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Flashcards in Things to know for final Deck (50)
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1
Q

Indirect inguinal hernia

A
inguinal ring (most common)
Pain
SwellingIncreased abdominal pressure 

sac herniates thru internal inguinal ring; can remain in canal or pass into scrotum. Pain with straining; Congenital or acquired

2
Q

Direct inguinal hernia

A

(weak point in fascia of abdominal wall)
Always acquired
Increased abdominal pressure

directly behind and through external inguinal ring, above inguinal ligament; rarely enters scrotum. Painless, swelling. Brought on by heavy lifting, muscle atrophy, obesity, chronic cough, or ascites

3
Q

Femoral hernia

A

Anatomical defect
Usual in females
Can be strangulated

Through femoral ring and canal, below inguinal ligament, more on right side. Pain severe, strangulated. Acquired; increased abdominal pressure, muscle weakness, frequent stooping.

4
Q

Incisional hernia

A

Through scar

Poor wound healing

5
Q

Umbilical hernia

A

Congenital: age of 2. May disappear by 3-4. They do surgery

obese/ascites

6
Q

Hernia

A

very common/ can’t feel it sometimes.
Born with it
Pain or no pain
painful→ strangulated→ no blood supply→ ER→ OR
Incarcerated: urgent but not so much. Cannot be reduced. Don’t force
Reducing hernias: reducible

7
Q

Gonorrhea

A

Purulent discharge. Needs culture

8
Q

Herpes

A

Vesicles (fluid filled pustules) in clusters. They rupture in 1-2 days and leave an ulcer.

9
Q

Chlamydia

A

Urinary urgency/painful discharge or no symptoms.

10
Q

Vaginal warts

A

firm, cauliflower

11
Q

Syphilis:

A

papules (>1 cm)

12
Q

Stools by 4th day of breastfed

A

golden yellow, pasty and smell like sour milk.

13
Q

Formula fed

A

brown yellow firmer and smell fecal.

14
Q

S&S of intestinal obstruction

A
Abdominal surgery
Dehydration and loss of electrolytes 
Accumulation of fluid and gas in bowel above obstruction
Colicky pain from peristalsis
Fever
Leaking fluid into peritoneum
Hypovolemic shock.
15
Q

in small bowel

A

crampy pain, bile projectile vomit, constipation and diarrhea.
Head of bed up

NPO, IV, NG tube, decompress, ileostomy
Postop: risk of DVT and PE (do leg exercises, electrical stockings, fluids)

16
Q

In large bowel

A

deep pain/long/dull, Feces/constipation/diarrhea. Vomit smells like feces/ BP down, RR up, fever up

blood cross match/surgery/colostomy
Postop: risk of DVT and PE (do leg exercises, electrical stockings, fluids)

17
Q

Cerebral cortex:

A

highest function, thought, reasoning, sensation, and voluntary movement

18
Q

Frontal:

A

personality, behavior, emotions, and intellectual functions.

19
Q

Parietal

A

sensation. movement/orientation

20
Q

Temporal:

A

hearing, taste and smell.

memory/speech

21
Q

Wernicke’s area

A

language comprehension.
Receptive aphasia: sound has no
meaning like a foreign language

22
Q

Broca’s area

A

motor speech

Expressive aphasia: the person can’t talk.

23
Q

Basal ganglia

A

help to initiate and coordinate movement and control automatic associated movements.

24
Q

Thalamus

A

synapses occur here.

25
Q

Hypothalamus

A

Respiratory center, temp, HR, BP, sleep, stress, autonomic nervous system activity,

26
Q

Cerebellum

A

motor coordination, equilibrium, and muscle tone.

27
Q

COMPLETE NEURO ASSESSMENT

A
CN
Muscle strength
Sensory systems
Cerebellar functioning (posture, equilibrium)
Reflexes
28
Q

QUICK ASSESSMENT

A

LOC: alert, verbal stimuli, painful stimuli
oriented to person, place, time.
Motor function: squeeze my hands, raise arms.
Pupillary response
Glasgow coma scale: eye opening, motor response and verbal response.

29
Q

Brains stem

A

midbrain pons medulla: BP, HR, RR.

30
Q

dysphagia sign

A

drooling

31
Q

dysarthria

A

pt cannot formulate their words

32
Q

Screen symptoms of stroke:

A

sudden vision change, fleeting blindness, weakness, loss of consc.

33
Q

mental status

A

LOC/orientation

34
Q

Cerebellum testing

A

coordinated voluntary movements

balance

35
Q

Sensory cortex (parietal lobe)

A

-stereognosis test
Graphesthesia: ability to read a number by having it traced on the skin.
-2-point discrimination
Extinction

36
Q

Reflexes

A

+2 is normal

37
Q

Rooting

A

(CN 5)

38
Q

Moro reflex

A

(CN 8) flex side

39
Q

Neurologic recheck

A
  • LOC– Change is important!!!
  • Motor function
  • Pupillary response
  • Vital signs
40
Q

Decorticate

A

flexion of arm, wrist, and fingers; adduction of arm/extension of legs, internal rotation, plantar flexion. Lesion in cerebral cortex

41
Q

Decerebrate

A

arms extremely extended, internally rotated, palms pronation. Legs swiftly extended.
Lesion in brainstem.

42
Q

Increased Intracranial pressure

A

-LOC changes early sign
-Pupils (ipsilateral at first. becomes larger and doest react) dilated and fixed (CN 3)
-Deteriorating motor function (bilateral or unilateral)
-Decorticate position. Arms curl up
-Decerebrate position.
-Headache
-Presses on medulla (vomiting)
late changes —> VS
-BP systolic up diastolic down (widening) then drops
-pulses will be fast and then all of a sudden it goes down and stop
-Resp: fast, then slow
-temp: rises
-Pupil edema (optic disk swelling)

43
Q

Tx for ICP

A
call others (rapid response team)
increase HOB to 30 degrees
no trandelenberg
no suctioning 
no pressure on the neck 
check temp
seizure control 
diuretics (mannitol) 
pain management
44
Q

CVA tx

A

aspirin with no coating
r/o hypoglycemia
start IV, electrolytes, PT/PTT, CBC, BS, EKG, blood work
CAT scan (hemorrhagic)
tPA (manage BP—> less than 180 systolic) VS q 15 minutes watch for changes in LOC!!!
hypothermia treatment after it happened

45
Q

Risk factors for CVA

A
smoking
DM
atherosclerosis
oral contraceptives 
HTN
46
Q

Tetralogy of Fallot

A

Right Ventricular outflow stenosis
VSD
Right ventricular hypertrophy
Overriding aorta
Result: shunts a lot of venous blood into aorta away from pulmonary system; blood never gets oxygenated
Severe cyanosis (as infant grows) with crying and exertion, then at rest.
DOE.
Development slowed.
Thrill at left lower sternal border
Murmur is systolic, loud, crescendo-decrescendo.

47
Q

Patent Ductus Arteriosus (PDA)

A
Pulmonary artery and aorta connected. 
BP wide pulse pressure 
Bounding peripheral pulses 
Thrill palpable at left upper sternal border
Machinery murmur (systole and diastole)
48
Q

Atrial Septal defect (ASD)

A

Abnormal opening in atrial septum. Left to right shunt. Increase in pulmonary blood flow
Young adults: mild fatigue and DOE
Sternal lift. S2 fixed split
Murmur is systolic, ejection, medium pitch, best heard at base in 2nd left interspace.

49
Q

Ventricular Septal Defect (VSD)

A
Abnormal opening between the ventricles (subaortic area). 
Large defects: infants have 
Poor growth
Slow weight gain
Pale, thin, delicate. 
Feeding problems
DOE
Frequent respiratory infections
HF if severe
Loud, harsh holosystolic murmur (left lower sternal border)
Thrill 
Large: soft diastolic murmur at apex (mitral flow murmur) by increased blood flow through mitral valve.
50
Q

Coarctation of the Aorta

A

Severe narrowing of descending aorta. Increased workload on left ventricle.
Associated with PDA or VSD.
HF develops
Teens: lower-extremity cramping, worse with exercise
Arm HTN over 20 mm Hg.
Absent/diminished femoral pulses
Systolic murmur at the left sternal border.