problems - cirrhosis, hepatitis
Renal or kidney problems
Metabolic diseases
Brain tumors
Toxins
Changes in ICP
Poor nutrition/starvation, ketosis, extreme dieting |
|
|
Term
| Mental manifestations of encephalopathy |
|
Definition
Confusion
Altered LOC
Forgetfulness
Poor judgement
Personality changes
Nervousness |
|
|
Term
| Physical manifestations of encephalopathy |
|
Definition
Breath with musty or sweet odor
Sleep pattern disturbances
Shaking hands
Slurred speech, sluggish movements |
|
|
Term
| Manifestations of encephalopathy with infection |
|
Definition
Fever
Headache
Nausea
Seizures
Abnormal CSF |
|
|
Term
| Diagnostic tests for encephalopathy |
|
Definition
Physical exam
Mental status tests
Memory tests
Coordination tests
CBC
Blood cultures
Altered BP
Metabolic tests
Drug or toxin levels
Creatinine levels
CT or MRI scans
US
Encephalograms
Autoantibody analysis |
|
|
Term
| Negative consequences: encephalopathy |
|
Definition
Frequent injuries
Institutionalized/dependence
Poor health outcomes
Unexpected consequences for actions/victimization
Inability to form/maintain relationships |
|
|
Term
| Primary prevention: encephalopathy |
|
Definition
No alcohol consumption
Healthy diet and exercise
Protected sexual intercourse
Safety measures to prevent trauma
Avoiding exposure to infections |
|
|
Term
| Goal is to minimize possibility of exposure to toxins, trauma, or infections that may cause encephalopathy and to maintain healthy lifestyle goals |
|
Definition
|
|
Term
| Will depend on the primary cause of the disease process and the timeliness in which the diagnosis was made |
|
Definition
|
|
Term
| Critical skills: encephalopathy |
|
Definition
Neurologic assessment skills
Communication skills
Safety assessment and implementation skills |
|
|
Term
| Collaborative care: encephalopathy |
|
Definition
Medical management
Physical/occupational/speech therapy
Case manage
Social worker |
|
|
Term
| 3 essential components of the skull |
|
Definition
|
|
Term
| The intracellular and extracellular fluids of brain tissue make up approximately _______ of the skull volume. |
|
Definition
|
|
Term
| What makes up 12% of the skull volume? |
|
Definition
| Blood in the arterial, venous, and capillary network |
|
|
Term
| What makes up 10% of the skull volume? |
|
Definition
|
|
Term
| the hydrostatic force measure in the brain CSF compartmnet |
|
Definition
|
|
Term
| Factors that influence ICP |
|
Definition
Arterial pressure
Venous pressure
Intraabdominal and intrathoracic pressure
Posture
Temperature
Blood gases - particularly CO2 levels |
|
|
Term
| States that the three components of the skull must remain at a relatively constant volume within the closed skull structure |
|
Definition
|
|
Term
| States that if the volume of any one of the three components increases within the cranial vault and the volume from another component is displaced, the total intracranial volume will not change |
|
Definition
|
|
Term
| This hypothesis is only applicable in situations in which the skull is closed |
|
Definition
|
|
Term
| The hypothesis is not valid in persons with displaced skull fractures or hemicranectomy |
|
Definition
|
|
Term
| Where can ICP be measured? |
|
Definition
in the ventricles
subarachnoid space
subdural space
epidural space
brain tissue |
|
|
Term
| Measured by a pressure transduced |
|
Definition
|
|
Term
|
Definition
|
|
Term
| Normal compensatory adaptations: ICP |
|
Definition
Changes in CSF volume
Changes in intracranial blood volume
Changes in brain tissue volume |
|
|
Term
| As the volume increase continues, the ICP ______ and ____________ ultimately occurs, resulting in ____________ and _____________. |
|
Definition
rises
decompensation
compression
ischemia |
|
|
Term
| the amount of blood in ml's passing through 100g of btain tissue in 1 minute |
|
Definition
|
|
Term
|
Definition
| 50ml/min per 100 g of brain tissue |
|
|
Term
| The maintenance of blood flow to the brain is critical because the brain requires a constant supply of ________ and __________. |
|
Definition
|
|
Term
| The brain uses _____ of the body's oxygen and _____ of its glucose. |
|
Definition
|
|
Term
| has the ability to regulate its own blood flow in response to its metabolic needs despite wide fluctuations in systemic arterial pressure |
|
Definition
|
|
Term
| the automatic adjustment in the diameter of the cerebral blood vessels by the brain to maintain a constant blood flow during changes in arterial blood pressure |
|
Definition
|
|
Term
| What is the purpose of autoregulation? |
|
Definition
| to ensure a consistent CBF to provide for the metabolic needs of brain tissue and to maintain cerebral perfusion pressure within normal limits |
|
|
Term
| adjusts diameter of blood vessels |
|
Definition
|
|
Term
|
Definition
|
|
Term
| only effective if MAP is 70-150 mmHg |
|
Definition
|
|
Term
| the pressure needed to ensure blood flow to the brain |
|
Definition
| cerebral perfusion pressure |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| A CPP < 50 mmHg is associated with what? |
|
Definition
|
|
Term
| A CPP less than _____ results in ischemia and is not compatible with life. |
|
Definition
|
|
Term
| maintains an adequate CBF and perfusion pressure primarily by adjusting the diameter of cerebral blood vessels and metabolic factors that affect ICP |
|
Definition
|
|
Term
| It is critical to maintain _____ when ICP is elevated. |
|
Definition
|
|
Term
|
Definition
|
|
Term
| When cerebral vascular resistance is high, blood flow to __________ is impaired. |
|
Definition
|
|
Term
| a noninvasive technique used in ICU's to monitor changes in cerebrovascular resistance |
|
Definition
|
|
Term
| The relationship of pressure to volume is depicted in the ________________. |
|
Definition
|
|
Term
| The curve is affected by what? |
|
Definition
|
|
Term
| the expandability of the brain |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
1-total compensation
2 - decreased compensation, risk for increased ICP
3 - failing compensation; clinical manifestations of increased ICP (Cushing's Triad)
4 - Herniation imminent leading to death |
|
|
Term
| the brain is in total compensation, with accommodation and autoregulation intact |
|
Definition
|
|
Term
| the compliance is beginning to decrease and an increase in volume places the patient at risk of increased ICP and secondary injury |
|
Definition
|
|
Term
| compensatory mechanisms fail, there is a loss of autoregulation and the patient will exhibit manifestations of increased ICP |
|
Definition
|
|
Term
| with a loss of autoregulation, there is an attempt to maintain cerebral perfusion by the body's attempt to increase systolic BP |
|
Definition
|
|
Term
| decompensation is imminent |
|
Definition
|
|
Term
| The patient's response is characterized by systolic hypertension with a widening pulse pressure, bradycardia with a full bounding pulse and altered respirations |
|
Definition
|
|
Term
| herniation occurs as the brain tissue is forcibly shifted from the compartment of greater pressure to a compartment of lesser pressure |
|
Definition
|
|
Term
| intense pressure is placed on the brainstem and if herniation continues to occur, brainstem death is imminent |
|
Definition
|
|
Term
| Factors affecting cerebral blood vessel tone |
|
Definition
CO2
O2
hydrogen ion concentration |
|
|
Term
| An increase in the partial pressure of carbon dioxide in arterial blood does what? |
|
Definition
relaxes smooth muscle
dilates cerebral vessels
decreases cerebrovascular resistance
increases CBF |
|
|
Term
| A decrease in PaCO2 does what? |
|
Definition
constricts cerebral vessels
increases cerebrovascular resistance
decreases CBF |
|
|
Term
| Cerebral O2 tension less than ________ results in cerebrovascular dilation. |
|
Definition
|
|
Term
| Cerebrovascular dilation causes: |
|
Definition
cerebrovascular resistance
increases CBF
increases O2 tension |
|
|
Term
| If O2 tension is not increased, ______________ begins resulting in an accumulation of lactic acid. |
|
Definition
|
|
Term
| a potentially life threatening situation that results from an increase in any or all of the three components within the skull |
|
Definition
|
|
Term
| clinically significant because it diminishes CPP, increases risks of brain ischemia and infarction, and is associated with a poor prognosis |
|
Definition
|
|
Term
| Increased ICP can be caused by changes in any three of the components: |
|
Definition
|
|
Term
| Common causes of increased ICP |
|
Definition
mass - hematoma, contusion, abscess, tumor
cerebral edema - brain tumors, hydrocephalus, head injury, or brain inflammation |
|
|
Term
| Increased ICP may result in: |
|
Definition
hypercapnia
cerebral acidosis
impaired autoregulation
systemic hypertension
increase the formation and spread of cerebral edema |
|
|
Term
|
Definition
insult to brain
tissue edema
increased ICP
compression of ventricles
compression of blood vessels
decreased cerebral blood flow
decreased O2 with death of brain cells
edema around necrotic tissue
increased ICP with compression of brainstem and respiratory center
vasodilation
increased ICP resulting from increased blood volume
death |
|
|
Term
| an increased accumulation of fluid in the extravascular spaces of brain tissue |
|
Definition
|
|
Term
|
Definition
mass lesions
head injuries
cerebral infection
vascular insult
toxic or metabolic encephalopathy |
|
|
Term
| 3 types of cerebral edema |
|
Definition
vasogenic
cytotoxic
interstitial |
|
|
Term
| the most common type of cerebral edema |
|
Definition
|
|
Term
| occurs mainly in the white matter |
|
Definition
|
|
Term
| characterized by leakage of macromolecules from the capillaries into the surrounding extracellular space |
|
Definition
|
|
Term
| this results in osmotic gradient that favors the flow of fluid from the intravascular to the extravascular space |
|
Definition
|
|
Term
| A variety of insults, such as brain tumors, abscesses, and ingested toxins, may cause an increase in the permeability of the blood-brain barrier and produce an increase in the extracellular fluid volume |
|
Definition
|
|
Term
| The speed and extent of the spread of edema fluid are influenced by the systemic BP, the site of the brain injury, and the extent of the blood brain barrier defect |
|
Definition
|
|
Term
| This edema may produce a continuum of symptoms ranging from headache to disturbances in consciousness, including coma and focal neurologic deficits |
|
Definition
|
|
Term
| It is important to recognize that although a _______ may seem to be a benign symptom, in cases of cerebral edema, it can quickly progress to coma and death. |
|
Definition
|
|
Term
| results from a disruption of the integrity of the cell membranes |
|
Definition
|
|
Term
| develops from destructive lesions or trauma to brain tissue resulting in cerebral hypoxia or anoxia and SIADH secretion |
|
Definition
|
|
Term
| in this type of edema, the blood brain barrier remains intact with cerebral edema occurring as a result of a fluid and protein shift from the extracellular space directly into the cells with subsequent swelling and loss of cellular function |
|
Definition
|
|
Term
| secondary to destructive lesions or trauma to brain tissue |
|
Definition
|
|
Term
| fluid shift from extracellular to intracelluar |
|
Definition
|
|
Term
| usually a result of hydrocephalus |
|
Definition
| interstitial cerebral edema |
|
|
Term
| a build up of fluid in the brain and is manifested by ventricular enlargement |
|
Definition
|
|
Term
| it can be due to an excess of CSF production, obstruction of flow, or inability to reabsorb |
|
Definition
| interstitial cerebral edema |
|
|
Term
|
Definition
| ventriculostomy or ventriculoperitoneal shunt |
|
|
Term
| the most sensitive and reliable indicator of the patient's neurologic status |
|
Definition
|
|
Term
| Changes in LOC are a result of impaired ______, which deprives the cells of the cerebral cortex and the reticular activating system of oxygen. |
|
Definition
|
|
Term
|
Definition
|
|
Term
| What happens when CN 3 is compressed? |
|
Definition
| dilation of the pupil on the same side as or ipsilateral to the mass lesion, sluggish or no response to light, inability to move the eye upward, and ptosis of the eyelid |
|
|
Term
| the deepest state of unconsciousness |
|
Definition
|
|
Term
| a medical emergency as this is a sign of brainstem compression and impending death |
|
Definition
|
|
Term
| an edematous optic disc seen on retinal examination |
|
Definition
|
|
Term
| may cause a dilated unilateral pupil |
|
Definition
|
|
Term
| a nonspecific sign associated with persistent increases in ICP |
|
Definition
|
|
Term
| symptoms of compression in other cranial nerve |
|
Definition
diploplia
blurred vision
extraocular eye movements |
|
|
Term
| opposite side of the mass lesion |
|
Definition
|
|
Term
| As ICP continues to rise, a ____________ or ________ may develop, depending on the location of the source of the increased ICP. |
|
Definition
contralateral hemiparesis
hemiplegia |
|
|
Term
| internal rotation and adduction of the arms with flexion of the elbows, wrists, and fingers as a result of interruption of voluntary motor tracts in the cerebral cortex |
|
Definition
|
|
Term
|
Definition
|
|
Term
| indicates more serious damage |
|
Definition
|
|
Term
| results from disruption of motor fibers in the midbrain and brainstem |
|
Definition
|
|
Term
|
Definition
|
|
Term
| the arms are stiffly extended, addicted and hyperpronated, there is also hyperextension of the legs with plantar flexion of the feet |
|
Definition
|
|
Term
| Flexion of arms, wrists, and fingers with adduction in upper extremities. Extension, internal rotation, and plantar flexion in lower extremities. |
|
Definition
|
|
Term
| all four extremities in rigid extension with hyperpronation of forearms and plantar flexion of feet |
|
Definition
|
|
Term
| Although the brain itself is insensitive to pain, compression of other intracranial structures, such as the walls of arteries and veins and the cranial nerves, can produce _______________. |
|
Definition
|
|
Term
| When is a headache caused by head injury the worst? |
|
Definition
|
|
Term
| what is often a nonspecific sign of increased ICP? |
|
Definition
| vomiting usually not preceded by nausea |
|
|
Term
| may also occur and is related to increased ICP |
|
Definition
|
|
Term
| What are the major complications of uncontrolled increased ICP? |
|
Definition
inadequate cerebral perfusion
cerebral herniation |
|
|
Term
| a thin wall of dura that folds down between the cortex, separating the two cerebral hemispheres |
|
Definition
|
|
Term
| a rigid fold of dura that separates the cerebral hemispheres from the cerebellum |
|
Definition
|
|
Term
| it forms a tentlike cover over the cerebellum |
|
Definition
|
|
Term
| another name for tentorial herniation |
|
Definition
|
|
Term
| occurs when a mass lesion in the cerebrum forces the brain to herniate downward through the opening created by the brainstem |
|
Definition
|
|
Term
| occurs with lateral and downward herniation |
|
Definition
|
|
Term
| occurs with lateral displacement of brain tissue beneath the falx cerebri |
|
Definition
|
|
Term
| Different kinds of cerebral herniation |
|
Definition
Tentorial herniation
Uncal herniation
Cingulate herniation |
|
|
Term
| Diagnostic studies that can identify the cause of increased ICP |
|
Definition
CT/MRI/PET
EEG
Cerebral angiography
ICP and brain tissue oxygenation measurement (LICOX catheter)
Doppler and evoked potential studies |
|
|
Term
| Why is a lumbar puncture not performed when increased ICP is suspected? |
|
Definition
| cerebral herniation could occur from the sudden release of pressure in the skull from the area above the lumbar puncture |
|
|
Term
| When is measurement of ICP indicated? |
|
Definition
GCS less than or equal to 8
Abnormal CT/MRI |
|
|
Term
| the gold standard for monitoring ICP |
|
Definition
|
|
Term
| a specialized catheter is inserted into the latera ventricle and coupled to an external transduced |
|
Definition
|
|
Term
| this technique directly measures the pressures within the ventricles, facilitates removal and/or sampling of CSF, and allows from intraventricular drug administation |
|
Definition
|
|
Term
| CSF can be drained via a ______________ when ICP exceeds the upper pressure parameter set by the physician. |
|
Definition
|
|
Term
| it is important to make sure that the transducer of the ventriculostomy is level to the __________________ and that the ventriculostomy system is at the ideal height |
|
Definition
|
|
Term
|
Definition
|
|
Term
| What is a reference point for the foramen of monro? |
|
Definition
|
|
Term
| uses a sensor transducer located within the catheter tip |
|
Definition
|
|
Term
| the sensor tip is placed within the ventricle or the brain tissue and provides a direct measurement of brain pressure |
|
Definition
|
|
Term
| it is placed just through the skull between the arachnoid membrane and the cerebral cortex |
|
Definition
| subarachnoid bolt or screw |
|
|
Term
| It does not allow for CSF drainage but is ideal for patients with mild or moderate hear injury |
|
Definition
| subarachnoid bolt or screw |
|
|
Term
| It can easily be converted into a ventriculostomy if the patient decompensates |
|
Definition
| subarachnoid bolt or screw |
|
|
Term
| a serious complication with ICP monitoring |
|
Definition
|
|
Term
| Factors the contribute to the development of include with ICP monitoring |
|
Definition
ICP monitoring > 5 days
Use of a ventriculostomy
Presence of a CSF leak
Concurrent systemic infection |
|
|
Term
| Important nursing interventions in preventing infection with ICP monitoring |
|
Definition
Assessment of the insertion site
Use of aseptic technique
Monitoring the CSF for a change in color or clarity |
|
|
Term
| How should ICP be measure? |
|
Definition
|
|
Term
| If a CSF drainage device is in place, the drain must be closed for at least ________ to ensure an accureate reading. |
|
Definition
|
|
Term
| Waveform should be recoreded |
|
Definition
|
|
Term
|
Definition
normal
elevated
plateau waves |
|
|
Term
| Immediately report to the HCP any ICP elevation either as: |
|
Definition
a mean increase in pressure
an abnormal waveform configuration |
|
|
Term
| Inaccurate ICP readings can be caused by: |
|
Definition
CSF leaks
Obstruction of the intraventricular catheter or bolt
Kinks in the tubing
Differences in height of bolt/transducer
Incorrect height of drainage system
Bubbles/air in tubing |
|
|
Term
| With a ventricular catheter, it is possible to control ICP how? |
|
Definition
|
|
Term
| 2 options of CSF drainage |
|
Definition
|
|
Term
| How long is CSF drained in intermittent drainage |
|
Definition
|
|
Term
|
Definition
|
|
Term
| Total CSF volume within the ventricles and subarachnoid space |
|
Definition
|
|
Term
| Complications of CSF drainage |
|
Definition
ventricular collapse
infection
herniation
subdural hematoma formation from rapid decompression |
|
|
Term
| 2 devices used to measure cerebral oxygenation and assess perfusion |
|
Definition
LICOX catheter
jugular venous bulb catheter |
|
|
Term
| measures brain oxygenation and temperature |
|
Definition
|
|
Term
| placed in viable health white matter of the brain |
|
Definition
|
|
Term
| provides continuous monitoring of the oxygen in brain tissue |
|
Definition
|
|
Term
| Normal range for oxygen in brain tissue |
|
Definition
|
|
Term
| A lower than than normal PbtO2 is indicative of what? |
|
Definition
|
|
Term
| A __________ brain temperature may produce better outcomes. |
|
Definition
|
|
Term
| placed in the internal jugular vein and positioned so that the catheter tip is located in the jugular bulb |
|
Definition
| jugular venous bulb catheter |
|
|
Term
| How is placement of jugular venous bulb catheter verified? |
|
Definition
|
|
Term
| Provides a measurement of jugular venous oxygen saturation which indicates total venous brain tissue extraction of oxygen |
|
Definition
| jugular venous bulb catheter |
|
|
Term
| a measure of cerebral oxygen supply and demand |
|
Definition
| jugular venous bulb cathter |
|
|
Term
| Normal jugular venous oxygen saturation |
|
Definition
|
|
Term
| What do jugular venous oxygen saturation values of less than 50% indicate? |
|
Definition
| impaired cerebral oxygenation |
|
|
Term
| Goals of collaborative care: ICP |
|
Definition
treat the underlying cause of increased ICP
support brain function |
|
|
Term
| The underlying cause of increased ICP is usually: |
|
Definition
an increase of blood
brain tissue
CSF in the brain |
|
|
Term
| Goal PaO2 in oxygen therapy |
|
Definition
|
|
Term
| PaCO2 goal in oxygen therapy |
|
Definition
|
|
Term
| What might be necessary in increased ICP to maintain adequate oxygenation? |
|
Definition
|
|
Term
| What is the best treatment option if the increased ICP is caused by a mass lesion? |
|
Definition
| surgical removal of the mass |
|
|
Term
| In aggressive situations, a __________ may be performed to reduce ICP and prevent herniation. |
|
Definition
|
|
Term
| removal of part of the skull |
|
Definition
|
|
Term
|
Definition
|
|
Term
| acts to decreased the ICP in 2 ways; plasma expansion and osmotic effect |
|
Definition
|
|
Term
| What 2 ways does Mannitol decrease ICP? |
|
Definition
plasma expansion
osmotic effect |
|
|
Term
| There is an immediate plasma-expanding effect that reduces the hematocrit and blood viscosity, thereby increasing CBF and cerebral oxygen delivery |
|
Definition
|
|
Term
| creates a vascular osmotic gradient |
|
Definition
|
|
Term
| Fluid moves from the tissues into the blood vessels |
|
Definition
|
|
Term
| ICP is reduced by a decrease in the total brain fluid content |
|
Definition
|
|
Term
| What should be monitored when osmotic diuretics are used? |
|
Definition
|
|
Term
| Produces massive movement of water out of edematous swollen brain cells and into the blood vessels |
|
Definition
|
|
Term
| Hypertonic solution requires frequent monitoring of what? |
|
Definition
|
|
Term
| Has been shown to be just as effective as Mannitol when treating increased ICP and both are often used concurrently when caring for severely head injured patients |
|
Definition
|
|
Term
|
Definition
|
|
Term
| are used to treat vasogenic edema surrounding tumors and abscesses |
|
Definition
|
|
Term
| these drugs are not recommended for head injured patients |
|
Definition
|
|
Term
| stabilize the cell membrane and inhibit the synthesis of prostaglandins thus preventing the formation of proinflammatory mediators |
|
Definition
|
|
Term
| improve neuronal function by improving CBF and restoring autoregulation |
|
Definition
|
|
Term
| Complications of corticosteroids |
|
Definition
hyperglycemia
increased incidence of infections
GI bleeding |
|
|
Term
| Perform BGL monitoring at least every _______ for any patient receiving corticosteroids until hyperglycemia is ruled out as a concern. |
|
Definition
|
|
Term
| Patients receiving corticosteroids should also be given what to prevent GI ulcers and bleeding? |
|
Definition
Antacids
Histamine 2 receptor blockers
PPI's |
|
|
Term
| Ex of Histamine 2 receptor blockers |
|
Definition
Cimetidine (Tagamet)
Ranitidine (Zantac) |
|
|
Term
|
Definition
|
|
Term
| What should be monitoring during corticosteroid therapy? |
|
Definition
Fluid intake
Serum sodium and glucose levels |
|
|
Term
| What examples of metabolic demands can also increase ICP? |
|
Definition
Fever
Agitation/shivering
pain
seizures |
|
|
Term
| methods to control fevers |
|
Definition
antipyretics
cool baths
cooling blankets
ice packs
intravascular cooling devices |
|
|
Term
| should be avoided as this increase the metabolic workload on the brain |
|
Definition
|
|
Term
| used in patients with increased ICP refractory to other treatments |
|
Definition
|
|
Term
| Decrease cerebral metabolism, causing a decrease in ICP as well as reduction in cerebral edema |
|
Definition
|
|
Term
|
Definition
Antiseizure medications
Antipyretics
Sedatives
Analgesics
Barbiturates |
|
|
Term
| The patient with increased ICP is in a __________ and __________ state that increases the need for ________ to provide necessary fuel for metabolism of the injured brain. |
|
Definition
hypermetabolic
hypercatabolic
glucose |
|
|
Term
| What should be initiated if the patient with increased ICP cannot maintain an adequate oral intake of food? |
|
Definition
enteral feedings
parenteral nutrition |
|
|
Term
| may improve outcomes following a brain injury |
|
Definition
|
|
Term
| Nutritional replacement should begin within _____ after injury to reach full nutritional replacement within __________ after injury. |
|
Definition
|
|
Term
| Patients should be kept in a __________ state following a head injury. |
|
Definition
|
|
Term
| What to evaluate to keep patients in a normovolemic state |
|
Definition
urine output
insensible fluid loss
serum and urine osmolality
serum electrolytes |
|
|
Term
| The preferred solution for administration of piggyback medications in increased ICP |
|
Definition
|
|
Term
| If _________ or ___________ is used, serum osmolality decreases and an increase in cerebral edema may occur. |
|
Definition
|
|
Term
| How to assess LOC in head injury |
|
Definition
|
|
Term
| a quick practical and standardized system for assessing LOC |
|
Definition
|
|
Term
|
Definition
eye opening
best verbal response
best motor response |
|
|
Term
| what does high scores of GCS indicate? |
|
Definition
| the higher the level of brain functioning |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| A GCS score of _____ is generally indicative of a coma. |
|
Definition
|
|
Term
| the gold standard assessment tool for LOC |
|
Definition
|
|
Term
| If the oculomotor nerve is compressed, the pupil on the affected side becomes ________ until it fully ______. |
|
Definition
|
|
Term
| a sluggish pupil reaction can indicate what? |
|
Definition
|
|
Term
| a fixed pupil unresponsive to light stimulus usually indicates what? |
|
Definition
|
|
Term
| Other causes of a fixed pupil |
|
Definition
direct injury to CN 3
previous eye surgery
administration of atropine
use of mydriatic eyedrops |
|
|
Term
| eye movements are controlled by which cranial nerves |
|
Definition
|
|
Term
| Testing the ___________ gives information about the functioning of CB 5 and 7. |
|
Definition
|
|
Term
|
Definition
|
|
Term
| turn the patient's head briskly to the left or right while holding the eyelids open |
|
Definition
|
|
Term
| a normal response is movement of the eyes across the midline in the direction opposite that of the turning |
|
Definition
|
|
Term
| quickly flex and then extend the neck; eye movement should be opposite to the direction of head movement - up when the neck is flexed and down when it is extended |
|
Definition
|
|
Term
| abnormal responses of the oculocephalic reflex can help locate what? |
|
Definition
|
|
Term
| this test should not be attempted if a cervical spine problem is suspected |
|
Definition
|
|
Term
| an excellent measure of strength in the upper extremities |
|
Definition
|
|
Term
| the patient raises the arms in front of the body with the palmar surface facing upwarrd |
|
Definition
|
|
Term
|
Definition
|
|
Term
| how to test motor strength |
|
Definition
squeeze hands
palmar drift test
raise foot off bed or bend knees |
|
|
Term
| how to test motor response |
|
Definition
| spontaneous movement or to pain |
|
|
Term
| bilateral hemispheric disease or metabolic brain dysfunction |
|
Definition
|
|
Term
| cycles of hyperventilation and apnea |
|
Definition
|
|
Term
| brainstem between lower midbrain and upper pons |
|
Definition
| central neurogenic hyperventilation |
|
|
Term
| sustained regular rapid and deep breathing |
|
Definition
| central neurogenic hyperventilation |
|
|
Term
|
Definition
|
|
Term
| prolonged inspiratory phase or pauses alternating with expiratory pauses |
|
Definition
|
|
Term
|
Definition
|
|
Term
| clusters of breaths follow each other with irregular pauses between |
|
Definition
|
|
Term
| reticular formation of the medulla |
|
Definition
|
|
Term
| completely irregular with some breaths deem and some shallow; random irregular pauses, slow rate |
|
Definition
|
|
Term
| Nursing diagnoses for the patient with increased ICP |
|
Definition
Decreased intracranial adaptive capacity
Risk for ineffective cerebral tissue perfusion
Risk for disuse syndrome |
|
|
Term
| Overall goals for the patient with increased ICP |
|
Definition
Maintain patent airway
ICP within normal limits
Normal F&E balance
Prevent complications secondary to immobility and decreased LOC |
|
|
Term
| critical in the patient with increased ICP and a primary nursing responsibility |
|
Definition
| maintenance of a patent airway |
|
|
Term
| As the LOC decreases, the patient is at an increased risk of airway obstruction from the ________ dropping back and occluding the airway or from accumulation of ___________. |
|
Definition
|
|
Term
| In increased ICP, elevation of the head of the bed to ________ enhances respiratory exchange and aids in decreasing cerebral edema. |
|
Definition
|
|
Term
| Keep suctioning to a minimum and less than _______ in duration with administration of 100% oxygen before and after to prevent decreases in the PaO2. |
|
Definition
|
|
Term
| To avoid cumulative increases in the ICP with suctioning, limit suctioning to ____ passes per suction procedure of possible. |
|
Definition
|
|
Term
| Try to prevent __________ as it can interfere with respiratory function. |
|
Definition
|
|
Term
| Nursing implementation: respiratory function |
|
Definition
Maintain patent airway
Elevated HOB 30 degrees
Suctioning needs
Minimize abdominal distension
Monitor ABGs
Maintain ventilatory support |
|
|
Term
| rapid onset analgesics with minimal effect on CBF or oxygen metabolism |
|
Definition
|
|
Term
| The IV anesthetic sedative __________ has gained popularity in the management of anxiety and agitation in the ICU because of its rapid onset and short half life. |
|
Definition
|
|
Term
|
Definition
|
|
Term
| an alpha 2 adrenergic agonist used for continuous IV sedation of intubated and mechanically ventilated patients in the ICU setting for up to 24 hours |
|
Definition
| Dexmedetomidine (Precedex) |
|
|
Term
| It is another ideal agent for neurologic patients because of the ease in obtaining a neurologic assessment without altering the dose due to its anxiolytic properties |
|
Definition
| Dexmedetomidine (Precedex) |
|
|
Term
| When using continuous IV sedatives, be aware of the side effects of these drugs, especially __________ as this can result in a lower ______ value. |
|
Definition
|
|
Term
| Ex of neuromuscular blocking agents |
|
Definition
Pancuronium (Pavulon)
Succinylcholine (Anectine) |
|
|
Term
| are useful for achieving complete ventilatory control in the treatment of refractory intracranial hypertension |
|
Definition
| neuromuscular blocking agents |
|
|
Term
| because these agents paralyze muscles without blocking pain or noxious stimuli, they are used in combination with sedatives, analgesics, or benzodiazepines |
|
Definition
| neuromuscular blocking agents |
|
|
Term
| avoided in the management of the patient with increased ICP because of the hypotensive effect and long half life unless they are used as an adjunct to neuromuscular blocking agents |
|
Definition
|
|
Term
| Monitor urinary output to detect problems related to: |
|
Definition
|
|
Term
| caused by a decrease in ADH |
|
Definition
|
|
Term
| results in increased urinary output and hypernatremia |
|
Definition
|
|
Term
|
Definition
Fluid replacement
Vasopresin
DDAVP |
|
|
Term
| If not treated, severe dehydration will occur |
|
Definition
|
|
Term
| caused by an excess secretion of ADH |
|
Definition
|
|
Term
| results in decreased urinary output and dilutional hyponatremia |
|
Definition
|
|
Term
| it may result in cerebral edema, changes in LOC, seizures and coma |
|
Definition
|
|
Term
| Factors that can increase ICP |
|
Definition
valsalva maneuver
coughing
sneezing
suctioning
hypoxemia
arousal from sleep |
|
|
Term
| Maintain the patient with increased ICP in what position? |
|
Definition
|
|
Term
| Take care to prevent extreme ____________, which can cause venous obstruction and contribute to elevated ICP. |
|
Definition
|
|
Term
| Raising the HOB above 30 degrees may ________ the CPP by lowering systemic _____. |
|
Definition
|
|
Term
| Interventions to optimize ICP and CPP |
|
Definition
HOB elevated appropriately
Prevent extreme neck/hip flexion
Turn slowly
Avoid coughing, straining, valsalva
Space out care
Avoid constricting garments, dressings
Adequate oxygenation |
|
|
Term
| protection from self injury |
|
Definition
judicious use of restraints/sedatives
seizure precautions
quiet non-stimulating environment |
|
|
Term
| Expected outcomes: ICP management |
|
Definition
Maintain ICP and CPP WNL
No serious increases in ICP during or following care activities
No complications of immobility |
|
|
Term
| an emotional response to frustration of desires, threat to one's needs or a challenge |
|
Definition
|
|
Term
| action or behavior that results in verbal or physical attack |
|
Definition
|
|
Term
| In the hospital, violence is most frequent in: |
|
Definition
psych units
ED
geriatric units |
|
|
Term
|
Definition
PTSD
Substance abuse disorders |
|
|
Term
| Anger and aggression coexist with: |
|
Definition
depression
anxiety
psychosis
personality disorders |
|
|
Term
| responsible for primitive emotions |
|
Definition
|
|
Term
| mediates anger and judges events |
|
Definition
|
|
Term
| role in aggressive behavior |
|
Definition
|
|
Term
| Biological factors: anger |
|
Definition
Areas of the brain
Neurotransmitters
Predisposition |
|
|
Term
| Psychological factors: anger |
|
Definition
behavioral therapy
social learning theory |
|
|
Term
| enhances aggression but suppresses impulses |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
Low serotonin
Dopamine
GABA |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| General assessment: Anger |
|
Definition
Irritability
Frowning
Red face
Twisting hands
Clenched fists
Pressured speech or quiet speech
Yelling
Pacing
Intense eye contact
Avoidance of eye contact
Stone silence |
|
|
Term
|
Definition
General assessment
Past experiences of violence
Self assessment |
|
|
Term
| knowledge of your response to anger and aggression |
|
Definition
|
|
Term
|
Definition
| Awareness of voice, tone, posture, communication skills, cultural norms |
|
|
Term
| Nursing diagnoses: anger/aggression |
|
Definition
Ineffective coping
Stress overload
Risk for self-directed violence
Risk for other directed violence |
|
|
Term
| Interventions of dealing with angry/violent individuals |
|
Definition
Build trust at initial interaction
Brief non-threatening interactions early
Listen and acknowledge patient feelings
De-escalation, seclusion, restraint, pharmacotherapeutics
Remain calm and relaxed - model control
Respect for space and eye level
Don't take it personally |
|
|
Term
| Pharmacotherapeutics in dealing with angry/violent individuals |
|
Definition
Lorazepam
Haloperidol
Chlorpromazine
Risperidone
Ziprasidone |
|
|
Term
| Staff safety: dealing with angry/violent individuals |
|
Definition
No dangling jewelry
Staff available for back up
Be aware of environment and layout of area
Don't stand directly in front of patient
Know your way out |
|
|
Term
| the single best predictor of future violence |
|
Definition
|
|
Term
| What patients are at a higher risk for violence? |
|
Definition
delusional
hyperactive
impulsive
predisposed to irritability |
|
|
Term
| involuntary confinement alone in a room that the patient is physically prevented from leaving |
|
Definition
|
|
Term
| any manual method, physical or mechanical device, material, or equipment that restricts freedom of movement |
|
Definition
|
|
Term
| These are not therapeutic interventions, they are done only in emergency situations for the protection of the patient or others; other interventions should be used first |
|
Definition
|
|
Term
| Use of mechanical restraints |
|
Definition
Indications for use
Legal requirements
Documentation
Clinical assessments
Observation
Release procedure
Restraint tips |
|
|
Term
| Occurrence of violence requires: |
|
Definition
Perpetrator
Vulnerable person
Crisis situation |
|
|
Term
|
Definition
Stress/burnout
Poor coping skills
Mental health issues
Substance use
Burdened
Financial dependence
Lack of support system
Previous violence |
|
|
Term
| Routine universal screening for intimate partner violence means the following: |
|
Definition
| Asking every individual at every health care encounter if they have been abused by a spouse, date, or other intimate partner or ex-partner |
|
|
Term
| Required by most nursing professional organizations |
|
Definition
| routine screening for IPV |
|
|
Term
| Has issued a policy statement supporting the positive benefits of routine screening for IPV |
|
Definition
| US preventative task force |
|
|
Term
|
Definition
"Because domestic violence is so common in our society, we are asking all individuals the following questions."
"Because DV has such serious health care consequences we are asking all our patients the questions that follow." |
|
|
Term
| If the client answers yes to any of the Abuse Assessment Screen questions, what questions do you ask next? |
|
Definition
| how recent and how serious the abuse was |
|
|
Term
| It is appropriate to show _______ and _______ about degree of violence. |
|
Definition
|
|
Term
| One message that needs to be conveyed is that abuse is __________________; this can be said several times. |
|
Definition
|
|
Term
| may trigger or increase violence |
|
Definition
|
|
Term
| may escalate when the abused makes move toward independence |
|
Definition
|
|
Term
| When is the greatest risk for violence? |
|
Definition
| when the victim attempts to leave the relationships |
|
|
Term
|
Definition
Tension building stage
Acute battering stage
Honeymoon stage |
|
|
Term
| IPV Nursing interventions |
|
Definition
Do not allow the victim to feel responsible
Do not judge
Develop trust and spend time listening
Private interview
Document that patient's own words
Document carefully - body map, pattern bruises, defense injuries
Assess safety and refer to shelter or safe place as needed
Discuss an escape plan
Assess for suicide potential
Discuss options
Counsel about a safety plan |
|
|
Term
| What to carry in your go bag |
|
Definition
Birth certificates/social security cards for you and children
DL/passports
Marriage, divorce, or custody papers
Legal protection or restraining orders
Health ins cards/medical records
Immunization records
Car title, registration, ins documentation
Cash and prepaid credit cards that can't be traced
Prepaid cell phone or a cell phone with a new contract and number
Current medications and prescriptions for yourself and child
Clothing
Keepsakes
Spare of set keys |
|
|
Term
|
Definition
|
|
Term
| any penetration of the vagina or anus with any object or body part, or the oral penetration by a sex organ of another person |
|
Definition
|
|
Term
| second most violent crime |
|
Definition
|
|
Term
| most of the time the victim knows their attacker |
|
Definition
|
|
Term
|
Definition
|
|
Term
| Unwanted sexual advances and sexual harassment sources |
|
Definition
Spousal rape
Acquaintance rape
Drugs facilitated sexual assault
Stranger rape
Incest
Human sex trafficking
Female genital mutilation |
|
|
Term
| Drugs that facilitate sexual assault |
|
Definition
GBH - Gamma hydroxybutyrate
Flunitrazepam (Rohypnol)
Ketamine |
|
|
Term
|
Definition
Victim in crisis, acute stress
Acute stress disorder
PTSD |
|
|
Term
| How long do symptoms last in acute stress disorder |
|
Definition
|
|
Term
| vivid dreams, flashbacks, recurring images, avoidance of stimuli related to the event |
|
Definition
|
|
Term
| How long do symptoms last in PTSD |
|
Definition
|
|
Term
| re-living event, flashbacks, nightmares |
|
Definition
|
|
Term
| changing routines to avoid similar situations, numbness |
|
Definition
|
|
Term
| hyperarousal, difficulty concentrating, insomnia, tense, anger |
|
Definition
|
|
Term
| Psychological effects of sexual assault |
|
Definition
Depression
Suicide
Anxiety
Fear
Rage
Helplessness
Difficulties with daily functioning
Low self-esteem
Sexual dysfunction
Somatic complaints |
|
|
Term
| Incest victims may experience: |
|
Definition
Negative self image
Depression
Eating disorders
Personality disorders
Self-destructive behaviors
Substance abuse |
|
|
Term
| Best practice guidelines: rape |
|
Definition
Consent to examine and/or treat comes first
SANE nurse referral ASAP
Empathetic, private, unbiased, nonjudgemental, limited personnel |
|
|
Term
| Examination of rape involves 5 phases |
|
Definition
1. Head to toe physical assessment for signs of injury
2. Detailed genital examination
3. Evidence collection and preservation
4. Documentation of physical findings
5. Treatment, discharge planning, and follow up care |
|
|
Term
|
Definition
Informed consent
Inspect/palpate
Do not ever force a victim to remove clothes
Head to toe, then more detailed genital
Evidence - blood, hair, oral, nail, anal, genital, vaginal, penile swabs
Sexual assault kits
Document in writing and photographs
No bathing till after exam by qualified professional and evidence collection
Prophylaxis for STI, HIV, HBV
Pregnancy test, emergency contraception
Provide written information on f/u care and referral sources
Patient has right to refuse at any time medical and legal examination and interventino
F/U by phone 24-48 hours later
F/U visits with counselor at 2, 4, and 6 weeks
Level of anxiety
Coping mechanisms
Available support systems
Get up to date contact information
S/sx of emotional trauma
S/sx of physical trauma |
|
|
Term
| Examples of coping mechanisms |
|
Definition
crying
withdrawal
agitation
disoriented
incoherent
joking
ETOH or drugs
smoking |
|
|
Term
|
Definition
|
|
Term
| When are sexual assault survivors considered to be recovered? |
|
Definition
| if they are relatively free of any signs or symptoms of acute stress disorder and PTSD |
|
|
Term
|
Definition
| sexual assault nurse examiner |
|
|
Term
| RN's with specialized training in care for sexual assault patients |
|
Definition
|
|
Term
| demonstrated competency in conducting medical and legal evaluations |
|
Definition
|
|
Term
| ability to be an expert witness in court |
|
Definition
|
|
Term
| How long is SANE training? |
|
Definition
| typically 5 days - 40 contact hours |
|
|
Term
|
Definition
| sexual assault response team |
|
|
Term
| provide direct services to crime victims and perpetrators of crime |
|
Definition
|
|
Term
| consultation services to colleagues in nursing, medical and law related agencies |
|
Definition
|
|
Term
|
Definition
|
|
Term
| offer input on policy changes in the corrections setting |
|
Definition
|
|
Term
| offer evaluation services for inmates |
|
Definition
|
|
Term
|
Definition
|
|
Term
| creation of appropriate treatment plans |
|
Definition
|
|
Term
| collection, documentation, and preservation of potential evidence |
|
Definition
|
|
Term
| the body is a crime scene |
|
Definition
|
|
Term
| able to distinguish right from wrong |
|
Definition
|
|
Term
| presence of a major mental disrder |
|
Definition
|
|
Term
| must not know if the act is right or wrong |
|
Definition
|
|
Term
| knew the act was wrong but could not control behavior |
|
Definition
|
|
Term
| _____ of abuse by family members |
|
Definition
|
|
Term
| umbrella term that refers to any intentional or negligent act by a caregiver or any other person that causes harm or a serious risk of harm to a vulnerable adult |
|
Definition
|
|
Term
| use of physical force that results in bodily injury, pain, or impairment |
|
Definition
|
|
Term
|
Definition
striking
beating
pushing
shaking
slapping
burning
inappropriate use of drugs
physical restraints
force feeding
physical punishment |
|
|
Term
|
Definition
physical abuse
sexual abuse
emotional abuse
neglect
economic abuse |
|
|
Term
| any nonconsensual sexual contact and could include unwanted touching and all types of sexual assault or battery |
|
Definition
|
|
Term
| infliction of distress through verbal or nonverbal acuts |
|
Definition
|
|
Term
|
Definition
verbal assaults
insults
intimidation
humiliation
harassment
social isolation
treating an older adult like an infant |
|
|
Term
| not providing basic needs for safe care |
|
Definition
|
|
Term
| when unable or unwilling to adequately or safely care for self and refuse assistance |
|
Definition
|
|
Term
| unauthorized use of property, assets, or funds, including accounts, credit cards, forged signatures, identity theft, stealing checks or cash, investments, and scams |
|
Definition
|
|
Term
| characteristics of elder abuse perpetrator |
|
Definition
Consider their own needs more important than the needs of others
Poor social skills
Extreme pathological jealousy
May control family finances |
|
|
Term
| Characteristics of vulnerable persons: older adult |
|
Definition
Poor mental or physical health, dementia, numerous illnesses
Dependent on perpetrator
Female, > 75 years, white, living with a relative
Elderly father cared for by a daughter he abused as a child
Elderly woman cared for by a husband who has abused her in the past
Advanced age
Isolation |
|
|
Term
|
Definition
Lacerations
Fractures
Malnutrition
Skin breakdown - urine/stool burns
Inability to account for money
Evidence of being left along for extended periods of time
Elder abuse screening tool |
|
|
Term
| Assessment of abuse or neglect in _______________ is complicated. |
|
Definition
| cognitively challenger persons |
|
|
Term
|
Definition
Has anyone done the following:
Touched you inappropriately?
Made you do things you didn't want to do?
Taken things that were yours without asking?
Physically hurt, scolded, or threatened you?
Failed to help you take care of yourself?
Have you signed documents you didn't understand?
Are you afraid of anyone at home?
Are you alone alot? |
|
|
Term
| What to ask on admission and in ED? |
|
Definition
|
|
Term
|
Definition
neglect
physical abuse
sexual abuse
emotional abuse |
|
|
Term
| failure to provide for a child's basic physical, educational, medical, and emotional needs |
|
Definition
|
|
Term
| physical injury due to punching, beating, kicking, biting, burning, shaking, or otherwise harming a child even if the parent or caretake did not intend harm |
|
Definition
|
|
Term
| includes fondling a child's genitals, incest, penetration, rape, sodomy, indecent exposure, and exploitation through prostitution or production or phonographic materials |
|
Definition
|
|
Term
| any pattern of behavior that harms child's emotional development or sense of self-worth |
|
Definition
|
|
Term
| includes frequent belittling, rejection, threats, and withholding of love and support |
|
Definition
|
|
Term
| Characteristics of vulnerable persons: children |
|
Definition
< 3 years of age
Perceived as different
Remind parents of someone they do not like
Product of an unwanted pregnancy
Interference with emotional bonding between parent and child
Disabilities or mental retarding in children that may increase caregiver burden |
|
|
Term
| immediate consequences of child abuse |
|
Definition
bruises
fractures
lacerations
shaken baby syndrome |
|
|
Term
| more severe forms of maltreatment, child abuse |
|
Definition
death
long term disability
mental retardation
blindness
physical disability |
|
|
Term
| Medical history of child abuse/neglect |
|
Definition
Previous hospitalizations, injuries, chronic medical conditions
Take any medications that may cause easy bruising?
History of repeated visits to hospital?
Delays seeking care for other than minor injury? |
|
|
Term
| Atypical bruising in child abuse |
|
Definition
|
|
Term
| should raise concern for further injury including fractures and intracranial injury |
|
Definition
| bruising in non-mobile children |
|
|
Term
| Assessment for all violence should include: |
|
Definition
violence indicators
level of anxiety and coping response
family coping patterns
support systems
suicide and/or homicide potential
drug and alcohol use |
|
|
Term
| Implementation for all violence |
|
Definition
Reporting abuse
Counseling
Case management
Therapeutic environment
Promotion of self-care activities
Health teaching and health promotion |
|
|
Term
|
Definition
|
|
Term
| assess needs of a family in crises; housing, child care, physical safety |
|
Definition
|
|
Term
| economic and job resources |
|
Definition
|
|
Term
| Primary prevention of abuse |
|
Definition
| measures taken to prevent the occurrence of abuse |
|
|
Term
| Secondary prevention of abuse |
|
Definition
| Early intervention in abusive situations to minimize their disabling or log term effects |
|
|
Term
| Tertiary prevention of abuse |
|
Definition
Facilitating the healing and rehabilitation process
Providing support
Assisting survivors of violence to achieve their optimal level of safety, health, and well being |
|
|
Term
| violent shaking that causes head trauma |
|
Definition
|
|
Term
|
Definition
|
|
Term
| usually associated with frustration due to crying |
|
Definition
|
|
Term
|
Definition
shearing
intracranial bleeding
subdural hematoma
retinal hemorrhaging
acceleration/deceleration injury |
|
|
Term
|
Definition
flu-like symptoms
vomiting
irritability
poor feeding
listlessness
seizures
posturing
bradycardia
apnea |
|
|
Term
|
Definition
ABC's
spinal immobilization
be alter for subtle neurological cues
ICP monitoring if needed
Mannitol and hypertonic saline
HOB at 30 degrees
Deal with family stress
Be nonjudgemental |
|
|
Term
|
Definition
Teaching about ways to cope with crying
Preventive programs in the PP unit |
|
|
Term
| the recruitment, harboring, transportation, provision, obtaining, patronizing, or soliciting of a person for the purpose of a commercial sex act in which the commercial sex act is induced by force, fraud, coercion, or in which the person induced to perform such act has not attained 18 years of age |
|
Definition
|
|
Term
| the recruitment, harboring, transportation, provision, or obtaining of a person for labor or services through the use of force, fraud, or coercion for the purpose of subjection to involuntary servitude, peonage, debt bondage, or slavery |
|
Definition
|
|
Term
| Under federal lab, any minor under the age of 18 who is involved in commercial sex |
|
Definition
|
|
Term
| of serious harm to or physical restraint against a person |
|
Definition
|
|
Term
| any scheme, plan, or pattern intended to cause a person to believe that a failure to perform an act would result in serious harm to or physical restraint against any person |
|
Definition
|
|
Term
| the abuse or threatened abuse of the legal process |
|
Definition
|
|
Term
| act Any sex act on account of which anything of value is given to or received by any person |
|
Definition
|
|
Term
| The status or condition of a debtor arising from a pledge by the debtor of his or her personal services or of those of a person under his or her control as a security for debt, if the value of those services as reasonably assessed is not applied toward the liquidation of the debt or the length and nature of those services are not respectively limited and defined |
|
Definition
|
|
Term
| Physical restraint or harm, sexual assault, battery, or control by confinement or monitoring |
|
Definition
|
|
Term
| false promises and hopes given to the victim |
|
Definition
|
|
Term
| deceptions concerning employment, wages, the type of job that is offered, love, marriage, or a better life |
|
Definition
|
|
Term
| A condition of servitude induced by means of any scheme, plan, or pattern intended to cause a person to believe that, if the person did not enter into or continue in such condition, that person or another person would suffer serious harm or physical restraint |
|
Definition
|
|
Term
| the abuse or threatened abuse of the legal process |
|
Definition
|
|
Term
| Why might leaving sex trafficking be difficult? |
|
Definition
Fear of threats of physical abuse
False promises
Manipulation
Isolation
Feeling ashamed
Controlled by drugs
Traumatic bond |
|
|
Term
| Sex trafficking: individuals may present with chronic health conditions such as: |
|
Definition
diabetes
chronic pain
chemical dependency
HIV
depression |
|
|
Term
| Adolescents in sex trafficking may present with: |
|
Definition
not up to date on immunizations
vitamin deficiency
developmental issues
malnutrition
toxic stress |
|
|
Term
| Physical symptoms of sex trafficking |
|
Definition
fatigue
headaches
stomach problems
significant weight loss
back pain
chronic pain
chemical dependency
dental problems |
|
|
Term
| recruitment, transportation transfer, harboring, receipt of persons, by means of threat, use of force, or other forms of coercion, of abduct, of fraud, of deception, or the abuse of power or of a position of vulnerability or of the giving or receiving or payments or benefits to achieve the consent of a person having control over another person for the purpose of exploitation |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
Trafficking of adults for forced labor
Trafficking of adults for sex
Trafficking of children to forces labor
Trafficking of children for sex |
|
|
Term
| Largest markets for sex trafficking |
|
Definition
USA
Germany
Netherlands
Japan |
|
|
Term
| Sex trafficking: states of entry |
|
Definition
Minnesota
Rhode Island
Texas
California
Arizona |
|
|
Term
| #2 place of sex trafficking in USA |
|
Definition
|
|
Term
| Other kinds of trafficking |
|
Definition
organ trafficking
egg trafficking
surrogate mother trafficking
debt bondage
child soldiers |
|
|
Term
| amount per year the traffickers are able to exploit at the expense of the victims |
|
Definition
|
|
Term
| cost of care to the victims and survivors |
|
Definition
|
|
Term
| What is the largest driving force of sex trafficking victim? |
|
Definition
|
|
Term
| vulnerable groups in trafficking |
|
Definition
poor
LGBTQ
family violence/abuse
kids in CPS system |
|
|
Term
| Trafficking is hard to identify: some signs |
|
Definition
Accompanied by a person who won't leave the victim alone
Coersion
STD's
Tattoos - $ signs, mans name, barcode
Signs of violence
Malnourished
Frightened
Scripted answers |
|
|
Term
| profound disruption of normal psychological homeostasis |
|
Definition
|
|
Term
| normal coping mechanisms fail |
|
Definition
|
|
Term
| results in inability to function as usual |
|
Definition
|
|
Term
|
Definition
|
|
Term
| self limiting (4-6 weeks) |
|
Definition
|
|
Term
| Outcomes of crisis depends on: |
|
Definition
Realistic perception of the event
Adequate situational supports
Coping skills/mechanisms |
|
|
Term
| grief is normal during acute vents and bereavement interventions help in times of distress |
|
Definition
|
|
Term
| advanced the theory and promoted crisis intervention strategies |
|
Definition
|
|
Term
| 7 stage model crisis theory |
|
Definition
|
|
Term
| 7 stage crisis intervention model |
|
Definition
Plan and conduct crisis assessment
Establish rapport and rapidly establish relationship
Identify major problems
Deal with feelings and emotions
Generate and explore alternative
Develop and formulate an action plan
F/U plan and agreement |
|
|
Term
|
Definition
Maturational
Situational
Adventitious |
|
|
Term
| Maturational crisis theorist |
|
Definition
|
|
Term
| New developmental stage is reached |
|
Definition
|
|
Term
| Old coping skills no longer effective |
|
Definition
|
|
Term
| Leads to increased tension and anxiety |
|
Definition
|
|
Term
| Situational crisis arise from: |
|
Definition
Events that are extraordinary, external, often unanticipated
Death
New job
Divorce |
|
|
Term
| Ex of adventitious crisis |
|
Definition
Natural disaster
National disaster
Crime of violence
Fire, flood, hurricane
Terrorism
School shooting, abuse, rape |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| use of problem solving techniques and defense mechanims |
|
Definition
|
|
Term
| try to resolve conflict or problem: if can then reduce anxiety |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| feelings of extreme discomfort |
|
Definition
|
|
Term
|
Definition
|
|
Term
| trial and error, attempt to solve problem and restore normal balance |
|
Definition
|
|
Term
| trial and error attempts fail |
|
Definition
|
|
Term
| anxiety can escalate to severe level or panic |
|
Definition
|
|
Term
| automatic relief behaviors mobilized |
|
Definition
|
|
Term
| some form of resolution may be devised |
|
Definition
|
|
Term
| problem is unsolved and coping skills are ineffective |
|
Definition
|
|
Term
|
Definition
|
|
Term
| possible serious personality disorganization, depression, confusion, violence against others, or suicidal behavior |
|
Definition
|
|
Term
|
Definition
General assessment
Assessment of perception and precipitating even
Assessment of situational supports
Assessment of personal coping skills
Self assessment |
|
|
Term
| Crisis: problem identification |
|
Definition
|
|
Term
|
Definition
decrease in physical symptoms
decrease in negative feelings
exhibits non labile mood
tends to ADL's
exhibits impulse control |
|
|
Term
| Primary care crisis intervention |
|
Definition
| promoting mental health, education |
|
|
Term
| Secondary care crisis intervention |
|
Definition
| acute intervention and anxiety prevention |
|
|
Term
| Tertiary care crisis intervention |
|
Definition
| crisis has occurred and they are recovering from the altered mental state |
|
|
Term
| 7 phases of critical incident stress debriefing |
|
Definition
Introductory phase
Fact phase
Thought phase
Reaction phase
Symptom phase
Teaching phase
Re-entry phase |
|
|
Term
| the qualities that form an individual's unique character |
|
Definition
|
|
Term
|
Definition
|
|
Term
| psychological perspective from childhood experiences |
|
Definition
|
|
Term
| treated as outpatients and often not in treatment at all |
|
Definition
|
|
Term
| personality disorders have trouble with: |
|
Definition
cognition
impulse control
affect
interpersonal functioning
self identity
insight
empathy
intimacy |
|
|
Term
| 3 clusters of personality disorders |
|
Definition
A - Odd/eccentric
B - dramatic, erratic
C - anxious, fearful |
|
|
Term
| Odd/eccentric personality disorders |
|
Definition
Paranoid
Schizoid
Schizotypal |
|
|
Term
| dramatic/erratic personality disorders |
|
Definition
narcissistic
histrionic
antisocial
borderline |
|
|
Term
| anxious/fearful personality disorders |
|
Definition
|
|
Term
|
Definition
| paranoid personality disorder |
|
|
Term
| structural changes in brain in schizotypal personality disorder |
|
Definition
large ventricles
reduced basal ganglia size
altered dopamine transmission |
|
|
Term
| Treatment of paranoid personality disorder |
|
Definition
Antianxiety agents
Antipsychotics
Reject treatment |
|
|
Term
| Reject treatment of paranoid personality disorder |
|
Definition
psychotherapy
developing trust |
|
|
Term
| nursing approach: paranoid personality disorder |
|
Definition
Strictly adhere to promises and schedules
If overly nice it will be suspect, be clear and straightforward
Simple neutral language
Limit setting when threatening |
|
|
Term
|
Definition
| schizoid personality disorder |
|
|
Term
| Treatment of schizotypal personality disorder |
|
Definition
low dose antipsychotics
antidepressant and antianxiety agents
psychotherapy |
|
|
Term
| treatment of schizoid personality disorder |
|
Definition
Antidepressants to increase pleasure
Antipsychotics to increase affect and emotions
Psychotherapy to improve social cues
Group therapy to practice interactions |
|
|
Term
| nursing approach: schizoid personality disorder |
|
Definition
don't be overly friendly and nice
don't force socialization
be thorough in assessment to ID symptoms
protect from shaming and ridicule by other clients
will discuss coping and anxiety |
|
|
Term
| occurs more in men than women; 0.6 - 4% of population |
|
Definition
| schizotypal personality disorder |
|
|
Term
| personal and social deficits |
|
Definition
| schizotypal personality disorder |
|
|
Term
| anxiety in socials situations |
|
Definition
| schizotypal personality disorder |
|
|
Term
| speech is often unclear, overly detailed and abstract |
|
Definition
| schizotypal personality disorder |
|
|
Term
|
Definition
| schizotypal personality disorder |
|
|
Term
| misinterpret others motivations |
|
Definition
| schizotypal personality disorder |
|
|
Term
| off beliefs - superstitious, magical |
|
Definition
| schizotypal personality disorder |
|
|
Term
| may be first step of schizophrenia spectrum |
|
Definition
| schizotypal personality disorder |
|
|
Term
|
Definition
| schizotypal personality disorder |
|
|
Term
|
Definition
| schizotypal personality disorder |
|
|
Term
| may be involved in "cults" |
|
Definition
| schizotypal personality disorder |
|
|
Term
| nursing approach: schizotypal personality disorder |
|
Definition
respect the need for isolation
assessment and communication like a paranoid PD due to their suspiciousness |
|
|
Term
| strange beliefs, activities, and thoughts are integrated into their lives |
|
Definition
| schizotypal personality disorder |
|
|
Term
|
Definition
| histrionic personality disorder |
|
|
Term
|
Definition
| histrionic personality disorder |
|
|
Term
|
Definition
| histrionic personality disorder |
|
|
Term
|
Definition
| histrionic personality disorder |
|
|
Term
| low tolerance for frustration |
|
Definition
| histrionic personality disorder |
|
|
Term
|
Definition
| histrionic personality disorder |
|
|
Term
|
Definition
| histrionic personality disorder |
|
|
Term
|
Definition
| histrionic personality disorder |
|
|
Term
|
Definition
| histrionic personality disorder |
|
|
Term
|
Definition
| histrionic personality disorder |
|
|
Term
| out of touch with their own feelings |
|
Definition
| histrionic personality disorder |
|
|
Term
| treatment of histrionic personality disorder |
|
Definition
antidepressants
antianxiety
"I don't need help" |
|
|
Term
|
Definition
| paranoid personality disorders |
|
|
Term
|
Definition
| paranoid personality disorders |
|
|
Term
| belief that others will harm or exploit them |
|
Definition
| paranoid personality disorders |
|
|
Term
| hypervigilant and plan "Counterattacks" |
|
Definition
| paranoid personality disorders |
|
|
Term
|
Definition
| paranoid personality disorders |
|
|
Term
|
Definition
| paranoid personality disorders |
|
|
Term
|
Definition
| paranoid personality disorders |
|
|
Term
| reluctant to share so difficult to assess |
|
Definition
| paranoid personality disorders |
|
|
Term
| commonly suspicious of infidelity |
|
Definition
| paranoid personality disorders |
|
|
Term
| object of rage or humiliation in childhood - feel inadequate |
|
Definition
| paranoid personality disorders |
|
|
Term
| emotional detachment - loners |
|
Definition
| schizoid personality disorder |
|
|
Term
| doesn't want close relationships |
|
Definition
| schizoid personality disorder |
|
|
Term
| little interest in sexuality |
|
Definition
| schizoid personality disorder |
|
|
Term
| observe, not participate in life |
|
Definition
| schizoid personality disorder |
|
|
Term
|
Definition
| schizoid personality disorder |
|
|
Term
| few things provide pleasure |
|
Definition
| schizoid personality disorder |
|
|
Term
|
Definition
| schizoid personality disorder |
|
|
Term
| cold or neglectful childhood - relationships unsatisfying |
|
Definition
| schizoid personality disorder |
|
|
Term
| employment may be difficult because of interpersonal skills |
|
Definition
| schizoid personality disorder |
|
|
Term
| nursing approach: histrionic personality disorder |
|
Definition
Limit set with seductive behavior, but this is a response to stress, anxiety
Stay professional
Exaggerate symptoms
Model and teach concrete descriptions, not feelings and exaggerations
Teach assertiveness
Help with feeling clarification
Watch and assess for suicidal ideation |
|
|
Term
|
Definition
| narcissistic personality disorder |
|
|
Term
|
Definition
| narcissistic personality disorder |
|
|
Term
|
Definition
| narcissistic personality disorder |
|
|
Term
|
Definition
| narcissistic personality disorder |
|
|
Term
|
Definition
| narcissistic personality disorder |
|
|
Term
|
Definition
| narcissistic personality disorder |
|
|
Term
|
Definition
| narcissistic personality disorder |
|
|
Term
| underlying shame and fear of abandonment |
|
Definition
| narcissistic personality disorder |
|
|
Term
|
Definition
| narcissistic personality disorder |
|
|
Term
| childhood neglect or criticism |
|
Definition
| narcissistic personality disorder |
|
|
Term
| may feel they are depressed due to lack of appreciation by others |
|
Definition
| narcissistic personality disorder |
|
|
Term
| treatment of narcissistic personality disorder |
|
Definition
cognitive therapy
behavioral therapy |
|
|
Term
| nursing approach: narcissistic personality disorder |
|
Definition
Remain neutral in communication
Therapeutic communication to teach and practice meaningful interactions
Don't become defensive if the patient insults the nurse or staff
Role model empathy
Don't get into a power struggle over rules or behavior |
|
|
Term
| Patient is afraid of shame, fear, and abandonment |
|
Definition
| narcissistic personality disorder |
|
|
Term
|
Definition
| avoidant personality disorder |
|
|
Term
| low self esteem and inferiority |
|
Definition
| avoidant personality disorder |
|
|
Term
|
Definition
| avoidant personality disorder |
|
|
Term
| parental rejection and criticism |
|
Definition
| avoidant personality disorder |
|
|
Term
| timid temperament in childhood |
|
Definition
| avoidant personality disorder |
|
|
Term
| treatment of avoidant personality disorder |
|
Definition
antidepressants - SSRIs
group therapy for practice and planning |
|
|
Term
| forcing social interaction will cause severe anxiety |
|
Definition
| avoidant personality disorder |
|
|
Term
| nursing approach: avoidant personality disorder |
|
Definition
be friendly, accepting, reassuring
accept their fears
provide opportunity to practice social skills with caution, failure increases poor self worth
assertiveness training |
|
|
Term
|
Definition
| dependent personality disorder |
|
|
Term
|
Definition
| dependent personality disorder |
|
|
Term
| separation and abandonment fear |
|
Definition
| dependent personality disorder |
|
|
Term
|
Definition
| dependent personality disorder |
|
|
Term
|
Definition
| dependent personality disorder |
|
|
Term
| disordered detachment and dependency on parents, chronic illness, punishment of independent behaviors |
|
Definition
| dependent personality disorder |
|
|
Term
| Treatment of dependent personality disorder |
|
Definition
antidepressants
antianxiety
psychotherapy
cognitive therapy |
|
|
Term
| nursing approach: dependent personality disorder |
|
Definition
have them ID their stressors
watch for countertransference
let them practice assertiveness
Role model and teach assertiveness |
|
|
Term
| do not have actual obsessive and compulsive thoughts/behaviors |
|
Definition
| obsessive compulsive personality disorder |
|
|
Term
|
Definition
| obsessive compulsive personality disorder |
|
|
Term
|
Definition
| obsessive compulsive personality disorder |
|
|
Term
|
Definition
| obsessive compulsive personality disorder |
|
|
Term
|
Definition
| obsessive compulsive personality disorder |
|
|
Term
|
Definition
| obsessive compulsive personality disorder |
|
|
Term
|
Definition
| obsessive compulsive personality disorder |
|
|
Term
| child responded to negatively by trying to control the environment through perfectionism |
|
Definition
| obsessive compulsive personality disorder |
|
|
Term
|
Definition
| obsessive compulsive personality disorder |
|
|
Term
| treatment of obsessive compulsive personality disorder |
|
Definition
SSRI antidepressants
psychotherapy |
|
|
Term
| nursing approach: obsessive compulsive personality disorder |
|
Definition
no power struggles
avoid unexpected changes
structure - let them complete their habitual behaviors
ID their own ineffective coping and help develop new coping skills |
|
|
Term
|
Definition
| antisocial personality disorder |
|
|
Term
|
Definition
| antisocial personality disorder |
|
|
Term
|
Definition
| antisocial personality disorder |
|
|
Term
| manipulation for personal gain |
|
Definition
| antisocial personality disorder |
|
|
Term
| personal power and pleasure motivation |
|
Definition
| antisocial personality disorder |
|
|
Term
|
Definition
| antisocial personality disorder |
|
|
Term
|
Definition
| antisocial personality disorder |
|
|
Term
|
Definition
| antisocial personality disorder |
|
|
Term
| absence of remorse or guilt |
|
Definition
| antisocial personality disorder |
|
|
Term
| disinhibited behaviors such as risk taking, criminal behavior, substance use, no responsibility, impulsiveness |
|
Definition
| antisocial personality disorder |
|
|
Term
| psychopathy or sociopathy |
|
Definition
| antisocial personality disorder |
|
|
Term
|
Definition
| antisocial personality disorder |
|
|
Term
| low serotonin, high dopamine |
|
Definition
| antisocial personality disorder |
|
|
Term
| aggression and impulsiveness |
|
Definition
|
|
Term
| aggressiveness and disinhibition |
|
Definition
|
|
Term
| abuse, neglect, or inconsistent parenting |
|
Definition
| antisocial personality disorder |
|
|
Term
| clearly linked to conduct disorders in childhood |
|
Definition
| antisocial personality disorder |
|
|
Term
| high substance abuse co-morbidity |
|
Definition
| antisocial personality disorder |
|
|
Term
| court ordered psychotherapy or through ED |
|
Definition
| antisocial personality disorder |
|
|
Term
| no self directed treatment |
|
Definition
| antisocial personality disorder |
|
|
Term
| often behaviors lessen with age |
|
Definition
| antisocial personality disorder |
|
|
Term
| no approved medication, off label lithium for impulse control and aggression |
|
Definition
| antisocial personality disorder |
|
|
Term
| nursing approach: antisocial personality disorder |
|
Definition
Maintain safety of patient and others
Limit setting and set boundaries
Provide realistic choices
Protection of patient and others from impulsiveness
Impulse control training
Teach and model coping skills
Anger expression assistance
Assess life stressors, criminal history, suicidal or homicidal thoughts, substance use |
|
|
Term
|
Definition
| borderline personality disorder |
|
|
Term
| hyper-responsive amygdala and impaired prefrontal cortex - vulnerable, emotional, sensitive to words, facies, and interpersonal interactions |
|
Definition
| borderline personality disorder |
|
|
Term
|
Definition
| borderline personality disorder |
|
|
Term
| impaired sensation and individuation as young child |
|
Definition
| borderline personality disorder |
|
|
Term
| maladaptive response from childhood |
|
Definition
| borderline personality disorder |
|
|
Term
| cognitive beliefs about self |
|
Definition
| borderline personality disorder |
|
|
Term
| excessive use of defense mechanisms: repression, suppression, regression, undoing, splitting |
|
Definition
| borderline personality disorder |
|
|
Term
| our temperament and biogenetics as affected by physical, social, and emotional influences in environment |
|
Definition
|
|
Term
|
Definition
| borderline personality disorder |
|
|
Term
|
Definition
| borderline personality disorder |
|
|
Term
|
Definition
| borderline personality disorder |
|
|
Term
|
Definition
| borderline personality disorder |
|
|
Term
| self mutilation - cutting |
|
Definition
| borderline personality disorder |
|
|
Term
|
Definition
| borderline personality disorder |
|
|
Term
|
Definition
| borderline personality disorder |
|
|
Term
|
Definition
| borderline personality disorder |
|
|
Term
|
Definition
| borderline personality disorder |
|
|
Term
|
Definition
| borderline personality disorder |
|
|
Term
| angry, aggressive behavior |
|
Definition
| borderline personality disorder |
|
|
Term
| behaviors decrease with age |
|
Definition
| borderline personality disorder |
|
|
Term
| self mutilation, self directed violence, impaired social interaction, disturbed personal identity, ineffective coping |
|
Definition
| borderline personality disorder |
|
|
Term
| changes occur in adulthood |
|
Definition
| borderline personality disorder |
|
|
Term
| diagnosis: borderline personality disorder |
|
Definition
self mutilation
self directed violence
impaired social interaction
disturbed personal identity
ineffective coping |
|
|
Term
| outcomes: borderline personality disorder |
|
Definition
no self harm
upholds no suicide contract
expresses needs in appropriate manner
verbalizes personal identity
performs social roles
establishes personal boundaries
uses effective coping strategies
takes responsibility for actions |
|
|
Term
| Treatment: borderline personality disorder |
|
Definition
Assess SI and recent loss
Build therapeutic relationships
Determine if co-morbidities effect behavior
Determine cultural influences on behavior
Determine losses
Model coping
Dialectical behavior therapy
Mindfulness therapy
Cognitive therapy
Structured and supportive environment
Avoid overdependence on staff
Set realistic goals
Be aware of and limit set manipulative behavior
No approved meds |
|
|
Term
| What meds can be used for borderline personality disorder? |
|
Definition
Lamotrigine
Carbamazepine
Antipsychotics
Omega 3 supplements
Naltrexone |
|
|
Term
| Dialectical behavior therapy |
|
Definition
Meals with chronically suicidal clients
Cognitive and behavioral approach
Mindfulness
Increase ability to manage distress
Improve interpersonal skills |
|
|
Term
| Targets of dialectical behavior therapy |
|
Definition
Suicide behavior
Behavior that interferes with therapy
Behaviors that interfere with quality of life |
|
|
Term
| Assessment, diagnosis, outcome identification: borderline personality disorder |
|
Definition
Risk for other directed violence
Defensive coping
Impaired social interaction
Ineffective health maintenance |
|
|
Term
| Implementation: borderline personality disorder |
|
Definition
Safety and teamwork
Pharmacological interventions
Case management |
|
|
Term
| Advanced practice intervention |
|
Definition
Psychotherapy
Cognitive therapy
Dialectical behavior therapy |
|
|
Term
| identify and change inaccurate perceptions |
|
Definition
|
|
Term
| cognitive therapy combined with mindfulness, awareness, improving interpersonal skills, and interrupts impulsive destructive behavior |
|
Definition
| dialectical behavior theray |
|
|
Term
|
Definition
|
|
Term
|
Definition
epidermis
dermis
subcutaneous tissue |
|
|
Term
| What is impaired in a burn? |
|
Definition
Direct injury to skin
Fluid shifts
Pulmonary system
Inhalation injury
Myocardial depression
Altered skin integrity
Immunosuppression
Psychological resonse |
|
|
Term
|
Definition
|
|
Term
| direct contact with heated object |
|
Definition
|
|
Term
| may be as many as 85& of all burns |
|
Definition
|
|
Term
|
Definition
|
|
Term
| Prevention: thermal burns |
|
Definition
hot beverages in microwave
mishandling fireworks
supervise bathing/water temp |
|
|
Term
|
Definition
Remove patient from heart source if it's safe
Remember the fire safety
Remove metal objects unless adhered
Loosen garments, remove garments, cover with sterile or clean sheet |
|
|
Term
| Thermal burn interventions |
|
Definition
Assess airway
Maintain thermoregulation
Cool with water
Initiate an IV |
|
|
Term
| tissue injury from acid, alkalis, and organic compounds often found at home |
|
Definition
|
|
Term
| Prevention: chemical burns |
|
Definition
Store chemical safely
Educated on dangerous substances
Protective gear |
|
|
Term
|
Definition
REMOVE all clothing
Flush liquids with water for 20 min
Remove and dispose of contacts
Brush off powders - no water
Poison control |
|
|
Term
| Chemical burns: manifestations |
|
Definition
Blisters at site of contact
Redness, irritation
Pain or numbness
Vision issues |
|
|
Term
| Intense heat from electric current |
|
Definition
|
|
Term
| tissue anoxia and tissue death |
|
Definition
|
|
Term
|
Definition
|
|
Term
| can also cause a flash injury and ignite clothes |
|
Definition
|
|
Term
|
Definition
|
|
Term
| direct damage to nerves and vessels |
|
Definition
|
|
Term
|
Definition
Cervical spine
EKG
ABG
Chemistries, output
Beneath surface |
|
|
Term
| A burn might be electrical if: |
|
Definition
LOC
Paralysis
Loss of peripheral pulse
Myoglobinuria
Elevated CK
Cardiac arrest |
|
|
Term
| increased pressure due to edema & less blood flow |
|
Definition
|
|
Term
| 6 P's of compartment syndrome |
|
Definition
Pain
Pressure
Paresthesia
Pallor
Paralysis
Pulselessness |
|
|
Term
| inhalation of hot air of breathing noxious chemicals |
|
Definition
| smoke and inhalation injury |
|
|
Term
| high mortality due to airway compromise and edema |
|
Definition
| smoke and inhalation injury |
|
|
Term
| can cause ARDS within 12-24 hours |
|
Definition
| smoke and inhalation injury |
|
|
Term
| Prevention of smoke and inhalation injury |
|
Definition
| Install smoke and carbon monoxide detectors |
|
|
Term
| Suspect inhalation with burns to: |
|
Definition
|
|
Term
| Assessment: smoke and inhalation injury |
|
Definition
coughing
black sputum
hoarseness
singed nose hair |
|
|
Term
| injury to mouth, oropharynx, and larynx |
|
Definition
|
|
Term
|
Definition
|
|
Term
| eschar tightens chest making expansion difficult |
|
Definition
|
|
Term
| Clinical manifestations: upper airway injury |
|
Definition
blisters
stridor
copious secretions
retractions |
|
|
Term
| involves trachea, bronchioles, and alveoli |
|
Definition
|
|
Term
| tissue damage depends on duration of exposure |
|
Definition
|
|
Term
|
Definition
|
|
Term
| Clinical manifestations: lower airway injury |
|
Definition
AMS
dyspnea
facial burns
wheezing |
|
|
Term
| clothing burns around neck and chest |
|
Definition
|
|
Term
| pulmonary edema may manifest 12-48 hours after initial insult |
|
Definition
|
|
Term
| death related to carbon monoxide or hydrogen cyanide |
|
Definition
|
|
Term
| hypoxia, carboxyhemoglobin |
|
Definition
|
|
Term
| can occur without damage to skin |
|
Definition
|
|
Term
| Manifestations: metabolic asphyxiation |
|
Definition
Headache
N/V
tachycardia
changes in LOC
cherry red skin |
|
|
Term
| Treatment: metabolic asphyxiation |
|
Definition
|
|
Term
| Prevention: metabolic asphyxiation |
|
Definition
Don't use generator in your home
inspect furnace
CO detector |
|
|
Term
| which type of burn injury would cause myoglobinuria, long bone fractures, dysrhythmias, and/or cardiac arrest |
|
Definition
|
|
Term
|
Definition
depth
location
extent
history |
|
|
Term
| superficial, partial thickness |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| blanch, no vesicles, no blisters |
|
Definition
|
|
Term
| how long does it take a first degree burn to heal? |
|
Definition
|
|
Term
| example of a first degree burn |
|
Definition
|
|
Term
|
Definition
|
|
Term
| fluid filled vesicles that are red, shiny, and wet |
|
Definition
|
|
Term
| severe pain and mild edema |
|
Definition
|
|
Term
| dry, waxy, leathery skin - brown, tan, waxy |
|
Definition
|
|
Term
| visible thrombosed vessels |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| extends below dermis into muscle, bone, and tendon |
|
Definition
|
|
Term
| prioritize overall health over wound |
|
Definition
|
|
Term
| involves nerves, fat, muscle, and bone |
|
Definition
|
|
Term
| third and fourth degree burns |
|
Definition
|
|
Term
|
Definition
|
|
Term
| First aid for small burns |
|
Definition
Remove pt from the source
Clean, cool cloth |
|
|
Term
| First aid for large burns |
|
Definition
Cool for max of 10 minutes
DO NOT immerse in cold water or ice
Remove burned clothing
Wrap in dry, clean sheet |
|
|
Term
| Large burns: focus on _____ if unresponsive |
|
Definition
|
|
Term
|
Definition
Circulation - check for pulses, elevate burned limbs
Airway - check for patency
Breathing - quality of ventilation |
|
|
Term
| What kinds of burns should go to a burn center? |
|
Definition
Partial thickness > 10%
Burns that involve the face, hands, feet, genitalia, perineum, major joints
Third degree burns
Any electrical burns
Chemical burns
Inhalation injury
Anything preexisting that could affect outcome/mortality
Trauma
Burned children
Burn injury patients who need special social, emotional, or rehabilitative intervention |
|
|
Term
| phases of burn management |
|
Definition
emergent - resuscitative
acute - wound healing
rehabilitative - restorative |
|
|
Term
|
Definition
|
|
Term
| Main issues of emergent burn management |
|
Definition
|
|
Term
| Emergent phase of burn managements ends when? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| How soon can fluid and electrolyte shift and hypovolemic shock begin after a burn? |
|
Definition
|
|
Term
| fluids shift from vascular space to interstitial space |
|
Definition
|
|
Term
|
Definition
|
|
Term
| leads to intravascular depletion - edema, hypotension, tachycardia |
|
Definition
|
|
Term
| Emergent phase: RBC _____ due to injury which causes _____________. |
|
Definition
|
|
Term
|
Definition
|
|
Term
| Emergent phase: ____________ of burned tissue |
|
Definition
|
|
Term
| when it resolves, body gets of excess fluid and urine has a low specific gravity |
|
Definition
|
|
Term
|
Definition
|
|
Term
| What to watch for in the emergent phase? |
|
Definition
Dysrhythmias
Shock
Impaired circulation
VTE
Oxygenation
Airway protection
ARDS
S/sx of CO
ATN
Renal failure
Urine output |
|
|
Term
|
Definition
|
|
Term
| speaking in rhyming words |
|
Definition
|
|
Term
| linking words together with connection |
|
Definition
|
|
Term
| Respiratory interventions in burns |
|
Definition
Early intubation - 1-2 hours
Escharotomies of chest |
|
|
Term
|
Definition
|
|
Term
| Parkland formula for 24 hour fluid resuscitation |
|
Definition
| 4 mL LR x weight (kg) x % TBSA |
|
|
Term
| Rate of fluid resuscitation |
|
Definition
1/2 in first 8 hours
1/4 in second 8 hours
1/4 in third 8 hours |
|
|
Term
| Emergent nursing interventions - unresponsive burn patient |
|
Definition
|
|
Term
| Emergent nursing intervention - responsive burn patiente |
|
Definition
|
|
Term
| Emergent nursing interventions: burns |
|
Definition
FLUID
Assess for inhalation injury
Give O2/intubation
VS, LOC
IV access
Foley if > 15% TBSA
Remove nonadherent anything
Pain management
Assess other injuries
Give support |
|
|
Term
| Emergent wound care: burns |
|
Definition
Gentle debridement until surgical interventions
Clean, antimicrobial - PPE, sterile |
|
|
Term
| Ways of gentle debridement of wounds |
|
Definition
|
|
Term
| Emergent drugs & things: burns |
|
Definition
IV pain meds - sedatives, antidepressants
Tetanus vaccine
Antimicrobials
Feed - NGT, Check residuals d/t delayed emptying, hypermetabolic state |
|
|
Term
| What is one clinical manifestation the nurse would expect to find during the emergent phase in a patient with a full thickness burn over the lower half of the body? |
|
Definition
|
|
Term
| wound care, excision and grafting, pain management, physical therapy, and nutrition |
|
Definition
|
|
Term
| when do partial thickness burns heal? |
|
Definition
|
|
Term
| need debridement on deeper burns |
|
Definition
|
|
Term
|
Definition
Hyponatremia - GI loss or excess fluid intake
Hypernatremia - good fluid resuscitation
Hypokalemia - V, D, wounds
Hyperkalemia - renal failure, electrical burn |
|
|
Term
|
Definition
|
|
Term
|
Definition
cadaver skin
porcine skin
amnion |
|
|
Term
| human skin donated for medical use post mortem |
|
Definition
|
|
Term
| a thin layer of skin harvested from a pig |
|
Definition
|
|
Term
| membrane covered from the placenta following birth |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| cultured epithelial autograft |
|
|
Term
| grown from biopsy samples from unburned skin |
|
Definition
| cultured epithelial autograft |
|
|
Term
| 18-25 days, expand up to 10000x and form sheets to use as grafts |
|
Definition
| cultured epithelial autograft |
|
|
Term
| very thin so can have issues |
|
Definition
| cultured epithelial autograft |
|
|
Term
| shortening of scare tissue |
|
Definition
|
|
Term
| when can contractures occur? |
|
Definition
neck
fingers
groin
ankles
knees |
|
|
Term
| how to help with contractures |
|
Definition
positioning
splinting
exercise |
|
|
Term
| how long does mature healing take? |
|
Definition
|
|
Term
| promotes cell integrity and hemoglobin formation |
|
Definition
|
|
Term
| what vitamins promote wound healing |
|
Definition
vitamin A, C, E
multivitamin |
|
|
Term
| Emergency burn care in pediatrics |
|
Definition
ACLS
Airway
C-spine precautions
Stop the burn |
|
|
Term
|
Definition
Head - 9
arms - 4.5
legs - 7
abdomen -18
back -18 |
|
|
Term
|
Definition
| for each year over one, subtract 1% from the head, add 0.5% to each leg |
|
|
Term
| produced by ischemic pancreas |
|
Definition
| myocardial depressant factor |
|
|
Term
| decreases contractility of the heart and impairs phagocytosis |
|
Definition
| myocardial depressant factor |
|
|
Term
| oxygen need is not matches by supply |
|
Definition
|
|
Term
| hemodynamic changes in MODS |
|
Definition
redistribution of intravascular fluid volume from reduced arterial vascular tone
diminished venous return
venous dilation
release of more myocardial depressant substances |
|
|
Term
| Used for patients with sepsis or septic shock who have risk factors for GI bleeding |
|
Definition
|
|
Term
| What is used for stress ulcer prophylaxis? |
|
Definition
PPI's
Histamine 2 receptor antagonists |
|
|
Term
| Early initiation of ____________ rather than a complete fast or only IV glucose in critically ill patients with sepsis or septic shock who can be fed otherwise. |
|
Definition
|
|
Term
| Placement of _______________ in critically ill patients with sepsis or septic shock with feeding intolerance or who are considered to be at high risk of aspiration |
|
Definition
| post pyloric feeding tubes |
|
|
Term
| is of critical importance with septic shock |
|
Definition
| early nutritional support |
|
|
Term
| Preferred route of nutrition in shock unless the patient has an ileus or other abnormality |
|
Definition
|
|
Term
| is observed commonly and can be treated with motility agents and small bore intestinal tube insertion |
|
Definition
|
|
Term
| use in patients with sepsis or septic shock and feeding intolerance |
|
Definition
|
|
Term
| has become a prominent emphasis in the care of critically ill patients |
|
Definition
|
|
Term
| Glucose level recommendation for surviving sepsis |
|
Definition
|
|
Term
| ______ less mortality in those with sepsis with tighter glycemic control |
|
Definition
|
|
Term
| In sepsis, commence insulin dosing when? |
|
Definition
| 2 consecutive BGL's > 180 |
|
|
Term
| How often are BGLs monitored in sepsis |
|
Definition
1-2 hours until stable
then ever 4 hours |
|
|
Term
| In sepsis, use _________ blood rather than __________ blood for POC testing using glucometers if patients have arterial catheters. |
|
Definition
|
|
Term
|
Definition
PTT/aPTT mildly elevated
moderate reduction in platelet count
DIC may develop |
|
|
Term
| In MODS, coagulopathy is caused by deficiencies in coagulation system proteins: |
|
Definition
protein C
Antithrombin III
tissue factor inhibitors |
|
|
Term
| In MODS, coagulopathy is caused by what deficiencies? |
|
Definition
| coagulation system proteins |
|
|
Term
| initially increased synthesis of clotting factors along ischemic injury causes widespread coagulation and many micro-emboli throughout the circulation system which causes further ischemic injury to organs and uses up the clotting factors so when the body needs to initiate a clot, there are not adequate amounts of prothrombin or fibrinogen along with lowered platelets |
|
Definition
|
|
Term
| What causes encephalopathy and peripheral neuropathy in MODS? |
|
Definition
systemic hypotension
brain hypo-perfusion
possible hepatic encephalopathy if liver is dysfunctioning |
|
|
Term
| In MODS, _________ or ___________ should be used in patients with sepsis and AKI. |
|
Definition
|
|
Term
| what causes acute renal failure in mods? |
|
Definition
|
|
Term
| renal manifestations of mods |
|
Definition
decrease in effective intravascular volume
direct renal vasoconstriction
release of cytokines
activation of neutrophils |
|
|
Term
| acts as a first line of defense in clearing bacteria |
|
Definition
|
|
Term
| leads to a spillover of bacteria into systemic circulation |
|
Definition
|
|
Term
| another name for liver failure |
|
Definition
|
|
Term
| can be manifested by elevations in liver enzymes and bilirubin, coagulation defects, and failure to excrete toxins such as ammonia which leads to worsening encephalopathy |
|
Definition
|
|
Term
| In MODS, overgrowth of bacteria in the ________________ may be aspirated into the lungs, causing pneumonia. |
|
Definition
|
|
Term
| In mods, ____________ of the bowel is decreased through endothelial injury, allowing bacteria and endotoxins into the systemic circulation. |
|
Definition
|
|
Term
| Septic shock can cause ____________ that can lead to a delay of enteral feeding, in the face of high protein and calorie requirements. |
|
Definition
|
|
Term
| can further worsen GI tract motility |
|
Definition
narcotics
muscle relaxants |
|
|
Term
| Mechanically ventilated sepsis patients are maintained with the HOB elevated between __________ to limit aspiration risk and to prevent the development of VAP. |
|
Definition
|
|
Term
| __________________ in mechanically ventilated patients with sepsis who are ready for weaning |
|
Definition
| spontaneous breathing trial |
|
|
Term
| _________________ in mechanically ventilated patients with sepsis induced respiratory failure who can tolerate weaning |
|
Definition
|
|
Term
|
Definition
| 1st generation antipsychotics |
|
|
Term
| should be minimized in mechanically ventilated sepsis patients |
|
Definition
|
|
Term
| _________ probably with ARDS |
|
Definition
|
|
Term
| Use _____________ in adult patients with sepsis induced ARDS |
|
Definition
|
|
Term
| positioning for patients with sepsis induced ARDS |
|
Definition
|
|
Term
| PaO2/FiO2 ratio in sepsis induced ARDS |
|
Definition
|
|
Term
| how many are awaiting organ donation |
|
Definition
|
|
Term
| how many transplants area done per year |
|
Definition
|
|
Term
| who regulates organ donation |
|
Definition
| uniform anatomical gift act |
|
|
Term
| whole or partial organs that can be donated |
|
Definition
heart
lung
liver
kidney
intestine
pancreas
colon |
|
|
Term
| tissues that can be donated |
|
Definition
corneas
skin
veins/arteries
heart valves
bone
connective tissue
stem cells |
|
|
Term
| Tissue typing: organ donation |
|
Definition
ABO
HLA
Reactive antibodies
Crossmatch |
|
|
Term
|
Definition
| human lymphocytic antigen |
|
|
Term
| In HLA typing, which antigens are tested? |
|
Definition
|
|
Term
| Each has 2 antigen encoding alleles |
|
Definition
|
|
Term
| how many antigens are tested in HLA typing? |
|
Definition
|
|
Term
| In HLA typing, a match of _____ is considered a strong match. |
|
Definition
|
|
Term
| ________ are avascular, so no matching is needed. |
|
Definition
|
|
Term
| In regards to organ donation, what is the most specific? |
|
Definition
|
|
Term
| In regards to organ donation, what is not as specific? |
|
Definition
|
|
Term
| _______________ is tested in the recipient to determine sensitivity to antigens. |
|
Definition
|
|
Term
| Crossmatch of recipient with ____________________. |
|
Definition
|
|
Term
| identify as early as possible |
|
Definition
|
|
Term
| Notify _____________________ for near death or on life support with poor prognosis. |
|
Definition
|
|
Term
| What can the patient have to determine organ donation? |
|
Definition
|
|
Term
| Who is consulted for organ donation if the patient does not have an advanced directive? |
|
Definition
|
|
Term
| family prepared, family decides ahead, go to OR on life support and remove life support after harvest |
|
Definition
|
|
Term
| family to remove life support before death |
|
Definition
|
|
Term
| decision made before life support removal |
|
Definition
|
|
Term
| A DBD donor can donate up to _________ organs. |
|
Definition
|
|
Term
| What organs can a DBD donor donate? |
|
Definition
heart
2 lungs
liver
pancreas
2 kidneys
small intestine |
|
|
Term
| What organs can a DCD donor donate? |
|
Definition
|
|
Term
| In donors, the _______ and _______ are uncovered so the family can touch the patient. |
|
Definition
|
|
Term
| cared for in the same manner as any patient |
|
Definition
|
|
Term
| In donation, the patient receives standard care, including __________ and ___________ and is monitored closely throughout the process. |
|
Definition
|
|
Term
| Typically, a ____________ and ___________ from the OPO remain with the family and can provide updates as appropriate. |
|
Definition
hospital chaplain
family services coordinator |
|
|
Term
| What can a live donor donate? |
|
Definition
1 kidney
skin
a liver segment
a lobe of the lung
a portion of the pancreas
a portion of the intestine
several tissues |
|
|
Term
| The donor has the option to decide if he or she wants to have ________ or __________ donation. |
|
Definition
|
|
Term
| What must a donor have prior to donation? |
|
Definition
be fit and in good overall health
excluding chronic health conditions
consent to procedures
lab testing before surgery |
|
|
Term
| What can a living donor experience? |
|
Definition
|
|
Term
|
Definition
scarcity of resources
lifestyle of recipient
economics
urgency
age
care for someone that is deceased |
|
|
Term
| The recipient: organ donation |
|
Definition
Organ failure
Multiple lab tests, psychological tests, and compliance concerns
Waiting list
Remain infection and malignancy free
Call at any time |
|
|
Term
| Preparation: organ donation |
|
Definition
Immune suppression
Lifelong drug regimen and compliance |
|
|
Term
| Acute care: organ donation |
|
Definition
Hourly temp, BP HR, RR, and urine volume
daily
Daily blood count, electrolytes, BUN, creatinine, liver function, coagulation labs, blood glucose, C-peptide, insulin, urine amylase
Wound drainage, duodenal decompression tube drainage, hemodynamic lines, nephrostomy, t-tube
Evaluate the recovery of each organ until the level become normal or stable
1 week stay |
|
|
Term
|
Definition
|
|
Term
|
Definition
CBC with diff
Renal, liver, and bone profile
Cholesterol
Glucose
CMV
CRP
Organ specific enzymes
Therapeutic drug levels
Urine - protein, infection
Weight, BP, Temp |
|
|
Term
| During the first few months following organ donation, what are the risks? |
|
Definition
rejection
infection
organ failure |
|
|
Term
| Patient teaching following organ donation |
|
Definition
How to monitor their own urine output, pulse, weight, BP, temp, and glucose concentrations
S/sx of rejection |
|
|
Term
| What kinds of infections can happen following organ donation? |
|
Definition
donor derived infection
recipient infection
HAI
community related infection |
|
|
Term
| simple infection control measure following organ donation |
|
Definition
good hygiene
handwashing
oral care
proper disposal of waste
food handling
caution around pets
avoid individuals who are sick
avoid children who recently have been vaccinated
wear gloves when gardening
cuts should be covered and kept dry, clean
fresh fruits and vegetables should be washed well before eating or cooking |
|
|
Term
| Following organ donation, patients should promptly report what? |
|
Definition
wounds
injuries
s/sx of UTI or URI |
|
|
Term
| opportunistic infections: organ donation |
|
Definition
CMV
HSV
pneumocystis jiroveci |
|
|
Term
| What is encouraged following organ donation? |
|
Definition
Get vaccines but not live ones
do not travel long distances for a few months following transplantation
Take sufficient supply of medication in carry on if traveling |
|
|
Term
| What vaccines are live vaccines? |
|
Definition
MMR
Varicella
H1N1
Nasal flu
Rotavirus
BCG
Yellow fever
Typhoid vaccines |
|
|
Term
| will minimize the risk of CAD |
|
Definition
|
|
Term
| When is new onset diabetes risk the greatest following transplantation? |
|
Definition
|
|
Term
| Long term chronic illnesses following transplantation |
|
Definition
Serum lipid/glucose levels
CVD
HTN
DM
Graft dysfunction
Dietary modification
Smoking cessation |
|
|
Term
| primary cause of mortality for transplant patients |
|
Definition
|
|
Term
| Discharge instructions following transplantation |
|
Definition
Med compliance for life
Adhere to a health lifestyle
Exercise
Avoid contact sports
Walking can prevent weight gain
Drink 2 L/fluid or more daily - more if in hot weather or pyrexia
Contact the transplant provider if vomiting or diarrhea
Normal balanced healthy diet - reduced in fat, sugar, salt, and high in fiber
Smoking cessation
Avoidance of alcohol
Increase cancer screening |
|
|
Term
| Following transplantation, weight should be aimed at a BMI of? |
|
Definition
|
|
Term
| How long should women wait to get pregnant following transplantation? |
|
Definition
|
|
Term
| Risk factors for non-adherence to medication regimen following transplantation? |
|
Definition
H/o prior non-adherence behavior
Psychiatric illness
Personality disorders
Limited social support
High risk behavior - substance abuse
High education level
Adolesnce
Time since transplantation
Limited F/U with transplant specialists
Poor pre-transplant education
Difficult drug regimens
Multiple adverse effects from meds |
|
|
Term
|
Definition
|
|
Term
| viable immune tissue in the graft - usually bone marrow or stem cells |
|
Definition
|
|
Term
|
Definition
|
|
Term
| causes mucocutaneous response such erythema and irritation |
|
Definition
|
|
Term
| can cause retinitis, diarrhea, edema, or jaundice |
|
Definition
|
|
Term
|
Definition
|
|
Term
| How is graft vs host treated? |
|
Definition
|
|
Term
| _____ of transplant patients experience mild incidences of rejection in the first few months following surgery. |
|
Definition
|
|
Term
|
Definition
Fever
Graft tenderness
Tenderness at site
Edema
Trough drug levels under therapeutic level
Organ failure |
|
|
Term
| natural kills cells and cytotoxic T cells attack foreign cells |
|
Definition
|
|
Term
| inflammatory and immune system tries to destroy the foreign tissue |
|
Definition
|
|
Term
|
Definition
Hyper acute
Acute rejection
Chronic rejection |
|
|
Term
| immediate rejection is antigen antibody complex driven |
|
Definition
|
|
Term
| complexes attach to the lining of blood vessels and activate the complement system |
|
Definition
|
|
Term
| clotting begins causing ischemic necrosis |
|
Definition
|
|
Term
| lysosomal enzymes release |
|
Definition
|
|
Term
| cellular destruction occurs |
|
Definition
|
|
Term
| When does hyper acute rejection occur? |
|
Definition
| minutes up to 24 hours after a new organ is placed |
|
|
Term
| Treatment of hyper acute rejection |
|
Definition
|
|
Term
| In hyper acute rejection, preformed antibodies react with: |
|
Definition
alloantigens on the vascular endothelium of the graft
activate complement |
|
|
Term
| trigger rapid intravascular thrombosis and necrosis of the vessel wall |
|
Definition
|
|
Term
| When does acute rejection occur? |
|
Definition
|
|
Term
| Cell mediated or antibody mediated vascular infllamation |
|
Definition
|
|
Term
| NK cells and T cells enter the organ and start inflammation |
|
Definition
|
|
Term
| manifests in lab through decreased organ function |
|
Definition
|
|
Term
| usually reversible with immune suppressants |
|
Definition
|
|
Term
| immune suppressant limit the damage and maintain the grafted organ |
|
Definition
|
|
Term
| When does chronic rejection occur? |
|
Definition
| months to years after transplant |
|
|
Term
| B and T cells infiltrate the organ |
|
Definition
|
|
Term
| chronic inflammation and scarring of the organ occurs |
|
Definition
|
|
Term
| fibrosis through the organ and decreased organ function occurs |
|
Definition
|
|
Term
| Cure for chronic rejection? |
|
Definition
|
|
Term
| If extreme, then re-transplant occurs |
|
Definition
|
|
Term
| treatment of minor chronic rejection |
|
Definition
| immune suppression and continued monitoring |
|
|
Term
| Eligible candidates for heart transplant life expectancy |
|
Definition
|
|
Term
| may require circulatory support device while waiting |
|
Definition
|
|
Term
| indications for a heart transplant |
|
Definition
dilated cardiomyopathy
ischemic cardiomyopathy
EF < 25%
Infractable angina
malignant cardiac dysrhythmias
< 65 years old
pulmonary vascular resistance less than 2 woods units |
|
|
Term
| women have lower survival rates |
|
Definition
|
|
Term
| Heart transplant recipients who die after the procedure usually do so within the first ______ post op |
|
Definition
|
|
Term
| New heart is unresponsive to ________________. |
|
Definition
|
|
Term
| What is common following heart transplant? |
|
Definition
|
|
Term
| What might be required following heart transplant? |
|
Definition
|
|
Term
| Symptoms of heart transplant rejection |
|
Definition
SOB
Fatigue
Edema
Increased weight
Abdominal bloating
New bradycardia
Hypotension
A-Fib/Flutter
Decreased activity tolerance
Decreased EF |
|
|
Term
| The newly transplanted heart does not have what? |
|
Definition
vagus nerve
sympathetic nerve fibers |
|
|
Term
| In heart transplantation, the client cannot experience angina in response to __________________, instead they will experience ________ or ___________. |
|
Definition
cardiac ischemia or infarction
dyspnea, dysrhythmias |
|
|
Term
| this procedure is performed as an intervention in stage 5 CKD |
|
Definition
|
|
Term
| How are kidney transplants performed? |
|
Definition
| surgically placed extraperitoneally in the iliac fossa |
|
|
Term
| When does kidney function begin following transplant? |
|
Definition
|
|
Term
| Kidney transplant: dialysis ______ prior to transplant |
|
Definition
|
|
Term
| blood transfusion from donor is common |
|
Definition
|
|
Term
| the only absolute contraindications of kidney transplantation |
|
Definition
infection
active malignancy |
|
|
Term
| Where is the incision on donor and recipient in kidney transplants? |
|
Definition
|
|
Term
| Kidney transplant: place kidney where? |
|
Definition
|
|
Term
| How often is I&O checked following kidney transplantation? |
|
Definition
|
|
Term
| color of urine following kidney transplant |
|
Definition
|
|
Term
| Symptoms of hyper acute rejection in kidney transplantation |
|
Definition
fever
increased BP
pain at site |
|
|
Term
| Symptoms of acute kidney transplantation rejection |
|
Definition
oliguria
fever
htn
lethargy
fluid retention
increased bun, creatinine |
|
|
Term
| symptoms of chronic kidney transplantation |
|
Definition
increased bun/creatinine
fluid retention
fatigue |
|
|
Term
| cadaver liver can be preserved for up to ___ hours |
|
Definition
|
|
Term
| involves removing the diseased liver and insertion of the donor liver, anastomosis of the vena cava, portal vein, hepatic artery and bile duct are performed |
|
Definition
| orthotopic liver transplantation |
|
|
Term
| the diseases liver is left in and the transplanted liver is inserted alongside it |
|
Definition
| heretotopic liver transplantation |
|
|
Term
| what liver surgery is the most common |
|
Definition
| orthotopic liver transplantation |
|
|
Term
| less vulnerable to rejection |
|
Definition
|
|
Term
| signs of liver transplant rejection |
|
Definition
fever
tachycardia
RUQ pain
elevated AST, ALT, bilirubin
Prolonged PT
Increased alkaline phosphatase |
|
|
Term
| complications of liver transplant |
|
Definition
infection
hepatic bile leaking
hepatic thrombosis
acute renal failure |
|
|
Term
| after transplantation, liver function is monitored through assessment of: |
|
Definition
ALT
AST
bilirubin
albumin
clotting factors
F&E status
BGL
ph |
|
|
Term
| watch for what following liver transplant |
|
Definition
|
|
Term
| clotting problems following liver transplant |
|
Definition
petechia
ecchymosis
bleeding |
|
|
Term
| watch for nephrotoxic and hepatotoxic drugs |
|
Definition
|
|
Term
| where is a t tube inserted |
|
Definition
|
|
Term
| keep site of t tube ____ site of surgery |
|
Definition
|
|
Term
| where should a t tube be clamped |
|
Definition
|
|
Term
| may stay in a place a week or more |
|
Definition
|
|
Term
| should have drainage, call if there is none or too much |
|
Definition
|
|
Term
|
Definition
|
|
Term
| post cornea transplant care |
|
Definition
antibiotic ointments
eye shields
lie on non-operative side
no ice pack on eye
no nose bowing, avoid sneezing, no heavy lifting |
|
|
Term
| symptoms of cornea rejection |
|
Definition
reduced vision
pain
photosensitivity
floaters
cloudy cornea
opaque graft with neovascularization
use steroids topically |
|
|
Term
| what does a cornea not have |
|
Definition
|
|
Term
| Cornea donor care at death |
|
Definition
HOB up to 30 degrees
Antibiotic eye drops
Small ice pack to closed eyes |
|
|
Term
| used to establish healthy cells in both malignant and nonmalignant disease |
|
Definition
| hematopoietic stem cell transplantation |
|
|
Term
| prior to transplant, ablative therapy as well as chemotherapy to eradicate unhealthy cells to prevent rejection of the transplanted cells |
|
Definition
| hematopoietic stem cell transplantation |
|
|
Term
| transfusion reactions and preservative reactions of fever and hypertension as possible |
|
Definition
| hematopoietic stem cell transplantation |
|
|
Term
| donor action: bone marrow |
|
Definition
HLA testing
multiple aspirates |
|
|
Term
| recipient action: bone marrow |
|
Definition
immune suppression and marrow destruction
blood count begins to increase 12+ days
look for chimerisms |
|
|
Term
| uses the patient's own marrow collect from disease free tissue |
|
Definition
| autologous bone marrow transplantation |
|
|
Term
| frozen and sometimes treated to remove malignant cells |
|
Definition
| autologous bone marrow transplantation |
|
|
Term
| autologous bone marrow transplantation has been used to treat what? |
|
Definition
neuroblastoma
hodgkins disease
non hodgkin lymphoma
wilms tumor
rhabdomyosarcoma
ewing sarcoma |
|
|
Term
| for hematopoietic stem cell transplantation, donors may be: |
|
Definition
relatives or nonrelatives
antigen matched or mismatched |
|
|
Term
| ex of hematopoietic stem cell transplantation |
|
Definition
peripheral blood
cord blood |
|
|
Term
| cells are given via IV infusion after bone marrow has been ablated |
|
Definition
| hematopoietic stem cell transplantation |
|
|
Term
| in HSTC, new cells engraft by day ___________. |
|
Definition
|
|
Term
| after HSCT, ____, ____, and _________ start to return to normal |
|
Definition
|
|
Term
| a type of autologous transplant |
|
Definition
| peripheral stem cell transplantation |
|
|
Term
| different type of collection from the patient |
|
Definition
| peripheral stem cell transplantation |
|
|
Term
| stimulate the production of a high number of stem cells and then collect stem cells by an apheresis machine |
|
Definition
| peripheral stem cell transplantation |
|
|
Term
| stem cells are separated from whole blood, the remaining cells and plasma are returned to the patient after apheresis |
|
Definition
| peripheral stem cell transplantation |
|
|
Term
| stem cells are frozen for later transfusion to the patient |
|
Definition
| peripheral stem cell transplantation |
|
|
Term
| rich source of hematopoietic stem cells for use in children with cancers |
|
Definition
| umbilical cord blood stem cell transplantation |
|
|
Term
| stem cells are found with high frequency in the circulation of newborns |
|
Definition
| umbilical cord blood stem cell transplantation |
|
|
Term
| benefit of umbilical cord blood |
|
Definition
| the blood's immunodeficiency at birth, allowing for partially matched unrelated cord blood transplants to be successful |
|
|
Term
| Choosing HSCT transplantation is a difficult decision: |
|
Definition
child faces death without transplantation
preparing child for transplantation places the child at great risk |
|
|
Term
| no rescue procedure if complications occur |
|
Definition
|
|
Term
|
Definition
|
|
Term
| use of immunosuppressants |
|
Definition
prevention of organ rejection
treatment of autoimmune diseases |
|
|
Term
| toxicity: immunosuppressants |
|
Definition
increased risk of infection
increased risk of neoplasms |
|
|
Term
| principle use is for prevention of organ rejection in transplant recipients |
|
Definition
|
|
Term
| 2 main calcineurin inhibitors |
|
Definition
|
|
Term
| most effective immunosuppressants available |
|
Definition
|
|
Term
| differ in structure but share the same mechanism |
|
Definition
|
|
Term
| inhibition of calcineurin suppresses the production of what? |
|
Definition
|
|
Term
| IL2 is needed for T cell proliferation so T cells are suppressed |
|
Definition
|
|
Term
| developed first and used more than tacrolimus |
|
Definition
|
|
Term
|
Definition
|
|
Term
| adverse effects of cyclosporine (sandimmune) |
|
Definition
nephrotoxicity
hepatotoxicty
infection
lymhpoma
HTN
tremor
hirsutism
leukopenia
gingival hyperplasma
gynecomastia
sinusitis
hyperkalemia
anaphylactic reactions |
|
|
Term
| a powerful immunosuppressant |
|
Definition
|
|
Term
| the drug of choice for prevention organ rejection in recipients an an allogenic transplant |
|
Definition
|
|
Term
| cyclosporine's primary molecular target |
|
Definition
|
|
Term
| does not cause bone marrow suppression |
|
Definition
|
|
Term
| renal damage occurs in up to 75% of patients |
|
Definition
|
|
Term
| drugs that can decrease cyclosporine levels |
|
Definition
|
|
Term
| drugs that can increase cyclosporine levels |
|
Definition
|
|
Term
| grapefruit juice prevents metabolism of the calcineurin inhibitors |
|
Definition
|
|
Term
| oral therapy is preferred to IV therapy |
|
Definition
|
|
Term
| initial oral dose of cyclosporine |
|
Definition
| 10-14 mg/kg given 4-12 hours before surgery |
|
|
Term
| maintenance dose of cyclosporine |
|
Definition
|
|
Term
| an alternative to cyclosporine |
|
Definition
|
|
Term
| somewhat more effective but also more toxic |
|
Definition
|
|
Term
| adverse effects of tacrolimus (prograf) |
|
Definition
nephrotoxicity
neurotoxicity
GI effects
HTN
Hyperkalemia |
|
|
Term
| drugs/foods to be avoided in tacrolimus (prograf) |
|
Definition
|
|
Term
| enzyme known as mammalian target of rapamycin |
|
Definition
|
|
Term
| protein kinase that helps regulate cell growth, proliferation, and survival |
|
Definition
|
|
Term
| structurally similar to tacrolimus |
|
Definition
|
|
Term
| does not involve inhibition of calcineurin |
|
Definition
|
|
Term
| only used for prevention of renal transplant rejection |
|
Definition
|
|
Term
| used in conjunction with cyclosporine and glucocorticoids |
|
Definition
|
|
Term
| suppresses T cell proliferation and activation |
|
Definition
|
|
Term
| patients should take this medicine to prevent pneumocystis pneumonia following transplantation |
|
Definition
|
|
Term
| for 3 months after transplant surgery, patients should take medicine to prevent infection with CMV |
|
Definition
|
|
Term
| drug/food interactions with sirolimus (rapamune) |
|
Definition
high fat foods
grapefruit juice |
|
|
Term
| adverse effects of sirolimus (rapamune) |
|
Definition
increased risk of infection
raises levels of cholesterol/triglycerides
risk of renal injury
severe complications in liver/lung
rash
acne
anemia
thrombocytopenia
joint pain
diararhea
hypokalemia |
|
|
Term
| used to widely suppress immune response |
|
Definition
|
|
Term
| glucocorticoids are used for: |
|
Definition
suppression of allograft rejection
treatment of asthma, RA, SLA, MS |
|
|
Term
| large doses used to prevent rejection |
|
Definition
|
|
Term
| glucocorticoids can cause: |
|
Definition
increased risk of infection
thinning of skin
bone dissolution with fracture
impaired growth in children
suppression of hypothalamic pituitary adrenal axis |
|
|
Term
| common dosage to prevent organ rejection of glucocorticoids |
|
Definition
|
|
Term
| dosage of methylprednisolone in acute organ rejection |
|
Definition
|
|
Term
| suppresses immune response by killing B and T lymphocytes undergoing proliferation |
|
Definition
|
|
Term
| nonspecific; toxic to all proliferating cells |
|
Definition
|
|
Term
| Averse effects of cytotoxic drugs |
|
Definition
bone marrow suppression
neutropenia
thrombocytopenia
GI disturbances
reduced fertility
alopecia
neoplasms |
|
|
Term
|
Definition
|
|
Term
| used for autoimmune diseases and cancer treatment |
|
Definition
|
|
Term
|
Definition
azathioprine (imuran)
cyclophosphamide
methotrexate |
|
|
Term
| approved for prophylaxis of organ rejection in patients receiving allogenic heart, liver, or kidney transplants |
|
Definition
|
|
Term
| the drug should be combined with cyclosporine and glucocorticoids |
|
Definition
|
|
Term
| acts on B and lymphocytes to inhibit inosine monophsophate dehydrogenase |
|
Definition
|
|
Term
| selective inhibition of B and T lymphocyte prolisteration |
|
Definition
|
|
Term
| major adverse effects of mycophenolate mofetil |
|
Definition
diarrhea
vomiting
severe neutropenia
sepsis
pure red cell aplasia |
|
|
Term
| very rarely, patients have developed progressive multifocal leukoencephalopathy |
|
Definition
|
|
Term
| Ex of monoclocal and polyclonal antibodies |
|
Definition
Muromonab
Basiliximab
Thymoglobulin |
|
|
Term
| interferes with T cell functioning |
|
Definition
| monoclonal and polyclonal antibodies |
|
|
Term
| side effects of monoclonal and polyclonal antibodies |
|
Definition
flu like symptoms
headache
myalgia
allergic response |
|
|
Term
| are derived from animals so allergy to antigens from the animal call occur |
|
Definition
|
|
Term
| how long to administer polyclonal antibodies |
|
Definition
|
|
Term
| pre medicate monoclonal and polyclonal antibodies with what |
|
Definition
|
|
Term
| adverse effects of monoclonal and polyclonal antibodies |
|
Definition
fever
chills
dyspnea
chest pain
N/V |
|
|
Term
| occurrence of HIV/AIDS in 2019 |
|
Definition
38 million
36.2 million - adults
1.8 million - children |
|
|
Term
| a global pandemic affecting millions |
|
Definition
|
|
Term
| a retrovirus that causes immunosupression |
|
Definition
|
|
Term
| causes the person to be susceptible to infections that would normally be controlled through immune responses |
|
Definition
|
|
Term
|
Definition
| a type of chimpanzee in central america |
|
|
Term
| chimpanzee version of HIV |
|
Definition
| simian immunodeficiency virus |
|
|
Term
| was probably passed to humans when humans hunted chimpanzees for meat and came in contact with their infected blood |
|
Definition
|
|
Term
| When did HIV jump from chimpanzees to humans? |
|
Definition
|
|
Term
| How long has HIV been in the UD |
|
Definition
|
|
Term
| HIV goes from _______ to _______ |
|
Definition
|
|
Term
| where does HIV replicate? |
|
Definition
| inside the living CD4 cell |
|
|
Term
| RNA virus discovered in 1983 |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| an enzyme that transforms HIV RNA into a single strand of DNA |
|
Definition
|
|
Term
| allows the newly formed double stranded DNA to integrate itself into the host's genetic structure |
|
Definition
|
|
Term
| cleaves the newly formed strands of HIV genetic material into smaller pieces |
|
Definition
|
|
Term
| HIV has ______ genetic material. |
|
Definition
|
|
Term
| HIV binds to protein on immunologically active cells and inserts its _______. |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| HIV uses ____________ to convert RNA into DNA and copies itself. |
|
Definition
|
|
Term
| HIV uses ____________ to insert itself into the host's double stranded DNA helix. |
|
Definition
|
|
Term
| instructs the cell to make new HIV |
|
Definition
|
|
Term
| When CD4 cells are destroyed, _____ are released to attach to more cells |
|
Definition
|
|
Term
| the most common type of HIV and occurs all over the world |
|
Definition
|
|
Term
| mainly in west africa but is slowly spreading to other regions including the US, Europe, and india |
|
Definition
|
|
Term
| the type of HIV that tends to develop more slowly |
|
Definition
|
|
Term
|
Definition
male to male sexual contact
heterosexual contact
injection drug use
male to male sexual contact and injection drug use |
|
|
Term
| HIV diagnosis by ethnicity |
|
Definition
Blacks
Hispanics
Whites
Multiple races
Asians
American indians/alaska natives
native hawaiins |
|
|
Term
| In the past 30 years, important advances have been made in HIV ________, _________, and ___________. |
|
Definition
prevention
testing
treatment |
|
|
Term
| often associated with lifestyles that are disenfranchised by much of society |
|
Definition
|
|
Term
|
Definition
blood
semen
vaginal secretions
breast milk
contact with blood/blood products |
|
|
Term
| what is the most common mode of HIV transmission? |
|
Definition
| sexual contact with an infected partner |
|
|
Term
| fragile virus transmitted only through contact with body fluids under specific conditions |
|
Definition
|
|
Term
| major route of HIV transmission in developing countries |
|
Definition
|
|
Term
| most likely population of HIV in developing countries |
|
Definition
|
|
Term
| During any form of sexual intercourse, the risk of HIV infection is greater for the partner who _______ the semen, although infection can also be transmitted to the __________ partner. |
|
Definition
|
|
Term
| HIV is easier to infect _______ than _______ during heterosexual intercourse. |
|
Definition
|
|
Term
| the most common means of work related HIV transmission |
|
Definition
|
|
Term
| In north america, transfusion of infected blood and blood products has caused only __ of adult AIDS cases. |
|
Definition
|
|
Term
| Risk of infection after a needle stick exposure to HIV infected blood |
|
Definition
|
|
Term
| The risk for HIV transmission from puncture wounds is higher in: |
|
Definition
patients with high levels of circulating HIV
a deep puncture wound
a needle with a hollow bore and visible blood
device used for venous or arterial access
patient who dies within 60 days |
|
|
Term
| When can perinatal transmission of HIV occur? |
|
Definition
pregnancy
delivery
breastfeeding |
|
|
Term
| An average of ___ of infants born to women with untreated HIV will contract the infection. |
|
Definition
|
|
Term
| Treatment of HIV during pregnancy can reduce the rate of transmission to less than _____. |
|
Definition
|
|
Term
| The risk of HIV transmission can be reduced to less than ____ in setting where pregnant women are routinely tested for HIV infection and treated with ART if positive. |
|
Definition
|
|
Term
| HIV is not spread through: |
|
Definition
hugging
dry kissing
toilet sets
eating utensils
tears
saliva
urine
emesis
sputum
feces
sweat |
|
|
Term
| HIV is present in these fluid but at low levels and they have not been shown to transmit the disease |
|
Definition
tears
saliva
urine
emesis
sputum
feces
sweat |
|
|
Term
| HIV promotes immunodeficiency by killed ______________________. |
|
Definition
|
|
Term
| how many CD4 T cells does HIV destroy daily? |
|
Definition
|
|
Term
| cannot replicate unless it is inside a living cell |
|
Definition
|
|
Term
| surrounded by an envelope made up of proteins and contains a core of viral RNA and proteins |
|
Definition
|
|
Term
| what attaches HIV to CD4 cells |
|
Definition
gp 120 glycoproteins
chemokine CXCR4 CCR5 receptors |
|
|
Term
| 2 consequences when HIV binds to cells |
|
Definition
all daughter cells will be infected
viral DNA in the genome will direct the cell to make new HIV |
|
|
Term
| In HIV, new viral RNA develops initially in __________ that are cut in the presence of protease and leave the cell through a _____________ that ultimately contributes to cellular destruction. |
|
Definition
long strands
budding process |
|
|
Term
| large viral levels in blood |
|
Definition
|
|
Term
| When is transmission of HIV more likely? |
|
Definition
| when the viral load is high |
|
|
Term
|
Definition
|
|
Term
| How long does viremia last |
|
Definition
|
|
Term
| Viremia is followed by prolonged years of _________________________. |
|
Definition
|
|
Term
| how long does low viral load last in HIV |
|
Definition
| can last more than 10 years |
|
|
Term
| What is a major consequence of rapid replication in HIV? |
|
Definition
| errors can occur in the copying process causing mutations that contributes to ART resistance and limits treatment options |
|
|
Term
| HIV infected individuals can transmit HIV to others within ___________ after becoming infected. |
|
Definition
|
|
Term
| Variables that influence whether HIV infection will be established after an exposure: |
|
Definition
1. duration and frequency of contact with the organism
2. volume, virulence, and concentration of the organism
3. host immune status |
|
|
Term
| In the initial stages of HIV infection, ______ and _______ respond and function normally. |
|
Definition
|
|
Term
| make HIV specific antibodies that are effective in reducing viral loads in the blood |
|
Definition
|
|
Term
| mount a cellular immune response to viruses trapped in the lymph nodes |
|
Definition
|
|
Term
| Immune dysfunction in HIV disease is caused predominantly by damage and destruction of what? |
|
Definition
|
|
Term
| play a key role in the immune system's ability to recognize and defend against pathogens |
|
Definition
|
|
Term
| adults without immune dysfunction have how much CD4 T cells in their blood? |
|
Definition
| 800-1200 CD4T cells/uL of blood |
|
|
Term
| normal life span of a CD4 T cell |
|
Definition
|
|
Term
| normal life span of a CD4 T cell with HIV |
|
Definition
|
|
Term
| Which cells with CD4 receptor sites are infection in HIV? |
|
Definition
CD4 T cells
lymphocytes
monocytes/macrophages
astrocytes
oligodendrocytes |
|
|
Term
| Immune problems started when CD4T cell counts drop to what? |
|
Definition
|
|
Term
| Severe problems occur when CD4 T cells drop below what? |
|
Definition
|
|
Term
| Insufficient immune response in HIV allows for _________________. |
|
Definition
|
|
Term
| When might an HIV antibody test become positive? |
|
Definition
|
|
Term
| When does HIV turn into AIDS? |
|
Definition
| years 10-13 without treatment |
|
|
Term
| HIV infections are divided into different stages: |
|
Definition
Acute
Asymptomatic
Symptomatic
AIDS |
|
|
Term
| seroconversion is often accompanied by a mononucleosis like syndrome that may be mistaken for the flu |
|
Definition
|
|
Term
| How long do symptoms last in acute infection stage of HIV? |
|
Definition
|
|
Term
| When do symptoms of acute infection occur in HIV? |
|
Definition
| 2-4 weeks after the intial infection |
|
|
Term
| Neurological complications in acute HIV infection |
|
Definition
aseptic meningitis
peripheral neuropathy
facial palsy
GBS |
|
|
Term
| during this time, a high viral load is noted and CD4 T cell counts fall temporarily but quickly return to baseline or near baseline levels |
|
Definition
|
|
Term
| Acute infection HIV symptoms |
|
Definition
Fever
Swollen lymph glands
Sore throat
Headache
Malaise
Nausea
Muscle and joint pain
Diarrhea
Diffuse rash that accompanies seroconversion |
|
|
Term
| the interval between untreated HIV infection and a diagnosis of AIDS |
|
Definition
|
|
Term
| During this time, CD4 T cell counts remain above 500 or only slightly decreased and the viral load in the blood will be low |
|
Definition
|
|
Term
| median interval of 10-11 years between infection and diagnosis of AIDS |
|
Definition
|
|
Term
| Most are not aware of infected status and this continue usual activities which may include high risk sexual or drug using behaviors causing a serious public health problem |
|
Definition
|
|
Term
| occurs as the CD4 T cell count drops to 200-500 and the viral load increases |
|
Definition
|
|
Term
| symptoms seen in earlier phases become worse |
|
Definition
|
|
Term
| symptomatic infection symptoms |
|
Definition
fever
headache
fatigue
night sweats
persistent generalized lymphadenopathy
chronic diarrhea |
|
|
Term
| Other infections that can occur during symptomatic infection |
|
Definition
shingles
persistent vaginal candida infections
herpes
bacterial infections
thrush
kaposi sarcoma
oral hairy leukoplakia
oral/genital herpes outbreaks |
|
|
Term
| the most common infection associated with the symptomatic phase of HIV infection |
|
Definition
|
|
Term
| rarely causes a problem in healthy adults but is more common in HIV infected people |
|
Definition
|
|
Term
| an EBC that causes painless white raised lesions on the lateral aspect of the tongue |
|
Definition
|
|
Term
| can occur during the symptomatic phase of infection and is also an indicator of disease progression |
|
Definition
|
|
Term
| malignant vascular lesions that can appear anywhere on the skin surface or on internal organs |
|
Definition
|
|
Term
| What causes kaposi sarcoma? |
|
Definition
|
|
Term
| lesions vary in size from pinpoint to very large and may appear in a variety of shades |
|
Definition
|
|
Term
| immune system is severely compromised |
|
Definition
|
|
Term
| great risk for opportunistic dieases |
|
Definition
|
|
Term
| possible malignancies, wasting, and dementia |
|
Definition
|
|
Term
| AIDS is characterized by: |
|
Definition
CD4 T cell counts < 200
An opportunistic infection
An opportunistic cancer
Wasting syndrome
AIDS dementia complex |
|
|
Term
| loss of 10% or more of ideal body mass |
|
Definition
|
|
Term
|
Definition
Candida of airway or esophagus
Pneumocystis jiroveci
Coccidiodomycosis
Extra pulmonary histoplasmosis
CMS outside liver, spleen, or nodes
CMS retinitis
Toxoplasmosis
Herpes simplex with chronic ulcers
Isosporiasis
MB, mycobacterium avium
Recurrent salmonella septicemia |
|
|
Term
|
Definition
Kaposi's sarcoma
Burkitt's lymphoma
Immunoblastic lymphoma
primary lymphoma of the brain
Invasive cervical cancer |
|
|
Term
| the only sure method of determining HIV infection |
|
Definition
|
|
Term
| The CDC recommends universal voluntary testing for HIV for everyone ages _____________. |
|
Definition
|
|
Term
| An estimated ____ of people are living with HIB and are not aware they are infected. |
|
Definition
|
|
Term
| HIV/AIDS diagnostic testing |
|
Definition
Lymphocyte counts
CD4 and CD8 counts |
|
|
Term
|
Definition
ELISA and Western Blot
Rapid HIV antibody testing
Saliva tests
Antigen testing viral load testing
Antigen antibody testing |
|
|
Term
| How long does rapid HIV antibody testing and HIV antigen antibody testing take? |
|
Definition
|
|
Term
| The most useful screening tests for HIV |
|
Definition
| those that detect HIV specific antibodies |
|
|
Term
| Major problems of HIV specific antibody testing? |
|
Definition
| there is a median delay of 4 weeks after infection before antibodies can be detected |
|
|
Term
| provide HIV results in 20 minute and are recommended by the CDC |
|
Definition
|
|
Term
| Positive HIV antibody tests should be confirmed by another test, usually the _______________. |
|
Definition
|
|
Term
| looks for the actual virus in the blood and involves drawing blood from a vein |
|
Definition
|
|
Term
| This test can either tell if a person has HIV or tell how much virus is present in the blood |
|
Definition
|
|
Term
| known as an HIV viral load test |
|
Definition
|
|
Term
| This test is very expensive and is not routinely used for screening individuals unless they recently had a high risk exposure and have early symptoms of HIV infection |
|
Definition
|
|
Term
| looks for both HIV antibodies and antigens |
|
Definition
|
|
Term
| produced by your immune system when you're exposed to viruses like HIV |
|
Definition
|
|
Term
| foreign substances that cause your immune system to activate |
|
Definition
|
|
Term
| If you have HIV, an antigen call ____ is produced even before antibodies develop. |
|
Definition
|
|
Term
| recommended for testing done in labs and is now common in the US |
|
Definition
|
|
Term
| only look for antibodies to HIV in your blood or oral fluid |
|
Definition
|
|
Term
| most rapid tests and the only currently approved HIV self test |
|
Definition
|
|
Term
| The progression of HIV infection is monitored by 2 important labs: |
|
Definition
CD4 T cells
HIV viral load |
|
|
Term
| How are viral loads reported? |
|
Definition
| in real numbers or as undetectable |
|
|
Term
| indicates the viral load is lower than the test is able to report |
|
Definition
|
|
Term
| does not mean that the virus has been eliminated from the body or that the individual can no longer transmit HIV to others |
|
Definition
|
|
Term
| provide a marker of immune function and decrease as the disease progresses |
|
Definition
|
|
Term
| The lower the viral load = |
|
Definition
| the less active the disease |
|
|
Term
| Abnormal blood test results are common in HIV infection and may be caused by: |
|
Definition
HIV
opportunistic diseases
complications of therapy |
|
|
Term
| What abnormal blood tests are seen commonly in HIV? |
|
Definition
Decreased WBC counts
Lymphopenia
Neutropenia
Thrombocytopenia
Anemia |
|
|
Term
| What can cause altered liver function in HIV? |
|
Definition
HIV infection
drug therapy
co-infection with Hep B or Hep C |
|
|
Term
| These infectious have a more serious course in patients with HIV and may ultimately limit options for ART and can cause liver related morbidity and mortality |
|
Definition
|
|
Term
| can help determine new drug combinations for patients not responding to ART |
|
Definition
|
|
Term
| 2 types of resistance tests in HIV |
|
Definition
genotype assay
phenotype assay |
|
|
Term
| detects drug resistant viral mutations that are present in reverse transcriptase and protease genes |
|
Definition
|
|
Term
| measures the growth of HIV in various concentrations of ART drugs |
|
Definition
|
|
Term
| Initial patient visit: HIV |
|
Definition
Gather baseline data
Begin to establish rapport
Use patient input to develop a plan of care
Initiate teaching about spectrum of HIV, treatment, preventing transmission, improving health, and family planning |
|
|
Term
| Collaborative care of the HIV infected patient focuses on: |
|
Definition
1. Monitoring HIV disease progression and immune function
2. Initiating and monitoring ART
3. Preventing the development of opportunistic diseases
4. Detecting and treating opportunistic diseases
5. Managing symptoms
6. Preventing or decreasing complications of treatment
7. Preventing further transmission of HIV |
|
|
Term
| Several ________ may occur at the same time, further compounding the difficulties of diagnosis and treatment of HIV. |
|
Definition
|
|
Term
| Common opportunistic diseases: HIV |
|
Definition
Candidiasis
Cryptococci meningitis
Cytomegalovirus retinitis
Lymphoma
Mycobacteriam avium complex
Kaposi sarcoma
Influenza virus
Pneumocystis jiroveci
Cryptosporidium
Encephalopathy
AIDS wasting syndrome |
|
|
Term
| complicate management of HIV infection |
|
Definition
|
|
Term
|
Definition
|
|
Term
| What measures can be effective in delaying or preventing many opportunistic diseases associated with HIV? |
|
Definition
adequate ART
Vaccines - Hep B, influenza, pneumococcal
Prevention measures |
|
|
Term
| Although it is not usually possible to eradicate opportunistic diseases once they occur, ______________ can significantly decrease morbidity and mortality rates. |
|
Definition
|
|
Term
| can delay disease progression by decreasing viral replication |
|
Definition
|
|
Term
| When taken consistently and correctly, ART can reduce viral loads by __________, which makes adherence to treatment regimens extremely important. |
|
Definition
|
|
Term
| A major problem with most drugs used in ART |
|
Definition
| resistance develops rapidly when they are used alone or taken in inadequate doses |
|
|
Term
| Main goals of drug therapy in HIV |
|
Definition
Decrease viral load
Maintain/increase CD4 counts
Prevent HIV related symptoms and opportunistic diseases
Delay disease progression |
|
|
Term
| At risk patients for HIV? |
|
Definition
received blood transfusion or clotting factors before 1985
Shared needles, syringes or other injection equipment
Had a sexual experience with your penis, vagina, rectum, or mouth in contact with these areas of another person?
Had a STI before |
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Term
| The first step in prevention HIV transmission |
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Definition
| assess the patient's individual risk behaviors, knowledge, and skills |
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Term
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Definition
Past health history
Medications
Functional health patterns
Presence of symptoms |
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Term
| Nursing interventions that can help the patient with HIV |
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Definition
1. Adhere to drug regimen
2. Promote healthy lifestyle including avoiding exposure to other sexually transmitted/blood borne diseases
3. Protect others from HIV
4. Maintain/develop healthy and supportive relationships
5. Maintain activities and productivity
6. Explore spiritual issues
7. Come to terms with issues related to disease, disability and death
8. Cope with symptoms caused by HIV and its treatments |
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Term
| the most effective strategy for diseases of a chronic nature including HIV |
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Definition
| primary prevention and health promotion |
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Term
| encourages early detection of the disease so that if primary prevention has failed, early interventions can be initiated |
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Definition
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Term
| When HIV prevention fails: |
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Definition
disease results
early intervention is facilitated by health promotion practices |
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Term
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Definition
Blood exposure to mucous membranes
Percutaneous injury
Splash exposure to mucous membranes |
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Term
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Definition
| 1-2 hours, 72 hours at most after exposure |
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Term
| 2 different three drug regimens |
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Definition
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Term
| Regimen is taken for 28 days |
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Definition
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Term
| HIV testing for non-occupational exposures |
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Definition
at HIV exposure
6 weeks
12 weeks
6 months |
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Term
| based on risk - no PEP or 2 NRTIs |
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Definition
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Term
| Usually a protease inhibitor + emtricitabine + tenfovir |
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Definition
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Term
| Taken for 28 days and routine testing |
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Definition
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Term
| currently only indicated for men who have sex with men and those high risk for HIV infection |
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Definition
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Term
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Definition
| Tenofovir/Emtricitabine (Truvada) |
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Term
| May reduce infection risk by up to 70% |
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Definition
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Term
| Still must maintain safe sexual practices |
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Definition
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Term
| What is the recommended initial regimens for most people with HIV? |
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Definition
| an integrase strand transfer inhibitor anchor drug in combination with at least one NRTI |
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Term
| Typically combinations of HIV treatment consists of ____ drug regimens. |
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Definition
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Term
| those that eliminate risk |
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Definition
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Term
| those that decrease by do not eliminate the risk |
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Definition
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Term
| HIV infection is _____________. |
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Definition
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Term
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Definition
Avoid risky behaviors
Modify risky behaviors
Candid, culturally sensitive, language appropriate, age specific information and behavior change counseling |
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Term
| eliminate the risk of exposure to HIV in semen and vaginal secretions |
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Definition
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Term
| the most effective strategy in preventing HIV |
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Definition
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Term
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Definition
masturbation
mutual masturbation |
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Term
| Risk reducing sexual activities |
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Definition
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Term
| the most commonly used barrier |
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Definition
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Term
| means protection provided under ideal circumstances |
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Definition
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Term
| means protection provided in real life circumstances |
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Definition
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Term
| Female condom effectiveness is ________ against HIV and other STIs. |
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Definition
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Term
| squares of latex used to cover external female genitalia during oral sex |
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Definition
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Term
| has significantly decreased the risk for infants born to HIV infected women |
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Definition
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Term
| Decreasing risks: Perinatal transmission |
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Definition
Family planning
Prevent HIV in women
Appropriately medicate HIV infected pregnant women |
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Term
| promotes health and delays disability |
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Definition
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Term
| can significantly slow disease progression |
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Definition
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Term
| negative consequences of cART |
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Definition
complex
has side effects
does not work for everyone
is expensive |
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Term
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Definition
Prevents irreversible injury
Decreases viral replication
Decreases opportunistic infection or cancer risk
Decreases transmission risk |
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Term
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Definition
Adverse effects
Viral mutation
Drug resistance
Length of treatment
Toxicity
Treatment fatigue |
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Term
| Adherence to drug regimens is critical to prevent: |
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Definition
disease progression
opportunistic disease
viral drug resistance |
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Term
| Issues to consider when selecting an initial HIV drug regimen: |
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Definition
Ability of the HIV/ to resist specific drugs
Potential medication side effects
Existing co-morbidities
Dosing schedules |
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Term
| generally a HIV patient's best chance for success |
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Definition
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Term
| The most important concern of ART |
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Definition
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Term
| a major consideration to ART due to effectiveness, cost, and complexity of many drug regimens |
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Definition
| patient's ability to comply |
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Term
| can help delay HIV progression whether or not the patient chooses to use ART interventions |
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Definition
| supporting a health immnune system |
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Term
| Ways to support a health immune system |
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Definition
Adequate nutrition
Elimination of alcohol, tobacco, and drug use
Up to date on vaccinations
Reducing stress
Avoiding risky behaviors
Supportive relationships |
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Term
| Chronic diseases are characterized by __________________. |
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Definition
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Term
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Definition
has no cure
continues for life
causes physical disability
impairs social, emotional, economic, and spiritual well being
ultimately leads to death |
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Term
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Definition
LOC change
H/A with N/V, vision change, coordination change
Persistent SOB
Hematemesis
Dehydration
Jaundice
Melena
Flank pain with anuria
Hematuria
CP unrelated to cough
Seizure
Rash with fever
Depression, hallucination, delusion |
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Term
| the most common opportunistic infection |
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Definition
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Term
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Definition
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Term
| causes gastroenteritis and watery diarrhea |
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Definition
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Term
| causes meningitis, cognitive decline, seizures and headache |
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Definition
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Term
| Bacterial opportunistic infections |
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Definition
Mycobacterium tb
MYCOBACTERIUM AVIUM COMPLEX
salmonellosis
bacterial pneumonia |
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Term
| fungal opportunistic infection |
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Definition
PCP
candidiasis
CRYPTOCOCCOSIS
histoplasmosis
coccidioidomycosis |
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Term
| causes encephalitis, cognitive loss, seizures |
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Definition
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Term
| causes diarrhea, abdominal pain, weight loss |
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Definition
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Term
| causes cognitive loss, mental and motor deficiency, PML |
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Definition
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Term
| causes organ affected changes, retinitis, loss of vision, esophagitis, weight loss, pain, colitis, diarrhea, pneumonitis, respiratory inflammation, cough, respiratory distress |
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Definition
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Term
| protozoal opportunistic infections |
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Definition
toxoplasmosis
cryptosporidium
isosporiasis |
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Term
| viral opportunistic infections |
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Definition
cytomegalovirus
herpes simplex
varicella
hepatitis
JC papovirus (PML) |
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Term
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Definition
HIV encephalopathy
Progressive multifocal leukoencephalopathy |
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Term
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Definition
Hyperthermia
Fatigue
Imbalanced nutrition: less than body requirements
Pain
Ineffective gas exchange
Knowledge deficit
Risk for altered family processes
Altered elimination: diarrhea
Self care deficit
Compliance |
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Term
| Common physical problems - drug side effects - HIV |
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Definition
Anxiety, fear, depression
Diarrhea
Peripheral neuropathy
Pain
N/V
Fatigue |
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Term
| Certain metabolic disorders in HIV treatment cause: |
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Definition
Hyperlipidemia
Insulin resistance
Bone disease
Lactic acidosis
Renal disease
CVD |
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Term
| Changes in body shape: HIV |
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Definition
Fat deposits in abdomen, upper back, and breasts
Fat loss in arms, legs, and face |
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Term
| Manifestations of lipodysrtophy |
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Definition
Buffalo hump
Facial wasting |
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Term
| major drug classifications for HIV |
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Definition
entry/fusion inhibitors
non-nucleoside reverse transcriptase inhibitors
nucleoside reverse transcriptase inhibitors
nucleotide reverse transcriptase inhibitors
integrase inhibitors
protease inhibitors |
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Term
| which drug classes inhibit the ability of HIV to make a DNA copy early in replication |
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Definition
| nucleoside, non-nucleoside, and nucelotide reverse transcriptase inhibitors |
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Term
| interfere with the activity of protease which is needed for viral growth and inefectivity |
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Definition
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Term
| interfere with HIV CD4 receptor site binding and entry into cells |
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Definition
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Term
| interfere with replication and insertion into DNA |
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Definition
| integrase strand inhibitors |
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Term
| three or more drugs from different groups are prescribed at full strength |
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Definition
| combination antiretroviral therapy |
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Term
| reduced AIDS deaths by 72% |
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Definition
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Term
| 5 types of antiretroviral drugs |
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Definition
reverse transcriptase inhibitors
integrase strand transfer inhibitors
protease inhibitors
fusion inhibitors
CCR5 antagonists |
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Term
| which ARTs inhibit enzymes required for HIV |
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Definition
reverse transcriptase inhibitors
integrase strand transfer inhibitors
protease inhibitors |
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Term
| which ARTS block viral entry into cells |
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Definition
fusion inhibitors
CCR5 antagonists |
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Term
| Integrase strand transfer inhibitor |
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Definition
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Term
| Inhibits an enzyme needed for replication and insertion into cellular DNA |
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Definition
| integrase strand transfer inhibitor |
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Term
| Adverse side effects of integrase strand transfer inhibitors |
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Definition
Insomnia
Headache
rare hypersensitivity reactions |
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Term
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Definition
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Term
| Inhibits HIV replication by suppressing synthesis of viral DNA |
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Definition
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Term
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Definition
Anemia
Neutropenia
Lactic acidosis
Hepatic steatosis |
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Term
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Definition
| bone marrow suppressing agents |
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Term
| Drug of choice for preventing mother baby transmission of HIV |
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Definition
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Term
| differ from NRTIs in structure and mechanism of action |
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Definition
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Term
| bind to the active center of reverse transcriptase and cause direction ihibition |
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Definition
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Term
| Active as they are administrered |
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Definition
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Term
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Definition
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Term
| Preferred agent for treating HIV |
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Definition
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Term
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Definition
| decreases hormonal contraception effectiveness |
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Term
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Definition
Insomnia
Dreams
Hallucination
Rash
Teratogenicity |
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Term
| among the most effective ART drugs available |
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Definition
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Term
| used in combination with NRTIS |
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Definition
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Term
| can reduce viral load to an undetectable level |
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Definition
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Term
| Ex of a protease inhibitor |
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Definition
| Saquinavir (Invirase, Fortovase) |
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Term
| Adverse effects of protease inhibitors |
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Definition
hyperglycemia/diabetes
fat malredistribution
hyperlipidemia
reduced bone density |
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Term
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Definition
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Term
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Definition
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Term
| First HIV fusion inhibitor |
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Definition
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Term
| Blocks entry of HIV into CD4 cells |
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Definition
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Term
| Twice daily subcutaneous dosing |
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Definition
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Term
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Definition
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Term
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Definition
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Term
| Indicated for combined use with other ARTS |
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Definition
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Term
| For use to stop entry to CD4 cells if HIV is a strain that requires CCR5 |
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Definition
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Term
| best measurement for predicting clinical outcome of HIV |
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Definition
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Term
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Definition
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Term
| can reduce the risk for infection after accidental exposure |
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Definition
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Term
| Advanced HIV disease may require _____________ because of decreased CD4 T cell counts. |
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Definition
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Term
| a potentially fatal opportunistic infection |
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Definition
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Term
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Definition
Patient comfort
Promoting acceptance of finite nature of life
Helping SO deal with loss
Maintaining safe environment |
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Term
| caution of hiv drugs in pregnancy |
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Definition
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Term
| What HIV drug should be avoided in pregnancy? |
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Definition
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Term
| course of HIV moves faster |
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Definition
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Term
| Diagnostic testing for HIV with antibody test is not accurate until after __________ because of maternal antibodies. |
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Definition
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Term
| What is used for diagnosis of HIV in children? |
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Definition
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Term
| Symptoms of HIV in children |
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Definition
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Term
| death rates from opportunistic infections are reduced |
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Definition
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