-
Part of eyes for color recognition
cones
-
Improve hearing with changing elevation
swallow to equalize pressure
-
Meds used for open angle glaucoma
Timolol and Xalatan
-
Cause of burning, itching, and pain in eyes
conjuctivitis
-
Symptom of retinal detachment
flashing lights
-
Decrease in hearing r/t medication
ototoxicity
-
Removal of insect from ear
Instill mineral oil, NO WATER
-
Priority assessment post mastoidectomy
Infection/temperature
-
Patient teaching about cleaning ear
External ear only
-
Site of excessive scar tissue-scar that gets large
keloid
-
Multiple lesions on a child with no other symptoms
possibly insect bites
-
Linear lesions are associated with
- poison ivy
- dermatitis
- hookworm
-
Vitamin to be given with large burns
Vitamin D
-
Priority in history with skin assessment
Environmental changes like laundry detergent
-
Yellow tone in skin caused by
Keratanoids
-
Innermost layer of skin
stratum germinativum
-
Sweat gland
ecrrine gland
-
crescent shape in nails
lunula
-
characteristics of elderly skin
- loss of subcutaneous fat
- thin
- lack of elasticity
-
first line med for pain with burns
morphine
-
diet for burn patients
- increased calorie
- vit A
- vit C
-
Wet to dry dressing is what type of debridement
mechanical debridement
-
Showing burn quickly is not typically a sign of
abuse
-
patient with major burns in the ER should get
Foley, NG tube, large bore IV, lactated ringers
-
Heterograft
from another species
-
-
-
Highest priority with burns
Airway
-
Emergent phase in tx of burns
24-72 hours
-
Parkland Formula
2-4 mL LR X wt (kg) X %of burn
-
smoke inhalation symptoms
cough, hoarseness, increased respirations
-
Checking fluid status in burn patients
Urine output should be at least 30 mL/hr
-
Priority teaching with fatty liver Dx
no alcohol
-
Impairment of the GI System affects
- food absorption
- digestion
- metabolism
-
Assessing a patient with dysphagia
Assess for ability to swallow, watch for aspiration
-
Biliary atresia requires
liver transplant
-
order of assessing abdomen
inspect, auscultate, percuss, palpate
-
Grapefruit juice
- block P-glycoprotein
- inactivates Cytochrome P450 for 24 hours
- changes absorption
-
Food intake interfering with coumadin
high vit K foods
-
Lifestyle contributing to risk for gum disease
smoking
-
Lifestyle contributing to throat cancer risk
alcohol
-
Drug given for increased ammonia r/t liver dysfunction
Lactulose
-
Portal HTN causes
- esophageal varices
- spleen emergencies
- hemorroids
- caput meducia
-
Food high in iron
organ meats, muscle, whole grains, sweet potato, dark meats, thigh of chicken, beans, shrimp, tuna, oatmeal
-
Food with B12
meats and dairy
-
Normal folic acid range
1.8-9 ?
2.7-17
-
-
Zollinger Ellison syndrome patient will have
peptic ulcer
-
Priority intervention post upper GI series
Check gag reflex
-
Mylanta given for GERD
- Takes care of heartburn
- Will not affect diverticulitis or IBD
-
Interventions r/t the following symptoms w/Hx of peptic ulcer disease-severe pain, board like abdomen
- Perforated ulcer
- IV access
- NG Tube
-
Intervention before upper GI series
NPO status
-
Major symptom of Crohn's
Diarrhea
-
Normal response post surgery
Elevated temp, not fever
-
Symptom of severe liver disease
agraphia
-
Action of Tagamet
Block acid/H2 Inhibitor
-
Intervention for post liver biopsy bleeding
turn patient on side and hold pressure
-
Microcytic hypochromic anemia diet recommendation
include eggs
-
Foods high in B12
green leafy vegetables
-
Pernicious anemia
lacking intrinsic factor
-
Aplastic anemia
decreased immunity, limited to no contact with others depending on severity
-
Symptoms of low B12
fatigue, tingling, SOB, sore tongue, weakness
-
Teaching for iron intake for vegetarians
Cook using iron cookware
-
B12 injections needed when
B12 deficiency is a result of lack of intrinsic factor
-
Post surgical H&H
will be somewhat lower than normal
-
Late symptom of polycythemia vera
Pruritis
-
A plastic anemia patients will have problems with (in addition to immunity deficiency)
bleeding
-
Sharing HIPPA protected information regarding HIV status
Slander
-
Blood specific filter
Amyeron mesh filter
-
Lupus
Auto-immune disease involving connective tissue
-
Highest priority in anaphylactic shock
Airway
-
Intervention for a sickle cell anemia patient with O2 sat=90%
Oxygen
-
Inflammatory response
swelling, heat, redness, pain
-
Alzheimer's Early Stage Drug
Cholinesterase Inhibitor-now given in combination with Namenda
- Aricept
- Reminyl
- Exelon-patch
- Cognex
-
Alzheimer's late stage drug
Namenda-now given in combination with Cholinesterase inhibitors
-
-
ALS Death usually r/t
- infection
- respiratory failure
-
Rilutek
- Only ALS specific FDA approved drug
- BID on empty stomach
- liver toxicity risk
-
Patient planning and ALS
Living will very important, patient will become unable to express desires
-
Antispasmodics given for ALS
-
Bell's Palsy pharmacological tx
- Prednisone 60-80mg/day
- Acyclovir-antiviral
-
Interventions with Bell's Palsy
- Cornea protection
- Meal hints
- Warm moist heat
- Facial exercises
- Surgery
-
Symptoms of Tension headaches
- Steady, constant pressure
- Bandlike
- Begins in forehead, temple, back of neck
-
Tension headache pharmacology
- NSAIDS
- Caffeine
- Muscle relaxers
-
Tension headache interventions and treatments
- Decrease stress
- Yoga
- Massage
- Meditation
- Heat
- Cold
- Acupuncture
-
Migraine symptoms
- Often unilateral
- SEVERE
- Nausea
- sensitivity to light
- Three stages
-
Migraine triggers
- menstrual cycle fatigue
- lights MAOI's
- stress
- depression
- fatigue
- certain foods-aged cheeses, red wine, nitrates, sodium, milk
-
Prodromal stage of migraines
One or two days before a migraine, you may notice subtle changes that may signify an oncoming migraine, including:
- food cravings
- mood changes
- aura phase
- focal sx
- visual disturbance
- tingling,numbness of lips
- confusion
- vertigo
- aphasia
-
2nd Stage of Migraine
- Headache severe
- "Throbbing"
- Unilateral 60%
- Nausea/Vomiting
-
3rd Stage Migraine
- Headache changes to dull
- Nausea and Vomiting
-
Postprodrome Migraine
- Fatigue
- Irritability
- Muscle pain
-
3 R's of Migraines
- Recognize---migraine symptoms
- Respond---and see health care provider
- Relieve---pain and symptoms
-
What population does not get triptans?
- patients with Hx of CAD
- No Imitrex, Zomig, Amerge, Maxalt, Relpax
-
Triptans for Migraines
- Imitrex
- Zomig
- Amerge
- Maxalt
- Relpax
-
Preventative for Migraines
Beta Blockers
- Atenolol
- Metoprolol
- Other ---lol drugs
-
Antiepileptics for Migraines
-
Non-pharmacological management for migraines
- yoga Comfort-Quiet/Dark
- meditation Elevate HOB
- massage Anti-emetics
- exercise Patient teaching
- biofeedback Foods/Bevs to avoid
- relaxation Meds to avoid
- accupuncture/accupressure
-
Drugs that combined with Triptans cause serotonin syndrome
Tramadol and SSR's
-
Cluster headache symptoms
- Vascular
- unilateral
- 1-8 clusters/day
- eyes/temple/cheek
- Penetrating, steady
- Often patient will be pacing or rocking
-
Pharmacology for cluster headaches
- Imitrex
- 100% Oxygen
- Intranasal lidocaine
- Steroids
- Ergotamines
- Li
- Ca channel blockers
- Anticonvulsants
-
Non-pharmacological tx of cluster headaches
- Avoid light exposure
- Wear sunglasses
-
Sinus Headache symptoms
Pain usually behind the forehead and/or cheekbones
-
Ischemic vs. Embolic stroke
Ischemic-gradual onset, r/t artherosclerosis
Emoblic-sudden onset, r/t embolus traveling from another part of the body
-
Warning signs of impending ischemic stroke
- TIA-a few seconds to 24hours
- RIND-reversible ischemic neurologic deficit >24 hours, <one week
-
Causes of hemmorhagic stroke
- bleeding into brain tissue
- aneurysm
- trauma
- AVM
- HTN
- Amphetamine abuse
- Cocaine abuse
-
Common source of Embolus causing stroke and medication given to prevent it
embolus from the heart r/t A-fib, given coumadin to prevent
-
Symptoms of Left Sided Stroke
- Right paralysis
- Right Visual Deficit
- Aphasia
- Altered intellect
- Slow, cautious
-
Symptoms of Right Sided Stroke
- Left paralysis
- Left Visual Deficit
- Increased distractability
- Impulsive behavior
- Lack of awareness of deficit
-
Emergent Care for Stroke
- CT Scan within 25 minutes
- 2 large IV sites
- Evaluate for t-PA
-
t-PA administration
0.9 mg/kg up to 90 mg max
- Push 10% over 1-2 min
- Give remainder over an hour
-
Treatment for Ischemic stroke when t-PA exclusion is present
- Aspirin within 24-48 hours
- Heparin 800-1200 units/hr to maintain therapeutic PTT
- Manage blood pressure
-
Glasgow Coma Scale-Three parts
- Eye Opening-1-4
- Verbal Response-1-5
- Motor Response 1-6
- Mild LOC 13-15
- Moderate LOC 9-12
- Severe 3-8, 7=coma
-
Eye opening-Glasgow Coma Scale
- Spontaneous 4
- To loud voice 3
- To pain 2
- None 1
-
Verbal Response Glasgow Coma Scale
- Oriented 5
- Confused 4
- Inappropriate language 3
- Incomprehensible 2
- None 1
-
Best Motor Response-Glasgow Coma Scale
- Obeys commands-6
- Localizes-5
- Withdraws-4
- Abnormal flexion-3-decorticate
- Abnormal extension-2-decerebate
- None-1
-
Generalized Seizure
Involves whole brain
- Tonic clonic/Grand Mal
- Clonic
- Absence
- Myclonic
- Atonic
-
Focal Seizures
One part of brain involved
- Simple partial
- Complex partial
- Partial evolving to generalized
-
Status Elepticus-description and pharmocological Tx
Seizure > 5 min or Repeated seizures over 30 min
- Rectal Valium-Diastat
- IV Ativan
- Then Dilantin or Cerebyx
-
Priority intervention with status elepticus
airway, have suction available
-
Symptoms of Tonic Clonic/Grand Mal
- Loss of postural control
- Bilateral tonic extension
- Clonic activity w/rhythmic movement
- Closed glottis sounds
- Loss of continence, memory, & consciousness
- Post ictal state
-
Febrile seizures-causes and Tx
Usually r/t rate of temperature increase rather than maximum temperature
<5 min long
Often associated with URI and GI infections
Give valium
Tylenol and sponge baths usually do not help
-
Nimotop-action and important to know?
- Prevents vasospasm
- Used with aneurysm
- CAN NOT HOLD WITH OUT CALLING PHYSICIAN FIRST
- Ca channel blocker specific to cerebral vasculature
-
Three types of Hematomas and venous vs. arterial
Which is worst?
Subdural-venous
Intracerebral-venous
Epidural-arterial-most dangerous
-
Tx for Epidural Hematoma
Drill Burr holes and drain
-
Epidural Hematoma
Cause
What happens at occurence
- Usually caused by trauma
- Quick pass out, then short period of lucidity then pass out again
-
-
-
MAP Calculation
(Systolic + 2(Diastolic))/3
-
-
What happens to vitals with increased ICP
- Cushing's response
- Widened pulse pressure
- Bradypnea
- Bradycardia
-
Lobes of the brain
- Cerebrum
- Parietal
- Temporal
- Occipital
-
Function of the Cerebrum
- Judgement
- Personality
- Motor control of speech-Broca's area
-
Broca's area
Area of the Cerebrum controlling the motor function of speech
-
Parietal Lobe Function
- Sensory
- Sing/play an instrument
- Depth perception
-
Temporal Lobe Function
- Auditory and Smell
- Short Term Memory
- Processing language-Wernicke's area
-
Wernicke's area
Part of the Temporal lobe responsible for processinglanguage
-
Occipital Lobe Function
Sight
-
Solumedrol Dosage for SCI
- Loading Dose- 30mg/kg over 15 min
- Then 5.4 mg/kg/hr for 23 hours
-
Drugs given for MS and their side effects
Avonex and Interferon both cause flu-like symptoms
-
Mannitol
Loop diuretic given to decrease ICP--also aids in chemo drugs crossing the blood brain barrier
-
3 Layers of Meninges
- Dura mater-tough gray
- Arachnoid-meshy delicate
- Pia mater
-
Part of the brain first affected by alcohol/responsible for coordination of movement
Cerebellum
-
Amount of CSF produced each day
Amount reabsorbed
- 500 mL produced
- All but 150mL reabsorbed
-
Pupils and Drugs
Uppers Dilate
Downers Constrict
-
Deep Tendon Reflex Scale and What is normal
0-4+
Normal is 2+
-
Common site for aneurysms
Circle of Willis
-
Prenumbra
- Salvageable ischemic tissue
- If blood flow is restored this tissue can be restored
- Surround the infarction
-
Munroe Kellie Hypothesis and volumes for components
Brain tissue+blood+CSF=ICP of 10-15
If the volume of any of these three increases, ICP will increase
- Normal amounts
- Brain 1400 gram
- Blood 75 mL
- CSF 75 mL
-
Common first sign of increased ICP in adults
change in level of consciousness---even if very minor
-
C1-C4 Injury
Intercostal and diaphragm paralyzed
-
Patients with C1, C2 and C3 injury are always dependent on ____________. C4 are sometimes
a ventilator
-
Patients with a C6 SCI have___________. They can learn to _________________.
- some recovery of tricep muscles
- drive
-
Patients with C7&8 injuries can become_________________.
independent
-
Landmark for T5
Nipple line
-
Landmark of T10
umbilicus
-
Landmark for L3
lower limbs and saddle area
-
Symptoms of SCI below S3
- no paralysis
- possible loss of sensation of the saddle area
-
Autonomic Dysreflexia
- Excessive uncontrolled sympathetic activity
- Caused by an noxious stimuli after SCI
- Can occur years after injury
- Raise HOB
- Give Apresoline
-
Baclofen
Antispasmodic given in SCI and MS
-
Do not administer warfarin with ________________ because ________________.
- phenytoin
- they are both highly protein bound
-
What intervention is necessary if a patient is on Cerebyx?
Heart monitor
-
Common first line medication for myesthenia gravis
Mestinon
-
Surgical treatment for myesthenia gravis
Thymectomy
-
Syndrome of Inappropriate Antidiuretic Hormone-Oncologic emergency
Define
Intervention
Most common in what type of cancer
Body makes too much ADH
Interventions-fluid restriction and accurated I's and O's
Most common with lung cancer
-
Spinal Cord Compression-Oncologic emergency
Sx
Tx
- Palliative
- Steroids
- Radiation
- Surgery
- Braces
-
Hypercalcemia
Tx
- Oral hydration
- Normal Saline IV
- Drug therapy
- Dialysis
-
Hypercalcemia
Sx
- Fatigue
- Loss of appetite
- Nausea/Vomiting
- Constipation
- Polyuria
- Severe muscle weakness
- Loss of deep tendon reflexes
- Paralytic ileus
- Dehydration
- ECG changes
-
Superior Vena Cava Syndrome- Oncologic Emergency
- Superior vena cava compressed or obstructed by tumor growth
- Painful life threatening emergency
- Edema-face, arms, hands, dyspnea, erythema, and epstaxis
- Stokes' sign
-
Stoke's sign
- Tightness of the shirt collar
- Indicates superior vena cava syndrome
-
Tumor Lysis Syndrome
- follows destruction of tumor cells
- cell contents dumped faster than the body can get rid of them
- hyperkalemia and hyperuracemia
-
Epgogen/procrit
- Erythropoeisis stimulating drugs
- goal is to return to acceptable levels of H&H to be able to continue treatment
-
Signs of cervical cancer
- often asymptomatic
- painless vaginal bleeding
- watery blood tinged vaginal discharge
- leg and flank pain
-
Bethesda System
- Reporting System for PAP Smears
- Cells placed in categories based on severity of problem
-
Most common type of Ovarian cancer
Adenocarcinoma
-
Most common sign of fallopian tube cancer and common Tx
- postmenopausal bleeding
- increased abdominal pain
- water vaginal discharge
- leukorrhea
total abdominal hysterectomy and bilateral salpingo-oophorectomy
-
When should PAP smears be started/repeated?
Upon becoming sexually active or age 21 and every 2 years after
-
Fibrocystic breast
- benign
- range of changes involving lobules, ducts, and stromal tissues
- thought to be caused by estrogen-progesterone imbalance
-
Fibrocystic pharmacology and other interventions
- Hormone manipulation
- Vitamins C, B, and E
- Diuretics
- Reduce fat, caffeine
- Mild analgesics
- Limit salt
- Well padded supportive bra
- Heat and ice for pain
-
Ductal ectasia
- Dilation and thickening of collecting ducts
- Mass with irregular borders
- Greenish brown nipple discharge
-
Intraductal Papilloma
- Epithelial lining of duct forms an outgrowth of tissue
- Bloody or serous nipple discharge
-
Post catheter care
- burning on urination
- frequency
- dribbling
- leagage
- all normal
Keep accurate I's and O's
-
Continuous bladder irrigation
- three way urinary catheter with 30-45 mL retention balloon
- uncomfortable urge to void continuously is normal
- antispasmodics help
- bright blood in irrigation is normal following surgery
-
Initiation
Promotion
Progression
Metastasis
- Initiation-DNA gene change-turned on by oncogenes
- Promotion-environmental factors
- Progression-continued growth and change with time
- Metastasis-travel to another part of the body
-
What happens to risk for cancer as age increases?
It goes up
-
Naming tumors
Benign ending
Cancerous ending
Benign---oma
- Cancerous---carcinoma
- ---sarcoma
-
CAUTION
Warning Signs of Cancer
- Change in bladder/bowel habits
- A sore that does not heal normally
- Unusual bleeding or discharge from any orfice
- Thickening or presence of lump of the breast, testicle, or any part of the body
- Indigestion or difficulty swallowing for prolonged period
- Obvious change in a wart or mole, such as color, size, texture
- Nagging cough or hoarseness that is prolonged
-
Cachexia
- wasting sydrome r/t cancer
- loss of muscle mass
- anorexia
- persistent erosion of host body cell mass in response to malignant growth
-
Oncologic Emergency-Sepsis and DIC Tx
- Prevention best
- IV antibiotic therapy
- Anitcoagulants and cryoprecipitated clotting factors in some cases
-
Assess these to detect Sepsis/DIC
- Watch vitals
- skin bruising
- pain-especially in joints
- peripheral pulses
-
Checking gag reflex tests cranial nerve
X
-
Sticking out tongue tests cranial nerve
XII
-
Shrugging shoulders tests cranial nerve
XI
-
Testing pupillary reflexes tests cranial nerves
III, IV, and VI
-
Smiling, raising eybrow, frown, closing eyelids against resistance test cranial nerve
VII
-
Testing the corneal reflex tests cranial nerve
V
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