CEN FLASHCARDS
(232 cards)
1
Q
Treatment for cocaine OD for A.C.S.?
A
Nitroglycerin
2
Q
Positive for ethylene glycol toxicity in urine?
A
Calcium oxalate crystals
3
Q
Patient loses 30% of blood volume. What happens?
A
Shunting to increase end organ perfusion. VASOCONSTRICTION
INCREASE PERIPHERAL VASCULAR RESISTANCE INCREASE PRELOAD
INCREASE CARDIAC OUTPUT
4
Q
Classic triad for CARDIOGENIC SHOCK?
A
Tachypnea / Distended Neck Veins / Hypotension
5
Q
Recommended bolus with blood products in pediatrics?
A
10ml / kg
6
Q
Life threatening emergency caused by edema above the vocal cords. Rapid onset of high fever. Sore throat. Mouth breathing, drooling, and tripod positioning.
A
Acute Epiglottitis
7
Q
Psychotic situation that’s a symptom of schizophrenia?
A
Paranoia
8
Q
Implied consent
A
Unable to give consent but needs life saving measures.
9
Q
Expressed consent
A
Written or oral agreement.
10
Q
Involuntary consent
A
Patient refuses but police or MD deem it necessary.
11
Q
Informed consent
A
Full understanding.
12
Q
Excess A.D.H. causes what kind of electrolyte imbalance?
Puts the patient at high risk for developing _______ which leads to ________.
A
Hyponatremia
Cerebral edema which leads to seizure activity
13
Q
What’s the opposite of Excess A.D.H.?
A
Diabetes Insipidus (suppression of A.D.H.)
14
Q
Can be a life threatening condition if infection spreads to deeper tissues like skull base, cranial nerves, and even coratid artery. Usually starts at the ear. Whose at risk?
A
Malignant otitis externa
Elderly and immunocompromised patients
15
Q
What type of stool with peptic ulcers?
A
Tarry stools
16
Q
Foul smelling fatty stools
A
Pancreatitis
17
Q
What type of stools with Ulcerative Colitis?
A
Bloody diarrhea stools
18
Q
What type of stools with I.B.S.?
A
Large frequent stools
19
Q
Right Atrial Hypertrophy EKG changes
A
Leads 2 and 3 has peaked P waves, more than 2.5mm in height.
20
Q
Left Atrial Hypertrophy EKG changes
A
Broad notched P waves in V1.
21
Q
Recommended treatment to lower b/p with chronic HTN?
Decrease by ____to____% over what time frame?
A
20-30% over 2-3 hours
22
Q
Define Q-wave? Type of deflection? Appears after _____. Height?
A
Negative deflection
Comes after P wave
Deeper than 1/3 QRS height or longer than 0.04 seconds.
23
Q
What to watch for with unknown amount of Tricyclic Antidepressant (Elavil) ingested?
A
Cardiovascular status because it causes prolonged PR, QT, widened QRS, and eventually leads to v-tach.
24
Q
Most common dysrhythmia of a patient that has suffered electric shock?
A
v-fib
25
What's the palpation systolic pressure for
| Coratid, Femoral, and Radial pulse?
CORATID 60mmhg
FEMORAL 70mmhg
RADIAL 80mmhg
26
GSW arrives to ED. During the assessment and documentation the nurse would do what with
forceps, clothes, wounds, and gun powder.
Place plastic over the teeth to not damage the bullet.
Place clothes in clean paper bag, seal, and label.
Document as wound; not entrance and exit.
Scrape gun powder onto clean paper and place into envelope, seal, and label.
27
2 days after patient is in car crash they c/o flashes of light, floaters in peripherals, or looking through cob webs, what do you do?
Shield the eyes and obtain ophthalmology consult.
| DETACHED RETINA
28
You decrease the K in a patient in renal failure. What are the EKG changes to show the treatment worked?
Shortened PR interval
Decreased T save height
Increased HR
Shortened QRS
29
COPD characteristics of fingers, type of breathing, expiratory phase does what?
Clubbing
Prolonged Expiratory Phase
Purse lipped breathing to aid in exhalation r/t permanent over-distention of alveoli
30
Patient has been to the ER 4 times in the past 2 months w/ asthma flare ups at night. Bronchiodilators given with the ABG reading Bicarb of 30mEq & PaCo2 50mmhg. What's the problem?
Gastroesophageal Reflux
31
Pt with tension pneumo needs what before what?
Needle thoracentesis (treatment) before CXRAY (diagnostics).
32
The purpose of a water seal chamber in a chest tube drainage system is to ......
allow air out of the chest but not let air into it. Once the air is expelled from the chest the chamber shouldn't bubble. If it does then there is an air leak. Start at the chamber and work your way towards the patient in order to trouble shoot.
33
Critical Incident Stress Debriefing (CISD) sessions should commence with in what time frame of the event?
1-4 hours
34
Partial seizure
Facial grimace or lip smacking (specific body part).
35
Absence (Petite Mal)
children 4-12, abrupt LOC, last about 15 seconds
36
Tonic Clonic (Grand Mal)
Sudden LOC, major muscle group movements
37
Status Epilepticus
Series of consecutive seizures or a single one that doesn't respond to treatment.
38
Damage to which area of the central cord will result in loss of voluntary movement?
Anterior Corticospinal Tract
39
Complication with Diphtheria and why? How to diagnose?
Difficulty breathing and swallowing r/t the GRAY WHITE membrane covering the pharynx and larynx. Diagnostic by throat culture.
40
List 3 s/s with thyrotoxic crisis. One being more serious than the others. What's another name for this disorder?
Tachydysrhythmias, hyperthermia, and agitation
| Thyroid storm
41
Cardiac arrest r/t 9.3 K. What's the treatment and why? Most 2 important drugs to give.
Calcium to antagonize the toxic effects of K at the myocardial cell membrane.
Albuterol for intracellular shift.
Other drugs like sodium bicarbonate, insulin, D50, and Kayexalate (onset 1-2 hours).
42
Most common fluid electrolyte imbalance seen in renal failure?
Elevated K (LIFE THREATENING)
Decreased NA
Decreased Calcium
Elevated Phosphorus
43
Most reliable diagnostics for suspected pancreatitis.
CT scan
44
Blunt force trauma, diffuse abdomen tenderness, and pain shoots to the testicles. What organ is injured?
Duodenum
45
Indication that the patient is being paced?
Wide complex after the spacer spike, palpable central pulse at 70 beats per minute.
46
Implantable defib/pacer who develops v-fib, what to do?
Difibrillate and avoid placing pads over the pacemaker.
47
The time frame for the start of iron overdose symptoms? When does it peak?
60 minutes
| 3-4 hours
48
What does the water chamber do when patient is breathing?
Moves up and down. On exhale it may bubble a little r/t lung trying to expand.
49
8 hour history of priapism, what's the priority?
Pain meds and then drain.
50
Side effect of Tensilon (given for myasthenia gravis). You need to have ______ at the bedside.
BRADYCARDIA
| Atropine
51
Antidote for thyroid storm? Mortality rate?
Propylthiduracil (PTU). High.
52
Hep A incubation period and can't work for how many days?
15-50 days and can't work for 1 month
53
What happens to oxygen level, metabolic state, b/p, blood vessels, and hematocrit level in patient with sickle cell crisis?
```
Hypoxia
Acidosis
Hypotension
Vasoconstriction
Increase in hematocrit
```
54
Primary complication associated with Addison's? Why? What 3 meds used to treat?
Shock
Cortisol deficiency is life threatening because corticoids are needed for maintenance of blood volume, blood pressure, hemostasis (process which causes bleeding to stop), and glucose.
Steroids, Glucose, and vasopressors.
55
Reye's syndrome in children is characterized by what lab test? Ranges for Reye's? 2 Tests in particular.
Ammonia, will be greater the 300mg/dl (normal 10-60)
| Lactic Acid, will be around 21mmol/L (normal is 0.5-1)
56
Clinical feature of hypercalcemia? EKG? Urination? General feeling, muscle strength, and reflexes?
QT shortening with wide T wave.
Polyuria.
Fatigued, decrease strength and reflexes.
57
Ectopic pregnancy given methotrexate, patient teaching?
Vaginal bleeding doesn't occur until patient has normal period.
Pt with ectopic pregnancy is likely to have another one.
Beta-HCG should drop; if not she needs another dose.
58
Incomplete Abortion
Inevitable Abortion
Threatened Abortion
Missed Abortion
Incomplete - Heavy vaginal bleeding, abd cramping, retention of SOME POC.
Inevitable - Heavy vaginal bleeding, abd cramping, open cervix but no passage of POC.
Threatened - Vaginal bleeding, mild cramping, closed cervix.
Missed - Death of fetus w/o expulsion, no maternal symptoms, no FHT, no movement.
59
Early s/s of hypovolemic shock? Respiratory, Diastolic, LOC?
Increase rate and depth
Diastolic increases r/t sympathetic response on peripheral vascular resistance (Vasoconstrict to save vital organs).
Anxiety, restlessness, and confusion
60
Residual volume in children vs. elderly.
| What is residual volume?
DECREASED in children
INCREASED in elderly
Amount of air left in the lungs after exhalation.
61
Corticoid steriods may cause _______ in elderly.
Confusion
62
Serious side effect in dilantin?
Hypotension and Bradycardia
63
Elderly with head injury and gets progressively altered over 3 weeks?
Subdural Hematoma
64
What area of the rhythm is the synch button synching with?
R-Waves
65
Patient presents to ED with lacrimation, salivation, n/v, bradycardia after eating blackberries? What is it from? Medication to treat?
Organophosphates (Nerve Agent).
| Administer atropine sulfate.
66
Treatment of hydrofluoric acid (found in home rust removers)? Antidote? DO NOT apply_____?
Calcium Gluconate
| Water
67
______ ______ are not calculated in the total body surface area.
Superficial burns.
68
3 S/S of epididymitis?
Urethral Discharge
Pain develops gradually
Pain decreases w/ scrotal elevation
69
Sounds with obstruction of trachea vs. larynx?
Trachea - wheezes
| Larynx - hoarseness, aphonia
70
Joint effusion presents with.....
Localized pain, warm skin, limited ROM, erythema, joint tenderness, and edema.
71
Early sign vs. late sign of ICP.
Early- decreased LOC
Late- widened pulse pressure / low HR / Dilated nonreactive pupils.
72
Body position for ICP? List 2.
Supine with neutral body position.
| Reverse Trendelenberg
73
CVP monitoring ranges? Where does it measure from? What's it for?
8-12mmhg
Measures pressure in the Rt. Atrium.
Gives estimation of the fluid volume in the vascular system.
74
Pt. vomiting every 30-40 minutes would put them in ______ ______ and ______ as an electrolyte imbalance.
Metabolic Alkalosis (loss of potassium, chloride, and hydrogen ions)
Hypokalemia.
75
Pt's discharge instructions for mononucleosis. List 3. What organ do you need to be concerned about? Symptoms last? Return to ER if?
No heavy lifting related to splenomegaly; may cause splenic bleeding.
Pt may have fever for 10-14 days, as well as sore throat, diarrhea, and earache.
Return to ER if increased abd pain, SOB, cough, chest pain, and increase fever.
76
Lap belt injury from MVC will be at risk for (ADULT)?
Rupture of the colon.
77
Discharge instructions with acute prostatitis?
Increase fluids to assist in bacteria elimination.
78
Drug treatment for preclampsia? Watch for what side effect?
Respiratory rate needs to be closely monitored. Muscle weakness.
79
Greatest concern in a patient with a chemical burn to the eye?
Altered visual sensory perception.
80
STD discharge
Trichomoniasis
Gonorrhea
Candidiasis
Trichomoniasis = Gray or Greenish
Gonorrhea = Yellow
Candidiasis = Thick and White (Cheese Like)
81
Kehr's sign? Injury to what organ?
Left shoulder pain r/t irritation by the diaphragm; found in splenic injury.
82
NSR and the pt's ICD goes off, what is the treatment?
Place magnet over it to turn it off.
83
Organism associated with respiratory infections?
Streptococcus Pyogenes
84
Organism associated with puncture wound of the foot while wearing a rubber soled shoe?
Pseudomonas Aeruginosa
85
Injured the central cord that's responsible for proprioception, fine touch. Which part?
Posterior Tract
86
```
Spinal Cord injury assessment
C 2,3,4
C 5,6,7
L 2,3,4
L 4,5
S 3,4,5
```
C 2,3,4 Diaphragm (Needs to be placed on vent)
C 5,6,7 Extension / Flexion of arms
L 2,3,4 Extension / Flexion of legs
L 4,5 Flexion of foot / Extension of toes
S 3,4,5 Anal sphincter tone
87
Diagnostic for posterior wall MI?
EKG to the back of the patient.
88
ST elevation in
Inferior Wall MI
Anterior Wall MI
Lateral Wall MI
Inferior - II, III, AVF
Anterior Septal - v1 -v4
Lateral - v4, v5, Lead 1, AVL
89
Why administer beta blockers to STEMI pt?
Reduce mortality and morbidity.
90
Characterized by alternating euphoric moods with depressive moods?
Bipolar disorder
91
Characterized by bizarre behaviors, hallucinations, and an inability to care for self or function well in a social environment.
Schizophrenia
92
Colorimetric exhale CO2 detector colors and what do they mean?
Purple or Beige = Placement is questionable. If it yields a purple color on inspiration and stays purple on expiration it is most likely in the esophagus (when adequate perfusion is present).
Yellow = It's in place.
93
A nurse may delegate a task if the other person has the appropriate _____, ______, ______, and ______.
License
Education
Experience
Competency
94
Characterized by nightmares, hyper vigilance (watchfulness), hallucinations, and generalized anxiety.
PTSD
95
Describe the HALO sign and what is it indicative of?
Drainage from ear placed on filter paper where it separates into two distinct rings.
Basilar Skull Fracture
96
Serotonin Syndrome characteristics?
Confusion, agitation, hyperreflexia, hyperthermia, and diaphoresis.
97
ACE Inhibitor side effects?
Angioedema is the most concerning but cough is one also.
98
Fears at what ages....
Birth to toddler
Preschooler
Adolescence
Stranger and parental separation.
Bodily mutilation, insides leaking out, the dark, pain, and the unknown.
Loss of control and change in body image.
99
Bradycardia in pediatric patient is defined as _____?
Slower than the lowest expected rate for the child's age.
100
High speed MVC patient sustained an injury to the abdomen.
RUQ - What's injured? List 3.
LUQ - What's injured? List 5
Retro-peritoneal Area - What's injured?
RUQ - Liver, ascending colon,and spleen.
LUQ - Pancreas, small intestine, transverse & descending colon, stomach. 50% MORTALITY RATE!!!!
Retro-peritoneal - Kidneys.
101
Pt is pregnant and has headache, swelling of ankles, elevated blood pressure, FINE RED LINE RASH on the pt's abdomen. What is it?
s/s of HELLP (hemolysis, elevated liver enzymes, low platelets)
102
Respiratory Acidosis ABG?
PH Low, PaCO2 High (Indicates respiratory issue), HCO3 High (Compensated for increase PaCO2).
103
Respiratory Alkalosis ABG?
PH High, PaCO2 Low
104
Metabolic Acidosis ABG?
PH Low, PaCO2 Low to Normal, HCO3 Low
105
Metabolic Alkalosis ABG?
PH High, PaCO2 Normal, HCO3 high
106
What is a Pneumomediastinum?
Cause?
S/S?
Treatments?
Air in the mediastinum (space between lungs).
Occurs in rapid ascent altitude changes.
Chest pain beneath the sternum and progressive dyspnea.
Remove mediastinal gas via mediastinoscopy, thoracostomy, and percutaneous drainage.
107
Medication for treatment of pericarditis?
Indocin (NSAIDS)
108
Subjective s/s of pregnancy induced hypertension?
| List 4.
Visual changes / Headache / Right sided upper abd. pain / Decreased urination.
109
Methotrexate given to ectopic pregnant patient. What,s the patient education of med and situation? Return if ______, _______, and ______.
Folic acid antagonist that prevents duplication of the fetal cells. Serum HCG levels should drop as the pregnancy fails to develop.
Dizzy, Pallor, or Increased HR.
110
Diet for GERD?
Small frequent meals.
111
Diet for Gastric Ulcer?
Bland low fiber diet.
112
----------Physical characteristics of a child---------
Blood = How much can a child lose before s/s of hypotension?
Body Surface = Body surface r/t body weight? Extra and Intracellular volume ratio?
Respiratory = In relation to inhalation of toxic substances?
Children can lose 25% of blood volume before s/s of hypotension.
Greater body surface in proportion to body weight, and they have a higher extra and intracellular fluid volume ratio.
Increase respiratory rate puts them at risk for inhaling more toxic substances.
113
```
Childhood immunizations time frame
HIB (influenza B)
Hep B
DTap
MMR
```
HIB - Immediately after birth.
Hep B - Immediately, 4 weeks, 16 weeks, 24 weeks (six months)
DTap - 2 months, 4 months, 6 months
MMR - 12 months, 4-6 years old.
114
Medication commonly used for schizophrenia?
Respiradal
115
Pt is on coumadin, falls, and ends up with subdural hematoma. What's the treatment?
200 to 500ml of FFP to return clotting factors back to normal.
116
--------Heart Sounds--------
S3 - Condition - Cause
S4 - Condition - Cause
Split S1 - Condition -
S3 - CHF - Excess fluid remains in the ventricle at the end of systole. The new blood entering the chamber interacts with the residual fluid that causes S3 sound.
S4 - CAD & Hypertension - From a forceful atrial contraction in presystole.
Split S1 - BBB & Aortic Stenosis
117
Flow of the heart and start at the superior vena cava and end with the aorta.
superior vena cava - rt atrium - tricuspid - rt ventricle - pulmonary valve - pulmonary artery for oxygenation - pulmonary veins - lt atrium - mitral valve - lt ventricle - aortic valve - aorta
118
Left side heart failure
| Cause and Symptom
Blood backs up into the pulmonary system, causing dyspnea.
119
Right side heart failure
| Cause and Symptom
Blood backs up into the systemic vasculature giving s/s of JVD, Peripheral Edema, and Hepatomegaly.
120
Organism seen in cat bites?
Pasteurella Multocida
121
```
--------Meneires Disease--------
Nature?
How often are the symptoms?
How long the episodes last?
Symptom that differentiates it form vertigo?
```
Episodic
Several times a week or month
Duration of 2 - 8 hours
Vertigo has unilateral hearing loss along with N/V
122
Most common consequence w/ trauma of a pregnant patient?
Rx. treatment?
Place the patient in what position?
Preterm labor contractions 5/t the releasing of prostaglandins from cellular damage, which stimulates the uterus.
Treatment is tocolysis (Magnesium) to stop the contractions. Fluid replacement.
Place the patient in lateral tilt position.
123
HCO3 normal ranges?
| Too low or high means what?
22-26 meq/L
Lower than 22 = acidosis
Higher than 26 = alkalosis
(Same as the PH)
124
PaCO2 normal ranges?
| Too low or high means what?
35 - 45 mmhg
Lower than 35 Alkalosis
Higher than 45 Acidosis
A level greater than 45 could be indicative of hyperventilation.
125
```
Base Excess (BE) normal ranges?
Too low or high means what?
```
-2 to +2 mEq/L
Indicates the amount of excess bicarbonate is in the system and how well the body is trying to compensate or correct itself.
Lower than -3 is Metabolic Acidosis
Higher than +3 is Metabolic Alkalosis
126
List 3 diagnosis of when to use the hyperbaric chamber?
Decompression sickness
Air of Gas Embolism
Carbon Monoxide Poisoning
127
May need rabies shot if bit from _____, _____. _____, and _____.
raccoon, skunks, foxes, and bats.
128
----------Reye's Syndrome--------
List two most important organs affected.
Hallmark finding?
Found in children that have been given aspirin that previously had a viral infection.
2 organs that are affected is the liver and brain (encephalopathy, cerebral edema)
Hallmark finding is an ammonia levels greater than 300 in children.
129
Normal findings of CSF?
RBC
Spinal fluid pressure
WBC
Glucose
RBC - 0, If the RBC count is elevated suspect traumatic spinal tap or subarachnoid bleed.
Spinal fluid pressure - 50-200mm/h2o; High pressure could indicate intracranial hypertension or cerebral edema.
WBC - 0-5mm3; High indicates infection
Glucose - 50-75 / 100ml ; Decreased levels are associated w/ bacteria in spinal fluid.
130
A child's circulating blood volume?
80ml/kg
131
An infant's circulating blood volume?
90ml/kg
132
An adult's circulating blood volume?
70ml/kg
133
Post transplant patient should not take _________ herb because they may experience transplant rejection.
St. John's Wart
134
Adverse effects of urecholine (bethanechol)? What is it used for?
Polyuria, diarrhea, abd cramping, hypotension, and increased salivation.
Used in the treatment of GERD, increases sphincter pressure and facilitates gastric emptying.
135
```
Suture removal days and body parts?
Upper or lower ext. without joint involvement?
Face?
Scalp?
Knee or Joint?
```
Upper or lower ext. 7-10 days.
Face 3-5 days.
Scalp 5-8 days.
Knee or Joint 12-14 days.
136
Colle's fracture? What bones are involved?
"fork" deformity. Combined fracture of the radius and ulnar forming a "hump" deformity.
137
Most common fractures of ______ and ______ when landing on feet from high fall.
Calcaneous and lumbosacral compression fracture.
138
EKG changes for WPW?
Treatment?
Explain the electrical conduction issue in the heart.
Shortened PR Interval and Widened QRS complex with DELTA wave (looks like an upwards ski slope coming right after the P wave).
Ablation, if critical pt may need synchronized cardioversion.
Extra electrical conduction pathway causing electrical signal to arrive at the ventricle too soon.
139
Hyphema is usually caused by_____.
Describe it.
Trauma.
Blood suspended in the anterior chamber of the iris.
140
Patient is in sickle cell crisis, list 2 tests done and their values.
LDH Lactate Dehydrogenase 75-220 U/L
Reticulocyte Count 2-20%
Retic % .50-2.0%
141
Edema to the conjunctiva and pertains to the superficial portion of the eye.
Chemosis
142
Difference between Infarction vs. Ischemia?
| EKG differences?
Ischemia left untreated leads to infarct.
T-wave depression is indicative of the ischemia.
ST elevation indicates infarction.
143
Classic s/s tracheobrachial injury? List 4?
1. Subcutaneous Emphysema in the neck, face, and suprasternal area.
2. Tachypnea.
3. Hemoptysis.
4. Hoarseness.
144
Sympathomimetric toxidrome s/s, rx. examples?
Cool, clammy, dilated pupils, increase heart rate.
| Ephedrine in the cold medicine.
145
Cholinergic toxidrome s/s, rx. examples?
Bradycardia, hypothermia, tachypnea, and bronchorrhea.
| Organophosphates.
146
Anticholinergic toxidrome s/s, rx. examples?
Coma, Decreased breath sounds (resp. suppression), flushing, hallucinations, dilated pupil.
All the "ANTI's" like antihistamines, antipsychotics, antiparkinsonians, antidepressants.
147
Sedative / Hypnotic toxidrome s/s, rx. examples?
Decrease CNS functions, apnea is major concern.
| GHB, Barbituates, Anticonvulsants, Ethanol.
148
Hypokalemia on monitor shows? List 3?
ST depression
Bradycardia
Prolonged PR interval
149
What's the treatment for Black Widow Spider Bite?
Muscle Relaxant related to it being a neurotoxin.
150
What's the treatment for Jellyfish sting?
Apply vinegar.
151
What's the treatment for Brown Recluse Spider?
Give Dapsone.
152
Ammonia Hydroxide causes?
Corrosive alkaline that can cause severe necrosis to esophagus on contact.
153
Sulfuric Acid causes?
Necrosis of the stomach.
154
Lithium Carbonate causes?
Heavy metal that damages CNS.
155
Paint thinner causes?
Petroleum distillate that affects the lung surfaces, causing pneumonitis.
156
CVP Levels for a patient in septic shock. What do the levels need to be?
Fluid resuscitation is used to maintain the CVP from 8-12mmhg.
157
Cyanide antidote
Amyl Nitrate
158
Organophosphates antidote
Atropine
159
Mustard Gas (Vesicants) antidote
Dimercaprol
160
Iron poisoning antidote
Deferoxamine
161
S/S of carbon monoxide poisoning, list 4?
Headache, tachycardia, hypotension, and metabolic acidosis.
162
Used to treat depression?
Elavil (Tricyclic Antidepressant)
163
Medication used for bipolar presenting in a manic state?
Lithium
164
Advair may cause ________ in the elderly. What type of drug is it?
Depressive Symptoms.
| Corticosteriods.
165
Associated with emphysema? List 3.
| 2 are forms of breathing and 1 physical characteristic
```
Thin limbs (Dyspnea limits eating)
Tripod posture
Pursed lips (self peep)
```
166
Premedicate with _________ to alleviate increased ICP associated with RSI. Name 3 medications that fall into this catagory.
Nondepolarizing blocking agent (pancuronium, vecuronium, and rocuronium).
167
Name example of depolarizing agent.
Succs.
168
Describe Myoclonic Seizures
No LOSS OF CONSCIOUSNESS!
| Sudden muscle contraction that may be generalized or limited to individual muscle groups. Looks like subtle tremors.
169
Describe Generalized siezure
No LOSS OF CONSCIOUSNESS!
| They stare into space. Minor motor movements such as blinking or nystagmus.
170
Potential complication of solumedrol in a patient with spinal injury? List 5.
```
Hyperglycemia
Infection
HTN
Low K+
Thrombocytopenia
GI Bleeding
```
171
What to think about when patient receives multiple units of PRBCs?
Name two electrolyte imbalances?
After 5 units give______.
After 10 units give______.
Hypocalcemia after 5 units because citrate binds with free calcium. The treatment is to give calcium.
Hyperkalemia because lysis of red blood cells releases potassium. The treatment is to put them on the monitor.
Acidosis since blanked blood is 7.1. The treatment is to monitory the heart.
Decreased clotting time after 10 units. The treatment is to administer FFPs.
172
APGAR score, describe
Appearance-Blue, Pale, or Pink
Pulse-None, less than 100 or greater than 100
Grimace-None, Weak, or Cries
Activity-None, Some flexion of arms or Both extended
Respiration-None, Weak, or Strong Cry
0-10 scoring system.
173
You should watch for an injury to _____, _____, and _____ if it's a lap belt injury in children.
Lumbar spine fracture, Duodenal, and Pancreatic injuries.
174
Capnography wave form that looks like a shark fin?
| What does hyperventilation look like?
Bronchospasm. The shape is caused by uneven alveolar emptying as the patient struggles to exhale.
Normal shape but a lower plateau.
175
Most common electrolyte imbalances seen in ARF patients? List 4. Which is the most important?
Hyperkalemia (most important)
Hyponatremia
Hypocalcemia
Hyperphosphatemia
176
The 4 classes of hemorrhage.
% lost?
ml lost?
s/s?
1. 15%, 750ml, HR and BP normal.
2. 15-30%, 750ml-1500ml, 100-120 BPM with BP being normal.
3. 30-40%, 2000ml, 120-140bpm, Increase in RR, Increase in BUN.
4. Greater than 40%, above 150 bpm, low BP, coma and cyanosis.
177
Myexedema Coma
| Cause, EKG, and Lab values?
Occurs with untreated hypothyroidism.
EKG shows bradycardia, prolonged QT intervals, ST segment and T wave changes.
Labs = Increased TSH and Decreased T4; LOW Blood sugar, b/p, HR, and sodium.
178
What's the cause of Thyroid Storm and what's the lab values?
Undiagnosed and untreated hyperthyroidism.
LOW TSH and HIGH T4.
Opposite of myexedema coma.
179
What's the cause of inappropriate antidiuretic hormone (ADH)? Electrolyte imbalance? High risk for_______.
Occurs when the pituitary gland releases excessive ADH which results in excessive H2O retention causing water intoxication.
Severe hyponatremia, which leads to fluid shifts causing cerebral edema. Puts patient at high risk for seizures.
180
What's the cause of diabetes insipidus? S/S? Electrolyte imbalance?
Suppression of the ADH or the kidney's ability to concentrate the urine.
S/S are polyuria and polydipsia
The H2O disturbance results in dehydration and hypernatremia.
181
What is found in soil, human and animal intestines?
Clostridium Tetani
182
Treatment for ASA overdose?
Activated Charcoal
183
Which electrolyte imbalance would you find in a patient in adrenal crisis? List 3. What metabolic state would you find them in?
Hypoglycemia r/t low cortisol levels not balancing insulin. Hyponatremia r/t unable to retain NA because of low levels of aldosterone.
Hyperkalemia r/t aldosterone levels dropping causes body to retain K+ and lose NA.
METABOLIC ACIDOSIS
184
What's the difference between heat stroke and heat exhaustion?
Heat stroke - Temp 106, organ damage, dilated fixed pupils, tachypnea, delirium.
Exhaustion - Temp 104, dizzy, Low B/P, oliguria, muscle cramping.
185
Wellen's syndrome?
T wave changes plus a history of anginal chest pain with out serum marker abnormality.
186
Recommended diet for IBS?
High fiber diet to decrease cramping and bloating.
187
Blood collection between the dura and the skull?
| Fatality%?
Epidural
| 15-20%
188
Pt on Bipap for acute pulmonary edema. What's the most accurate indicator for improvement? ABG finding?
In what time frame should you see improvement?
The PaCO2 will be decreased, and happens with in 1-2 hrs.
189
Example: Feeling on the right side of the body but not the left, and can move the left but not the right.
Brown Sequard Syndrome
190
ABG of pregnant patient wound indicate?
| Why?
Due to increased levels of progesterone it causes the patient to have a low PaCO2. 30-34 mmHg. (35-45 is normal).
191
Hypercalcemia s/s?
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Decreased muscle strength
Hyporeflexia
Lethargic
Hypertensive
Confused
Polyuria
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192
Most common dysrythmia with inferior wall MI? What artery is affected?
Bradycardia r/t infarction of RCA
193
Bowel sounds for small bowel obstruction?
Frequent high pitches r/t the force of peristalsis attempting to move bowel contents thru the obstruction.
194
Bowel sounds for Gastroenteritis?
Hyperactive bowel sounds r/t hyperperistalsis causing diarrhea along with n/v.
195
Bowel sounds for paralytic ileus?
Absent bowel sounds caused by bowel paralysis and decrease in peristalsis.
196
Primary complication associated with bowel obstruction?
Dehydration.
197
Core temp 86. Treatment?
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ACTIVE CORE REWARMING
Continuous arteriovenous rewarming (CVR)
Warm humidified oxygen
Mechanically warmed fluids
Peritoneal lavage
Bladder irrigation
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198
Core temp 95. Treatment?
PASSIVE REWARMING
Blankets
Bear Hugger
Remove we clothes
199
Pt falls on out stretched hand and complains of pain and tenderness at the "snuff box" the nurse should expect fracture of the _________ bone.
Scaphoid
| The fracture may not show up for 2 - 4 weeks.
200
S/S of diptheria?
How is it diagnosed?
What to watch for?
HIGHLY contagious disease that produces a systemic toxin.
Causes a gray white membrane that covers the pharynx and larynx. Swelling can make it difficult to swallow or breath.
Diagnosis by throat culture from beneath the membrane or the membrane itself.
201
Autonomic Dysreflexia
Spinal cord injury above the T6.
S/S are headache, sweating, HTN, dysrhythmia.
FLUSHING above the level of the injury and COOLNESS below the level of the injury.
202
2 Hours after eating seafood and the patient complains of n/v/d with generalized weakness. What's the cause?
Bacterial food poisoning (RAPID ONSET).
| FYI: Heavy metal contamination of fish or shell fish may produce neurological s/s later.
203
Diaphragmatic Injury
Pain where?
Commonly ruptured on ______ side.
Where are the bowel sounds heard?
Left shoulder (Kehr's).
Left side r/t liver protecting the right.
Bowel sounds in the thoracic cavity.
204
What's the difference between Varicella vaccine (Varivax) & Varicella Zoster Immune Globulin (VZIG)?
Varivax is for HEALTHY CHILDREN 12 months -18 years old who haven't been immunized or who haven't had the pox.
VZIG is for post exposure prophylaxis of susceptible PREGNANT WOMEN and perinatally exposed NEW BORNS.
205
Type of embolism that is caused by physical trauma such as fracture of long bones, soft tissue trauma, and burns? What are s/s and where?
FAT EMBOLISM which presents with petechiae on anterior neck and chest, upper arm, axilla, shoulder, oral mucosa, and even the conjuctiva.
It results from occlusion of dermal capillaries by fat, and increasing capillary fragility.
206
D/C instructions for peak exspiratory flow meter?
How many times do it?
What do the colors mean?
Do it 3 times and take the highest of the three.
Under 50% of personal best indicates need for urgent medical attention.
50-70% (Yellow Zone) use rescue inhaler but don't come to ER.
Green - OK
Yellow - Take inhaler
Red - Seek attention
207
A connective tissue disorder that's hereditary. These patients are unusually tall with long limbs, fingers, and toes. What's the most serious manifestations?
Morfans.
| Heart valves and aortic dissections.
208
Describe malignant hypertension? And complications with it?
Sudden increase in blood pressure possibly from missing doses of meds. This is a hypertensive emergency and needs to be addressed immediately. Long term isues could lead to retinopathy, heart failure, renal compromise, and even encephalopathy.
209
Genetic disorder.
RBBB with ST elevation in v1-v3.
AKA sudden unexpected death syndrome.
This is the most common cause of sudden death in young men with known cardiac disease.
Brugada syndrome.
210
Neurogenic Shock
Loss of sympathetic (voluntary) function below the level of the spinal cord injury.
The unopposed vagal (parasympathetic) stimulus which leads to hypotension and bradycardia r/t vasodilation.
(LOSS OF FUNCTION / HYPOTENSION / BRADYCARDIA)
211
S/S and cause of Rocky Mountain Spotted Fever?
Transmitted by Dog and Wood ticks.
NEUROLOGICAL SYMPTOMS
Ataxia, Paralysis of limb, Decrease in reflexes, Parasthesia
Respiratory failure if left on and not treated. Removal of tick and antibiotics ASAP.
212
S/S and cause of Lyme disease?
```
Caused by a Deer Tick.
EXPANDING BULL'S EYE CIRCLE ON SKIN
Flu like s/s
Menengitis
Atrioventricular Blocks
Hepatitis
```
213
Brisk, painless vaginal bleeding.
Placenta Previa (P=PAINLESS)
214
Board like Uterus, decreased fetal heart rate.
Abruptio Placenta
215
Medication used for major depression, PTSD, OCD, social anxiety, or panic disorder?
Zoloft (Selective Serotonin Re-uptake Inhibitor / SSRI)
216
```
Red rash that starts at the face, spreads to the trunk, and then ext.
Rash lasts 2-3 days.
Contagious 1 week prior to outbreak.
Joint pain.
Lymph nodes swollen.
```
Rubella
217
Varicella (Chicken Pox)
Presentation on skin?
Where is it located on body?
Symptoms develope about ____ to ____ days after contact with virus.
New spots will appear every day for up to ___ to ___ days.
Red dots to blisters being crusted over takes about ____Days.
```
Red, raised, and fluid filled lesions (all different stages).
Trunk and face.
14-16
5-7
10
```
218
Descriptive research
Attempts to describe a problem that has not been examined before.
219
Qualitative research
The findings are not presented statistically but rather in words through description.
220
Experimental research
Involves doing something different to at least one treatment group.
221
Quasi-experimental research
Manipulates a variable but can not randomly assign subjects to control group.
222
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Suture removal
3-5 days
5-7 days
7-10 days
10-14 days
```
3-5 Face, lips, and eyelids
5-7 eyebrow and scalp
7-10 back, chest, arm, hands, thigh
10-14 lower legs, feet, and joints
223
Early signs of ETOH withdrawal? List 2.
Insomnia and anxiety
224
Wound botulism infection s/s? What bacteria?
caused from clostridium botulinum
descending paralysis
difficulty speaking or swallowing
dilated fixed pupils
225
Increases risk of PID?
Increases risk of UTI?
Both are medical devices.
PID-IUD
| UTI-Diaphragms
226
Describe La Forte 1,2, & 3
1. Transverse fracture of the maxilla above the upper teeth at the level of the basal floor.
2. Pyramidal-shaped fracture that involves a triangular segment of the mid portion face and nasal bones.
3. Complete separation of the cranial attachments from the facial bones, resulting in craniofacial dysjunction.
227
Avoid _____, _____, _____, and _____ herbs when taking aspirin. 4 Gs
Garlic
Ginger
Ginseng
Ginkobiloba
228
Most common cause for PEAs? List two.
Hypovalemia and Acidosis.
229
Early signs of shock in child vs. late signs.
Early - tachycardia, pallor, tachypnea, cool mottled skin, and delayed cap refill.
Late - Bradycardia, hypotension, and lethargy.
230
Which chemical is primarily responsible for alterations in neurotransmitters?
Dopamine
231
Which abnormalities are associated with acute adrenal insufficiency?
Hypoglycemia
Hyponatremia / hyperkalemic
Hypercalcemia
232
Which abnormalities are associated with depletion of adrenal glucocorticoids (cortisol) and mineralocorticoids (aldosterone).
Hypernatremia
Hypokalemia
Hypocalcemia
