Exam 1 Topics
3 key distinctions/clinical manifestations of delirium
Sudden cog impairment
Disorientation
Clouded sensorium
A nursing student is asking you what the difference is between pneumonia and COPD. Give your best explanation.
Pneumonia is an acute infection of the lung parenchyma that can occur via inhalation,aspiration, or hematogenous spread. It is an inflam response where the alveoli fill with fluid and debris which increase the prod of mucus and lead to airway obstruction-->decreased gas exchange
(Resp Alkalosis)
COPD is a persistent airflow limitation and chronic inflam response that occurs in the airways/lungs. Usually progressive and involves the air trapping, inflammation and excessive mucous produc.
(Resp Acidosis)
Qsofa is how you screen for sepsis.
Calculated by the following:
RR>22/min
Altered mentation or GCS<15
SBP<100mmHg
Give the most probable diagnosis based off of the following s/sx:
Mid epi pain 2-5 hrs after meals.
"Burning and cramp like"
Pyrosis
PUD-Duodenal Ulcer
* Gastric ulcers are defined by high epi pain 1-2 hours after meals, with "gaseous" pain. Also aggravated by food.
What is the equianalgesic dosing of Hydromorphone (Dilaudid)?
1 mg of Dilaudid= 7 mg of morphine
A specific type of agitation, more confused in late afternoon/evening d/t disruption of circadian rhythms
Sundowning--Associated with AD
Robert is a 70-year-old diabetic who has a long history of not taking his insulin. He arrives to the ED his ABG results: pH 7.26, PaCO2 42, HCO3- 17
What do his ABGs indicate? Give at least 1 intervention.
Metabolic Acidosis – likely DKA. No evidence of compensation since PaCO2 is normal.
Interventions: Insulin drip, IV fluids, possibly sodium bicarbonate (IV push or drip).
pH: 7.35-7.45
PaCO2: 35-45
HCO3-:22-26
PaCO2: 80-100
What is SIRS criteria?
Pt satisfies 2 or more of the following:
Temp>38C or <36C
HR>90
RR>20 orPco2<32
Infection present-WBC>12K or <4K or >10%bands
In a patient with Cirrhosis, what labs would you monitor? (HINT: THERE ARE 6)
Describe the different MOA's of Finasterid (Proscar) and Tamsulosin (Flowmax) and give the indications.
Proscar-Decreases size of prostate(BPH)
Flowmax-Promotes smooth muscle relaxation and facilitates urinary flow through the urethra(BPH, Nephrolithiasis)
Maximum IV dose of Acetaminophen should not exceed _________g/day for adults greater than 50 kg
4/4000mg
List all low flow methods of O2 administration.
Then list the flow rate and FiO2 of each.
What masks are best for COPD patients?
NC:1-6L/min;24-44%
Simple face mask:6-12L/min;35-50%
Partial and Non-rebreather masks:10 to >15 L/min;60-90%
Oxy Mask: 1 to >15 LPM;24-90%
Non-rebreather and Venturi
Describe and discuss tx for acute chest syndrome
Sickle Cell:
Pulm complications that include PNA, FE
Characterized by fever, chest pain, cough, pulmonary infiltrates and dyspnea
TX: ABX,O2,Fluids and possible exchange transfusion
Ask, "When was your last bowel movement?"
Confirm any drug or food allergies
Confirm written consent
Clarify that the patient understands the procedure
What is pre-op colonoscopy patient prep?
Give the antidotes for the following:
Warfarin
Heparin
Benzos
Opioids
Warfarin-Vit K-Avoid leafy greens
Heparin-Protamine Sulfate
Benzos-Flumazenil (Romazicon)
Opioids-Narcan
5 side effects of opioid analgesics
Respiratory Depression
Constipation
N/V
Sedation
Pruritus
Marker of choice for distinguishing a cardiac or respiratory cause of dyspnea.
Give normal range.
BNP
>500--> Most likley HF
N:0-100
Describe and give parameters for permissive HTN.
Allows for brain perfusion
If ischemic:
Yes TPA<185/110
No TPA,only tx if HTN is extreme >220/120
If Hemm:
<160 is goal
Name the four complications of immobility.
Constipation
Renal Calculi
Cardiopulmonary Deconditioning
VTE(DVT and PE)
Give the three classes of Bronchodilators and give an example of medication that falls under each category.
Leukotriene antagonist:Montelukast (Singulair)
Adrenergics: B2 agonist (Albuterol)
Anticholinergics:Ipratropium(Atrovent)
Drug therapy for Delirium(3 categories)
Precedex--> Sedation
Neuroleptics--> antipsychotics
Short acting benzos--> Ativan
Describe 6 key differences of PAD and Venous Disease.
PAD:pulses dim. or absent, Cap refill is >3 sec, Edema usually absent, hair loss present, thin shiny taught, cool skin, intermittent caludification pain, Ulcers are rounded, smooth and "Punched out"
VD-Pulses present, refill<3sec, edema usually present in LE, Ulcers are irreg. shaped, yellow slough or dark red granulation, Dull ache or heaviness in calf, skin has bronze pigmentation, Skin is thick and hardened, temp is warm.
Describe the differences between the following:
MS
PD
MG
MS-Neurological, progressive, affects brain and spinal chord
MG-Autoimmune, affects skeletal muscle
PD-Progressive, affects substantia nigra,TRAP
Give 6 key differences between OA and RA.
OA:Usually >40, Often overweight, Localized, Weight bearing joints first-asymmetric, pain occurs in the AM but usually subsides within 30 min-pain relieved with rest, Clear synovial fluid(N.WBC count), RF, ANA, and Anti-CPP (-)
RA: Young-middle age, Weigh change(+-),systemic, usually small joints first-symmetrical, Pain occurs in AM-lasts 1 hr and may decrease with use, Pain may not be relieved with rest, High WBC-cloudy synovial fluid, + RF,ANA,CRP, ESR, and anti-CCP
Give the onset, peak and duration of the following:
Lispro (Humalog)
Regular Insulin(Humulin R)
NPH (Humulin N)
Glargine (Lantus)
10-30min,30min-3hr,3-5hr
30min-1hr,2-5hr,5-8hr
1.5-4hr,4-12hr,12-18hr
0.8-4hr,NA,16-24hr