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Nursing Struggle Bus > AC 3 Exam 2 > Flashcards

AC 3 Exam 2 Flashcards

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1
Q

What are some symptoms of a Black widow bite?

A

Pain, redness, edema, numbness, tingling, etc.
There is a great seizure risk with this
Multi-system problems
Severe abdominal pain, HTN

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2
Q

What are some symptoms of a snake bite?

A

Pain
Warmth, edema, if severe, anaphylaxis
High risk for airway compromise & respiratory failure
Renal damage
Clotting abnormalities
Numbness, tingling, etc

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3
Q

How do you manage a Black widow bite?

A

Tetanus shot
Ice/cold to bite to decrease action of neurotoxin
Opioid pain meds
Monitor VS

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4
Q

How do you manage a snake bite in the hospital?

A

Supplemental O2; intubation if needed
2 Large-bore IVs
Anti-venom

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5
Q

What education needs to be provided to prevent a Black widow bite?

A

Wear gloves/arms when working on gardens
Don’t apply heat; it will increase circulation, meaning venom will get distributed to the body faster

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6
Q

What is the nurse’s role in the hospital disaster system?

A

Prioritize victims who are likely to survive vs. not
Rapid discharge of patients

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7
Q

What are some ways to prevent drowning?

A

Observation in & around water
Don’t swim alone
Avoid alcohol/drugs
Test depth of water
Rescue equipment

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8
Q

Why is knowing how much & what kind of water important when someone drowns?

A

Salt water & contaminated water are more dangerous than fresh water; salt water causes F&E shifts and causes more water to be drawn into lungs
Contaminants = sepsis

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9
Q

What education can you provide to prevent altitude related illnesses?

A

Don’t ascend too quickly
Take oral acetazolamide 24 hours prior to ascent & 2 days into trip if you have a history of altitude-related illness
Drink lots of fluid

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10
Q

What are some symptoms of altitude related illnesses?

A

Acute mountain sickness: headache, anorexia, N/V, chills, irritable, looks hungover, SOB at rest or exertion, tachy or bradycardia, normal BP to orthostatic hypo

High-altitude cerebral edema: Extreme. mental status changes, impaired judgement, CN dysfunction

High-altitude pulmonary edema: SOB, pink frothy sputum, crackles

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11
Q

How does the 3-Tier triage system work?

A

Divides into Emergent (life threatening), Urgent (quickly/not life threatening), and non-urgent (can wait without fear of deterioration)

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12
Q

What are some examples of emergent situations using the 3-tier triage system?

A

Respiratory distress
Chest pain
Stroke
Active hemorrhage
Unstable VS
Anything that needs to be seen immediately; if not, we lose a system

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13
Q

What are some examples of urgent situations using the 3-tier triage system?

A

Severe abdominal pain
Displaced or multiple fractures
Pneumonia (that is not in respiratory distress)
But if any of these were to involve some kind of unstable VS, they would be emergent

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14
Q

What are some examples of non-urgent situations using the 3-tier triage system?

A

Skin rash
Strains & sprains
Colds
Simple fractures

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15
Q

Why do we have to use specific words like “death” and “died” when describing death to family members?

A

If we use words like expired, or passed away, they might not understand. Using vague words can be understood as there is still a chance that the patient can be resuscitated, which gives families false hope. We can’t do that

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16
Q

What 3 things need to be considered when discharging a patient and providing education?

A

Their primary language
Visual/hearing acuity
Education level

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17
Q

Why is CT more preferred initially than MRI when we have a trauma patient?

A

Because CT is faster than MRI

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18
Q

What’s the difference between the primary survey and the secondary survey in the ED?

A

Primary is checking briefly to see if the patient is alive; airway secured? are the breathing? (ABCDE) etc.
Secondary is more like the head-to-toe assessment that we do normally; more in-depth than primary

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19
Q

ABCDE is usually how we prioritize care. What if we were to have a patient who has a massive uncontrolled bleeding?

A

Then we do CABDE; we need to control the bleeding (circulation) first.

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20
Q

Why is knowing the mechanism of injury important?

A

To make sure to assess and do testing accordingly to plan the treatment. For example, for GSW, we need to know if it went through, where it entered from, if the bullet is still in there, etc.

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21
Q

What’s the biggest difference between the heat exhaustion and heat stroke?

A

Heat stroke is a emergency; involves altered mental status and no sweating.
No sweating is a bad sign. You’re body is not compensating
Heat exhaustion, you are very sweaty; body is trying to cool itself down by it

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22
Q

Why do we not use aspirin or antipyretics for heat stroke?

A

Because the patient is not having a fever. It’s heat from outside. So we just cool them down with cooling blanket, ice, and cooled NS.

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23
Q

What kind of temperature are we measuring when the patient has a heat stroke?

A

Core temperature; rectal or foley probe

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24
Q

Why do we not want heat stroke patients to shiver?

A

Shivering is the body’s attempt to keep heat. We don’t want to keep heat. So we give Benzos to not shiver

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25
Why is drinking alcohol a bad idea when you are hypothermic?
Alcohol is a diuretic; diuresis = blood shunting to major organs. Also, you won't feel that you are hypothermic, which will make everything bad. You are more at risk for death
26
Why is close monitoring of electrolytes important when rewarming the patient after hypothermic event?
Rewarming increases risk for F&E shifts, metabolic abnormalities, acute respiratory distress syndrome, renal failure, and pneumonia
27
How is frostbite related to compartment syndrome?
Affected tissues become crystallized and traps those soft tissues inside like a cast. Therefore at least an hourly check is needed
28
You are caring for a pt with a frostbite on the feet. Place the following interventions in the correct order. 1. Immerse the feet in warm water 99-102 degrees 2. Remove the victim from the cold environment 3. Monitor for signs of compartment syndrome 4. Apply a loose, sterile, bulky dressing 5. Administer a pain medication
2 5 1 4 3
29
What education is needed so snake bite can be properly managed before coming to the hospital?
Remove jewelry & clothes due to swelling Call 911 since there is a high risk for airway compromise Take a picture of the snake and the affected site Immobilize extremity at heart level No incise, suck wound, apply ice, or use tourniquet Come to the hospital to get anti-venom
30
What's the patho behind altitude-related illnesses?
Increased altitude = decreased barometric pressure = decreased pressure = decreased O2 available Leads to edema and hypoxia
31
What's one thing you need to check before giving someone an oral acetazolamide for altitude-related illnesses?
Check for sulfa allergy
32
What medication is used to decrease cerebral edema caused by altitude-related illnesses?
Dexamethasone. It doesn't really help with pulmonary edema though It's a steroid so anti-inflammatory
33
How does viagra help with altitude-related illnesses?
It causes pulmonary vasodilation
34
Prehospital drowning education
If diving, spinal stabilization Rapid rescue & airway clearance Abdominal or chest thrusts only if airway obstruction or cardiac arrest
35
Do we give rescue breaths even if they inhaled water?
Yes; if have a pulse, give breaths & chest thrust to get water out of lungs
36
Why is gastric decompression expected to drown patients?
They probably got water in their stomach. That's going to be uncomfortable & if it's contaminated water, we want it out
37
How does the triage color tag system work?
Red - immediate; will not survive if not seen immediately Yellow - not in immediate danger but needs observation or possible later re-triage Green - "walking wounded" needs medical care at some point, but after more critical injuries White - dismiss; minor injuries Black - dead/can't survive
38
What causes hypovolemic shock?
Acute loss of fluid/blood; dehydration, hemorrhage But also: surgery, liver disease, cancer therapy, meds, etc.
39
What does decreased MAP mean?
Decreased perfusion
40
What are the stages of shock?
1. initial stage 2. compensatory stage 3. progressive stage 4. refractory stage
41
What happens during the compensatory stage of shock?
Mild tachycardia, hypotension But we're good, stable. compensating
42
What happens during the progressive stage of shock?
Tachycardia, hypotensive. Lactate produced; acidosis. check ABGs
43
What happens during the refractory stage of shock?
Everything is deteriorating Hypotensive but not responding to fluid, blood, pressors, etc. We're dying
44
What are the first signs of shock?
Increased HR, changes in pulse quality
45
What are we focusing on when treating hypovolemic shock?
Reverse shock, restore fluid volume, prevent complications
46
What indicates that the body has good perfusion?
Good/adequate/normal urine output
47
What meds are we giving when treating hypovolemic shock?
O2 Fluids/blood Vasoconstrictors (dopamine, levo, neo) Inotropics (dobutamine, milrinone, dopamine, epi) Sodium nitroprusside
48
Why do we give O2 to hypovolemic shock patient?
Increase the amount of available O2 to all the blood they have
49
How do vasoconstrictors work?
Constricts blood vessels; increases MAP, venous return, and contractility Causes decreased peripheral perfusion
50
How do inotropics work?
Increases contractility; increases cardiac output, therefore increases BP
51
Why might we use sodium nitroprusside for shock patients?
It dilates coronary arteries; for HTN or cardiogenic patients
52
How often should we check vitals in shock patients?
Q15 mins until shock resolved
53
What measures amount of blood coming to the right atrium (preload)?
CVP
54
Why is preload important?
Shows fluid status. Low preload = low fluid available in body for perfusion
55
Why is glucose check important in shock patients? What range should we maintain?
Shock increases the body's demand. Glucose check is to see if the body can handle it; we're checking both the pancreas (insulin) and liver (glucagon) by checking sugar. 150-180 is ideal
56
Insulin decreases what electrolyte?
Potassium
57
What usually causes cardiogenic shock?
Acute MI
58
What's happening during cardiogenic shock?
Heart's ability to pump is impaired; therefore decreased cardiac output and BP
59
What are the risk factors for cardiogenic shock?
cardiac injury; MI, degeneration, tamponade, cardiomyopathies
60
How do we know if fluid is the problem when treating a shock patient?
Check CVP and assess them
61
How do we manage cardiogenic shock?
Support the pump Avoid dehydration and also fluid overload Inotropes Reduce workload
62
What are some ways to reduce the workload of the heart?
Rest Devices (LVAD, balloon pump)
63
What's the Parkland formula?
4 x % of burn x pt's weight in kg = required first over 24 hours Divide that by 2 and give the half in first 8 hours of injury and other half in next 16 hours
64
What does 1st degree burn look like?
Superficial; only top of the epidermis Dry, pink-red, no edema, pain, peels away Ex) sunburn
65
What does 2nd degree burn look like?
2 types: Superficial partial thickness; into dermis Moist red, blanching Blisters Mild-moderate edema Deep partial thickness; extend deeper into dermis Less moist, less blanching, less painful Soft/dry eschar Scar deposition, contraction & limited re-epithelialization
66
What does 3rd degree burn look like?
Full thickness; entire dermis, sometimes subQ fat Dry, black, brown, yellow, white, red Severe edema No pain or blisters Hard eschar non-elastic Skin graft needed Contraction & scar deposition
67
What does 4th degree burn look like?
Deep full thickness; damage down to bone, muscle, and tendon Black Severe edema No pain or blisters Hard eschar non-elastic Grafting may not work High risk of infection
68
At what burn stage do you start to see eschar & contraction?
Deeper 2nd degree burn
69
At what burn stage do you start not to feel pain?
3rd degree
70
How does burn increase risk for metabolic acidosis?
Fluid and electrolyte loss from burn -> hypovolemia -> decreased perfusion to body -> lactate is produced -> metabolic acidosis
71
What are the 3 phases of burn?
Emergent (resuscitation) phase Acute (healing) phase Rehab (restorative) phase
72
What happens during the emergent (resuscitation) phase of burn?
Time of injury up to 48 hours Fluid resuscitation (parkland formula) ABCs Pain relief
73
Are burn patients more at risk for hyperthermia or hypothermia?
Hypo because loss of skin = loss of insulation. Burn also causes fluid loss which decreases body temp
74
How long is the acute (healing) phase of burn?
36-48 hours after injury and lasts until wound closure complete
75
What happens during acute (healing) phase of burn?
Wound care management Infection prevention
76
What are some cardiovascular changes that can happen to burn patients?
Increased HR Decreased cardiac output (up to 36 hours after injury) Possible MI
77
What type of diet are burn patients on?
High calorie, high protein
78
Why is LR more preferable than NS when treating burn patients?
Electrolyte imbalance
79
What are some pulmonary changes that can happen to burn patients?
Lung inflammation Particles in lungs Sloughing of lining of bronchi due to heat Alveoli edema Inhalation burn
80
What are some GI changes that can happen to burn patients?
Fluid shifts Decreased blood flow to GI tract due to either hypovolemic or fight/flight vasoconstriction = risk for paralytic ileus GI secretions & gases increase Abdominal distention Risk for Curling's ulcer
81
Why do we give PPIs, H2 blockers, etc. to burn patients?
Prophylactic; they are at risk for Curling's Ulcer (stress ulcer)
82
Why do we give prophylactic abx to burn patients?
No skin barrier Increased risk of infection (raw skin) Inflammatory process suppresses immune function
83
What are some s/s of inhalation burn?
SpO2, breathing change Soot under, burnt nose hair Breath sounds (stridor/wheezing)
84
Where should smoke/carbon monoxide detectors be placed?
Each bedroom Each hallway Kitchen Stairways Entrance of home
85
How can carbon monoxide poisoning be a side effect of burn?
Home releases CO when burns
86
What are some s/s of carbon monoxide poisoning?
Big headache Symptoms like hypoxemia (SOB, wheezing, confusion, etc.) Depends on carboxyhemoglobin level
87
How do you treat CO poisoning?
GIve lots (100%) of O2; 15L on nonrebreather
88
Anna is a burn patient. Burn happened at 0300 and now it's 0400. Fluid resuscitation amount was calculated using the Parkland formula and 4500 cc is required for the first 8 hours. How should you program your pump?
4500/7; and hour has already passed so we need to give 4500 in 7 hours. 643cc/hr
89
Why would you wear gloves and PPE when caring for burn patients?
Because they are at a high risk for infection; kind of like leukopenia patients. Reverse isolation
90
What electrolyte are we monitoring during early phase of burn?
Potassium
91
What can be done to prevent contracture on the hand and UE that's burnt?
Elevate hands Apply splints as prescribed Work with PT
92
Why do we not want to wash burn area with cool tap water and put lotion on?
Infection. Cool sterile water and prescribed, sterile packed wound care supplies can be used instead
93
Who are at risk for HIV?
IV drug users Healthcare workers Sexually active (esp. multiple partners) Sex workers
94
What are some symptoms of acute HIV infection?
Flu-like; fever, night sweats, chills, headaches, muscle weakness, sore throat, rash (means viral infection), diarrhea
95
How does lab work look like as HIV progresses?
More CD4 & T cells infected Decreased WBC Increased antibodies that are incomplete or nonfunctional Increased macrophages that function abnormally
96
Does a positive rapid HIV test mean that you have HIV?
No; it can show false positive. You need both ELISA and Western Blot to confirm HIV ELISA alone does not confirm HIV; western blot does. However, western blot is usually done after a positive ELISA so you would still do both
97
What does Class 0 HIV mean?
First positive HIV test Regardless of T cell count No change in stage until 6 months after
98
What does Class 1 HIV mean?
T cell count > 500 No AIDS related illnesses
99
What does Class 2 HIV mean?
T cell count 200-499 No AIDS related illnesses
100
What does Class 3 HIV mean?
Class 3 = AIDS T cell count < 200 or AIDS related illness (even if counts normal)
101
What does unknown HIV class mean?
Confirmed HIV but don't really have T cell/CD4 count right now (unknown) AIDS related illness unknown
102
How is HIV transmitted?
Sexual transmission, blood (parenteral; contaminated needles), perinatal Mosquito does not transmit HIV
103
How can you prevent HIV?
Safe sex; condom use, monogamous Don't share needles
104
What medications are used for HIV pre-exposure prophylaxis (PREP)?
Tenofovir/Emtricitabine 300mg
105
Can you miss a dose of PREP?
Yes, but if you miss more, you need to restart regimen within 7 days
106
How long do you need to take PREP for it to protect you from HIV?
7 days of consistent dosing
107
Can you miss a dose of medication if you have HIV?
No
108
What kind of medication is used to treat HIV?
Antiretroviral These are expensive so you need community resources
109
What are the 4 common opportunistic infections that HIV patients may have as a complication?
Pneumocystis jiroveci pneumonia Toxoplasmosis encephalitis Candida albicans (yeast infection) Mycobacterium Tuberculosis
110
HIV patients have a higher risk of cancer; what are some examples?
Malignant lymphomas Kaposi's sarcoma Cervical & anal cancers
111
How should we care for HIV patients in the hospital?
Private room Assess for infection, especially mouth and skin for any open wound, sarcoma, etc Turn cough deep breath Encourage activity
112
Why are HIV patients at high risk for dehydration?
HIV causes diarrhea. HIV meds also can cause diarrhea. Therefore double diarrhea = high risk for dehydration
113
What kind of food should HIV patients avoid?
Fatty, spicy, fresh (low immune) foods Also sugary, alcohol, caffeine
114
What labs need to be monitored in HIV patients to ensure adequate protein/nutrition?
Ferritin, albumin, prealbumin, hemoglobin
115
Why might tube feeding/TPN be expected in HIV patients?
It is hard for them to maintain weight and nutritional status
116
What medication is used to treat oral candida?
Fluconazole (diflucan)
117
What medication is used to help stop diarrhea?
Loperamide (imodium)

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