Final Exam Material Flashcards
(183 cards)
1
Q
(“C”)
Assessments
A
- Need for CPR
2. Uncontrolled Bleeding
2
Q
(“C”)
Interventions
A
- Start CPR
2. Control Bleeding
3
Q
A
Assessments
A
Airway and C-SPine
- Look, listen, feel for air movement
- Clarity of speech
- Patency vs. obstruction (stridor, wheezing ..)
- AVPU
- C-spine injury
4
Q
A
Interventions
A
Airway and C-Spine
- Suctioning
- Oral or nasopharyngeal airway
- Jaw thrust / chin lift
- Advanced airway
- C-spine immobilization
5
Q
B
Assessments
A
Breathing
- Rate, effort, and quality of resps (diminished, WOB, nasal flaring)
- Auscultate lungs
- Skin colour
- Level of consciousness
6
Q
B
Interventions
A
Breathing
- Assist ventilations (BMV / ventilator)
- Pulse oximeter
- Supplemental oxygen
7
Q
C
Assessments
A
Circulation
- Skin: colour, temperature, moisture
- Capillary refill time
- Palpate pulses (quality, rate, rhythm)
- Chest pain: yes / no
8
Q
C
Interventions
A
Circulation
- Initiate IV
- Resuscitative fluids
- Cardiac monitor
- 12 lead ECG
9
Q
D
Assessments
A
Disability / Dextrose / Doctor / Discomfort
- Re-assess AVPU
- GCS
- Stroke scale
- Pupils (PERLA)
- Dextrose
- Barriers to assessment: pain, vomiting
- Need for physician (LOU)
10
Q
D
Interventions
A
Disability / Dextrose / Doctor / Discomfort
- Pain management / anti-emetic
- Notify physician / specialist
11
Q
E
Assessments
A
Expose
1. Bruising, wounds, skin temp and colour changes
12
Q
E
Interventions
A
Expose
- Gown and blanket
- Active warming procedures
13
Q
F
Assessments
A
Full set of VS / Family Presence
- Full set of vital signs
- Presence of family / notify family
14
Q
F
Interventions
A
Full set of VS / Family Presence
1. Facilitate family presence
15
Q
G
Assessments
A
Go Back and Re-assess
1. If necessary, go back and re-assess
16
Q
G
Interventions
A
Go Back and Re-assess
- Re-assess A-F
- Are applied interventions working?
17
Q
What are the components of the primary assessment?
A
- CPR / Uncontrolled bleeding
- Airway and C-spine
- Breathing
- Circulation
- Disability / Dextrose / Doctor / Discomfort
- Expose
- Full set of VS / Family Presence
- Go back and re-assess
18
Q
What are the main components of the secondary assessment?
A
- Subjective history
- Objective history (head to toe examination)
- Focused system assessment
19
Q
When do you ask LOTARP?
A
Secondary assessment
20
Q
What specifics do you ask in the secondary assessment?
A
- Allergies
- Medications
- PMHx
- Last meal
- Risk behaviours (smoking, ETOH, drugs)
- Biographical information
21
Q
J
Considerations
A
Journey
1. Disposition, movement, and treatment
2. Where might the patient need to go next?
(Lab work, imaging, OR, tubes and lines, discharge, teaching, equipment)
22
Q
What is the normal range for pH?
A
7.35 - 7.45
( < 7.35 = acidosis)
( > 7.45 = alkalosis)
23
Q
What is the normal range for pCO2?
A
35 - 45
( < 35 = alkalosis)
( > 45) = acidosis
24
Q
What is the normal range for HCO3?
A
22 - 26
( < 22 = acidosis)
( > 26 = alkalosis)
25
What qualifies pO2 as mild, moderate, or severe?
Mild = 60 - 79
Moderate = 40 - 59
Severe = < 40
* This is NOT oxygen saturation!
26
What is the definition of a stable patient?
NORMAL clinical findings and a history that is not life or limb threatening
27
What is the definition of an unstable patient?
ABNORMAL clinical findings and a history that IS considered life or limb threatening
28
What is the definition of a potentially unstable patient?
NORMAL clinical findings but history warrants concern and ongoing observation
29
What does CTAS Level I mean?
Resuscitation
- time = immediate
- conditions that are threats to life or limb, requiring aggressive interventions
30
What does CTAS Level II mean?
Emergent
- time = < 15 minutes
- conditions that are potential threat to life, limb or function
- require rapid medical interventions
31
What does CTAS Level III mean?
Urgent
- time = < 30 minutes
- conditions that could potentially progress to a serious problem
- associated with significant discomfort or affecting ADLs
32
What does CTAS Level IV mean?
Less Urgent
- time = < 60 minutes
- conditions related to pt age, distress, or potential for deterioration or complications
- would benefit from interventions within 1-2 hours
33
What does CTAS Level V mean?
Non-Urgent
- time = < 120 minutes
- conditions that may be acute but non-urgent
34
What are three types of visceral pain?
1. Tension pain
2. Inflammatory pain
3. Ischemic pain
35
How will a pt describe tension pain?
- Vague, deep, and poorly localized
| Pt will frequently change positions to get comfortable
36
How will a pt describe inflammatory pain?
- INITIALLY vague, deep and poorly localized but pain will increase in severity and localize
Pt will remain STILL
37
How will a pt describe ischemic pain?
Sudden in onset, intensity, continuous, and progressive
- Not relieved with analgesia
- Vomiting may occur
38
What does AVPU stand for?
Alert
Verbal
Painful
Unresponsive
39
What is AVPU used for?
To determine the need and type of intervention required
| - if the patient is not alert, the airway may be compromised and interventions must be considered
40
What does SpO2 measure?
The percentage of hemoglobin saturated with oxygen
| - helps to determine hypoxia
41
What does PERLA stand for?
Pupils equal and reactive to light and accommodation
42
What should be done next if AVPU is found to be abnormal?
GCS
- best eye response
- best verbal response
- best motor response
43
What is the earliest sign of decreased cerebral perfusion?
Altered LOC
44
If a CVA is suspected, what should be performed under "D"?
Rapid stroke assessment
- Face (is it drooping)
- Arms (can you raise both)
- Speech (slurred or jumbled)
- Time (get help asap)
45
True or False:
| Hypoglycemia is a frequent cause of altered LOC
True
46
What constitutes a full set of vital signs?
HR, BP, Temp, RR, O2
47
What are postural vital signs?
Measuring BP and HR in successive positions
| - from lying supine, to sitting, to standing
48
Why are postural vital signs important?
Gives an indication of compensatory mechanism (vasoconstriction)
- information about a patient's volume status
49
What is the most significant change in postural vital signs?
HR
| - increase in 20 bpm
50
True or False:
| ED assessments do not have to be completed sequentially
False
| - primary assessment MUST be completed before moving on to the secondary assessment
51
What are the four stages of clinical reasoning?
1. Attending to initially available cues (subjective and objective)
2. Generating tentative hypotheses
3. Gathering data to rule in or out tentative hypotheses
4. Evaluating hypotheses and gathering additional data
52
What is a pertinent negative?
Ruling out data
| - what symptoms does the patient deny?
53
What tool will you use to gather information on the history of the present illness?
LOTARP!
| - of the PROBLEM, not pain
54
What does LOTARP stand for?
```
L = Location
O = Onset
T = Timing / Type
A = Associated symptoms / Aggravating and alleviating factors
R = radiation
P = Precipitating events
```
55
What does CIAMPEDS stand for?
```
C = Chief complaint
I = Immunizations / Isolation
A = Allergies
M = Medications
P = PMHx / Parent Perception
E = Events surrounding illness
D = Diet / Diapers
S = Symptoms associated with illness
```
56
When do you perform a review of systems (ROS)?
| In adults? In children?
ROS should be used within LOTARP and CIAMPEDS
Adults = A
Children = S
57
Why do you perform a review of systems (ROS)?
Organized approach to rule IN or OUT hypotheses about causes for chief complaint
- GI, GU, GYNE, Musculoskeletal, Cardiovascular, Respiratory, Neurological
58
When does a focused system assessment take place?
After completing:
- Primary survey
- Subjective history
- Objective assessments
59
What are the components of a neurological assessment?
1. GCS
2. PERLA
3. ROM
4. Limb strength and equality
5. Presence of drift
60
What are the components of a cardiovascular assessment?
1. CWMS
2. Edema
3. Pulses (rate, equality, quality)
4. BP
5. HR, rhythm, and heart sounds
6. LOC
61
What are the components of a respiratory assessment?
1. Orientation
2. CWMS
3. Cough?
4. SOB / WOB
5. Breath sounds (adventitious, normal, diminished)
6. Symmetry
7. Tracheal tugging
8. Injury
62
What are the components of an abdominal assessment?
1. Bowel sounds
2. Tenderness in quadrants
3. Injury / trauma
4. Masses / pulsations / herniations
5. Symmetry
63
What needs to be included in ED documentation?
1. Chief complaint
2. History leading to admission
3. On arrival (what the nurse sees)
64
What are the three ways the body compensates for acid-base imbalances?
1. Chemical buffering
2. Respiratory compensation
3. Renal buffering
65
What is chemical buffering?
Takes place at the cellular level
- H+ or HCO3 molecules are either accepted or released by the cells to balance pH in the blood
- occurs within seconds
66
What is respiratory compensation?
Increasing or decreasing RR in response to CO2 levels
- respiratory centre in medulla is sensitive to changes in pH
- occurs within seconds to minutes
67
What is renal buffering?
Kidneys eliminate ether acids or bases as needed
- also control HCO3 by either reabsorbing or excreting H+ ions
- occurs within hours to days
- has stamina and is effective
68
Why are the respiratory and renal buffering systems not as effective in the elderly?
Gas exchange, alveolar membrane size, and renal function naturally decline with age
- acid-base imbalances are harder to correct in elderly
69
What is complete compensation?
Buffers have achieved homeostasis and pH is FULLY corrected!
70
What is partial compensation?
Buffers are working towards homeostasis
| - pH is not fully corrected
71
What two factors is end-organ perfusion dependent on?
1. Oxygen supply
| 2. Oxygen demand
72
What are the three main factors that determine oxygen supply?
1. Amount of O2 that is present in arterial blood
2. Capacity of blood to transport O2 to cells
3. Effectiveness of the pump that circulates the blood throughout the body
73
What does SaO2 represent?
Arterial oxygen content
- calculated in arterial blood gases
- reflects the amount of O2 that is present in the arterial blood when it leaves the lungs
74
What does Hgb indicate?
Hemoglobin indicated the carrying capacity of the blood to transport O2 to the cells
75
What does SpO2 measure?
Oxygen saturation
| = Saturation of hemoglobin with oxygen
76
What four things is arterial oxygen content dependent on?
1. Concentration of O2 in the air we breathe
2. Ability to get air into and out of the lungs (ventilation)
3. Effectiveness of gas exchange in alveoli (diffusion)
4. Ability of blood to exchange O2 in the lungs (perfusion)
77
What is the concentration of oxygen in room air?
21%
78
What percentage of O2 is given by nasal prongs?
24 - 44%
| 1-6 L/min
79
What percentage of O2 is given by face mask?
50 - 60%
| 6-10 L/min
80
What percentage of O2 is given by partial non-rebreather?
50 - 80%
| 6-10 L/min
81
What percentage of O2 is given by non-breather mask?
60 - 100%
| 12-15 L/min
82
What three things increase oxygen demand?
1. Temperature
2. Activity
3. Emotional stress
83
What is ventilation?
The movement of oxygen into and out of the lungs
- influenced by RR and tidal volume
- primary determinant of SaO2
84
What is lung compliance?
Relationship between the degree to which the tissue will stretch and the force or pressure required to make the stretch occur
- pneumonia will have low lung compliance = shallow, rapid breaths
85
What is diffusion?
Exchange of gases across the alveolar-capillary membrane
| - influenced by thickness of alveolar capillary membrane and difference in concentration of gases
86
What is perfusion?
Pulmonary blood flow
87
What is the first sign that the brain is hypoxic?
Altered LOC
88
What will the cardiovascular system do, if the body is hypoxic?
```
Increase HR
Peripherally constrict (shunt blood away from non-vital organs back to the core)
```
89
What does the absence of bowel sounds possibly indicate?
Hypoxia
| - body is shunting blood away from intestines
90
True or False:
| Hypoxic patients are drowsy
False
- Hypoxic patients are irritable and confused
- Hypercapnic patients are drowsy
91
What is a blunt injury?
Skin surface remains intact
92
What is a penetrating injury?
Skin surface is broken
93
What is a shearing injury?
Occur almost exclusively as a result of the acceleration and deceleration forces themselves
- can cause the liver, heart and other heavy organs to pull away or fold around the ligaments or muscles securing them = internal hemorrhage
94
What is a compression injury?
Occurs due to impact caused by deceleration
95
What is a recoil injury?
Occurs due to the recoil following deceleration (contra-coup brain injuries)
96
What is cavitation?
When internal organs are knocked out of position - Permanent or temporary depending amount of force involved
97
What does peripheral cyanosis result from?
- Vasoconstriction, reduced cardiac output or vascular occlusion
98
What does central cyanosis result from?
Increased amount of hemoglobin not bound to O2
| - best assessed by observing oral mucosa, lips and tongue
99
What three things cause hemoglobin to have an INCREASED affinity for oxygen?
1. Increased pH (basic)
2. Decreased temperature
3. Decreased PaCO2 (basic)
100
What three things cause hemoglobin to have a DECREASED affinity for oxygen?
1. Decreased pH (acidic)
2. Increased temperature
3. Increased PaCO2 (acidic)
101
What happens if the blood pH is below 6.8 or above 7.8?
The body's metabolic processes fail and the patient dies
102
What happens to PaCO2 with increased ventilation?
It decreases
103
What happens to PaCO2 with decreased ventilation?
It increases
104
What is the primary cause of respiratory acidosis?
Alveolar HYPOventilation
- causes a rise in PaCO2
- seen in Chronic respiratory disease, central nervous system depression
105
What is the primary cause of respiratory alkalosis?
Alveolar HYPERventilation
- causes a drop in PaCO2
- seen in early sepsis, hypoxemia, hypermetabolic states (such as fever)
106
What is the primary cause of metabolic acidosis?
Increased acids or the LOSS of HCO3 (creates a drop in the HCO3 levels)
- Diarrhea, ETOH ketoacidosis, shock
107
What is the primary cause of metabolic alkalosis?
Loss of acid or increase in HCO3 (creates an increase in HCO3 levels)
- vomiting, potassium depletion, renal loss of H+ (diuretics)
108
What is the "typical" presentation of CAP (community acquired pneumonia)?
- Sudden onset of fever
- Productive cough
- SOB
- Sign of pulmonary consolidation (dullness)
- Occasionally pleuritic chest pain
109
What is a normal cardiac output (per minute)?
Approx. 5 litres per minute
110
What is the valve between the right atrium and right ventricle?
Tricuspid valve
111
What is the valve between the left atrium and left ventricle?
Bicuspid valve
112
What is cardiac output determined by?
Stroke volume x HR
113
What is stroke volume determined by?
- Preload
- Afterload
- Contractility
114
What is the Frank-Starling Law?
The greater the heart is filled during diastole, the greater the quantity of blood pumped into the aorta
115
What is preload?
The resting force of the myocardial muscle and is determine by the volume in the ventricle prior to contraction
116
What is afterload?
The resistance to blood flow
| - force that the ventricles must overcome in order to contract and eject blood from the heart
117
How do vasodilators affect afterload?
Decrease afterload
| - improving stroke volume and cardiac output
118
What is contractility?
The contractile state of the myocardium is determined by the vigor of the contraction regardless of preload
119
What is ejection fraction?
The ratio of blood ejected from the ventricle in one contraction to the ventricle's total capacity
- expressed as a percentage
120
What is the order of the conduction system of the heart?
1. SA node
2. AV node
3. Bundle of His
4. Bundle branches (right and left)
5. Purkinje fibres
121
What is the role of baroreceptors?
Detect changes in blood pressure
| - in the walls of the aorta and internal carotid
122
What is the role of chemoreceptors?
Detect changes in CO2, H+, and O2 in the blood
| - medulla and carotid bodies
123
What do beta-blockers do?
Slow the heart rate
| - block beta receptors (that respond to sympathetic activation)
124
What happens if beta-1 receptors are stimulated?
HR increases
| - because SA node increases firing rate
125
What happens if beta-2 receptors are stimulated?
Bronchodilation
126
What happens if alpha (a) receptors are stimulated?
Vasoconstriction of peripheral vessels
| - blood goes back to the core
127
What are some subjective findings for decreased cardiac output?
- Chest pain
- Palpitations
- SOB
- Dizziness
128
What is the "forward" effect of HF?
Decreased cardiac output
129
What is the "backward"effect of HF?
Pulmonary and peripheral edema
130
What happens in systolic HF?
Cardiac muscle is stretched and unable to contract effectively
- decreased end-organ perfusion
- problem with the pump
131
What happens in diastolic HF?
Cardiac muscle cells are thickened and the heart "bulks up"
- in response to hypertension and left ventricular hypertrophy
- heart is unable to relax and fill properly
- problem with filling
132
What type of HF is most common?
Systolic HF
133
What are two types of beta-blockers that are cardio-selective?
1. Metoprolol
| 2. Atenolol
134
What beta blocker is NOT cardio-selective?
Propranolol
135
What do beta-blockers do?
- Slow the HR
- decrease cardiac workload
- decrease myocardial oxygen consumption
136
What are 4 examples of ACE inhibitors?
1. Captopril
2. Enalapril
3. Fosinopril
4. Lisinopril
137
What do ACE inhibitors do?
Prevent conversion of angiotensin I to angiotensin II
| - dilates blood vessels, decreases BP
138
What do angiotensin II receptor blockers do?
Combat HTN by preventing angiotensin II from binding to receptor sites
- dilates blood vessels, decreases BP
139
Why would a patient be prescribed an angiotensin II receptor blocker instead of an ACE inhibitor?
Sometimes patients develop a cough on ACE inhibitors
140
What are two examples of angiotensin II receptor blockers?
1. Losartan
| 2. Valsartan
141
What does nitroglycerine do?
Relaxes peripheral venous and arterial smooth muscle, decrease venous return and thus decreases workload of heart
- dilation of coronary arteries
142
What do diuretics do?
Increase urine output by blocking re-absorption of sodium and chloride
143
What is the mneumonic for causes of altered LOC?
AEIOUTIPS
- A = acidosis, alcohol intoxication
- E = epilepsy, encephalitis
- I = insulin reaction
- O = overdose
- U = uremia, underdose
- T = trauma, tumor
- I = infection
- P = pyschosis
- S = stroke
144
What is a CVA?
```
Cerebrovascular accident (stroke)
- sudden loss of brain function characterized by neurological deficits that persist for 24 hours or more
```
145
What are the two causes of a CVA?
1. Ischemic (interruption of blood flow)
| 2. Hemorrhagic (rupture of blood vessels)
146
What is ICP?
Intracranial pressure
| - pressure exerted on the ventricles by cerebrospinal fluid
147
What is the formula for CPP?
CPP = MAP - ICP
148
What is the Munro-Kellie Hypothesis?
There is reciprocal compensation among the three intracranial compartments (brain, blood, and CSF)
- a slight increase in one volume can be compensated by a decrease in one or both of the other two volumes
149
What are the first three compensatory actions for increased ICP?
1. Compensation limited to CSF movement down spinal cord
2. CSF production decreased
3. Small amount of distention of the dura mater
150
What happens during the second stage of increased ICP?
As pressure builds, the venous system is compressed
| - brain compression occurs and ICP begins to rise
151
What happen during the third stage of increased ICP?
All compensation systems fail
| - Increased pCO2 causes cerebral vasodilation, which increases blood flow, and dramatically increases ICP
152
True or False:
| Hydrogen is a potent vasodilator of cerebral arteries
True
153
True or False:
| Carbon dioxide is a vasodilator of cerebral arteries
True
154
What are the three layers of meninges?
1. Dura (outer)
2. Arachnoid (middle)
3. Pia (inner)
155
What does the subarachoid space contain?
CSF and cerebral arteries and veins
156
What are the three signs of Cushing's Triad?
1. Bradycardia
2. Abnormal respirations
3. Widening pulse pressure
157
What cranial nerves are associated with extraoccular eye movement?
III, IV, and VI
158
True or False:
| Vital signs are useful assessment parameters in the early stages of ICP
False
| - VS changes happen late in the game
159
In early stages of ICP, deterioration of motor function is manifested by:
Monoparesis or hemiparesis (weakness)
160
In later stages of ICP, deterioration of motor function is manifested by:
Hemiplegia, decortication, cerebration
161
In terminal stages of ICP, how do patients present?
Bilaterally flaccid
162
What is decortication characterized by?
- Abduction of the arm at the shoulder with flexion at the elbow
- Pronation and flexion at the wrist
- Legs extend at hips and knees (internally rotated)
163
What is decerebrate characterized by?
- extended, adducted and internal rotation of the arm
- flexion of the wrist and fingers
- legs are extended and plantar flexed
164
What drug is given for increased ICP?
Mannitol
165
What is the worst case scenario for infection?
Septicemia and septic shock
166
What is the definition of the immune system?
Complex network of specialized organs and cells that protect the body from destruction by foreign agents and microbial pathogens
167
What are innate lines of defense?
1. Physical Barriers (skin, tears, urine, sweat)
| 2. Inflammatory response
168
What is the acquired immune response?
Immune-mediated inflammatory reaction (acquired)
- pathogen specific
- immunological memory
- delay between exposure and response
169
What has a faster response time, innate or adaptive immunity?
Innate
- response is FAST and non-specific
- no memory
170
Which white blood cell is the first responder?
Neutrophils
171
What does the inflammatory response involve?
- Dilation
| - Increased permeability of blood vessels
172
What happens if the inflammatory response is not controlled?
SIRS
Shock
Multi-organ dysfunction
173
When is the immune response activated?
When the first and second lines fail
| - occurs naturally or by vaccination
174
What are the two essential components of the immune repsonse?
1. Recognition of the presence of foreign substances
| 2. Taking action to destroy foreign substances
175
What is SIRS?
Uncontrolled inflammatory reaction
- results from systemic mediator release
- mediators such as histamine, cytokins, and endotoxins
176
What is the definition of infection?
A host response to the presence of micro-organisms or tissue invasion by microorganisms
177
What is the definition of bacteremia?
Presence of viable bacteria in circulating blood
178
What are the 4 clinical manifestations of SIRS?
1. Temper > 38 or < 36
2. HR > 90
3. RR > 20 or PaCO2 < 32
4. WBC count > 12,000 or < 4,000 OR > 10% immature forms
- two or more must be present
179
What is the definition of sepsis?
Same as clinical manifestations of SIRS
| - WITH CONFIRMED INFECTION
180
What is the definition of multi-organ dysfunction syndrome?
Presence of altered organ function in acutely ill patients where homeostasis cannot be maintained without intervention
181
How much blood are the kidneys perfused with each minute?
1200 cc
| - 20-25% of cardiac output
182
What are the three main functions of the kidneys?
1. Maintenance of body composition
- pH, fluid volume, osmolarity, electrolyte concentration
2. Excretion of metabolic end products and foreign substances
- urea, toxins, drugs
3. Production and secretion of enzymes and hormones
183
What are the three main enzymes and hormones that are produced by the kidneys?
1. Renin (regulation of blood pressure)
2. Erythropoietin (stimulates maturation of erythorcytes - RBCs in the bone marrow
3. Vitamin D3 (regulation of calcium and phosphate balance)
