Misc.

Question 1

most common causes of infectious fever in the acute care setting

Answer 1

bacteria and fungus

Question 2

neutrophils

Answer 2

fights bacterial infection

60% of differential

Question 3

lymphocytes

Answer 3

fight viral infections

30% of differential

Question 4

monocytes

Answer 4

clear cellular debris

Question 5

eosinophils

Answer 5

worms, wheezes, weird diseases (allergic responses, parasitic infections)
3% of differential

Question 6

basophils

Answer 6

role undetermined

0-1% of differential

Question 7

left shift

Answer 7

suggests bacterial infection
neutrophils >70%
Absolue neutrophil count >7000
Bands >4% or 400

Question 8

risks of fever

Answer 8

double cardiac requirement
uncomfortable and may inhibit mobility
teratogenic
rapid temp rise precipitates seizure

Question 9

benefits of fever

Answer 9

kills most infectious organisms
augments the inflammatory response; accelerates it
improves survival in animal studies

Question 10

infectious fever pattern

Answer 10

lowest in the morning, climbs throughout the day, highest in the middle of the night

Question 11

drug fever pattern

Answer 11

tends to be higher and stay higher, does not exhibit the diurnal pattern

Question 12

calories needed to maintain body weight

Answer 12

30-35kcal/kg body weight

Question 13

enteral nutritional support

Answer 13

use nasoenteric tube if support is needed for 6 weeks, use enterostomal tube

Question 14

parenteral support

Answer 14

2 wks use central vein (TPN - highest glucose D50)

Question 15

complications of nutritional support

Answer 15

Complications of nutritional support Enteral - diarrhea; usually related to the solution

Parenteral - usually related to delivery; pneumothorax from line placement, line infection, etc.

Question 16

hyponatremia

Answer 16

most common electrolyte imbalance < 135

Question 17

Isotonic hyponatremia

Answer 17

Na is low, but osmolality is normal (270-290)

Most common with hyperlipidemia (>1000-1500 mg/dl) and
hyperproteinemia (>12-15 g/dl - seen in multiple myeloma)

Body water is normal, pts. are asymptomatic

Question 18

hypotonic hyponaremia

Answer 18

Low Na and low osmo (<270)

Need to assess volume status to determine cause

Question 19

hypervolemic hypotonic hyponatremia

Answer 19

Most common type of hyponatremia

Pt. is fluid overloaded and retaining free water typically caused by cardiac, hepatic or renal failure

Treatment aimed at free H2O restriction and diuresis

Question 20

hypovolemic hypotonic hyponatremia

Answer 20

Pt. is clinically dry - losing water & sodium

Assess urine sodium for cause:
Urine Na 20 - renal loss; diuretic excess is most common cause

Treatment is replace Na, water, and treat underlying cause

Question 21

euvolemic hypotonic hyponatremia

Answer 21

most common cause is hypothyroidism

Question 22

hypertonic hyponatremia

Answer 22

osmo >290, Na <135
Increase in some other solute raises osmolality

Hyperglycemia is most common

Question 23

assessing hyponatremia

Answer 23

1. Serum Sodium
   135-145
2. Serum Osmolality
   270-290
3. Clinical Volume
4. Urine Sodium
   10-20

Question 24

normal urine osmolality

Answer 24

250-400

Question 25

hypernatremia

Answer 25

Due to free water loss Assess urine osmolality 400 (very concentrated urine) - good water conservation, look for extrarenal source of water loss

Question 26

cardiac effects of hypokalemia

Answer 26

tachycardia, vtach, vfib, dysrhythmias, very excitable heart

Question 27

cardiac effects of hyperkalemia

Answer 27

bradycardia, systole- heart cannot excite

Question 28

S/S of hypocalcemia

Answer 28

Carpopedal spasm Increased DTRs Chvostek's sign

Question 29

S/S hypercalcemia

Answer 29

Symptoms vague >12 is medical emergency and produces a progressive decline in neuro status. Can lead to coma.

Question 30

Step 1 of WHO pain management

Answer 30

Patients with mild to moderate pain Non-opiod +/- adjuvant Tylenol, ASA, Ibuprofen

Question 31

Step 2 of WHO pain management

Answer 31

Patients with moderate-severe pain or who fail to achieve adequate relief after a trial of a nonopioid analgesic Weaker opioid +/- non-opioid, +/- adjuvant Oxycodone (Percocet/Percodan), Hydrocodone, Codeine

Question 32

Step 3 of WHO pain management

Answer 32

Patients who present with severe pain or who fail to achieve adequate relief following appropriate administration of drugs on the second step of the analgesic ladder Strong opioid +/- non-opioid, +/- adjuvant Morphine, Dilaudid, OxyContin, Methadone

Question 33

Most common causes of post-op fever

Answer 33

volume contraction and atelectasis

Question 34

caloric needs in a hyper metabolic pt.

Answer 34

Figure calories needed to sustain weight - kg x 35 (kcal/kg) Multiply that by 2

Question 35

calories per gram of carbohydrates

Answer 35

4

Question 36

calories per gram of fat

Answer 36

9

Question 37

calories per gram of protein

Answer 37

4

Question 38

best assessment of TPN efficacy

Answer 38

positive nitrogen balance | this fluctuates daily so it is a good assessment of daily efficacy

Question 39

medications associated with hyperkalemia

Answer 39

ACE inhibitors Heparin- aldosterone antagonist property excretes Na so body reabsorbs K NSAIDS

Question 40

granulocyte colony stimulating factor (neupogen) stimulates what

Answer 40

WBCs

Question 41

Redman syndrome

Answer 41

IgE mediated vasodilation secondary to vancomycin administration

Question 42

most common organism to cause line sepsis

Answer 42

staphylococcus epidermis

Question 43

management of a tar burn includes

Answer 43

Immersion of the burned area to stop the expansion of the burn Do NOT remove the tar - it will peel away the skin. The tar will debride itself