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Flashcards in Final Deck (144):
1

Emergent triage

Respiratory distress
Chest pain
Active hemorrhage
Unstable vital signs

2

Urgent triage

Severe abdominal pain
Displaced/multiple fractures
Complex/multiple soft tissue injuries
Respiratory infection

3

Non-urgent triage

Skin rash
Strains & sprains
Cold
Simple fracture

4

Exertional heat stroke

Sudden onset
Strenuous physical activity in hot conditions
Change in LOC
Hypotension
Tachycardia
Tachypnea

5

Classic heat stroke

Over period of time
Chronic exposure to hot environment
Change in LOC
Hypotension
Tachycardia
Tachypnea

6

Pit viper envenomation

Local necrosis & swelling
Minty, rubbery, metallic taste
Paresthesias of scalp, face, & lips

7

Antivenom for pit vipers

C/I pineapple allergies
4-6 vials 1st 60 min
2 vials every 6 hrs for 18hrs

8

Antivenom for coral snakes

3-6 vials over 2 hrs

9

Early S/S frostbite

White, waxy appearance of skin

10

Prerenal AKI

Caused by direct damage to kidneys (arrythmias, burns, dehydration, diuretic overuse)
Hypotension
Tachycardia
Decreased urine output
Lethargy

11

Intrarenal AKI

Caused by nephrotoxins, transfusion reaction
Edema
Oliguria/anuria
Lethargy
NV
Flank pain
Hypertension
Tachycardia

12

Postrenal AKI

Caused by pelvic cancers & stones
S/S same as intrarenal

13

Onset phase AKI

Begins with event & ends with oliguria
Hours to days

14

Oliguric phase AKI

Urine output 100-400mL/24 hrs--does not respond to diuretics
Lasts 1-3 wks
Dyspnea

15

Diuretic phase AKI

Sudden onset 2-6 wks after oliguric
Urine flow increases
Up to 10L/day
Normal kidney tubular function is reestablished

16

Recovery phase AKI

May take up to 12 mos
Kidney function may not return to normal

17

AKI drug therapy

Fluid challenge
Diuretics
CC blockers
Kayexelate--hyperkalemia
Glucose & insulin

18

Chronic kidney disease

Progressive
Irreversible; kidney function doesn't recover

19

Reduced renal reserve

No buildup of wastes in blood
Nephrons compensate
No manifestations of kidney dysfunction

20

Reduced GFR

Nephron damage has occurred
Increased dilute UO
Reduced GFR

21

ESKD

Urea & creatinine build up in blood
Kidneys can't maintain homeostasis

22

Continuous ambulatory peritoneal dialysis

Dialysate infused & remains for specified time
Removed by gravity

23

Automated peritoneal dialysis

Cycling machine
Continuously, intermittently, or at night

24

Post-dialysis assessment

Hypotension
Headache
Nausea, vomiting
Malaise
Muscle cramps

25

Dialysis disequilibrium syndrome

Rapid decrease in fluid volume & BUN

26

PE manifestations

Dyspnea/tachypnea
Tachycardia
Chest pain
Dry cough
Distended neck veins
Hypotension

27

Ventilatory failure extrapulmonary causes

Neuro disorders
Spinal cord injuries
CNS dysfunction
Chemical depression

28

Ventilatory failure intrapulmonary causes

COPD, asthma
PE
Pneumothorax
ARDS

29

Oxygenation failure causes

High altitudes
Pneumonia
PE
ARDS

30

ARDS manifestations

Hypoxia even when O2 at 100%
Dyspnea
Pulmonary edema
Whited-out chest xray

31

Assist-control ventilation

Ventilator takes over the work of breathing for the pt
Tidal volume & ventilatory rate preset

32

SIM ventilation

Allows spontaneous breathing at pt's own rate
Tidal volume & ventilatory rate preset

33

BiPAP

Preset inspiratory pressure & expiratory pressure similary to PEEP

34

Tidal volume

Amount of air received with each breath
7-10

35

Peak inspiratory pressure (PIP)

Highest pressure reached during inspiration

36

CPAP

Positive airway pressure throughout entire respiratory cycle for spontaneously breathing pts
Keep alveoli open during inspiration & prevents collapse during expiration

37

PEEP

Positive pressure exerted during expiratory phase
Prevents atelactasis

38

Barotrauma

Damage to lungs by positive pressure
Pneumothorax

39

Volutrauma

Excess volume delivered to one lung over the other

40

Thrombotic stroke

Atherosclerosis in blood vessel wall

41

Embolic stroke

Emboli break off & travel to cerebral arteries
Common source is heart
Pts with atrial fibrillation

42

Left hemispheric stroke

Aphasia/dysphagia
Alexia
Agraphia
Acalculia

43

Right hemispheric stroke

Visual & spacial awareness
Disoriented to time & place
Personality changes
Poor judgement

44

Broca's aphasia

Pt understands, but can't communicate verbally

45

Wernicke's aphasia

Pt can't understand spoken & often written word
May be able to speak, but speech is meaningless

46

Cushing's triad

Severe hypertension
Widened pulse pressure
Bradycardia

47

Normal ICP

10-15 mmHg

48

Epidural hemorrhage

Neurologic emergency
Temporal bone fractures

49

Subdural hemorrhage

Highest mortality rate
Laceration of brain tissue

50

Intracerebral hemorrhage

Brain edema & ICP elevation
Brain stem hemorrhage

51

Brain herniation

Brain tissue may shift & herniate downward in presence of increased ICP

52

Brain abscess

Pus forms in extradural, subdural, or intracerebral areas
Treat with penicillin

53

Bradycardia tx

Atropine 0.5 mg IV up to 3 mg
Monitor for tachycardia

54

Tachycardia tx

Treat cause of tachycardia

55

PAC

Premature P wave
No symptoms
No caffeine

56

SVT

Usually caused by PAC
150-280 BPM
Adenosine 6 mg IV, then 12 mg IV push
Asystole after

57

A-fib

Alcohol excess (holiday heart)
No discernable p waves
Antidysrhythmics--cardizem, amiodarone, beta-blockers, digoxin
Anticoagulants

58

PVC

Wide QRS
Unifocal (all alike) or multifocal (different)
Multifocal more dangerous
Can trigger V-tach or V-fib

59

V-tach

Pt may seem fine
Wide QRS

60

Torsade de pointes

Twisting--too fast to cardiovert
Mg sulfate IV

61

V-fib

Epi--1mg (1:10,000) every 3-5 min
Vaso--50 mg for 1st 2 doses of epi
Ami--300 mg, then 150 IV push

62

1st degree AV block

PR >.20 sec
No S/S; no treatment

63

2nd degree AV block type 1

PR gets wider & wider & then drops
Atropine

64

2nd degree AV block type 2

PR normal & then drops
Cardiac pacing

65

3rd degree AV block

P wave & QRS regular, but at different intervals
Cardiac pacing
Atropine

66

Bradycardia tx

Atropine 0.5 mg IV up to 3 mg
Monitor for tachycardia

67

Tachycardia tx

Treat cause of tachycardia

68

PAC

Premature P wave
No symptoms
No caffeine

69

SVT

Usually caused by PAC
150-280 BPM
Adenosine 6 mg IV, then 12 mg IV push
Asystole after

70

A-fib

Alcohol excess (holiday heart)
No discernable p waves
Antidysrhythmics--cardizem, amiodarone, beta-blockers, digoxin
Anticoagulants

71

PVC

Wide QRS
Unifocal (all alike) or multifocal (different)
Multifocal more dangerous
Can trigger V-tach or V-fib

72

V-tach

Pt may seem fine
Wide QRS

73

Torsade de pointes

Twisting--too fast to cardiovert
Mg sulfate IV

74

V-fib

Epi--1mg (1:10,000) every 3-5 min
Vaso--50 mg for 1st 2 doses of epi
Ami--300 mg, then 150 IV push

75

1st degree AV block

PR >.20 sec
No S/S; no treatment

76

2nd degree AV block type 1

PR gets wider & wider & then drops
Atropine

77

2nd degree AV block type 2

PR normal & then drops
Cardiac pacing

78

3rd degree AV block

P wave & QRS regular, but at different intervals
Cardiac pacing
Atropine

79

Chronic stable angina

Predictable following exertion
Relieved by nitrates & rest

80

Unstable angina EKG

Depressed ST
Inverted T-wave
Resolves when pain goes away
At rest or with exertion

81

Variant angina

Coronary spasm
Elevated ST
Responds to nitrates

82

New onset angina

1st angina symptoms
Increased exertion

83

Pre-infarction angina

Occurs in days or weeks before MI

84

Subendocardial

Only through subendocardial muscle
NSTEMI
More likely to have STEMI later on

85

Transmural

All the way through heart muscle
STEMI
ST elevation in 2 contiguous leads

86

Heart changes in MI

Blue & swollen initially
48 hrs gray with yellow streaks
8-10 days granulation tissue
2-3 mos scar tissue

87

Anterior MI

L anterior descending artery
ST elevation V1-V4
Tachycardia; 2nd & 3rd degree heart blocks

88

Posterior (lateral) MI

Circumflex artery
ST elevation V5 & V6
Sinus arrhythmias

89

Inferior MI

Right coronary artery
ST elevation in 2, 3, & aVF
Sinus bradycardia; heart blocks

90

LDL

<70 known CAD risk

91

HDL

>40

92

Triglycerides

<150 men

93

Metabolic syndrome risk factors

Hypertension
Decreased HDL
High LDL
High triglycerides
Large waist

94

Creatinine Kinase

Women 30-135
Men 55-170

95

Cardiac catheterization

Determine extent & exact location of MI
Watch for cold extremities

96

Unstable angina/NSTEMI treatement

Glycoprotein inhibitors
Beta-blockers
ACE inhibitors
ARBs
CC blockers

97

Thrombolytics C/I

Abdominal surgery/stroke
Intracranial hemorrhage
Malignant neoplasm
Ischemic stroke w/in 3 mos unless w/in 3 hrs
Closed head injury w/in 3 mos

98

Class 1 heart failure

Absent crackles & S3
IV nitrates & diuretics

99

Class 2-3 heart failure

More aggressive interventions needed

100

Class 4 heart failure

Cardiogenic shock
Tachycardia
Hypotension
UO <30 ml/hr
Tachypnea

101

Cardiogenic shock tx

IV morphine--pain
O2--decrease O2 requirements
Vasopressors--maintain tissue perfusion

102

Intra-aortic balloon pump

Inflates during diastole to keep vessel open

103

PTCA

Balloon compresses plaque against wall of vessel
Stent is usually inserted

104

CABG

Artery bypass
Angina w/ >50% occlusion
Acute MI w/ cardiogenic shock
PTCA not an option

105

Post-CABG hypertension

Nitroprusside
Cover tubing with aluminum foil; absorbed in light

106

Cardiac tamponade

Sudden cessation of drainage
JVD
Pulsus paradoxus

107

Progression of CABG pt

3-6 hrs--ventilator
2 hrs after extubation--pt dangled side of bed
4-8 hrs--pt up to chair
1st day postop--ambulating 25-100 ft 3x/day

108

Mediastinitis

Infection develops 5 days to several wks postop
Fever beyond 4 days postop
Boggy sternum
Redness & swelling of sutures
Increased WBC

109

Initial stage shock

MAP decreased <10
Compensatory mechanisms effective
HR & RR increased or slight increase in diastolic BP may be only signs

110

Non-progressive (compensatory) shock

MAP decreased 10-15
Kidney & hormonal compensatory mechanisms kick in
Acidosis & hyperkalemia
Decreased UO
Stop conditions that cause shock

111

Progressive (intermediate) shock

MAP decreased >20
Compensatory mechanisms no longer deliver O2 to vital organs
Feeling of impending doom
Multi-organ failure

112

Irreversible (refractory) shock

Therapy can't save pt's life even if cause corrected & MAP returns to normal

113

Hypovolemic shock

Loss of blood volume
Loss of O2-carrying capacity--loss of RBCs
Hemorrhage/dehydration
Changes in mental status early signs

114

Cardiogenic shock

Actual heart muscle is unhealthy

115

Distributive shock

Fluid delivered to interstitial tissues & can't be circulated properly

116

Neurogenic shock

Spinal cord injury
Head trauma
Widespread vasodilation

117

Chemical induced distributive shock

Anaphylaxis
Sepsis
Capillary leak syndrome

118

Septic inflammatory response (SIRS)

Organisms escape local control
Inflammatory response takes over

119

Septic shock tx

Vancomycin
Aminoglycosides
Penicillin
Cephalosporins

120

Primary prevention

Prevention of initial occurrence of disease or injury
Nutrition counseling
Sex education
Immunizations

121

Secondary prevention

Early detection of disease & treatments with goal of limiting severity & A/E
Screenings
Treatment of STDs
Treatment of TB
Control of communicable diseases

122

Tertiary prevention

Maximization of recovery after injury or illness
Rehabilitation
Support groups
Case management

123

School nurse primary prevention

Immunization status
Knowledge regarding health issues

124

School nurse secondary prevention

Assess illness or injury
Early detection of disease--scoliosis, lice
Detect child abuse or neglect

125

School nurse tertiary prevention

Assess children with disabilities
Long-term health needs--diabetes, asthma

126

HIV clinical A

Flu-like symptoms
Enlarged lymph nodes

127

HIV clinical B

HIV with 1 or more infections

128

HIV clinical C

HIV with AIDS

129

HIV 1

CD4 at least 500
29%

130

HIV 2

CD4 200-499
14-28%

131

HIV 3

CD4 <14%

132

Superficial thickness burns

Epidermis injured
Heals 3-5 days

133

Superficial partial-thickness burns

Involves entire epidermis
Blister formation
Blanchable
Increased pain (nerve endings exposed)
Heals 10-21 days

134

Deep partial-thickness burns

Deeper into dermis
No blister
May or may not blanch
Decreased pain (nerve endings are damaged)
Heals 3-6 wks
May require skin grafts

135

Full-thickness burns

Destruction of entire epidermis & dermis
Grafting necessary
Hard leathery eschar
No blood supply
Decreased sensation
Healing weeks to months

136

Deep full-thickness burns

Extends into fascia & tissues
Damage to bone, muscles, tendons
Excision & grafting

137

Fluid shift after burns

Capillary leak syndrom
Hyperkalemia
Hyponatremia
Hemoconcentration

138

Resuscitation/emergent phase

24-48 hrs
ABCs
Head to toe
Cool, cover, carry
Fluid resuscitation--crystalloids

139

Fluid resuscitation

4mL/kg/% burned
1st 1/2 over 1st 8 hrs
2nd 1/2 over next 16 hrs

140

Acute phase

36-48 hrs--fluid resuscitation finished to wound covered by tissue
Prevent infection--tetanus, antibiotics
Debridement
Silvadene

141

Autograft

Skin from burn victim

142

Homograft

Cadaver skin
Usually rejected 2-3 wks

143

Heterograft

Pig skin
High infection rate--treat with silver nitrate

144

Rehabilitative phase

Years-end of life--burn healing to reconstruction complete