Exam 2

Question 1

common causes of upper GI bleeds

Answer 1

gastric and duodenal ulcers
esophageal varices
erosive gastritis
esophagitis
Mallory-Weiss tears
angiomas of stomach or small bowel
aortoenteric fistulas

Question 2

common causes of lower GI bleeds

Answer 2

colonic angioma
diverticular
internal hemorrhoids

Question 3

difference between upper and lower GI bleed

Answer 3

upper: above duodenal junction; vomit bright, dark, or coffee ground blood, black tarry stool
lower: colon, rectum, anus - rectal passage of red/maroon/bloody stool

Question 4

most appropriate intervention for patient with large amounts of vomiting

Answer 4

NGT and upper endoscopy

Question 5

how to stabilize pt with acute, critical GI bleed

Answer 5

replace volume loss with crystalloids and blood to stabilize hemodynamics

Question 6

calculate blood replacement

Answer 6

each gram lost = 1 unit given

Question 7

considerations when deciding how many units of blood to give during acute GI bleed resuscitation

Answer 7

hemodilution from fluid replacement

Question 8

when to see results from PRBC

Answer 8

48-72 hours for intra- and extravascular equilibrium

Question 9

Hep A route of infection

Answer 9

oral-fecal, contaminated food

Question 10

Hep A Sx

Answer 10

fever
malaise
anorexia
nausea
abd discomfort
jaundice

Question 11

Hep B route of infection

Answer 11

blood + body fluid

Question 12

Hep B Sx

Answer 12

jaundice
fatigue
loss of appetite
nausea
GI upset
dark urine
clay-colored stool
joint pain

Question 13

Hep C route of infection

Answer 13

blood and body fluid

Question 14

Hep C Sx

Answer 14

80% w/o Sx

Question 15

etiology of acute pancreatitis

Answer 15

iatrogenic, idiopathic
infectious (HIV, mumps)
gallstones
genetics
ETOH
trauma
steroids
autoimmune, anesthesia
scorpion, snake bites
hyperlipid, hypoCa, hypothermia
ERCP
drugs

Question 16

Trousseau’s sign and Chvostek’s sign present with what electrolyte disturbance

Answer 16

hypocalcemia

Question 17

abnormal labs with acute pancreatitis

Answer 17

high: amylase, lipase, BG, triglycerides, LFTs, BUN/Creat, Hct, WBC, bili
low: albumin, calcium (binds to free fatty acid complexes, intracellular translocation)

Question 18

ACLS adaptations for pregnancy

Answer 18

A - jaw thrust d/t larynx displacement
B - 18-22 breaths/min to maintain resp alkalosis
C - higher on chest
D - displace uterus left to improve circulation

deliver fetus after 4-5 min
remove fetal monitor before defib
increase pressure to paddles

Question 19

benefits of enteral over parenteral feeding

Answer 19

prevent:
intestinal lumen atrophy
bacterial translocation
development of sepsis from bowel flora

Question 20

care of thrombocytopenic pt

Answer 20

limit invasive procedures
no rectal meds, temps
electric razors only
bowel regimen to decrease straining

Question 21

define prerenal AKI

Answer 21

decreased perfusion to kidneys w/o damage to renal tubules

Question 22

cause of prerenal AKI

Answer 22

hypovolemia
altered PVR (sepsis)
decreased CO
meds

Question 23

treat prerenal AKI

Answer 23

restore renal perfusion via:
fluids
pressors
eliminate problem beds
hemodynamic stability goal

Question 24

define intrarenal AKI

Answer 24

decreased perfusion to kidneys d/t damage to kidney

Question 25

cause of intrarenal AKI

Answer 25

prolonged hypotension or drugs toxic to tubular cells

Question 26

treat intrarenal AKI

Answer 26

immunosuppressive or cytotoxic meds | confirm with renal biopsy d/t risk/benefit

Question 27

define post renal AKI

Answer 27

obstruction of urinary flow (hydronephrosis)

Question 28

cause of postrenal AKI

Answer 28

prostatic hypertrophy, other tumors

Question 29

treat postrenal AKI

Answer 29

relieve obstruction

Question 30

labs to send during stroke

Answer 30

CBC electrolytes glucose PT/PTT

Question 31

ischemic stroke supportive care

Answer 31

``` ABCs IV normal saline supine normoglycemia normothermia aspirin DVT prophylaxis dysphagia screen don't treat BP unless MAP>140 stroke unit ```

Question 32

define delirium

Answer 32

disturbance of consciousness characterized by acute onset and fluctuating course of impaired cognitive functioning

Question 33

define cerebral auto-regulation

Answer 33

1. body's ability to maintain adequate BP to brain 2. cerebral circulation has capacity to maintain blood flow at constant level during changes in BP 3. adequate cerebral blood flow is maintained by constriction/dilation of cerebral vessels in response to changes

Question 34

ICP and CPP goals in patient with head trauma/injury

Answer 34

ICP > 20 | CPP > 60

Question 35

what happens when CPP drops?

Answer 35

cerebral ischemia

Question 36

early signs of elevated ICP

Answer 36

confusion, agitation headache N/V

Question 37

late signs of elevated ICP

Answer 37

puipillary changes papilloedema loss of motor fxn cardiovascular vital sign changes (Cushings traid - HTN, bradycardia, irreg resps)

Question 38

interventions of unstable pregnant patient

Answer 38

left lateral position or manually displace uterus 100% O2 via non-rebreather fluid bolus