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Flashcards in (1) Common problems in acute care Deck (61):
1

Acute Pain - what is the duration

< 6 months caused by tissue damage

2

Chronic Pain - What is the duration

Continual or episodic pain of >6 months

3

Acute versus chronic pain

acute < 6 months
chronic > 6 months

4

Dislocated knee playing tennis. What type of pain

Somatic

5

Cutaneous - describe

Skin

6

What type of pains is Cholelithiasis - gall bladder pain?

Visceral

7

Visceral - describe

Around internal organs

8

What type of pain is Sciatica?

Neuropathic

9

Neuropathic pain - describe

Along nerve pathway injury or compression

10

What type of pain is Herpes zoster?

Neuropathic

11

Somatic - describe

Soft tissue

12

WHO ladder of pain management

3 step initiative - cancer, anesthesia
1. Non-opioid +/- adjuvants
2. Non-opioid +/- adjuvants + mild narcotic
3. Non-opioid +/- adjuvants + moderate narcotic

13

WHO ladder of pain management

Breakthrough cancer pain

Sustained release patch

14

When discussing pain management, what is an adjuvant

Not typically used for pain management:
Antidepressants
Muscle relaxers
Sedatives
Anti-anxiety
Anti-seizure

15

Q!
58 year old korean male, complains of chest pain 4/10, pallor, reluctant to answer questions. What would cause NP to admit the patient to Chest pain unit?

Ethnicity -

stoic asian cultural - taught not to express pain

16

Q!
Cancer patient with break-through pain on MSO4. What is the best next step?

Add a fentanyl patch

17

What is normal body temp in C?

37 degrees = 98.6F

18

What is a fever in C?

38.3 = 101.5 F

19

Causes of fever - that require antibiotics

Bacterial, viral, rickettsial, fungal, or parasitic infections

All other causes - do not require antibiotics

20

Patient shows up to ER with high fever, history of taking anti-psychotics. Which is priority? and what is likely diagnosis?
A. Analgesics
B. Antibiotics
C. IVF
D. PRBC

Likely diagnosis Malignant hyperthermia

C. IVF - flush it out

21

Non-infectious post-op fever. What are the first questions?

What do lungs sound like?

What is I&O?

22

What is the 3 leading causes of non-infectious post-op fever?

1. Atelectasis

2. Dehydration

3. Drug reactions

23

What drugs cause Non-infectious post-op fever?

Amphotericin B
Trimethorpim-sulfamethoxazole
Beta-lactam
Procainamide
Isoniazid (INH)
Alpha-methyldopa
Quinidine
ect...

24

Can someone have a drug reaction with a 2nd dose of the drug?

Yes

25

Causes of INFECTIOUS post-op fever

1. Left shift - bandemia
2. Surgical sites
3. Catheters

26

is WBC > 30,000 due to infection?

Not likely

look more towards leukemia

27

Q! - Post-op patient fever for 3 days
WBC 15,000
Eosinopils 9%
Blood cultures negative
What is diagnosis?

Drug Fever

Rationale -
Viral infection - Eosinophilia - allergic reaction
Bacterial infection - cultures negative
Malignant hyperthermia - Happens immediately after succinylcholine

28

Malignant Hyperthermia

Succinylcholine given with anesthesia
Increase temp

Remove stimulus
Give IVF and Dantrolene

29

All of the findings are expected with cluster headaches except?
A. Nasal congestion, rhinorrhea
B. daily peri-orbital pain
C. Precipitated by alcohol
D. Vice like pain

D. Vice-like pain

Pain with cluster headache
-- pain around eye

30

Headache evaluation (5)

Chronology
Location and duration
Associated activity
Associated symptoms
Triggers

31

3 major types of headaches

Tension
Migraine
Cluster

32

Tension Headache
S/S, Labs, Management

Most common - 90% of headaches
S/S - vice like
generalized
no focal neurological symptoms
Management - Relaxation
OTC analgesics

33

Tension Headache -
S/S, Labs, Management

Most common - 90% of headaches
S/S - vice like
generalized
no focal neurological symptoms
Management - Relaxation
OTC analgesics

34

Migraine types (2)

Classic migraine (migraine with aura)

Common migraine (migraine without aura)

35

Migraine

Female
Late adolescence/early adulthood
Family history +

36

Migraine incidences

Female
Late adolescence/early adulthood
Family history +

37

Migraine Triggers

Emotional/physical stress
Lack/excess sleep
Missed meals
Specific foods
Alcohol
Menstruation
Use of birth control
Nitrates
Changes in weather

38

Migraine Symptoms

Unilateral, lateral throbbing episodically
May be dull/throbbing
Build up gradually
Focal neurologic disturbances
-- numbness, visual, clumsy
Photophobia and phonophobia

39

Migraine diagnosis

IF new migraine - rule out organic causes
-- BMP, CBC
-- VDRL - neuro syphilis
-- ESR
-- CT scan of head with neuro findings

40

Migraine management

Avoid triggers
Relax/stress management
Prophylactic daily therapy if >2-3xmo
-- topiramate, gabapentin, amitryptyline, propanolol

41

Migraine management of acute attack

Rest in dark/quiet room
ASA
sumatriptan (imitrex) 6mg SQ at onset x 3
Imitrex 25mg PO at onset

42

Cluster headache - causes

causes
Middle-aged man
Alcohol
s/s
Severe - unilateral periorbital pain daily
Occurs at night
< 2 hours
Ipsilateral nasal congestion
Rhinorrhea
Eye redness

43

What is the black box warning for tricyclic antidepressants?

Prolongation of the QT

44

Cluster headache treatment

100% O2
Sumatriptan 6mg SQ
Ergotamine tartrate aerosol inhalation

45

Sumatriptan is given to treat?

Cluster headaches and migraines

46

Nutritional support
What is the normal Albumin level & what does low albumin look like?

3.5-5
< 3.5 Protein malnutrition
< 2.7 -- edematous

47

What gives you the earliest indication of malnutrition?

Pre-albumin

48

What is the normal hemoglobin?

When do we transfuse?

Women 12-15.5
Men 13.5-17.5

Transfuse < 8/24
-- in certain patients 7 might be acceptable

49

Why do men have higher H&H than women?

Testosterone stimulates erythropoietin production.

50

What is the hemoglobin/hematocrit ratio?

1/3
Hemoglobin 10 - hematorcit 30

51

1 Unit PRBC should affect your H&H by how much?

Hemoglobin up by 1
Hematocrit up by 3

52

Clinical observation of Good nutrition

Clear nail beds free of ridges
Pink moist mucous membranes
Skin is shiny
Musculature
Hair not easily plucked

53

Determining the type of Nutritional Support

Use the gut if you can
-- > 6 weeks - Enterostomal Tube (PEG)
-- < 6 weeks - NGT
-----At risk for aspiration? uses Duodenal tube (nasoduodenal tube)

NO gut
--> 2 weeks - Central vein (also needed if 10% dextrose or more)
-- < 2 weeks - PIV

54

Complications of Enteral support (7)

Aspiration
Diarrhea
Emesis
GI bleeding
Mechanical obstruction of the tube
Hypernatremia
Dehydration

55

Complications of Parenteral Nutritional Support (8)

Pneumothorax
Hemothorax
Arterial laceration
Air emboli
Catheter thrombosis
Catheter sepsis
Hyperglycemia
HHNK

56

Re-feeding syndrome

low phosphorus

57

What are some changes you can make if diarrhea r/t enteral feeding occurs? (3)

Dilute solution
If on bolus feeding - change to continuous
Decrease rate

58

Q! - Suspected CLABSI. What is best intervention?
A. Start antibiotics
B. Cultures
C. Change wire
D. D/C line

If suspected - GET IT OUT

D. D/C line - pull line to get the tip

59

Q! - What does protein-rich supplementation do?

Aids in post op healing

60

Q! - What value is most critical in a cachexia patient?
A. Mag
B. Na
C. K
D. Ca

K - most critical

61

Q! - If a patient on TPN is in sepsis, What labs are appropriate
A. Blood cultures
B. CBC
C. LFT
D. BMP

D. BMP - glucose and electrolytes