Exam 2: Other Flashcards
(150 cards)
1
Q
3 types of pain
A
inflammatory, nociceptive, neuropathic
2
Q
2 types of nociceptive pain
A
visceral, somatic
3
Q
2 types of neuropathic pain
A
central, peripheral
4
Q
2 types of inflammatory pain
A
tissue inflammation, hypersensitivity
5
Q
2 types of somatic pain
A
deep, superficial
6
Q
pain type: presence of a potentially damaging stimulus
A
nociceptive
7
Q
pain type: promotes healing by preventing movement and contact
A
inflammatory
8
Q
pain type: withdrawal reflex
A
nociceptive
9
Q
pain type: commonly chronic
A
neuropathic
10
Q
pain type: transient
A
nociceptive
11
Q
pain type: associated with tissue damage and inflammation
A
inflammatory
12
Q
pain type: protective function
A
nociceptive
13
Q
nociceptive pain definition
A
caused by physiological activation of pain receptors
14
Q
neuropathic pain definition
A
caused by lesion in central or peripheral nervous system
15
Q
localization of nociceptive pain
A
local and referred
16
Q
mechanism of neuropathic pain
A
ectopic impulse generation, central sensitization, etc.
17
Q
dermatome definition
A
the area of the body affected by each nerve root
18
Q
tx step 1 of pain ladder
A
non-opioid, with or without adjuvant
19
Q
step 2 of pain ladder
A
pain increasing or persisting
20
Q
step 3 of pain ladder
A
pain increasing or persisting
21
Q
step 4 of pain ladder
A
free of cancer pain
22
Q
tx step 2 of pain ladder
A
opioid for mild-moderate with or without non-opioid, with or without adjuvant
23
Q
tx step 3 of pain ladder
A
opioid for moderate to severe pain with or without non-opioid, with or without adjuvant
24
Q
DMARD
A
disease-modifying anti-rheumatic drug
25
how long for IV pain meds to start working
30-60 seconds
26
how long for IM pain meds to start working
10-20 minutes
27
how long for SL pain meds to start working
3-5 minutes
28
onset IH pain meds
2-3 minutes
29
onset SQ pain meds
15-30 minutes
30
onset PR pain meds
5-30 minutes
31
onset PO pain meds
30-90 minutes
32
what type of opioids are best for severe pain
long-acting
33
what type of opioids are best for moderate pain
short-acting
34
3 long-acting opioids
transdermal fentanyl, oxycodone SR, morphine SR
35
commonly used opioids for moderate pain
hydrocodone, oxycodone, codeine, morphine
36
non-opioids for mild pain
APAP, NSAIDs, Cox-2 inhibitors, tramadol, salicylate
37
adjuvant pain meds
antidepressants, anticonvulsants, corticosteroids, topical agents
38
how often narcotic contract review
q 3 months
39
what must happen q 6 months for narcotic contract
urine drug screen
40
components of 3 month visit for narcotics
check PMP, confirm diagnosis, confirm pain plan, evaluate potential for abuse, update comorbidities, document alternative treatments tried, discuss risks and benefits
41
narcotic contract for sedative/hypnotics?
No, but need UDM
42
who does not need narcotic contract
patients who fill less than 90 pills in 90 days
43
which type of arthritis has swan neck deformity
rheumatoid
44
which type of arthritis has ulnar deviation
rheumatoid
45
which type of arthritis has bouchard's nodes
osteo
46
4 stages of healing
hemostasis, inflammatory, proliferative, remodeling
47
remodeling stage timeline
weeks to months
48
inflammatory phase timeline
hours to days
49
hemostasis phase timeline
seconds to hours
50
proliferative phase timeline
days to week
51
healing stage epithelialization
remodeling
52
healing stage vasoconstriction
hemostasis
53
healing stage early neutrophil, late macrophage
inflammatory
54
healing stage leukocyte migration
hemostasis
55
healing stage collagen synthesis
proliferation
56
healing stage increase tensile strength of wound
remodeling
57
healing stage chemoattractant release
inflammatory
58
healing stage phagocytosis
inflammatory
59
healing stage ECM reorganization
proliferation
60
healing stage ECM remodeling
remodeling
61
healing stage angiogenesis
proliferation
62
healing stage epithelialization
proliferative
63
healing stage platelet aggregation
hemostasis
64
healing stage granulation tissue formation
proliferative
65
what is wound undermining
when the edges of a wound become eroded and a pocket forms underneath, measured by putting a probe under the wound edge but parallel to the skin
66
tunneling occurs in what stage pressure ulcers
3 and 4
67
stage of wounds with slough
3 and 4
68
what should one assume in the presence of slough
that the wound is colonized with bacteria
69
composition of slough
serum proteins, collagen; may change color if bacteria also present
70
characteristics of stable eschar
hard, black, dry, leathery
71
composition of stable eschar
desiccated and necrotic tissue
72
when should stable eschar not be removed
when it is on a distal arterial wound
73
characteristics of unstable eschar
black, shiny, boggy, accompanied by inflammation
74
significance of unstable eschar
bacteria are present on viable tissue underneath, watch for signs of infection
75
characteristics of granulation tissue
red or deep pink, shiny, bumpy surface, moist
76
composition of granulation tissue
new capillaries, matrix, fibroblasts, collagen
77
rolled wound edge aka
epibole
78
characteristics of rolled wound edge
raised and rounded wound edges that have rolled under
79
rolled wound edge composition
healing skin, sealed edge of mature epithelium
80
characteristics of epithelialization
paler skin color, ground glass appearance
81
composition of epithelialization
epithelial cells (new skin)
82
thin, opaque wound exudate
seropurulent
83
think, opaque wound exudate
purulent
84
significance of sanguineous exudate
new blood vessel growth or disruption of blood vessels
85
significance of serous wound exudate
normal during inflammatory and proliferative phases
86
significance of serosanguineous wound exudate
normal during inflammatory and proliferative phases
87
significance of purulent wound exudate
signals wound infection, may have odor
88
significance of seropurulent wound exudate
may be the first sign of infection
89
Stage III pressure ulcer involves what
epidermis, dermis, subcutaneous tissue/superficial fascia
90
Stage 1 pressure ulcer involves what
epidermis
91
Stage IV pressure ulcer involves what
epidermis, dermis, subcutaneous tissue/superficial fascia, underlying structures
92
Stage II pressure ulcer involves what
epidermis, dermis
93
partial thickness corresponds to what stage
II
94
full thickness corresponds to what stage
III, IV
95
Diabetic ulcers are what grade
stage of pressure ulcer minus 1
96
appearance of stage III ulcer
deep ulceration with or without undermining of adjacent tissue
97
appearance of stage 1 ulcer
non-blanchable erythema of intact skin
98
appearance of stage IV ulcer
extensive tissue destruction with exposure of underlying structures, tissue necrosis
99
appearance of stage II ulcer
superficial ulceration: abrasion, crater, or blister
100
to avoid pressure ulcers, patients should be turned every
2 hours
101
dressings for skin tears
non-adherent
102
recheck for skin tears
24-48 hours
103
Category 3 skin tear
flap is completely absent
104
category 1 a skin tear
flap is present and can be replaced without stretching, no signs of flap compromise are present
105
category 2a skin tear
edges cannot be realigned to normal anatomical position, no signs of flap compromise
106
category 2b skin tear
edges cannot be realigned to normal position, signs of flap compromise
107
category 1b skin tear
flap is present and can be replaced with stretching, there are signs of flap compromise.
108
what percentage of ulcers are caused by venous insufficiency
70%
109
3 characteristics of wounds caused by venous insufficiency
shallow ulcer in lower third of leg, surrounding skin changes, irregular in shape
110
3 options for diagnosing venous insufficiency
venous duplex imaging, air plethysmography, venography
111
contraindications for pressure stockings
open wound, arterial occlusion
112
what pressure should be used for chronic venous insufficiency with edema
low-moderate, 30-40
113
high compression pressure and uses
50+, lymphedema/phlebolymphedema
114
what pressure is used for edema prevention during daily activities
10-15, light support
115
what pressure is used for refractory venous insufficiency or lymphedema
moderate, 40-50
116
what pressure is used for DVT prophylaxis in non-ambulatory patients with edema
low, 15-20
117
what pressure is used for venous insufficiency with varicosities and dependent edema
low, 20-30
118
when should compression stockings be replaced
every 3-4 months
119
what is Marjolin's ulcer and when is it suspected
type of squamous cell carcinoma, non-healing venous ulcer after 3 months
120
treatment for stasis derm, dry pruritic
moisturizer or petroleum-based emollient
121
tx for stasis derm, dry pruritic burning
impregnated gauze
122
tx for stasis derm, impetiginized
topical abx (-cin)
123
tx for stasis derm, vesiculation/oozing
topical corticosteroids (-inolone)
124
tx for stasis derm, refractory
corticosteroids
125
what percentage of PAD patients are asymptomatic
>50%
126
what percentage of diabetic foot ulcers results in LEA
25%
127
albumin signalling protein malnutrition
<3.5
128
critically low anemia that may inhibit wound healing
HCT<18
129
what is atrophie blanche
white scarring due to microthromboses
130
what is lipodermatosclerosis
fibrosing subcutaneous tissue with progressive induration and hyperpigmentation
131
what finding is normal on venous duplex
triphasic
132
what are clinical signs of Marjolin's ulcer
rolled margins, rapid increase in size, excessive granulation
133
what is Buerger's disease
progressive inflammation and thrombosis of small vessels in extremities
134
type of wound bed seen in PAD
pale or necrotic
135
what ABI is abnormal
<1.0 or >1.3
136
what is hyperkeratosis
callous formation at pressure points
137
when is hyperkeratosis seen
diabetic neuropathy
138
what is gastrocnemius soleus equinus
limited range of motion with increased pressure on sole of foot due to limited ankle dorsiflexion
139
charcot foot
rocker bottom
140
what is pes cavus
high arch
141
what is pes planus
flat foot
142
what A1C is suggestive of nonhealing ulcer
>12
143
what A1C is considered diabetic
>6.5
144
how much periwound erythema for OM
>2 cm
145
is imaging diagnostic for OM?
Not always, bone biopsy is gold standard
146
what bacteria is usually present in gangrene
clostridium
147
what is the best imaging modality for limb-threatening foot infection
CT
148
what are 3 signs of limb-threatening foot infection
crepitus, bullae, pain out of proportion
149
what lab values differentiate LTFE from cellulitis
elevated CK, AST
150
excess of what nutrient can cause retardation in healing and fibrosis
vitamin E
