Final Flashcards
1
Q
what virus causes Epstein Barr Virus?
A
HHV 4 (human herpes virus 4)
2
Q
highest incidence of mono is in what age group
A
15-24 yo
3
Q
incubation period of mono
A
30-50 days
4
Q
highest morbidity in mono
A
college and military
5
Q
EBV enters body thru
A
oral epithelial cell
6
Q
mono infects what type of cell
A
B cells
7
Q
mono causes the release of
A
cytokines
8
Q
diagnostic test for mono
A
heterophile abs
sheep and horse cells
9
Q
humoral immunity involves
A
extracellular microbes → bacteria
10
Q
cellular immunity involves
A
cellular immunity → intracellular viruses
11
Q
mono triad
A
fever
pharyngitis
posterior cervical LAD
12
Q
mono often starts w.
A
malaise, HA, low grade fever
kissing tonsils
tonsillar exudates
palatal petechiae
splenomegaly
13
Q
what type of drug causes rashes in mono pt
A
penicillins
14
Q
penicillin induced rash in mono is characterized by
A
maculopapular
generalized
pruritic
15
Q
less common findings in mono
A
+/- jaundice, periorbital edema, CNS findings, myocarditis
16
Q
mono lab findings
A
lymphocytic leukocytosis:
absolute count > 4500
differential: >50% → inverted differential
atypical lymphocytes
increase of CD8+ T lymphocytes
Downey cell
17
Q
what is an inverted differential
A
lymphocytes > neutrophils
18
Q
what is a downey cell
A
reactive, atypical lymphocyte specific to viral infxn
19
Q
the monospot test uses
A
heterophile abs
20
Q
the monospot test is not always ___ or ___
A
specific; sensitive
21
Q
how might mono affect LFTs
A
transient abnormal
22
Q
ddx for mono
A
strep pharyngitis
CMV
toxoplasmosis
malignancy
peritonsillar abscess
malignancy
23
Q
in strep pharyngitis, you will not see
A
splenomegaly
extreme fatigue
24
Q
CMV is not is not _
and doe not involve _
A
exudative
splenomegaly
25
toxoplasmosis does not involve hepatic or _ symptoms
pharyngeal
26
malignancy is more likely to be __ than mono
and _ is uncommon
asymmetric
pharyngitis
27
peritonsillar abscess triad
hot potato voice
trismus
deviation of uvula
pain unilaterally
28
mono is usually \_
and tx is mostly \_
self limited
supportive
29
pharm for mono
tyelonol
NSAIDS
30
indications for steroids in mono tx
impending airway obstruction
severe thrombocytopenia w. hemorrhage
meningitis
AI hemolytic anemia
sz
31
are antivirals recommended in mono
no!
32
contact sports should be avoided for how long in mono
2-3 weeks
33
complications of mono are rare, but include
splenic rupture
airway compromise
malignancy → lymphoma; nasopharyngeal carcinoma
AI hemolytic anemia
encephalitis
myocarditis
hepatitis
34
fatigue from mono could last
2-3 months
35
definition of acute sinusitis
\<4 weeks
36
definition of subacute sinusitis
4-12 weeks
37
definition of chronic sinusitis
\>12 weeks
38
definition of recurrent acute sinusitis
at least 4 episodes/year w. interim sx resolution
39
signs of bacterial sinusitis
symptoms \>10 days
unilateral maxillary sinus/facial pain
maxillary tooth pain
unilateral purulent nasal d/c
second sickening
fever
40
characteristics of viral URI fever
only first 2 days w. HA, myalgia
as fever resolves → respiratory s/sx may persist on day 10, but are less severe
41
acute bacterial sinusitis pathogens
1. **strep pneumo → 75%**
2. H.flu
3. M. catarrhalis
4. S. aureus
42
what pathogen accounts for 75% of bacterial sinusitis
strep pneumo
43
tx for bacterial sinusitis
1. Augmentin (Amox Clauv) → adults AND kids
2. Penicillin allergy → Doxycyline
44
bacterial sinusitis abx duration - kids
10-14 days
45
bacterial sinusitis abx duration - adults
5-7 days
46
sinusitis complications (8)
1. preseptal swelling
2. orbital cellulitis
3. orbital superiosteal abscess
4. septic cavernous sinus thrombosis
5. meningitis
6. osteomyelitis
7. subdural abscess
8. brain abscess
47
preseptal cellulitis
swelling, erythema of **periorbital** area and eyelids
NO proptosis or limitation of eye movement
48
orbital cellulitis
**peri**orbital swelling
eyelid erythema.
pain w. eye movements
chemosis and proptosis
ophthalmoplegia → paralysis/weakness of eye muscles
diplopia, vision loss
49
orbital superiosteal abscess
same s/sx as orbital cellulitis **plus marked globe displacement**
50
eye complications of bacterial sinusitis from least to most concerning
**least → most concerning:**
1. preseptal cellulitis
2. orbital cellulitis
3. orbital superiosteal abscess
4. osteomyelitis of frontal bone
51
septic cavernous sinus thrombosis
bilateral ptosis
proptosis
ophthalmoplegia
periorbital edema
AMS
septic appearing
52
osteomyelitis of frontal bone
**Pott Puff tumor**
**forehea**d/scalp swelling/tenderness
HA, photophobia
fever, vomiting, lethargy
53
subdural abscess
fever, severe HA
meningeal irritation
progressive neuro deficits, sz
papilledema
vomitting
54
brain abscess
HA, stiff neck
AMS, neuro deficits
vomiting
CN III, VI deficits
papilledema
55
chronic sinusitis may actually be
migraines
56
migraine pain is usually
unilateral
57
migraines are concerning if they last for \> than
18-24 hr
58
migraine pain is often described as
throbbing
59
response to what med can be diagnostic of mirgaines
triptans
60
4 Phases of a Migraine
1. prodrome
2. aura
3. HA
4. postdrome
61
migraine prodrome can last
a few hours to days
62
migraine aura can last
5-60 min
63
migraine HA can last
4-72 hr
64
migraine postdrome can last
24-48 hr
65
the longest phase of a migraine is
prodrome
66
5 symptoms of migraine prodrome
irritability
DPN
yawning
polyruria
nausea
67
migraine aura - 3 symptoms
1. visual disturbances
2. temporary loss of sight
3. numbness/tingling
68
migraine HA - 5 symptoms
1. throbbing
2. drilling
3. icepick in head
4. burning
5. vomiting
6. giddiness
7. nasal congestion
8. neck pain
69
migraine - postdrome 5 symptoms
1. inability to concentrate
2. fatigue
3. DPN
4. euphoria
5. lack of comprehension
70
fewer %age of people experience which phase of migraines
aura
71
3 abortive migraine meds
**order of most to least recommended:**
1. OTC analgesics → **Excedrin is most effective**
2. Triptans; Ergotamine spray
3. ketorolac injxn; ergotamine IV; dexamethsone
72
chronic migraine is defined as
at least 15 HA/mo lasting 4 hr/day or longer
73
migraine prophylactic meds
1. **beta blockers → Propranolol is best**
2. CCB
3. antidepressants → tines and triptylines
4. anticonvulsants → Valproic acid, Topamax
5. anti-calcitonin gene-related peptide therapy → expensive
6. botox
7. magnesium
8. CBT; acupuncture
74
best propylactic migraine med for pt w. HTN
beta blocker
75
best migraine med for pt w. insomnia
amitriptyline
76
best migraine med for pt who needs to lose wt
Topamax
77
s.e of Topamax
brain fog
tastes awful
78
OTC analgesics should be limited to
15 days or less/mo
79
Excedrin should be limited to
no more than 10 days/mo
80
which migraine med can cause rebound HA
Triptans
81
concern for rebound HA when
pt has to take med every day to control HA
82
CVA that lasts \< 24 hr
TIA
83
occlusion forms locally at ischemic site
thrombotic
84
clot breaks off from another location and travels to brain
embolic
85
reversibly damaged brain tissue around ischemic core
penumbra
86
3 causes of hemorrhagic stroke
1. aneurysm
2. head trauma
3. cocaine
87
small vessel/lacunar stroke is occlusion of the __ arteries
and is usually caused by \_\_
small
longstanding HTN
88
Afib can cause __ stroke
embolic CVA → clot forms in heart → travels to brain
89
scoring system that determines risk for ischemic stroke
CHADS 2
CHADSVASC
90
CHADS scores of 2 or more indicate
need for anticoagulation
91
components of CHADS2
CHF (1)
HTN (1)
age \> 75 (1)
DM (1)
stroke/TIA (2)
92
components of CHADSVAS
CHF
HTN
Age \>75 yo (2)
DM
stroke/TIA
vascular dz
age \> 65-74 (2)
female
93
symptoms of ACA stroke
contralateral paralysis and sensory loss **mostly affecting leg**
abulia → apathy
urinary incontinence
gait apraxia
grasp reflex or sucking reflex
94
symptoms of MCA stroke
hemiparesis **primarily affecting face and arm**
hemisensory deficit **primarily affecting face and arm**
gaze preference toward affected hemisphere
aphasia
hemianopsia
+/- apraxia
95
PCA stroke symptoms
homonymous hemianopsia affecting contralateral vision field
anomic aphasia → difficulty naming objects
alexia w.o graphia → can't read/write
visual agnosia → can't see or interpret visual info
**contralateral** hemisensory loss and hemiparesis
unilateral HA
CN III palsy
balance
96
which type of stroke is most common
MCA
97
lacunar stroke symptoms
**absence of cortical signs (aphasia, agnosia, hemianopsia, apraxia, etc)**
**PLUS ONE of the following:**
pure motor hemiparesis → face, arm, leg **on one side of body;** ***no sensory deficit***
pure sensory stroke → numbness of face, arm, leg on one side of body; **no motor deficit**
ataxic hemiparesis → weakness and ataxia out of proportion to motor deficit
sensorimotor stroke on one side of body
**dysarthria-clumsy hand syndrome →** facial weakness, dysarthria, dysphagia. slight weakness, clumsiness of one hand
98
evaluation of CVA
1. neuro exam
2. CT **non contrast to eval for hemorrhage**
3. MRI → detects early ischemia
4. EKG
5. carotid doppler/US → carotid stenosis
99
what should always be the first imaging for CVA
CT w.o contrast
100
best imaging to eval for stenosis
carotid doppler/US
101
best imaging to eval for possible embolic source of CVA
Echo
102
best imaging to identify early ischemia
MRI
103
tPA inclusion criterai
1. at least 18 yo
2. **clinical dx of ischemic CVA w. measurable deficit**
3. time of onset \<4.5 hr → *time of onset unknown → usually don't qualify for tPA*
104
hard no's for tPA
1. minor or isolated neurologic signs
2. rapidly improving
3. major surgery or serious trauma in past 2 weeks
4. GI or urinary tract bleeding in past 3 weeks
5. MI in last 3 weeks
6. sz at onset of stroke w. neurological impairments
7. pregnancy
105
gray areas for tPA
1. age \>80
2. oral anticoagulant use regardless of INR
3. severe stroke → NIHSS score \>25
4. combo of previous ischemic stroke and DM
106
tPA exclusion criteria
1. e.o intracranial hemorrhage on CT
2. previous intracranial hemorrhage
3. severe uncontrolled HTN → SBP \> 185; DBP \>110
4. known AVM, neoplasm, aneurysm
5. thrombocytopenia \<100k
6. current use of anticoags
7. Heparin w.in last 48 hr
8. hypoglycemia → BG \<50
9. ***basically anything w. high risk for bleeding***
107
significantly lowering BP in stroke patient can lead to
worse outcomes
108
bp goal pre thrombolysis
SBP: \<185 to \>110
109
maintenance bp post thrombolysis
\>180/105 for at least 24 hr
110
bp goal for no thrombolytic therapy
SBP \> 220 or DBP \>120
111
for chronic management post CVA what is preferred over Heparin
1. ASA
2. Warfarin
112
does Bell's Palsy have race, geographic, or gender predilection
NO
113
RF for Bell's Palsy
3x greater during pregnancy → 3rd trimester or 1 week postpartum
DM
114
most likely pathogen in Bell's Palsy
herpes simplex
115
second leading cause of Bell's Palsy
herpes zoster
116
non infectious Bell's Palsy etiologoes
trauma
ischemia
compression of CN VII
genetic predisoposition
117
Bell's Palsy clinical features
unilateral facial paralysis
ear pain
**inability to move forehead**
inability to close eye
flattening of nasolabial fold
drooping of mouth
decreased tearing
hyperacusis
loss of taste → anterior ⅔ of tongue
118
reflex eval in Bell's Palsy
orbicularis reflex → asymmetry in blinking
bell phenomenon → upward movement of eye w. eye closing
119
Bell's Palsy is a __ diagnosis
clinical
120
criteria for clinical dx of Bell's Palsy
1. diffuse facial nerve involvement w. paralysis of facial muscles
2. acute onset over 1-2 days
121
Bell's Palsy usually reaches maximal weakness w.in
3 weeks
122
partial or complete recovery in Bell's Palsy is usually w.in
6 months
123
imaging for Bell's Palsy is intended to
r.o other causes → CT/MRI
124
what is the House-Brackmann scale used to evaluate
Bell's Palsy
125
first line tx for Bell's Palsy
Prednisone 60-80 mg daily x 1 week → ***best w.in 3 days of onset***
126
if given alone, __ do not work well for Bell's Palsy
antivirals
127
combo therapy of Prednisone + antiviral is recommended for Bell's Palsy w. __ or higher on the HB scale
**IV →**
minimal movement, asymmetric resting tone
no forehead movement
incomplete eye closure
slight mouth movement
128
signs of improvement in Bell's Palsy are usually seen w.in __ weeks
3
129
further work up for BP if improvement not seen w.in \_
3-4 months
130
worse prognosis in BP if (3 things)
hyperacusis
advanced age
severe pain at onset
131
H&P clues that point to PAD
1. pt can walk 4 blocks (discrete distance) prior to pain
2. sitting helps → pain resumes w. activity
3. pain in legs w. reclining in chair → dangling them relieves pain
4. advil does not help
132
PAD PE exam findings
1. diminished pulses
2. smooth, hairless legs
3. legs that are cooler to the touch
4. thickened toenails
5. color changes
6. +Buerger test
133
what is the Buerger test
pt supine → elevate both legs to 45 degrees for 1-2 min:
pallor in feet/lower extremities → **indicates ischemia**
pt sits up and hangs legs over bed → color should return → blue or red
134
PAD is most commonly caused by
atherosclerosis
135
advanced PAD dz indicates
ischemia in multiple vessels
136
PAD can be
asymptomatic
137
common symptoms of PAD
1. intermittent claudication
2. atypical pain
3. nonhealing wounds → usually on feet
4. ulcers
5. gangrene
6. thin, hairless, shiny skin
7. cool skin
8. blue toe syndrome
9. ***DM worsens all of these***
138
in PAD, location of pain can correlate with
site of the lesion
139
PAD pain: buttocks and hips indicates
aortoiliac dz
140
Leriche syndrome triad
**PAD:**
claudication
absent or diminished femoral pulses
ED
141
PAD: thigh pain indicates what claudication site
common femoral artery
142
PAD: claudication in upper ⅔ of calf indicates ischemia
in the superficial femoral artery
143
PAD: claudication in the lower ⅔ of calf indicates ischemia
in the popliteal artery
144
PAD: claudication in the food indicates ischemia in the
tibial/peroneal arteries
145
most common claudication complaint in PAD
calf
146
complication of PAD: acute limb ischemia - 6Ps
pain
pale
pulseless
paresthesias
pallor
perishingly cold
147
tx for acute limb ischemia
immediate Heparin
immediate revascularization
emergent surgical consult
148
ABI test is done using a
Doppler probe
149
ABI is assessing the
ratio of the ankle systolic bp / brachial systolic pressure
150
nl ABI
1.0-1.4
151
ABI \<0.9
diagnostic for PAD
152
ABI \> \_\_
indicates \_\_
1.3
calcified vessels
153
exercise testing may be considered in PAD pt with (2 things)
atypical pain
normal ABI
154
ABI less than __ after exercise is diagnostic of arterial obstruction
20%
155
first test for PAD is always
ABI
156
after, ABI next test for PAD is
CTA
157
gold standard for vascular imaging
conventional arteriography (angiogram)
158
the pro of conventional arteriogaphy in acute ischemia is that
it can be simultaneously diagnostic and intervention
159
cons of conventional arteriography
invasive → have to puncture artery
higher risk
160
the go to imaging for acute linb ischemia
conventional arteriography (same same angiogram, angiography)
161
order of testing for PAD
1. ABI
2. CTA
3. conventional arteriography → best for acute ischemia
162
tx for PAD
1. lifestyle modifications
2. long term antithrombotic theray → ASA OR Plavix
3. at least a moderate intensity statin ***regardless of LDL***
163
all PAD patients should be on what 2 meds
**Aspirin OR Plavix**
**Statin** (at least moderate intensity regardless of LDL)
164
tx for claudication (3 things)
1. supervised exercise
2. Cliostazol (Pletal) → phosphodiesterase inhibitor
3. revascularization
165
Cliostazol (Pletal) is absolutely contraindicated in what pt population
CHF
166
s.e of Cliostazol (Pletal)
ha, diarrhea, infxn, rhinitis
167
revascularization for claudication is recommended in patients w.
life threatening ischemia
pt w. significant disabling symptoms unresponsive to lifestyle mods or meds
168
arterial ulcers are
severely painful
169
venous ulcers are
less painful than arterial
erythematous, brown-blue
170
neuropathic ulcers are
painless
171
Wells Criteria for DVT
1. cancer tx past 5 mo
2. paralysis or paresis or cast of lower extremity
3. bedridden for at least 3 days in past 4 weeks or major surgery past 12 weeks
4. tenderness localized along deep venous system
5. swelling of entire leg
6. unilateral calf swelling **\>3 cm compared to other side**
7. unilateral pitting edema
8. superficial collateral veins
9. prior DVT
10. alternate dx as or more likely than DVT
172
Wells DVT: 0 - \<0
3% probability for DVT
## Footnote
**order D-dimer**
**normal → no further testing**
**positive → US**
173
Wells DVT: 1-2 points
moderate probability - 7%
## Footnote
**order high sensitivity D-dimer:**
**normal → no further testing**
**positive → US**
174
Wells DVT 3-8 points
high probability - 50-75%
**NO Ddimer!!**
**order US**
175
Wells is used for
DVT and PE
176
Pretest Probability for PE: \<2
**low →**
**apply PERC:**
**all criteria fulfilled → done**
**one or more not fulfilled → CTPA**
177
Wells PE: 2-6
**intermediate →**
**D-dimer →**
**negative → done**
**positive → CTPA**
178
Wells PE: \>6
**high -→ CTPA**
179
PERC is only used for pt w. __ Wells probability for PE
low → \<2
180
Wells Pretest Probability for PE
DVT symptoms
PE is as likely or more likely than an alternate dx
bedrest 3 or more days or surgery in last 4 weeks
previous DVT/PE
hemoptysis
ca tx in last 6 mo or current palliation
heart rate \>100
181
There are separate Wells Pretest Probability criteria for both \_\_
and \_\_
DVT
PE
182
PERC criteria
Pulmonary Embolism Rule Out Criteria
183
DVT on an US will look like
noncompressibility of the veins
184
CTPA
computed tomography pulmonary angiogram
185
CTPA is same same
CTA
186
CTPA/CTA is both \_\_
and __ for diagnosing
\_\_
sensitive
specific
PE
187
proximal DVT locations (3)
popliteal veins
femoral veins
iliac veins
188
distal DVT locations (3)
anterior tibial veins
posterior tibial veins
peroneal veins
189
hemodynamically unstable (massive) PE definition
SBP \<90 for \>15 min
hypotn requiring vasopressors
clear e.o shock
190
tx for massive PE
IV fluids and vasopressor support (epinephrine, norepinephrine, vasopressin)
**reperfusion therapy:**
thrombolytic therapy OR
embolectomy
191
submassive PE definition
RV dysfxn and borderline BP
192
saddle pulmonary embolism
193
thrombolytic therapy is called
tPA
194
in pulmonary embolism, tPA is used for which dx
hemodynamically unstable (massive) PE
195
in pulmonary embolism, embolectomy is used for
those who fail tPA OR
those who have contraindication for tPA
196
unprovoked DVT/PE is
idopathic → start work up
197
provoked DVT is
caused by a known event
198
known events for provoked DVT include
surgery
hospital admit
C-section
pregnancy
estrogen therapy
reduced mobility
199
persistent risk factors for provoked DVT (inherited vs acquired)
malignancy
inheritable thrombophilias (Leiden Factor V, prothrombin gene mutation)
anatomic risk factors
chronic dz → ex IBD
200
common meds that cause provoked DVT
estrogen
OCPs
testosterone
tamoxifen
steroids
201
anticoagulation for DVT/PE
heparin (Lovenox) → bridging to Coumadin (5mg) OR
Eliquis, Pradaxa, Xarelto, Savaysa
202
INR goal for anticoagulant tx
2-3
203
do you need to Heparin bridge w. NOACs
No!
204
minimum amt of time to anticoagulate for DVT/PE
3 months
205
risk of VTE recurrence is highest in the
1-2 years after the event
206
pt w. active malignancy have a __ risk of DVT/PE recurrence
15-20%
207
DVT/PE pt's that are usually indefinitely anticoagulated (3)
1. recurrent proximal DVT and/or symptomatic PE w.o identifiable risk factors
2. any VTE associated w. active cancer not precipitated by major provoking event
3. 1st episode of proximal DVT and/or symptomatic PE w.o identifiable risk factor
208
indefinite anticoagulation not recommended for DVT/PE pt w.
first episode VTE w. transient major risk factor
209
goal of IVC filters
prevent embolization of a lower extremity clot to the lung
210
IVC filters are recommended for pt's w. acute proximal DVT and PE who have
absolute contraindication to anticoagulant therapy →
*active bleeding, hemorrhagic CVA, recent surgery etc*
211
emphysema definition
abnormal enlargement of terminal airspace
obvious fibrosis
212
mMRC scale
dyspnea
213
CAT (COPD Assessment Scale)
214
COPD FEV1/FVC diagnostic score
\<0.7
215
GOLD COPD Staging
216
COPD tx steps
1. assess symptoms w. mMRC or CAT
2. assess risk of future exacerbations using GOLD
3. Place pt in Group A-D
217
tx for COPD
1. SMOKING CESSATION!
2. flu and PNA vaccines
3. exercise
4. pt ed
218
SABAs
Albuterol (ProAir, Proventil, Ventolin)
Levalbuterol (Xopenex)
219
SAMAs
Ipratropium (Atrovent)
220
Combo: Ipratropium + Albuterol
Combivent
Duoneb
221
LABAs
Salmeterol
Formoterol
**Aformoterol**
Indacaterol
Olodaterol
222
Paulson's choice for COPD
Spiriva (LAMA) + Albuterol
223
LAMAs
Tiotropium **(Spiriva)**
Aclidinium
Umeclidinium
Glycopyrronium
224
ICS + LABA
Advair
Symbicort
Dulera
Breo Ellipta
225
Theophyline
Bronchodilator
* not used as much*
* lots of drug interactions*
226
Oxygen therapy for COPD must be used at least __ hr per day
16
227
PaO2 and O2 sat for O2 therapy in COPD
**PaO2: 55** or less
**O2 sat: 88%** or less
228
qualifications for hospice (3)
2 physicians certify that pt is terminally ill → \< 6 mo left to live
pt or family must sign to choose hospice over curative
eligibility depends on dz process
229
pulmonary dz hospice eligibility
1. disabling dyspnea at rest; poor response to meds
2. increasing ER visits/hospitalizations
3. PaO2 55 or less; O2 sat less than 88% at rest
4. cor pulmonale 2/2 to pulmonary dz
5. unintentional wt loss \>10% x 6 mo
6. resting tachycardia \>100/min
230
what are PAs allowed to do in hospice
1. provide, manage, Medicare reimbursement
2. establish and review plan of care
231
PA AND NP hospice limitations
1. only physician or medical director may certify terminal illness
2. only medical director may admit pt to hospice
3. PAs can't take position of physician in interdisciplinary team
232
PA but not NP hospice limitation
face-to-face encounter prior to recertification for hospice to determine continued eligibility → ***PAs can not do this, NPs can***
233
dying process - comfort meds (2)
1. morphine (oral elixir is Roxanol)
2. lorazepam
234
what comfort med also helps w. anxiety
Lorazepam (Ativan)
235
what helps w. the death rattle
discontinue IVF
place pt on side
**scopolamine patch**
**atropine**
**glycopyrrolate injxn**
236
comfort meds - nausea
1. Haloperidol (Haldol)
2. rectal prochlorperazine (Compazine)
3. Odansetron (Zofran)
237
comfort meds: pain, nausea, anorexia, and asthenia
glucocorticoids
238
ICDs in hospice
deactivating ICD will not cause immediate death!
w. biventricular pacing you can just turn off ICD
239
pronouncement of deat
check ID bracelet/pulse
check pupils
check response to verbal/tactile stimuli
check for spontaneous respiration
check for heart sound/pulses
note time of death
speak to family
240
what to document when pronouncing death
1. date and time
2. brief statement of cause of death
3. note absence of pulse, respiration, pupil response, rxn to verbal/tactile stimuli
4. not if family informed or response
5. notification of pastoral care, social work, hospice agency, attending
241
comfort meds that are good for pt w. impaired swallowing
morphine
ativan (lorazepam)
***available in liquid form***
