Flashcards in Midterm Exam: 1-24 +32. 22-24 Deck (97):
Where is the abdomen and where is it located?
abdomen contains many organs, from several different body systems. can cuase confusion when determining the cause of abdominal emergencies, thorough patient assessment key, specific diagnosis may not be necessary but an overall one.
area below diaphragm and above pelvis containing a variety of organs that perform digestive, reproductive, endocrine, and regulatory functions
What is the peritoneum?
membrane that lines the abdominal cavity (the parietal peritoneum) and covers the organs within it (visceral peritoneum) with fluid in between the layers. organs include stomach, liver, spleen, appendix, small and large colon and in women uterus, fallopian tubes, and ovaries
What is the liver?
unctions in regulating levels of carbohydrate and other substance in the blood in bile secretion and detox of blood
What does the gallbladder do?
What is the spleen?
organ removes abnormal blood cells and is involved in immune response
What is the retroperitoneal space?
the area posterior to the peritoneum, between the peritoneum and the back found in the extraperitoneal space: include kidney, pancreas and aorta
What is visceral pain?
variety of things. originates from organs within abdomen directly from organ. fewer nerve endings allow for only diffuse sensations of pain. “dull” or “achy” not a lot of nerve endings venerated on visceral layer so not easy to pinpoint and have regional coulicy(comes and goes resulting from distention and/contraction of hollow organs) type pain that is not constant. persistent in solid. dull, achy, or intermittent and may be diffuse or difficult to locate. intermittent, crampy or colicky comes from hollow organs of the abdomen and pain that is dull and persistent is from solid organs
What is parietal pain?
pinpoint pain.a localized, intense pain that arises from the parietal peritoneum, the lining of the abdominal cavity. from local irritation of the peritoneum caused by internal bleeding or infection/inflammation can be sharp or constant and localized to one area ask if it worsens as they move or gets better when lying still with knees drawn up
What is tearing pain/
sharp pain that feels as if body tissues are being torn apart from aorta and stomach. expanding abdominal aortic aneurysm inner layer of aorta damaged and blood leaks to vessels outer layers in retroperitoneal space felt in the back. ulcers in stomach can cause tears pain as tear open or perforate brunig or tears frequently bleeding. aortic aneurysm can be felt in gut from shoulderblades down unresponsive within 15 minutes little movement as possible position of comfort calm as possible
What is referred pain?
pain that is felt in location other than where the pain originates. gallbladder felt in area of right shoulder blade because return to spinal cord by shared pathway as it is with ectopic pregnancies.
What is appendicitis?
infection of the appendix, 1/15 people need surgery to fix. nausea, vomiting, pain in area of umbilicus follow by persistent pain in the right lower quadrant if it reptures sudden severe increase in pain with bowel let loose into peritoneal cavity leading to peritonitis
What is peritonitis?
inflammation of the abdominal cavity point tenderness rigidity
life-threatening with gastric juices, bowel contents and blood make it sensitive. from appendicitis, or trauma (bleeding from ruptured spleen), abdomen becoming painful and rigid involuntarily of muscles. fever and signs of infection.
What is cholecystitis/gallstones?
inflammation of the gallbladder, caused by gallstones. experiencing severe and sometimes duden right upper quadrant and/or epigastric pain (upper central abdomen below xiphoid process) may radiate to shoulder confused with chest pain. may be caused or worsened by ingestion of foods high in fat abruptly end as stone frees itself
female, fat, over forty, and finished menstruating higher risk. did they eat late fatty food, gallstones history of gird. women that have it have it 7 days after birth
What is pancreatitis?
serious with signs of shock and is the inflammation of the pancreas, common in patients with alcohol problems with pain found in epigastric area. retroperitoneal location of pancreas, behind stomach, may radiate to back and/or shoulder
What is gastrointestinal bleeding?
bleeding anywhere in GI system depending on size and source of blood vessel may be gradual or sudden and massive passing out through rectum and/or mouth dark black or maroon in color and tarry in appearance or just pass blood. if upper GI source- vomiting of blood or coffee grounds- breakdown of blood by digestive. without pain and painful is with ulcers. can be slow- chronic gastric bleed days to week eventually developing shock. if large bleeding fast symptoms of shock blood coming out rectum or vomiting. esophagus from alcohol or hypertension in liver can rupture and threaten airway. hemorrhage within lumen upper or lower GI post-trauma, surgical, ulcers, with blood eventually exits red vomiting- beginning part of stomach or esophageal or upper GI lower intestines brown, or thick tarry stool large intestines if at end is bright red frank blood (mouth or rectum). painless or severe (if ulcer). ALS, treat for shock, determine amount of blood and history most comfortable positon
What are ulcers?
lesions from acidic gastric juices wearing a hole in the upper gastrointestinal system and erosion can go into blood vessel and can leak to peritoneum.
What is AAA?
abdominal aortic aneurysm. rupturing high rate of death. ballooning or weakening in wall of aorta passing through abdomen results in tearing allowing blood to escape growing and rupturing. slow leaking with gradual abdominal pain sharp pain or tearing pain radiating to back. back pain in elderly high priority with excruciating abdominal and back pain may be inequality between femoral or pedal pulses may feel mass. bluge pulsating dont push can live up to a three cm before surgery if rupture will lose pulse rate in peripheral or a differenc ein plse rate from one side to another
What is hernia?
hole in muscle layer of abdominal wall allowing tissue intestine to protrude against skin aggravated by heavy lifting or straining causing intestine to push through weakened area in abdominal wall. with massive onset of pain after lifting palpated as a mass or lump on abdominal wall or in creases of groin very painful but only life-threatening if there is a twisting of intestines. tear in internal wall and organs protrude out common in guys who lift weights in groin areas
What is the renal colic?
kidneys form small, hard stones descending down ureter on way to bladder causing severe flank pain radiating anteriorly to groin area severe pain with nausea and vomiting writhing trying to move to a comfortable posiiton
What is cardiac involvement?
pain from a heart attack can be felt in abdomen indigestion felt in epigastric area (below xiphoid).
What are some questions to ask abdominal pain patients about onset?
pain/discomfort, pressure, bloating, cramping, or another sensation patients about onset: when did pain begin? at rest or activity? how? steady and severe or gradually?
What are some questions to ask abdominal pain patients about provocation?
makes it better or worse? does any position make it beter or worse? does movement affect pain?
What are some questions to ask abdominal pain patients about quality?
describe sensation in abdomen
What are some questions to ask abdominal pain patients about region/radiation?
show me. pain anywhere else? radiate or shoot to other parts of abdomen, back or body?
What are some questions to ask abdominal pain patients about severity?
how severe 1-2 scale ten being worst pain ever for children giving face
What are some questions to ask abdominal pain patients about time?
how long been in pain or discomfort? changed over time? better or worse?
What do you do with females who have abdominal pain?
ectopic pregnancy, ruptured ovarian cysts, pelvic inflammatory disease, and menstrual irregulatiries can also cause significant pain. where are you in mesntrual cycle? is period late? do you have bleeding that is not menstrual? if menstruating, is flow normal? have you had pain before? when did it happen and what was it like? is it possible you are pregnant or are you sexually active. if answer yes to any suspect ectopic pregnancy
What are some allergies that can affect abdominal pain?
allergic reactions can cause systemic inflammation and abdominal discomofrt and diarrhea.
What are some medications that can affect abdominal pain?
aspirin can cuase sotmach leeding, illegal substances can cause abdominal distress in use and withdrawl. diabetics for blood sugar abnormalities
What are some pertinent past history that can affect abdominal pain?
history of abdominal problems ask what conditons are, pain resembles past experiences with ocndition and what happened last time serios? shock? surgery? kidney stones, cholecystis, and hepatitis or epigastric pain with cardiac history can be recurrent.
What are some last oral intake that can affect abdominal pain?
liquids, meals, snacks, intake normal? cholecystitis- high fat food. pancreatitis- alcohol
What are some events that can affect abdominal pain?
progression of signs and symptoms about activity over past few days with vomiting nausea, diarrhea, and/or constipation if dark red, bright, bright red, or coffee grouns-like substances noted in vomit or feces, indicating internal blledding. recent bowel and urinary with kidney stones painful or didifuclt urination. abomdinal pain cause by difificulty moving bowels or obstruction.
What do you do when examining the abdomen?
inspect abdomin, look for distention, bloating, discoloration abnormal protrusion or other signs appearing abnormal or unusual. palpating each quadrant doing place of discomfort last as it can mask other areas. feel for rigidity or hardnening asking for pain if gentle doesnt cause pain go deeper if found pain dont palpate further.
What are guarding?
patient drawing arm down across abdomen or tensing muscles before touching abdomen
What do you do when you are caring for a patient with abdominal pain?
caring for patient with abdominal pain: check every 5 minutes. will have increased pulse from situation and increased respirations posisbly causing more porblems so place in posiiton of comfort and give oxygen.
What is behavior?
the manner in which a person acts and the way we act is heavily influenced by the challenges we face and our capability to respond to environmental stimuli or stress. it involves any or all activities of a person, including physical and mental activity differing from person to person and from situation to situation.
What is normal behavior?
appropriateness of response in any given setting defined by those around us and based on way we usually act.
What is a behavioral emergency?
when a patient’s behavior is not typical for the situation; when the patient's behavior is unacceptable or intolerable to the patient, his family or the community; or when the patient may harm himself or other. ¼ people have mental conditions
What is the kind of altered mental status resulting from behavioral emergency?
with low blood sugar causing hostile behavior (alcohol intoxication behavior), lack of oxygen restlessness and confusion, stroke or inadequate blood to brain causing confusion or dizziness impaired speech and loss of function, head trauma personality changes form irritability to irrational behavior amnesia or perfusion, mind-altering substances, or cold temperatures (staggering walking with increase losing consciousness. dont assume psychiatric behavior
What is situational stress reactions?
unexpected stress emotions such as fear, grief, and anger with typical stress reactions at an accident scene and common reactions to serious illness and death making sure to treat patient as individual. calmly and quietly assess the patient so they can calm down listening to them and if don't calm down by then perhaps psychiatric problems
What is acute psychosis?
severe break in patients’ abilities to process information and interact with their environments patient develops one or more things such as hallucinations, delusions, catatonia, or a thought disorder causing severely erratic behavior
What do you do when dealing with behavioral and psychiatric emergencies?
dentify yourself and your role, speak slowly and clearly, use a calm and reassuring tone, make eye contact with patient, listen to the patient showing you are listening by repeating part of what patients say back, don't be judgemental show compassion do not pity, use positive body language avoiding crossing arms or looking uninterested, acknowledge the patient’s feelings, do not enter their personal space at least 3 feet away, be alert for changes or aggressive behavior prevent harm
What are selective serotonin reuptake inhibitor?
elevates mood by preventing reuptake of neurotransmitter serotonin in synapse with prozac paxil and zoloft
What are the signs and symptoms of psychiatric emergencies?
panic or anxiety; unusual appearance, disordered clothing or poor hygiene; agitated or unusual activity such as repetitive motions, threatening movements, or withdrawn stance; unusual speech patterns, such as too-rapid or pressured-sounding speech (as if being forced out), or an inability to carry on a coherent conversation, bizarre behavior or thought patterns; suicidal or self-destructive behavior; violent or aggressive behavior with threats or intent to harm others
What is hallucinations?
inappropriate sensory observations such as visions or voices don't play along with any visual or auditory hallucinations a patient may be experiencing dont lie if it may help involve others
What are delusions?
falsely held beliefs such as paranoia, belief that one is being persecuted when that is not the case
What is catatonia?
characterized by either an almost complete no interaction with the environment or wild and completely inappropriate movement and interactions
what are thought disorders?
impact a patient’s ability to process information and to communicate and can cause unusual speech patterns or strange writing
What is suicide?
caused by depression from chemical imbalance, death of a loved one, financial problems, and to love affair, poor health, loss of esteem, divorce, fear of failure, and alcohol and drug abuse. usually attempted by drug overdose, hanging, jumping from high places, ingesting poisons, inhaling gas, wrist-cutting, self-mutilation, stabbing or shooting
What do you do for potential and attempted suicides?
Potential and attempted suicides from depression, high current or recent stress levels, recent emotional trauma: job loss, loss of a significant relationship, serious illness, arrest or imprisonment; age- 15-24 and over 40; alcohol and drug abuse; threatening suicide; suicide plan for how he'd go give away personal possessions; previous attempts or suicide threats; sudden improvement from depression
How do you treat suicidal patients?
dont leave alone unless you think they there is a risk to you and try to talk with patient from safe distance until police arrive performing physical exam only if it is safe and they may have an injury. try to convince to go to hospital and if violent again try to reestablish conversation and try again later transporting all suicidal patients
What are aggressive and hostile patients?
if scene has drugs, yelling, unclean conditions or broken furniture there are signs of aggression. patients stanc (tense muscles; fissts clenched; or quick irregular movement_ warning signs. dont isolate yourself from your patner or other sources of help, have escape route, dont let patient between you and door if violent retreat and wait for police. staying out of kitchens. they respond to people inappropriately, tries to hurt himself or others, may have rapid pulse and breathing, usually displays rapid spech and physical movments, appear anxious nervous or panicking
What is reasonable force?
force necesary to keep patient form injuring himself or others looking at circumstance involving including strength and size type of abnormal behavior, mental status and available methods of restraint protecting yourself from attack. EMT cant legally restrain, move against their will, or force patient to accept emergency care done by law enforcements or doctors ordering you to restrain you dont restrain have police and try not to help
What do you make sure of when restraining?
handcuffs and criminal restraints should not be used because of soft=tissue damage only use orignally use leather cuffs and restraints, waist-sized belt, and three short belts with restraints for wrists and ankles made from gauze rolelr bandages dont remove even if patient acts rationally
What do you do when restraining?
appraoch with minmum of four people at each limb to act at the same time, staying beyond range of extremities otherwise. secure all four limbs and never in prone positon or one that threatenes movemnt of chest wall dont restrain anyway to impair breathing. with drugs may need ALS to calm them down medically otherwise monitor continually. if patient spitting secure mask or wear protective masks eyewear and clothing if worried about vomit reassessing distal circulation
What is excited delirium?
bizarre and/r aggressive behavior, shouting, paranoia, panic, violence towards other, insensitivity to pain, unexpected physical strength, and hyperthermia, usually associated with cocaine or amphetamine use. has elevated temperature and someitmes alcohol or drug intoxication; patient will cease struggling, and often within minutes patient has inadequate or absent respirations and subsequently dies
What is positional asphyxia?
inadequate breathing or respiratory arrest caused by a body position that restricts breathing
What do you do if a hostile patient refuses care
police can say patient has to go or you can use implied that patient is a harm to himself or call mental health team having police come with oyu the whole way and have same sex working with person
What is coagulopathy?
loss of normal ability to form a blood clot with internal or external breathing dye to a deficiency in either platelets and clotting factors. when body forms clots too easily when patients clots too slowly resulting in uncontrolled bleeding
What is liver disease?
cirrhosis does not make adequate clotting factors to form stable clots
What is von willebrand?
platelets good number but defective
what are blood thinners?
Coumadin, Pradaxa, Eliquis, Xarelto, and Lovenox inhibit clotting factors and aspirin and Plavix inhibit platelet aggregation with patients on these medications more prone to having life=threatening bleeding when injured than patients who are not on medications with minor injuries leading to increased risk of uncontrolled bleedings and patients with atrial fibrillation are commonly on blood thinners asking all trauma patients if on blood thinners as part of assessment.
What is anemia?
lack of a normal number of red blood cells in the circulation. very pale
What is acute anemia?
may result from trauma or sudden massive bleeding from gastrointestinal tract rapidly exhibiting signs and symptoms of shock such as a rapid pulse rate: cool, clammy skin and eventual hypotension.
What is chronic anemia?
occurs over time and can be caused by conditions such as recurrent heavy menstrual periods, slow gastrointestinal blood loss, or diseases that affect the bone marrow or the structure of the hemoglobin itself. often appearing more pale than normal (from lack of circulating red blood cells) and often complain of fatigue and shortness of breath with exertion (because of a lack of adequate oxygen being delivered to the body’s cells. only after prolonged period of time will patients with chronic anemia exhibit signs and symptoms of shock so examine conjunctiva on lower eyelid.
What is sickle cell anemia and what does it do to the body?
an inherited disease in ;which a genetic defect in the hemoglobin results in abnormal structure of the red blood cells. occurs in patients of African, Middle Eastern, or INdian descent, which have defective hemoglobin losing their ability to have a normal shape and compressibility and they dont survive as long resulting in chronic anemia and which cause blockages. resulting in destruction of spleen as it is blocked with normal RBCs making them at higher risk for severe, life-threatening infections. some of the cells are sludged in capilarries resulting in severe pain in arms legs chest and abdomen. chest syndrome with shortness of breath and chest pain because of hypoxia when blood vessesl in lungs are blocked. painful prolonged erection because sludging of RBS prevent normal blood drainage from erect penis. stroke can occur when blocking supplying brain or jaudncdice when liver becomes overwhelemed by breakdwons.
What are urinary tract infections?
caused by bacteria, and most UTIs are limited to the baladder, causing symptoms of painful and frequent urinationand can be serious and life threatening if spread to the bloodstream.
What is pyelonephritis?
an infection that begins in the urinary tract and ascends up the ureter into the kidney if a urinary tract infection is left untreated placed unilaterally pain as well as UTI symptoms and appearing more ill than those with uncomplicated bladder infections
What are kidney stones?
are painful and made of calcium and formed within kidney. if they remain in kidney cause no symptoms but can cause severe unilateral flank pain radiating to groin area when stonedescends from kdiney and becomes lodged in the ureter and is ubale to pass into the bladder. patients with kidney stone pain often have associated nausea and vomiting
What are urinary catheters?
a drainage tube placed into the urinary system to allow the flow of urine out of the body. given to patient who has obstructed flow of the bladder such as a tumor or a large prostate or because of neurological disorder. in place for the long term or into own urethra each time they urinate or whole through skin to bladder for short or long term resulting in urinary tract infections and local trauma two most common complications
What is renal failure?
loss of the kidneys’ ability to filter the blood and remove toxins and excess fluid from the body. With acute or chronic reasons.
What is acute renal failure?
can occur as result of shock, toxic ingestions, and other causes. some patients who experience acute renal failure can recover normal kidney function if underlyingcause of insult to kidneys is rapidly identified and corrected. from severe dehydtraion. treating with aggressive fluids
What is chronic renal failure?
include inherited disease such as polycystic kidney disease with long-term damage caused by poorly controlled diabetes and/or high blood pressure that results in loss of normal renal failure.
Wha tis end stage renal disease?
(ESRD) irreversible renal failure to the extent that kidneys can no longer provide adequate filtration and fluid balance to sustain life; survival with ESRD usually requires dialysis
What is dialysis?
the process by which toxins and excess fluid are removed form the body by a medical system independent of the kidneys
What is hemodialysis?
patient connected to dialysis that punps blood thorugh specialized filters to remove toxins and excess fluid by two large catheters. one catheter allowing blood to flow out of body into dialysis machine, and other catheter returns blood to body after filtration. creating circuit where blood is removed from body, filtered, and returned to body continuosly over several hours while ptatient is connected to machine. requiring large blood flow from body. have veins into major veins or surgically created fistula in one of extremities having thrill when palpated using another extremity to obtain blood pressure.
What is peritoneal dialysis?
done in own homes, slower process requiring multiple treatments every day for most patients most common form outside Us and Canada. using large surface area inside peritoneal cavity surrounds abdominal organs as means of removing toxins and excess fluid from body with permamnt cather impanted through abdominal wall and into peritoneal cavity. several liters of solution run into abdominal cavity and left in place for several hours absorbing waste material and excess fluid with fluid drained back out into bag and discarded.
What is a thrill?
vibration felt on gentle palpation, such as that which typically occurs within an arterial-venous fistula
What is an exchange?
once cycle of filling and draining the peritoneal cavity in peritoneal dialysis
What is continuous ambulatory peritoneal dialysis?
(CAPD)- a gravity exchange process for peritoneal dialysis in which a bag of dialysis fluid is raised above the level of an abdominal catheter to fill the abdominal cavity and lowered below the level of the abdominal catheter to drain the fluid out. fluid left in cavity by clamping catheter for 4-6 hours, repeating exchange several times a day. with a continuous cycler using machine to exhcange 3-5 times during night while sleeping.
What is peritonitis?
bacterial infection within the peritoneal cavity developing abdominal pain, fever, and dialysis fluid that is cloudy when drained
What do you do for patients that have missed dialysis?
have symptoms of chronic heart fialure. shortness of breath because of fluid buildup in lungs and accumulation of fluids elsewhere such a ankles, hands, and face. no longer balancing and clearing excess electrolytes and other toxins and may suffer form electric disturbance in heart with proper funcitonig of heart’s electrical system requires that balance of electrolytes in bloodstream kept within certain tight range with elevated potassium dangerous and resulting in patient death
What are some complications from dialysis?
problems associated with major arteries accessed so much, bleeding from site of A-V fistula when dialysis needles removed while being disconnected from machine. clotting and loss of function of A-V fistula results in fistula;s feeling hard to touch and in los of normal thrill felt on palpation, and beacterial infection of blood from contamination during connection and disconnection.
What do you do to treat those with complications?
control serious bleeding from site of A-V fistula. using direct pressure, elevation, and hemostatic dressings as needed. tourniquet avoided but if life-threatning applied as proximally as possible on limb and not directly over fistula. give oxygen and be aware and treat for shock
What are the concerns with hollow organs?
more likely to rupture with contents spilling into cavity cuaisng distention and irritation such as digestion system by irritating gassy crampy filled with air (coulic- intermittent tracts)
What are the concerns with solid organs?
vascular so a lot of bleeding
What is upper right quadrant pain?
if painful have u been drinking. palpating it with distended liver beyond costal arch usually hidden below rib gets large and painful
What is upper left quadrant pain?
pancreas, stomach, spleen
What is flank pain?
kidneys men severe starting in flank when up high and as they travel comes around front towards umbilical to groin area on inside thigh. men who have one are more prone to having many with predisposed to it
What is right lower quadrant pain?
dull pain periumbilical around belly button traveling down to the right appendix painful pushing down if ebound pain much greater 98% definitive for appendicitis
What is epigastric area pain?
could be cardiac in origin or abdominal nerves travel same track and a lot of times people complain of epigastric pain also complain of heartburn indicator of birth of gurd or cardiac. get ALS to look at EKG don’t walk to stretcher position of comfort strap keeps knees up and pillow between knees and on belly
What is in the exztraperitoneal space?
kidneys pancreas aorta and bladder- pelvic cavity
What do corsets do?
reduced circulating volume 40-60% causing syncope was case of hypoxia organs displacing down reducing peristalsis exerting much more readily
How do you care for abdominal pain?
care for abdomenal pain- get as much history get very good phsycial examin (distention, discoloration bruising (right flank pancreatitis or inflamed liver, protrusion), rebound pain (hollow organ), pinpoint (solid organ) area of pain last transport in posiion of comfort. something warm on abdomen is helpful. never give anything by mouth
What is a future of the periumbilical lower quadrant pain
ruptured ovarian cyst- relief of pain, appendix rupture pain increases worried about sepsis and irritating to internal cavity. appendix- rebound tenderness
What is different about geriatric patients?
decreased ability to perceive pain more serious causes of abdominal pain and more liekly to be life threateneing