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MedSurg > S4E1 > Flashcards

S4E1 Flashcards

(73 cards)

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1
Q

RA dx

A

XR
Positive rheumatoid factor
Synovial fluid analysis
Elevated ESR
CBC

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2
Q

HIV/AIDs dx

A

EIA w/ western blot
Viral load
CD4/CD8

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3
Q

CD4+ below ______ = AIDs

A

200

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4
Q

HIV/AIDs tx

A

Antiretroviral therapies

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5
Q

Name that disease

Progressive immunodeficiency
⬆️susceptibility to opportunistic infections
Attacks T-cells
Affects CD4+

A

HIV/AIDs

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6
Q

HIV/AIDs s/s

A

Any organ system involvement
Resp
GI
Onc
Neuro
Fatigue

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7
Q

HIV/AIDs causes

A

Bodily fluids
Transfused blood products

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8
Q

HIV/AIDs risk factors

A

Sharing dirty needles
Intimate contact
Blood transfusion prior to 1985
Infants born to mothers with HIV

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9
Q

AIDs opportunistic infections

A

Protozoan/fungus: pcp
Fungi: candidiasis
Viruses: harpies simplex 1 & 2
Bacteria: TB

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10
Q

PCP

A

Pneumocystis carinii pneumonia
Most common
Non-productive cough
Fever
Chills
Dyspnea

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11
Q

PCP can cause resp failure to develop after ______ days of initial appearance

A

2-3

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12
Q

PCP dx

A

Sputum induction
Bronchial-alveolar lavage
Trans bronchial biopsy (broncoscopy)

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13
Q

Candidiasis

A

Occurs in almost all pt with AIDs
Oral infection can spread through GI
Unable to absorb nutrients

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14
Q

Opportunistic conditions

A

Kaposi’s sarcoma
Wasting disease
AIDs dementia complex

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15
Q

Name the opportunistic condition…

Most common HIV related malignancy
Endothelial layer of blood/lymphatic vessels
Localized cutaneous lesions on skin or organs
Can lead to organ failure

A

Kaposi’s Sarcoma

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16
Q

Kaposi’s sarcoma dx

A

Biopsy

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17
Q

Name the opportunistic condition…

Profound involuntary wt loss
Protein-energy malnutrition(hyper metabolic)
Chronic diarrhea for >30 days
Chronic weakness
Intermittent/constant fever

A

Wasting disease

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18
Q

Nurse management for HIV/AIDs

A

Individualized plan of care
Know code status
Note fever and pattern if present
Asses tender/swollen lymph nodes
Monitor for s/s of infection
Look inside pts mouth
Encourage daily oral rinse(NS or Bicarb)
Standard precautions
Support in social impact coping
Discourage prognosis of AIDs
Eval pt for tx response
Baseline labs
Follow ups
Ensure viral load ⬇️ and CD4+ ⬆️
Asses for compliance vs resistance
Watch for neuro changes
GI issues

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19
Q

What can peripheral neuropathy in an HIV/AIDs pt be indicative of ?

A

Toxicity

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20
Q

Post exposure of HIV/Aids in clinic

A

Wash area
Report immediately
Go to ED
Take prescribed meds
Don’t forget paperwork from ED

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21
Q

HIV transmission prevention/reduction

A

Abstinence
Barrier devices
Avoid sharing needles, razors, tooth brushes, etc
No breast feeding if positive
No donating blood products if positive
Standard precautions
Nurse must education pt

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22
Q

Guess the disorder

Causes muscle pain & fatigue
W>M

A

Fibromyalgia

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23
Q

Fibromyalgia causes

A

Stressful/traumatic events (MVA)
Repetitive injuries
Illness
Certain diseases
No cause

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24
Q

Fibromyalgia s/s

A

Troubles sleeping
Morning stiffness
Headaches
Painful menstrual periods
Tingling or numbness and hands and feet
Thinking and memory problems(fibro fog)

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25
Criteria for fibromyalgia
11 of 18 painful tender points 3 months or more
26
Fibromyalgia risk factors
Rheumatoid arthritis Systemic lupus erythematosus Ankylosis spondylitis Women with fam Hx of fibromyalgia
27
Fibromyalgia providers
Rheumatologist Physical therapist Pain or rheumatology clinic
28
Fibromyalgia pharm tx
NSAIDs (muscle pain/stiffness) Tricyclic antidepressants (restore sleep) SSRI’s Anticonvulsants
29
Fibromyalgia, nurse management
Individualized exercise programs Therapeutic massage/heat applications Make changes as needed Stress management Regular sleep schedule Relaxation time throughout the day Support/encouragement to improve QOL Take their concerns, seriously Education on medication regimen, and lifestyle interventions Connect patient to support groups & I’m fine resources
30
Guess that autoimmune disorder Exaggerated production of auto antibodies, resulting in chronic inflammation of connective tissues Affect multiple organ systems Recurring remission/exacerbation W>M Etiology unknown
SLE - systemic lupus erythematosus
31
SLE s/s
Facial arrhythmia(butterfly rash)* Arthritis Photosensitivity Pleurisy * Pericarditis * Fever Fatigue Wt loss Mouth/throat ulcers * Neurological changes Neurosis* Seizures* Depression Psych
32
SLE nurse management
Prevent loss of organ function, disability Monitor labs that reflect inflammation Supportive, physical and psychological care Apply heat packs to relieve joint pain/stiffness Encourage exercise
33
SLE common nursing diagnosis
Fatigue Impaired skin integrity Body image disturbance Knowledge deficit r/t self management of disease process
34
SLE patient teaching
Avoid ultraviolet light exposure Encourage routine Periodic screenings Health promotion activities Rest balance with exercise Nutritious diet/dietary consult Medication regimen with side effects Cardiovascular/renal involvement risk of: ⬆️ risk of Artherosclerosis Hypertension Renal failure
35
SLE pharm therapy
Corticosteroids Antimalarials NSAIDS Immunosuppressive agents B-cell depleting therapies
36
How to Monitor organ involvement in SLE
Joint pain/stiffness, weakness, fever, fatigue, chills dyspnea, Chest pain, edema of arm/legs Size, types, location of skin lesions I&Os Serum lab work Vitals Weight Inspect for hair loss Check skin/mucous membranes for Petechia, bleeding, ulcers, paler, bruising
37
Guess that auto immune disorder Chronic attacks on joints, tendons, muscles, ligaments, and blood vessels Results in deformity Spontaneous remission unpredictable exacerbations Requires lifelong treatment; sometimes surgery
Rheumatoid arthritis
38
Rheumatoid arthritis s/s
Bilateral joint pain, tenderness, warmth, swelling Morning stiffness, Parathesias Stiff, weak muscles Rheumatoid nodules Pannus tissue Sleep disturbance fatigue Altered mood Limited mobility
39
Rheumatoid arthritis pharmacy tx
Salicylates NSAID COX-2 enzyme blockers Cortical steroids Immunosuppressive DMARDs Antimalarials Gold penicillamine Sulfasalazine
40
Rheumatoid arthritis concerns
Addisonian crisis (⬇️ BP) Hypoglycemia
41
Rheumatoid arthritis flareup triggers
Emotional/physical stress Sick Surgery
42
Rheumatoid arthritis, nurse management
Monitoring/managing medication side effects Bone marrow suppress Anemia G.I. disturbances Rush Assess patient in taking medication correctly Use adopted devices correctly Occupational/physical therapy referrals Support services: meals on wheels; arthritis association Teach to maintain independence, function and safety in home
43
Sepsis schlock s/s
Sepsis (sirs+confirmed infection) Hypotension won’t resolve with adequate fluids
44
General Sepsis labs & numbers
Lactate >2 mmol/L WBC <4x10 /Lor >10x10/L Creatinine > 2mg/dL INR >1.5 APTT >60 seconds Platelet <100x10/L ⬇️ urine OP ⬆️WBC (left shift) ⬆️CRP/ESR (inflammatory markers) ⬆️lactate (hypoperfusion markers) ⬆️glucose,creatinine,bilirubin(organ failure) ➕ blood cultures Impaired coagulation (INR, PTT, platelets)
45
This improves morbidity and mortality outcome for sepsis
Early identification and appropriate management
46
Sepsis nurse management
Know H&P, labs & imaging Prompt recognition Timely antibiotic administration Fluid resuscitation Hemodynamic support Control source of infection with or w/o sx
47
Studies to identify source of infection
Chest radiograph Urinalysis Blood cultures CT
48
Surgical interventions for sepsis
Drainage Debridement Device removal
49
If sepsis is definite/probable and shock is either present or absent….
Administer antibiotics immediately, ideally within 1 hour of recognition
50
If sepsis is possible and shock is present…
Administer antibiotics immediately, ideally within 1 hour of recognition
51
If sepsis is possible, but shock is absent…
-Rapid assessment of infectious versus non-infectious causes of acute illness -Administer antibiotics within 3 hours if concerned for infection persist
52
____________ is the first line vasopressor
Norepinephrine or epi
53
Target MAP for patient with septic shock on vasopressors
65 mm Hg (Consider monitoring arterial BP)
54
_______ is the second line vasopressor
Dobutamine
55
Sepsis risk factors
Suppressed immune system Extreme age (young or old) Ppl who received organ transplant Surgical procedure Indeelling devices Sickness Existing wound Pressure associated injury or infection Infection risk Hospital admission Chronic disease Genetics
56
Sepsis can lead to_____
MODS
57
MODS starts with _____
An infection
58
SIRS initially occurs with
A localized infection & inflammation that caused a wide spread inflammatory response
59
SIRS dx is 2 or more of…
Fever or <36 >90 bpm >20 RR PaCO2 of <32 mmHg WBC >12x10 or <4x10
60
Sepsis is dx if…
Confirmed source of infection & Meets SIRS criteria (2 or more)
61
Severe sepsis (sepsis + organ dysfunction)
Hypotension Hypoperfusion Lactic acidosis SBP <90 or drop of >40 mmHg Low ph Low bicarbonate
62
No improvement to hypotension if adequate fluid resuscitation isn’t working
Septic shock
63
MODS is…
Septic shock (sepsis+hypotension) _>_ 2 organs failing
64
______ occurs at the beginning of sepsis
SIRS (but sirs doesn’t always mean sepsis)
65
If concern for sepsis or septic shock, take vital signs every….
5 to 15 minutes
66
What does the map tell us?
How well organs are being perfused
67
Why do we use vasopressors during septic shock?
To keep map above 65 ⬇️vasodialation
68
Why does lactic go up during septic shock?
Because body can’t use aerobic so they turn over to anaerobic to metabolize which means alter tissue perfusion
69
Why does hypovolemia/hypotension happen during septic shock
Extreme immune response Vasodilation Fluid leaves blood vessels goes into tissue Causing edema & hypovolemia
70
Common sepsis sites
GI (abdominal) Resp (lungs) GU ( urinary tract)
71
Early “warm” stage of septic shock
Warm skin Compensation happening Vasodilation Hyper dynamic ⬇️BP ⬆️HR ⬆️RR Fever ⬆️CO Restless Anxiety
72
Late “cold” septic shock
Cold and clammy Hypodynamic Vasoconstriction ⬇️⬇️⬇️⬇️⬇️BP ⬆️HR ⬆️RR Oliguria Coma Hypothermia ⬇️CO
73
Septic shock nurse management
Start antibiotics Enteral nutrition Protein activated C (drotrecogin Alpha) Titrate Vasopressors (norepinephrine) Initropics (dobutamine) Crystalloids/colloid solutions Steroids ( corticosteroids) Hemodynamic monitoring Oxygenate Cultures (B4 ANTIBIOTICS!!!) Keep glucose < 180 Monitor lactate & uop ⬆️ perfusion Oxygenate Fight microorganism ⬇️ inflammation Nutrition Control blood glucose vessels

MedSurg (8 decks)

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