Final Exam 2016 Flashcards

1
Q

S/s liver disease/failure (RUQ)

A

Jaundice, pruritis(itchy), spider angiomas, red palms, anorexia, N/V, DULL right up quad pain, clay colored stool, fector hepaticus (sweet musty breath), portal HTN (ascites/varices), dark brown frothy urine, decrease u/o, hepatic encephalopathy, asterixis (liver flap), anasarca (fluid in skin), pleural effusion, leukopenia (NOTHING FRESH), K loss, confusion, male breasts, woman face hair, amenorrhea

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2
Q

Prevent liver disease

A

Avoid raw shellfish, vent room, protect skin, limit meds, limit ETOH

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3
Q

Interventions

A

Lotion, high calorie high carbs LOW PROTEIN, I&O, fluids, neuro: alarms, freq checks, elevate edema, pericentesis for ascites, respiratory: fowlers, arms out, conserve energy, nothing fresh, electrolytes

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4
Q

High PT/INR means?

A

Coumadin or liver disease

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5
Q

Most specific serum test for liver used to monitor tx

A

ALT

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6
Q

Post liver biopsy

A

Bed rest 12 hrs, lay ON SITE (pressure)

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7
Q

Portal HTN

A
Comp liver disease
Ascites 
Peripheral edema 
Splenomegaly 
Increase venous pressure in portal circulation 
Varices 
HTN
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8
Q

Ascites main s/s and intervention

A

Abd pain, impaired respiratory, low u/o, low K, bacterial peritonitis

NA restrict
Diuretics
Paracentesis

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9
Q

Varices

A

Comp portal HTN (liver disease)

Bleeding/shock for esophageal varices

Gastric

Internal hemorrhoids

Caput medusae (around umbilicus)

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10
Q

Esophageal varices bleed tx

A

Caused from portal HTN
contributor: STRAINING, alcohol, coarse food

Stabilize and stop bleed (fluids, blood)

Tx w/ either sclerotherapy (heat), band ligation, balloon tamponade

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11
Q

Endoscopy interventions

A

Return of gag reflex, LOC, bleeding

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12
Q

Balloon tamponade care

A
For bleeding esophageal varices 
Patency
Position via X-ray 
Saline lovage/NG suction 
Semi fowlers 
NPO 
Scissors at bedside
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13
Q

Shunting

A

Used after bleeding varices episode

Shunts blood out of portal vein

TIPS (non surgical)

COMPLICATION = ammonia build up

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14
Q

Hepatic encephalopathy

A

Life threat complication liver disease
Ammonia (normal 15-40)
Neurotoxic

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15
Q

Hepatic encephalopathy interventions

A
Limit protein
Mental change 
Asterixis- Liver flap
Hyperreflexia 
Fector hepaticus (musty sweet breath) 

TX WITH LACTULOSE (bm to get rid ammonia)
Antibiotics
Electrolytes
Neuro asses Q2hrs

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16
Q

Hepatorenal syndrome

A

Life threat complication liver disease
Renal vasoconstrict –> renal fail
Liver transplant

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17
Q

Overall care liver disease

A
Rest 
No etoh, ASA, NSAIDS
Manage s/s 
Prevent complication 
Diet
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18
Q

Liver fail

A
Jaundice 
Coagulation defects
Encephalopathy 
Portal HTN
Cerebral edema
Electrolyte disturb 
Cardio abnormal
Renal fail
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19
Q

Key w/ hepatitis management

A

Rest and nutrition

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20
Q

Hep incubation phase

A

Most infectious
Flu-like (malaise, anorexia, low grade fever, N/V, arthralgia (joint aches))
RUQ pain

one month

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21
Q

Acute/icteric phase hep

A

No fever
Jaundice, pruritis, dark tea urine, clay stooo
Anicteric

2-4weeks

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22
Q

Convalescent/posticteric phase hep

A

Gradual improvement
Malaise, fatigue
REST
2-4 months

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23
Q

Hep nutrition

A

High cal/card low fat/protein

Sm freq meals

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24
Q

Hep A

A

Fecal/oral, dirty water, raw shellfish
“Newsmaker”
Acute only

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25
Q

Hep A diagnostics

A

Anti-HAV (antibody to hep A)
Anti-HAV IgM (immunoglobulin=acute hep)
Anti-HAV IgG= (G=gone, past infection, future immunity)

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26
Q

Tx hep A

A

Vaccine prophylaxis

Immunoglobulin within 2 weeks

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27
Q

Hep B

A

Blood, body fluids, sex, needles ,perinatal
Lives on dry surface 7days
Carrier/infectious lifetime
HIV test

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28
Q

Chronic hep b

A

HBsAg positive 2x
Seen in very young
Interferon and antivirala

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29
Q

Hep c

A

Silent killer
Asymptomatic for yrs
No vaccine
Always infectious perinatal, percutaneous, permucosal
Symptoms usually jaundice/bruising/fatigue
HIV
antibody test

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30
Q

Colorectal cancer

A

Change in bowel pattern

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31
Q

Polyps

A

All abnormal need removed
Adenomatous/neoplastic linked cancer
Risk cancer increase w polyp size increase
Gradual/insidious onset (0 symptoms until advanced)

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32
Q

Polyp risk

A
Genetics 
IBD
Age > 50
Increased red meat diet 
Lynch syndrome (born with hundreds polyps)
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33
Q

S/S polyps/colorectal cancer

A
Insidious/gradual
Non specific
Problems w/ bleed, obstruction, perforation, fistula 
Recent weight loss
Iron deficient anemia 
Rectal bleed
Abd tender 
Bowel change 
Hepatomegaly/ascites
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34
Q

Descending colon tumor s/s

A

Bleed and diarrhea

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35
Q

Ascending colon tumor

A

Detected later, presents as bowel obstruction

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36
Q

Cancer detect

A
Sigmoidoscopy Q5 years
Or
Colonoscopy Q10 yrs
Age 50+
Yearly feckless occult blood tests
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37
Q

Colorectal cancer geriatrics

A

Fatigue
Iron deficient
Minor bowel change/bleed
Tenesmus (feeling to have to poop)

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38
Q

colorectal cancer tx

A

Stage 1 hemicolectomy
Stage 2 resection w/ or w/o chemo
Stage 3 surgery and chemo
Stage 4 palliative

***bowel cleanse and antibiotics prior (ex miralax)

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39
Q

Low anterior reception (LAR)

A

Preserves sphincter function

Tx colorectal cancer

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40
Q

Chemo

A

Affects all systems

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41
Q

Ostomy care

A

High fiber

Increase fluids

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42
Q

What is celiac

A

Autoimmune genetic digestive disease
Malabsorption
Inflammation w/ gluten (wheat, barley, rye)

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43
Q

Celiac comp

A

Iron anemia, vit b/d deficient leading osteoporosis

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44
Q

Celiac s/s

A
Chronic diarrhea 
Steatorrhea (pale frothy floating poop) bc impaired fat absorb
Abd pain, distention, N/V, constipation 
Growth fail (lack energy/appetite) 
Bruising/anemia 
Tetany
Dehydration 
Hair thinning
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45
Q

Adult celiac s/s

A
Iron anemia
Fatigue
Bone/joint pain 
Depression
Tingling hands/feet 
Seizures/migraines 
Canker sores in mouth 
Itchy dry skin rash
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46
Q

Celiac tx

A
Only 100% gluten free + steroids short term 
Vitamins 
Replace w/ corn & rice 
Low fat 
Compliance
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47
Q

Celiac crisis

A

Dehydration
Profuse watery diarrhea
Emotional disturb
Infection

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48
Q

Diverticulosis

A

Sacs in sigmoid no inflame or symptoms
Vague abd pain, bloating, flatulence, change bowel
Some bleeding

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49
Q

Diverticulitis

A

Inflammation w/ infection
Acute LLQ pain, mass
Infection s/s: fever, leukocytosis
Abscess

Maybe asymptomatic

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50
Q

Risk diverticular disease

A

Age
Low fiber/fluid
Low exercise
Congenital

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51
Q

Dx diverticular disease

A

Colonoscopy or rectal bleed
**Never colonoscopy w/ itis
Do CT scan with contrast **

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52
Q

Tx diverticulitis

A

NPO, rest, antibiotics, NG tube, IVF

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53
Q

Tx diverticulosis

A
High fiber
Low fat/red meat 
Exercise/fluids
Weight reduction 
Stool soften 
No straining
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54
Q

Acute pancreatitis

A
Life threat 
Sudden severe deep piercing radiating Abd pain LUQ or midepigastrum 
Decreased bowel sounds 
Increase pain AFTER meals 
N/V (vomit doesn't help) 
Dyspnea, jaundice, cyanosis
S/S hypovolemic shock
Grey turners (flank ecchymosis)/Cullen's sign (peri umbilical ecchymosis)  
Hypocalcemia (chvosteks, trousseaus)
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55
Q

Chronic pancreatitis

A

LUQ pain
Chronic heavy gnawing feelings not relieved by foods/antacids
Malabsorption: weight loss, jaundice & dark urine, steatorrhea (fatty stool), DM
Frothy urine/stool

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56
Q

Acute pancreatitis complications

A
Respiratory: effusion, ARDS (LUNG SOUNDS!!!!)
Cardiac: shock 
Hypocalcemia: tetany 
Infection 
Compartment syndrome
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57
Q

Pancreatitis interventions

A
Pain
NG auction 
NPO (maybe ppn)
Semi fowlers 
Antacids, PPI, H2RA
Slowly advance food (high carbs!) 
Education (no alcohol, diet) 
Pancreatic enzyme meds WITH meals
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58
Q

Two types of IBD

A

Chrons and Ulcerative colitis (UC)

Chronic inflammation; exacerbations &a remission

*no cure

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59
Q

Diff btwn chrons and UC

A

Chrons- all layers bowl, anywhere in GI, skip lesions, recurrence

UC- inner layer GI, starts in rectum -> continuous, pseudopolyps, cured w surgery, cancer risk, toxic mega colon more common (perforation)

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60
Q

Chrons s/s

A

Diarrhea
Abd pain
Weight loss (malabsorption)

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61
Q

UC s/s

A

Bloody stool***
Anemia, weight loss, dehydration, diarrhea
Abd pain (lower cramping)
Tenesmus

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62
Q

Toxic megacolon

A
Complication UC 
SEVERE abd pain
Distention
Fever 
Severe bloody diarrhea 

Tx
NPO, rest, NG tube, IVF, steroids, antibiotics if no cure 24hrs -> colectomy

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63
Q

Systemic complication IBD

A
Finger clubbing
Erythema nodosum 
Aphthous ulcers 
Conjunctivitis 
Thromboembolism 
Gallstones 
Osteoporosis
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64
Q

IBD dx

A

Colonoscopy (never w/ exacerbation)

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65
Q

Pharm tx IBD

A

5-ASA (reduce inflam)

Sensitive to sun w/ meds! Know bleeding s/s, orange skin/urine NORMAL

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66
Q

IBD diet

A

High calorie, high vitamin, high protein, low residue (no dairy)

67
Q

Mechanical bowel obstruction

A

Small intestine

Surgical, cancer, diverticular disease

68
Q

Non mechanical bowel obstruct

A
Paralytic ileus (post op) 
Neuro or vascular
69
Q

Bowel Obstruction pathophysiology

A

Hyper bowel sounds above, absent below
Distention -> third spacing
Can lead to hypovolemic shock
Bowel ischemia -> necrosis -> perf-> septic shock

70
Q

Small bowel obstruction

A
Rapid dehydration 
Intermittent pain 
Freq projectile vomit (orange, brown) 
Greatly increase distention
Borborygmi (loud bowel sounds) above obstruction 
Hypovolemia
71
Q

Large bowel obstruct

A
Slow dehydration 
Persistent cramping pain 
Rare/gradual vomit
 increase distention
Borborygmi (loud bowel sounds) above obstruction 
Hypovolemia
72
Q

Obstruction dx

A

Ct

Abd X-ray

73
Q

Tx obstruction

A
Must resolve in 24 hrs
NPO
NG tube
IVF 
I & O
Pain
74
Q

GERD s/s

A
Pyrosis (burning in esophagus)
Dyspepsia (indigestion) 
Regurgitate 
Hyper salvation 
Dysphasia
Odynophagia (pain w swallow)
Globus sensation (lump in throat)
Non cardiac chest pain
75
Q

Esophagitis

A

Common comp GERD
inflammation esophagus
Ulcers -> structures/dysphasia

Tx with sucralfate*** to coat esophagus

76
Q

Barret’s esophagus

A

Lining lower esophagus changes
Precursor cancer
Freq heartburn, gnawing epigastric pain, bleed, perf

Tx: endoscopic ablation therapy

77
Q

GERD teaching

A
Low fat, small freq meals
No caffeine, beer, milk, carbonation 
Don't drink/eat before bed
Normal body weight 
No tight clothes 
Elevate HOB 

H2RB
Before meal PPI
Antacid
Prokinetic

78
Q

PPI side effect

A

Osteoporosis

79
Q

IBS s/s

A
Alter bowel pattern 
Abd pain/distention 
Bloating
Constipation/diarrhea/both 
Excessive flatulence 
  • no fluids with meals
80
Q

Cholecystitis

A
Obstruction gallbladder from stones 
Emergency 
S/s:
Indigestion
Pain RUQ radiate shoulder
Abd rigidity 
Fever
Jaundice 
Increased labs
81
Q

Cholecystitis care

A
NPO
rest
Fluids
NG tube 
Dressing
82
Q

Cholelithiasis

A
Intolerance fatty food 
Severe pain (biliary colic) 
Obstructive jaundice 
Dark amber urine 
Clay stool 

Tx
Surgery
ERCP
ESWL (shock wave)

83
Q

ERCP

A

Pt left side

Gag/cough reflex post procedure

84
Q

Peripheral artery disease

A
Intermit claudication (pain/cramps)
Paresthesia
Pallor when legs up (no blood) 
Rubor when legs down (blood pooling) 
Rest pain
No periph pulses 

Dx: ankle brachial index

85
Q

Percutaneous transluminal balloon angioplasty

A

Balloon tipped cath in stenotic vessel, inflates to compress plaque and stretch vessel –> stent

(PAD tx)

86
Q

Post surgical PAD nsg care

A

Avoid knee flexed position and prolonged sitting (cuts circulation)

ABI

pulses

87
Q

6 Ps of acute arterial ischemia

A
Pain 
Pallor
Pulsessness
Paresthesia 
Poikilothermia (coldness) 
Paralysis (advanced stage)  
  • caused from clot that cuts off blood supply
88
Q

Care for arterial embolism

A

SUPINE

89
Q

Venous leg ulcer

A
Near medial malleolus 
Edema
Exudate 
Superficial IRREGULAR shape 
Red/yellow color
Pain worsens when dangling legs
90
Q

venous insufficiency

A
Aching/crampy 
Present pulses
Stasis dermatitis 
Warm 
Thick/tough skin
Brown/leathery skin
91
Q

Arterial ulcer

A
In feet areas 
Very painful or no pain 
Deep CIRCULAR shape 
Ulcer pale black 
No edema or drainage
92
Q

PQRST assessment for angina

A
Pain 
Quality
Radiating
Severity
Timing
93
Q

Acute coronary syndrome

A

Is an MI just different types (stemi/nonstemi)

94
Q

Most cardiac specific biomarker

A

Troponin

95
Q

Tx ACS

A

Acute coronary syndrome (MI)

Oxygen, ASA, NTG, Morphine

“M-A-N-O”

PCI within 90 min

96
Q

1 complication MI

A

Dysrhythmias

97
Q

Post PCI care

A

SUPINE, leg straight, insertion site, pressure when sheath removed, distal extremity

98
Q

PDA

A

Patent ductus arteriosus

Widening pulse pressure
Bounding pulse
Acyanotic

99
Q

Aortic stenosis

A

Limit activity

Acyanotic

100
Q

Tetralogy of fallot

A

Pulmonary stenosis
Right ventricular hypertrophy
Ventrical septal defect
Overriding of aorta

Dx: cyanosis, Tet spells

101
Q

Tet spells

A

With activity that increases O2 demand

Tachypnea, tachycardia, irritable, crying, cyanosis, KNEE TO CHEST POSITION to compensate (calm the child down)

102
Q

Normal CO, MAP, and EF

A

CO: 5-7
MAP > 60
EF > 60

103
Q

Normal K

A

3.5-5

104
Q

Normal pH
Normal CO2
Normal bicarbonate

A

PH 7.35-7.45
CO2 35-45
Bicarbonate 22-26

105
Q

Left HF

A

PND

Pulmonary

106
Q

2 ACE inhibitor examples

A

Captopril
Lisinopril

HF !!!!!

107
Q

BB example

A

Metoprolol

108
Q

Digoxin and digoxin toxicity

A

Increase force contraction and slows conduction in HF

toxicity: nausea, blurred vision, halos, dysrhythmias

109
Q

HF symptom recognition teaching

A

FACES:

Fatigue
Activity limitation
Cough
Edema
SOB
110
Q

Reasons why went into HF exacerbation (acronym)

A

A3 I3 E

Arrhythmia
Angina
Anemia

Indiscretion of meds
Infarction
Infection

Endocrine

111
Q

Another name for ADHF

A

Pulmonary edema

112
Q

Early sx ADHF

A

Tachypnea

Decrease O2 sat

113
Q

“Donkey and cart up hill” interventions (3) for ADHF

A

Can either unload cart to get uphill (diuretics)
Have donkey go around hill (vasodilators)
Push donkey to go uphill (inotropes)

114
Q

Takotsubo

A

Stress related syndrome in women that mimics cardiomyopathy until cath

115
Q

Weird teaching about mouth to prevent IE

A

Prevent gum infections/tooth decay

Prophylactic antibiotics for dental cleanings

116
Q

IE s/s

A
Flu
Murmur
HF
Splinter hemorrhages 
Petechiae
Olsers nodes 
Janeways lesion
117
Q

PTBV

A

Percutaneous transluminal balloon valvuloplasty

Cath lab
Balloon prevents stenosis in valve
Extremity CMS, pressure dressing

118
Q

INR range onnnnnn Coumadin

A

2.5-3.5

Takes longer to work

119
Q

Immediate post op for heart replacement

A

Lethal arrhythmias and rejection

120
Q

Cor pulmonale

A

From copd (pulmonary artery HTN) -> increase work of R side heart -> right sided HF

121
Q

S/s COPD

A

Weight loss
Chronic cough
Dyspnea
Sputum

122
Q

Bacterial pneumonia sputum color

A

Purulent

123
Q

HAP

A

More virulent pneumonia

Onset 48hrs or longer after admission

124
Q

IHI ventilator bundle

A
Sedation vacation 
Chlorhexidine rinse 
Elevate HOB 
Ulcer prophylaxis 
DVT prophylactic
125
Q

S/s lung cancer

A
Silent
Persist cough 
Sputum volume/blood
Pneumonitis sx 
Chest shoulder back pain 
Dyspnea wheezing strider
Systemic (late)
Bone/joint pain 
Weight loss
Anorexia 
Fatigue 
N/V
Hoarseness
126
Q

2 main issues w/ end stage lung cancer

A

Dyspnea (air hunger)

Pain

127
Q

TB manifestations

A

DRY cough -> productive
Fatigue, weight loss, night sweats, fever (flu like)

Dyspnea
Hemoptysis (cough blood)

128
Q

Tuberculin skin test

A

Screening if infected

PPD objected read 48-72 hrs

129
Q

Positive TB skin test

A

Redness NOT positive, hardness (induration) is

If it’s over 15 induration = low risk
5 = immunosuppressed, recent exposure
10 = immigrant, high risk setting, IV drug users

Doesn’t mean disease present (exposed or vaccinated)

Should have CXR***

130
Q

Dx TB

A

Sputum culture (8 weeks) (and H&P and CXR)

131
Q

Positive TB sputum smear infection time

A

2 weeks

Avoid public

132
Q

TB meds

A
Rifampin
INH (causes hepatitis--> avoid alcohol)
133
Q

Main reason for TB tx fail and how to solve

A

Non-adherence

DOT (direct observed therapy)- watch them swallow meds

134
Q

ARDS

A

Severe dyspnea/hypoxemia UNRESPONSIVE to O2

Infiltrates on CXR

135
Q

ARDS tx

A
O2 + PEEP (positive end expiratory pressure to open alveoli) 
Manage underlying cause 
Lateral rotation therapy
PRONE position (tummy) 
Nutrition
136
Q

Acute respiratory failure

A

50/50

o2 50
CO2 50

137
Q

When is trach tube consider for pt on vent

A

If on vent longer than 10-14 days (damage)

138
Q

Flail chest

A

Floating seg ribs from fractures

Paradoxical chest movement

139
Q

Croup s/s

A

Harsh barking cough
Hoarseness
Inspiratory strider

LTB most common type
(Epiglottitis = emergency!)

140
Q

Epiglottitis

A
Type of croup: EMERGENT!
strider at rest
Cyanosis
Severe agitation
Retractions
CANT DRINK FLUIDS
141
Q

Croup (LTB) management

A
Patent airway (home care usually)
Moist air 
Room temp oral fluids 
Cool mist 
Steroids
142
Q

Cardinal signs of Epiglottitis (4 D)

A

Drooling
Dysphasia
Dysphonia
Distressed inspiration

(Never examine epiglottis until intubation equipment available- NPO)

143
Q

Bronchiolitis

A

Commonly from RSV
Most common ped. Respiratory infection
No cough but trouble breathing s/s
CONTACT/droplet precautions

144
Q

Cystic fibrosis

A

Inherited
Mucus in bronchioles, intestine, pancreatic/bile ducts)
Increase Cl and Na in sweat !
No cure

145
Q

S/s cystic fibrosis

A
Poor growth
Bulky greasy stool or STEATORRHEA (difficulty absorbing)
Freq colds/cough 
Thick sticky secretions
Cor pulmonale 
Diabetes
146
Q

Cystic fibrosis tx

A

Airway clearance therapy

Mucolytics

147
Q

Pancreatic enzyme capsule

A

WITH meals to breakdown high fat foods in CF

148
Q

Adrenal cortex

A

Cortisol (metabolism and stress)

Aldosterone (k/na for bp regulation)

149
Q

Addisons

A
Adrenal cortex insufficiency 
Hyper pigment
Low Na, low glucose
High K 
Muscle weakness 
Neuro 

Steroids (increase in times of stress)
** increase Na intake **

150
Q

Cushings

A
Excessive ACTH (from pituitary to adrenal cortex->cortisol)
From long term steroids; can be hypothalamus, pituitary, or adrenal
High Na, high glucose
Low K
Moon face
Muscle atrophy(low K)
HTN
buffalo humo 
Facial hair
Na and water retention 
Thin fragile skin, acne 
Fat tummy 
Facial hair 

Taped down steroids

151
Q

Primary hyper aldosteronism

A
Excess aldosterone (adrenal cortex) 
Tumor 
HTN
Low k 
Low Ca (tetany, paresthesia, weakness, cramps, dysrhythmias)
High Na (sodium retention, K excretion) 

K sparing diuretic
Na restrict, K supplements

152
Q

Adrenal medulla

A

Epi/norepi

Vasoconstrict; “fight or flight”

153
Q

Pheochromocytoma

A
Adrenal medulla tumor 
EXCESSIVE catecholemines (epi/norepi) 
Pounding headache
Tachycardia 
HTN
Diaphoresis
Flushing
Hyperglycemia 
Tremor 
Anxious 

Give antiHTN
Don’t palp abd

154
Q

Anterior pituitary

A

ACTH, TSH, GH

155
Q

Acromegaly

A
Excess GH 
Sweat
Mood disorders
Enlarged hands/feet
Deep voice 
Thick facial features
Hyperglycemia 
Thick leathery skin 
Large lips
156
Q

Pituitary tumor

A

Gland bear face/eyes
Headache
Visual disturb
Hypo or hyper secretion s/s

Tx transphenoidal hypophysectomy

157
Q

Transphenoidal hypophysectomy

A

Removal of pituitary (secretes ADH so at risk for DI) need lifelong hormones
Neuro assess
CSF drainage
Nasal packing
HOB up
Avoid straining *** (sneeze, lift, blow nose)

158
Q

Posterior pituitary

A

ADH (water balance)and vasopressin

Low osmolality=more dilute

159
Q

SIADH

A
Excess ADH 
increase H2O absorb, dilute Na (low osmality) 
Water retention low Na 
Weight gain
Muscle weakness 
Lethargy 
Low u/o 
Headache 
Confusion 
THIRST 

Tx fluid restrict (<1000), diuretics, IV hypertonic

160
Q

DI

A
Deficient ADH 
LARGE amounts dilute urine, increasing serum osmolality, hypernatremia
Low sp gravity (<1) 
Polydipsia 
Polyuria 
U/o > 20L
Weakness 
Dehydration 

Tx fluid replace, vasopressin

161
Q

Dignostic for thyroid disease

A

TSH
high= hypoactive thyroid
Low= hyperactive

162
Q

Thyroid hormone needs what

A

Iodine (in salt)

163
Q

Goiter

A

Enlarged thyroid gland

Swallowing/airway problems

164
Q

Hashimoto’s thyroiditis

A

Autoimmune
High TSH
hypothyroid