Mild/Moderate Hospital Problems Flashcards
(152 cards)
1
Q
What is pain?
A
A description of a subjective perception of distress
2
Q
What are the two types of pain?
A
Acute vs Chronic
3
Q
What is acute pain?
A
Pain duration that is under 6 months
4
Q
What is chronic pain?
A
Episodic pain that is longer than 6 months
5
Q
What are the four locations of pain?
A
- Cutaneous
- Visceral
- Somatic
- Neuropathic
6
Q
What is cutaneous pain?
A
Localized on the skin or surface of the body
7
Q
What is visceral pain?
A
Poorly localized pain that is associated with internal organs
8
Q
What is somatic pain?
A
Non localized; orignates in muscle, bone, nerves, blood vessels, and supporting tissue
9
Q
What is neuropathic pain?
A
Pain associated with nerve pathway injury or compression
10
Q
WHO’s ladder of pain management definition
A
A three-step progressive ladder that starts with ASA, APAP, or a NSAID and progressively continues in three steps with heavier narcotics added while maintaining the initial ASA, APAP, or NSAID
11
Q
What medications are part of WHO’s step one pain management ladder?
A
- ASA
- APAP
- NSAID
- Adjuvants
12
Q
What medications are part of Who’s step two pain management ladder?
A
- Codeine
- hydrocodone
- Oxycodone
- Dihydrocodeine
- Tramadol
- Adjuvants
13
Q
What medications are part of WHO’s step three pain management ladder?
A
- Morphine
- Hydromorphone
- Methadone
- Levorphanol
- Fentanyl
- Oxycodone
- Nonopioid analgesics
- Adjuvants
14
Q
What medication is typical used for cancer pain?
A
Fentanyl patches
15
Q
What pain medication is used in metastatic bone pain management?
A
Biphosphonates
16
Q
Whs
What are characteristics of a stage one pressure injury?
A
Intact skin with erythema that does not blanch
16
Q
What are pressure ulcers?
A
Any lesions caused by unrelieved external pressure resulting in occlusion of blood flow, tissue ischemia, and cell death
17
Q
What are characteristics of a stage two pressure injury?
A
Partial-thickness loss of skin with exposed dermis
18
Q
What are characteristics of a stage three pressure injury?
A
Full-thickness skin loss with adipose tissue still present
19
Q
What are characteristics of a stage four pressure injury?
A
Full-thickness skin and tissue loss with exposed, palpable fascia, muscle, tendon, ligament, cartilage, or bone in the ulcer
20
Q
What are characteritics of a unstageable pressure injury?
A
Full-thickness skin and tissue loss and the wound is eschared leaving it unable to stage the wound as a three or four
21
Q
What are characteristics of a deep tissue pressue injury?
A
Intact or non-intact skin with localized area of persistent non-blanachable deep red, maroon, purple discolaration or epidermal seperation
22
Q
What is a fever?
A
A temperature above 37 C
23
Q
What are 3 causes of a fever?
A
- Infection
- Autoimmune disease (SLE, arteritis)
- CNS disease
- Malignant neoplastic disease
- Hematologic disease
- Cardiovascular disease
- Gastrointestinal disease
- Endocrine disease
- Neuroleptic Malignant syndrome
24
Fever management
1. Antimicrobials
2. Antipyretics
3. Treat underlying condition
25
Causes of non-infectious postoperative fever
1. Postoperative atelectasis
2. Increased basal metabolic rate
3. Dehydration
4. Drug reactions
26
Causes of infectious postopertative fever
1. WBC with left shift
2. Surgical incision
3. IV site
4. Point of entry for any catheter
5. Urinary tract
6. Lungs
7. Siniusitis
8. Abscess
27
Initial treatment of postoperative fever
Fluids and lung expansion
28
Management of postoperative fever
1. Fluids
2. Acetaminophen
3. Treat the underlying source
4. C&S all invasive lines and catheters as indicated
29
Clinical observations of malnutrtion
1. Hair not easily plucked
2. Musculature
3. Clear nail beds free of ridges
4. PMMM
30
Complications of Enteral Nutrtional Support
1. Aspiration
2. Diarrhea
3. Emesis
4. GI Bleeding
5. Mechanical obstruction of tube
6. Hypernatremia
7. Dehydration
8. Refeeding syndrome
31
What is Refeeding Syndrome?
1. Hypophosphatemia
2. Hypokalemia
3. Hypomagnesmia
4. Hypocalcemia
5. Thiamine deficiency
32
Complications of parenteral nutritional support?
1. Pneumothorax
2. Hemothorax
3. Arterial laceration
4. Air emboli
5. Catherter thrombosis
6. Catheter sepsis
7. Hyperglycemia
8. HHS
33
What is included in gastrointestinal decontamination?
1. Gastric Lavage
2. Activated charcoal
3. Cathartics (Sorbitol)
4. Whole bowel irrigation
5. Antidotes
34
What are the different types of drug intoxication?
1. Acetaminophen
2. Salicylate
3. Organophophate
4. Antidepressent
5. Opioid
6. Benzodiazepine
7. Beta Blocker
8. Antifreeze
35
Signs and symptoms of acetaminophen overdose
1. Asymptomatic
2. Nausea/Vomiting
3. RUQ pain
4. Signs of hepatotoxicity
36
Manamgement of acetaminophen overdose
1. Activated charcoal
2. Mucomyst
37
Signs and symptoms of ASA overdose
1. Nausea/Vomiting
2. Tinnitus
3. Dizziness
4. Headache
5. Dehydration
6. Hyperthermia
7. Apnea
8. Cyanosis
9. Metabolic Acidosis
10. Elevated LFTs
38
Management of ASA overdose
1. Activated charcoal
2. Sodium bicarbonate
39
Signs and symptoms of insectiside poisoning
1. Nausea/Vomiting
2. Cramping
3. Diarrhea
4. Excessive salvation
5. Headache
6. Blurred vision
7. Miosis
8. Bradycardia
9. Mental Confusion
10. Slurred Speech
11. Coma
40
Managment of Insecticide poisoning
1. Activated Charcoal
2. Atropine
41
Signs and symptoms of antidepressent toxicity
1. Confusion
2. Hallucination
3. Blurred vision
4. Urinary retention
5. Hypotension
6. Tachycardia
7. Dysrhythmias
8. Hypothermia
9. Seizure
42
Management for antidepressent toxicity
1. Admit to ICU
2. Activated charcoal
3. Sodium bicarbonate
4. Benzodiazepine IV
5. Dantrolene for SS
6. Cooling blankets
43
Signs and symptoms of opioid toxicity
1. Drowsiness
2. Hypothermia
3. Respiratory depression
4. Shallow respirations
5. Miosis
6. Coma
44
Managment of opioid toxicity
1. Activated charcoal
2. Naloxone
45
Managment of benzodiazepine overdose
1. Respiratory and blood pressue support
2. Romazicon
3. Activated Charcoal
46
Signs and symptoms of benzodiapine overdose
1. Drowsiness
2. Confusion
3. Slurred speech
4. Respiratory depression
5. Hyporeflexia
47
Signs and symptoms of beta blocker overdose
1. Hypotension
2. Bradycardia
3. Delirum
4. Coma
5. Bronchospasm
48
Management of beta-blocker overdose
1. Activated charcoal
2. Glucagon
3. Atropine
4. Airway Managment
49
Antifreeze overdose stage one
1. Loss of cordination
2. Headache
3. Slurred speech
4. Nausea/vomiting
50
Antifreeze overdose stage two
1. Irregular heartbeat
2. Shallow breathing
3. Changes in blood pressure
51
Antifreeze overdose stage three
1. Kidney failure
52
Management of antifreeze overdose
1. Antizol
2. Ethanol only if antizol is not available
53
What is Compartment Syndrome?
Increased interstitial pressure within a closed fascial compartment resulting from hemorrhage, edema, sustained external pressure or constrictive cast
54
Signs and symptoms of compartment syndrome
1. Severe ischemic pain
2. Tensely swlloen
3. Skin perfusion
4. Parasthesia
5. Muscle is painful
6. Progressive loss of sensory/motor function
55
Diagnostics for compartment syndrome
Stryket tonometer reading is greater than 30 mm Hg
56
Managment of compartment syndrome
Release constricting appliances
Fasciotomy if performed within a first few hours of developing compartment syndrome
57
General pearls to bites
1. All bites can lead to inefction
2. High-pressure irrigation is indicated to reduce possibility for infection
3. Confirm if the animal has rabies or not
4. XRAY
5. Primary closure of wound
6. Wounds on the hand or lower extremity is left open to heal by secondary intention
7. Plastics consult
8. 3 to 7 day prophylatic antimicrobial coverage for all bites
58
General approach to managing infections
| PSSP
1. Establish **presence **of infection
2. Establish **severity** of infection
3. Establish **site** of infection
4. Determine likely **pathogen **
59
Types of G+ bacteria
1. Staphylococcus
2. Streptococci
3. Enterococci
4. Bacilli
5. Corynebacterium
60
Types of G- bacteria
1. Serratia marcescens
2. Escherichia coli
3. Klebsiella
4. Pseudomonas
5. Proteus mirabilis
6. Moraxella catarrhalis
7. Acinetobacter
8. Enterobacter
61
Empiric therapy for OM, Sinusitis
1. Amoxicillin
2. Aumentin
3. Bactrim
4. Cefuroxime
62
Empiric therapy for endocarditis
Vancomycin + ceftriaxone
or
penicillin + gentamicin
63
Empiric therapy for peritonitis
Metronidazole + 3rd gen chephalosporin or zosyn
64
Empiric therapy for intra-abdominal infections
Metronidazole + cefuroxime or ceftriaxone or ciprofloxacin or levofloxacin
65
Empiric therapy for cellulitis
1st generation cephalosporin, cefazolin, vancomycin, clindamycin, linezolid, daptomycin
66
Empiric therapy for sepsis
Vancomycin + cephalosorin or zosyn or imipenem or meropenem
67
Organ transplant considerations
1. All transplant patients are immunosuppresed patients
2. Antiregection therapy is warranted when there is acute rejection of an organ
68
Signs and symptoms of acute rejecction of an organ
1. Immediate failure of that organ
2. Flu-like symptoms
69
Therapy for acute rejection of an organ
1. Immediate biopsy of that organ
2. Corticosteroids
3. Antimetabolic
4. Calcineurin inhibitor
70
Steroids for organ rejection prevention
1. Methylprednisolone
2. Prednisone
71
Antimetabolites for organ rejection prevention
1. Azathioprine
2. Mycophenolate mofetil
3. Mycophenolate sodium
4. Cyclophosphamide
72
Calcineurin inhibitors for organ rejection prevention
1. Tacrolimus
2. Cyclosporine
73
Mammalian target of rapamycin inhibitor for organ rejection prevention
1. Sirolimus
2. Temsirolimus
3. Everolimus
74
What is herpes zoster?
An acute vesicular eruption due to an infection wit hthe varicella-zoster virus
75
Signs and symptoms of herpes zoster
1. Pain along a single or grouped dermatomes
2. Vesicle eruption along the dermatome with erythema and exudate
3. Regional lymphadenopathy may be present
76
Herpes zoster management
1. Antivirals like acyclovir, famciclovir, valacyclovir
2. Treat neuralgia with gabapentin or pregabalin
3. Singrix vaccination
77
When is the Shingrex vaccination indicated?
1. Adults aged over 50 regardless of previous shingles vaccination
2. It is a 2 step series given 2-6 months after initial dose
78
What kind of skin cancer is shown in the image?
**Actinic Keratoses**
2. Small patches occuring on sun-exposed parts of the body
3. Premalignant
4. Asymptomatic
5. Rough, flesh colored, pink, and may be hyperpigmented
79
Management of Actinic Keratoses
Liquid nitrogen
80
What kind of skin cancer is shown in the image?
**Squamos Cell Carcinoma**
1. Arise out of actinic keratoses
2. Firm, irregular papule or nodule
3. Due to prolonged sun exposure
4. Keratotic, scaly bleeding
81
Treatment for squamous cell carcinoma
Biopsy and surgical excision
82
What kind of cancer is shown in this image?
**Basal Cell Carcinoma**
1. Most common skin cancer
2. Slow growth
3. Waxy, pearl appearance
4. Central depression or rolled edge
5. May have telangietatic vessels
83
Treatment for Basal Cell Carcinoma
Shave/punch biopsy and surgical excision
84
The keys to malignant melanoma
| ABCDE
1. Asymetry
2. Border irregularity
3. Color variation
4. Diameter above 6 mm
5. Elevation
6. Enlargement
85
Brain death considerations
1. Meets brain death criteria
2. Family education and support
86
Brain death criteria
1. EEG
2. No cranial nerve function
3. normothermic
87
Terminal extubation consideration
1. Preperation/Education/Support
2. Opioid use
3. Scopolamine patch/Atropine drops
88
What are the different types of headache?
1. Tension
2. Migraine
3. Cluster
89
Signs and symptoms of a tension headache
1. Vise-like or tight
2. Generalized
3. Intense around the neck and back
4. No neurological deficet
5. Usually last for several hours
90
Management for tension headache
1. OTC analgesics
2. Relaxation
91
What is a migraine headache?
A migraine headache is a headache that last for 2-72 hours that is usually caused by dilation and excessive pulsation of branches of the external carotid artery that follow the trigeminal pathway
92
What are the two types of headache?
1. Classic (with aura)
2. Common (without aura)
93
Common causes of migraines
1. Female
2. Emotional/Physical stress
3. Lack of sleep
4. Missed meals
5. Specific foods
6. Alcohol
7. Menstrution
8. Contraceptive use
94
Signs and symptoms of migraines
1. Unilateral throbbing headache that occurs in episodes
2. Dull/Throbbing
3. Pain gradually builds
4. Focal neurologic distrubances (aura) before headache
5. Visual disturbances
6. Aphasia
7. Numbness
8. Tingling
9. Clumsiness
10. Weakness
11. Nausea
12. Vomiting
13. Photophobia/Phonophobia
95
Lab/Diagnostics for migraine headaches
1. BMP
2. CBC
3. VDRL
4. ESR
5. CT of head
6.
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Migraine Management
1. Avoidance of trigger foods
2. Relaxation/stress management
3. Prophylatic daily therapy
4. Dark, quiet room placement
5. Imitrex
97
Prophylatic therapy for migraines
1. Anticonvulsants
2. Beta-blockers
3. Botox
4. CCB
5. TCA
6. CGRP
7. NSAIDs
98
What are cluster headaches
Painful headache syndromes that usually affect middle-aged men
99
Causes of cluster headaches
1. Precipated by alcohol ingestion
2. Severe unilateral, periorbital pain occuring daily for weeks
3. Usually occurs at night
4. Ipsilsilateral nasal congestion, rhinorrhea, and eye redness
100
Management of cluster headaches
1. Oxygen
2. Imitrex
3. Ergostat
101
What is hyponatremia?
Low NA level
102
Hyponatremia evaluation
1. Urine sodium
2. Serum osmolality
3. Clinical Status
103
What is Isotonic Hyponatremia
"Pseudohyponatremia"
1. Occurs with extreme hyperlipidemia or hyperproteinemia
104
What is hypotonic hyponatremia
State of body water excess
105
Causes of hypovolemic with urine NA+ less than ten
1. Dehydration
2. Diarrhea
3. Vomiting
106
Causes of hypovolemia with urine NA+ greater than 20
1. Diuretics
2. ACE inhibitors
3. Minearalcorticoid deficiency
107
Causes of hypervolemic, hypotonic, hyponatremia
1. Edematous states
2. Heart failure
3. Liver Disease
4. Advanced renal failure
108
Causes of hypertonic hyponatremia
1. Hyperglycemia
109
Management of hyponatremia
1. Treatment based on cause and underlying condition
2. Hypovolemia indicates NSIV
3. Hypervolemia indicates fluid restrictions
4. Symptomatic patients get NSIV with loop diuretic
5. CNS invovlment indicates 3% NS with loop diuretic
110
What is hypernatremia
High NA level
111
Causes of hypernatremia
1. Excess water loss
2. Cushings disease
3. Hyperaldosteronism
112
Management of hypernatremia
1. NSIV transition to 1/2 NS
2. Euvolemic hypernatremia indicates D5W
3. Hypervolemic hypernatremia indicates NS with loo diuretics and possible dialysis
113
What is hypokalemia
Low potassium level
114
Signs and symptoms of hypokalemia
1. Muscular weakness
2. Fatigue
3. Muscle cramps
4. Constipation
5. Ileus
6. Flaccid paralysis
7. Tetany
8. Hyporeflexia
9. Rhabdomyolysis
115
Lab/Diagnostic for hypokalemia
1. Abnormal T waves
2. Prominent U waves
3. PVCs
4. V-tach
5. V-fib
116
Management of hypokalemia
1. Potassium PO replacement
2. IV replacement if <2.5 or with symptoms
117
Causes of hypokalemia
1. Chronic use of diuretics
2. GI lossess
3. Renal loss
4. Alkalosis
118
What is hyperkalemia
High potassium level
119
Causes of hyperkalemia
1. Renal failure
2. Excess intake
3. NSAIDs
4. Hypoaldosteronism
5. Cell death
120
Hyperkalemia acidosis conversion
Each 0.1 drop in pH indicates a 0/7 mEq/L increase in K+
121
Signs and symptoms of hyperkalemia
1. Weakness
2. Flaccid paralysis
3. Abdominal distension
4. Diarrhea
122
Lab/Diagnostics of hyperkalemia
1. Tall peaked T waves on ECG
123
Management of hyperkalemia
1. Calcium gluconate
2. Insulin
3. Glucose
4. Kayexalate
124
What is hypercalcemia
High calcium level
125
Causes of hypercalcemia
1. Hyperparathyroidism
2. Hyperthyroidism
3. Vitamin D intoxication
4. Prolonged immobilization
126
Signs and symptoms of hypercalcemia
1. Fatigue
2. Muscle weakness
3. Depression
4. Anorexia
5. Nausea
6. Vomiting
7. Constipation
8. Coma
9. Death
127
Management of hypercalcemia
1. Calcitonin
2. NS with loop diuretics
3. Dialysis
128
What is hypocalcemia
Low calcium level
129
Causes of hypocalcemia
1. Hypoparathyroidism
2. Hypomagnesemia
3. Pancreatitis
4. Renal failure
5. Severe trauma
6. Multiple blood transfusion
130
Signs and symptoms of hypocalcemia
1. Increased DTRs
2. Muscle/Abdominal cramps
3. Trousseaus sign
4. Convulsions
5. Chvosteks sign
6. Prolonged QT interval
131
Management of hypocalcemia
1. Observe for alkalosis
2. IV calcium gluconate
3. PO replacement
4. Vitamin D
5. Aluminum hydroxide
132
Name the four acid-base imbalances
1. Respiratory Acidosis
2. Respiratory Alkalosis
3. Metabiolic Acidosis
4. Metabolic Alkalosis
133
What is Respiratory Acidosis
1. Low pH
2. High CO2
134
Signs and symptoms of respiratory acidosis
1. Somnolence
2. Confusion
3. Coma
4. Asterixis
135
Causes of respiratory acidosis
1. Decreased alveolar ventilation
2. Obesity
2. Head Injury
3. Drug Injestion
4. Airway obstruction
5. Disorders of the chest wall
6. Disorder of respiratory muscles
136
Management of respiratory acidosis
1. Naloxone
2. Intubation
3. Increase rate on ventilator
137
What is Respiratory Alkalosis
Hyperventilation decreases arterial pCO2 and increases pH.
138
Causes of respiratory alkalosis
1. Hyperventilation due to hypoxemia
2. Direct stimulation of central respiratory center
139
Signs and symptoms of respiratory alkalosis
1. Light-headedness
2. Anxiety
3. Parasthesia
4. Tetany
140
Lab/Diagnostics for respiratory alkalosis
1. High pH
2. Low pCO2
3. Serum HCO3 low
141
Management for respiratory alkalosis
1. Manage underlying cause
2. Paper bag breathing
3. Decrease rate of ventilator
4. Sedation
142
What is matabolic acidosis
Low HCO3
143
Anion gap equation
[(NA+) + (K+)] - (HCO3 + Cl-)
144
Conditions where the anion gap is increased
Diabetic ketoacidosis
Alcoholic ketoacidosis
Lactic acidosis
145
Management of increased gap
1. Treat underlying disorder
2. Fluids
146
Conditions where the anion gap is decreased
Diarrhea
Ileostomy
Renal tubular acidosis
Recovery from DKA
147
What is metabolic alklalosis
High HCO3
148
What are causes of metabolic alkalosis
1. Post-hypercapnia alkalosis
2. NG suction
3. Vomiting
4. Diuretics
149
Management of metabolic alkalosis
1. Correct volume deficit
2. Discontinue diuretics
3. H2 blockers
4. Acetazolamide
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