Review

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kornberg
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217022
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Review
Updated:
2013-05-02 05:21:11
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Final
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Review for final exam
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  1. Part of eyes for color recognition
    cones
  2. Improve hearing with changing elevation
    swallow to equalize pressure
  3. Meds used for open angle glaucoma
    Timolol and Xalatan
  4. Cause of burning, itching, and pain in eyes
    conjuctivitis
  5. Symptom of retinal detachment
    flashing lights
  6. Decrease in hearing r/t medication
    ototoxicity
  7. Removal of insect from ear
    Instill mineral oil, NO WATER
  8. Priority assessment post mastoidectomy
    Infection/temperature
  9. Patient teaching about cleaning ear
    External ear only
  10. Site of excessive scar tissue-scar that gets large
    keloid
  11. Multiple lesions on a child with no other symptoms
    possibly insect bites
  12. Linear lesions are associated with
    • poison ivy
    • dermatitis
    • hookworm
  13. Vitamin to be given with large burns
    Vitamin D
  14. Priority in history with skin assessment
    Environmental changes like laundry detergent
  15. Yellow tone in skin caused by
    Keratanoids
  16. Innermost layer of skin
    stratum germinativum
  17. Sweat gland
    ecrrine gland
  18. crescent shape in nails
    lunula
  19. characteristics of elderly skin
    • loss of subcutaneous fat
    • thin
    • lack of elasticity
  20. first line med for pain with burns
    morphine
  21. diet for burn patients
    • increased calorie
    • vit A
    • vit C
  22. Wet to dry dressing is what type of debridement
    mechanical debridement
  23. Showing burn quickly is not typically a sign of
    abuse
  24. patient with major burns in the ER should  get
    Foley, NG tube, large bore IV, lactated ringers
  25. Heterograft
    from another species
  26. skin conditioning
    lotion
  27. Rule of Nines
  28. Highest priority with burns
    Airway
  29. Emergent phase in tx of burns
    24-72 hours
  30. Parkland Formula
    2-4 mL LR X wt (kg) X %of burn
  31. smoke inhalation symptoms
    cough, hoarseness, increased respirations
  32. Checking fluid status in burn patients
    Urine output should be at least 30 mL/hr
  33. Priority teaching with fatty liver Dx
    no alcohol
  34. Impairment of the GI System affects
    • food absorption
    • digestion
    • metabolism
  35. Assessing a patient with dysphagia
    Assess for  ability to swallow, watch for aspiration
  36. Biliary atresia requires
    liver transplant
  37. order of assessing abdomen
    inspect, auscultate, percuss, palpate
  38. Grapefruit juice
    • block P-glycoprotein
    • inactivates Cytochrome P450 for 24 hours
    • changes absorption
  39. Food intake interfering with coumadin
    high vit K foods
  40. Lifestyle contributing to risk for gum disease
    smoking
  41. Lifestyle contributing to throat cancer risk
    alcohol
  42. Drug given for increased ammonia r/t liver dysfunction
    Lactulose
  43. Portal HTN causes
    • esophageal varices
    • spleen emergencies
    • hemorroids
    • caput meducia
  44. Food high in iron
    organ meats, muscle, whole grains, sweet potato, dark meats, thigh of chicken, beans, shrimp, tuna, oatmeal
  45. Food with B12
    meats and dairy
  46. Normal folic acid range
    1.8-9 ?

    2.7-17
  47. Normal B12 range
    200-900
  48. Zollinger Ellison syndrome patient will have
    peptic ulcer
  49. Priority intervention post upper GI series
    Check gag reflex
  50. Mylanta given for GERD
    • Takes care of heartburn
    • Will not affect diverticulitis or IBD
  51. Interventions r/t the following symptoms w/Hx of peptic ulcer disease-severe pain, board like abdomen
    • Perforated ulcer
    • IV access
    • NG Tube
  52. Intervention before upper GI series
    NPO status
  53. Major symptom of Crohn's
    Diarrhea
  54. Normal response post surgery
    Elevated temp, not fever
  55. Symptom of severe liver disease
    agraphia
  56. Action of Tagamet
    Block acid/H2 Inhibitor
  57. Intervention for post liver biopsy bleeding
    turn patient on side and hold pressure
  58. Microcytic hypochromic anemia diet recommendation
    include eggs
  59. Foods high in B12
    green leafy vegetables
  60. Pernicious anemia
    lacking intrinsic factor
  61. Aplastic anemia
    decreased immunity, limited to no contact with others depending on severity
  62. Symptoms of low B12
    fatigue, tingling, SOB, sore tongue, weakness
  63. Teaching for iron intake for vegetarians
    Cook using iron cookware
  64. B12 injections needed when
    B12 deficiency is a result of lack of intrinsic factor
  65. Post surgical H&H
    will be somewhat lower than normal
  66. Late symptom of polycythemia vera
    Pruritis
  67. A plastic anemia patients will have problems with (in addition to immunity deficiency)
    bleeding
  68. Sharing HIPPA protected information regarding HIV status
    Slander
  69. Blood specific filter
    Amyeron mesh filter
  70. Lupus
    Auto-immune disease involving connective tissue
  71. Highest priority in anaphylactic shock
    Airway
  72. Intervention for a sickle cell anemia patient with O2 sat=90%
    Oxygen
  73. Inflammatory response
    swelling, heat, redness, pain
  74. Alzheimer's Early Stage Drug
    Cholinesterase Inhibitor-now given in combination with Namenda

    • Aricept
    • Reminyl
    • Exelon-patch
    • Cognex
  75. Alzheimer's late stage drug
    Namenda-now given in combination with Cholinesterase inhibitors
  76. ALS Prognosis
    2-6 Years
  77. ALS Death usually r/t
    • infection
    • respiratory failure
  78. Rilutek
    • Only ALS specific FDA approved drug
    • BID on empty stomach
    • liver toxicity risk
  79. Patient planning and ALS
    Living will very important, patient will become unable to express desires
  80. Antispasmodics given for ALS
    • Baclofen
    • Lirosol
    • Valium
  81. Bell's Palsy pharmacological tx
    • Prednisone 60-80mg/day
    • Acyclovir-antiviral
  82. Interventions with Bell's Palsy
    • Cornea protection
    • Meal hints
    • Warm moist heat
    • Facial exercises
    • Surgery
  83. Symptoms of Tension headaches
    • Steady, constant pressure
    • Bandlike
    • Begins in forehead, temple, back of neck
  84. Tension headache pharmacology
    • NSAIDS
    • Caffeine
    • Muscle relaxers
  85. Tension headache interventions and treatments
    • Decrease stress
    • Yoga
    • Massage
    • Meditation
    • Heat
    • Cold
    • Acupuncture
  86. Migraine symptoms
    • Often unilateral
    • SEVERE
    • Nausea
    • sensitivity to light
    • Three stages
  87. Migraine triggers
    • menstrual cycle      fatigue
    • lights                   MAOI's
    • stress                  
    • depression
    • fatigue
    • certain foods-aged cheeses, red wine, nitrates, sodium, milk
  88. 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
  89. 2nd Stage of Migraine
    • Headache severe
    • "Throbbing"
    • Unilateral 60%
    • Nausea/Vomiting
  90. 3rd Stage Migraine
    • Headache changes to dull
    • Nausea and Vomiting
  91. Postprodrome Migraine
    • Fatigue
    • Irritability
    • Muscle pain
  92. 3 R's of Migraines
    • Recognize---migraine symptoms
    • Respond---and see health care provider
    • Relieve---pain and symptoms
  93. What population does not get triptans?
    • patients with Hx of CAD
    • No Imitrex, Zomig, Amerge, Maxalt, Relpax
  94. Triptans for Migraines
    • Imitrex
    • Zomig
    • Amerge
    • Maxalt
    • Relpax
  95. Preventative for Migraines
    Beta Blockers

    • Atenolol
    • Metoprolol
    • Other ---lol drugs
  96. Antiepileptics for Migraines
    • Topamax
    • Depakote
  97. 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
  98. Drugs that combined with Triptans cause serotonin syndrome
    Tramadol and SSR's
  99. Cluster headache symptoms
    • Vascular
    • unilateral
    • 1-8 clusters/day
    • eyes/temple/cheek
    • Penetrating, steady
    • Often patient will be pacing or rocking
  100. Pharmacology for cluster headaches
    • Imitrex
    • 100% Oxygen
    • Intranasal lidocaine
    • Steroids
    • Ergotamines
    • Li
    • Ca channel blockers
    • Anticonvulsants
  101. Non-pharmacological tx of cluster headaches
    • Avoid light exposure
    • Wear sunglasses
  102. Sinus Headache symptoms
    Pain usually behind the forehead and/or cheekbones
  103. Ischemic vs. Embolic stroke
    Ischemic-gradual onset, r/t artherosclerosis

    Emoblic-sudden onset, r/t embolus traveling from another part of the body
  104. Warning signs of impending ischemic stroke
    • TIA-a few seconds to 24hours
    • RIND-reversible ischemic neurologic deficit >24 hours, <one week
  105. Causes of hemmorhagic stroke
    • bleeding into brain tissue
    • aneurysm
    • trauma
    • AVM
    • HTN
    • Amphetamine abuse
    • Cocaine abuse
  106. Common source of Embolus causing stroke and medication given to prevent it
    embolus from the heart r/t A-fib, given coumadin to prevent
  107. Symptoms of Left Sided Stroke
    • Right paralysis
    • Right Visual Deficit
    • Aphasia
    • Altered intellect
    • Slow, cautious
  108. Symptoms of Right Sided Stroke
    • Left paralysis
    • Left Visual Deficit
    • Increased distractability
    • Impulsive behavior
    • Lack of awareness of deficit
  109. Emergent Care for Stroke
    • CT Scan within 25 minutes
    • 2 large IV sites
    • Evaluate for t-PA
  110. t-PA administration
    0.9 mg/kg up to 90 mg max

    • Push 10% over 1-2 min
    • Give remainder over an hour
  111. 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
  112. 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
  113. Eye opening-Glasgow Coma Scale
    • Spontaneous 4
    • To loud voice 3
    • To pain 2
    • None 1
  114. Verbal Response Glasgow Coma Scale
    • Oriented 5
    • Confused 4
    • Inappropriate language 3
    • Incomprehensible 2
    • None 1
  115. Best Motor Response-Glasgow Coma Scale
    • Obeys commands-6
    • Localizes-5
    • Withdraws-4
    • Abnormal flexion-3-decorticate
    • Abnormal extension-2-decerebate
    • None-1
  116. Generalized Seizure
    Involves whole brain

    • Tonic clonic/Grand Mal
    • Clonic
    • Absence
    • Myclonic
    • Atonic
  117. Focal Seizures
    One part of brain involved

    • Simple partial
    • Complex partial
    • Partial evolving to generalized
  118. Status Elepticus-description and pharmocological Tx
    Seizure > 5 min or Repeated seizures over 30 min

    • Rectal Valium-Diastat
    • IV Ativan
    • Then Dilantin or Cerebyx
  119. Priority intervention with status elepticus
    airway, have suction available
  120. 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
  121. 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
  122. 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
  123. Three types of Hematomas and venous vs. arterial

    Which is worst?
    Subdural-venous

    Intracerebral-venous

    Epidural-arterial-most dangerous
  124. Tx for Epidural Hematoma
    Drill Burr holes and drain
  125. Epidural Hematoma
    Cause
    What happens at occurence
    • Usually caused by trauma
    • Quick pass out, then short period of lucidity then pass out again
  126. Normal ICP
    10-15
  127. Normal CPP
    70-100
  128. MAP Calculation
    (Systolic + 2(Diastolic))/3
  129. CPP Calculation
    MAP-ICP
  130. What happens to vitals with increased ICP
    • Cushing's response
    • Widened pulse pressure
    • Bradypnea
    • Bradycardia
  131. Lobes of the brain
    • Cerebrum
    • Parietal
    • Temporal
    • Occipital
  132. Function of the Cerebrum
    • Judgement
    • Personality
    • Motor control of speech-Broca's area
  133. Broca's area
    Area of the Cerebrum controlling the motor function of speech
  134. Parietal Lobe Function
    • Sensory
    • Sing/play an instrument
    • Depth perception
  135. Temporal Lobe Function
    • Auditory and Smell
    • Short Term Memory
    • Processing language-Wernicke's area
  136. Wernicke's area
    Part of the Temporal lobe responsible for processinglanguage
  137. Occipital Lobe Function
    Sight
  138. Solumedrol Dosage for SCI
    • Loading Dose- 30mg/kg over 15 min
    • Then 5.4 mg/kg/hr for 23 hours
  139. Drugs given for MS and their side effects
    Avonex and Interferon both cause flu-like symptoms
  140. Mannitol
    Loop diuretic given to decrease ICP--also aids in chemo drugs crossing the blood brain barrier
  141. 3 Layers of Meninges
    • Dura mater-tough gray
    • Arachnoid-meshy delicate
    • Pia mater
  142. Part of the brain first affected by alcohol/responsible for coordination of movement
    Cerebellum
  143. Amount of CSF produced each day
    Amount reabsorbed
    • 500 mL produced
    • All but 150mL reabsorbed
  144. Pupils and Drugs
    Uppers Dilate

    Downers Constrict
  145. Deep Tendon Reflex Scale and What is normal
    0-4+

    Normal is 2+
  146. Common site for aneurysms
    Circle of Willis
  147. Prenumbra
    • Salvageable ischemic tissue
    • If blood flow is restored this tissue can be restored
    • Surround the infarction
  148. 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
  149. Common first sign of increased ICP in adults
    change in level of consciousness---even if very minor
  150. C1-C4 Injury
    Intercostal and diaphragm paralyzed
  151. Patients with C1, C2 and C3 injury are always dependent on ____________.  C4 are sometimes
    a ventilator
  152. Patients with a C6 SCI have___________.  They can learn to _________________.
    • some recovery of tricep muscles
    • drive
  153. Patients with C7&8 injuries can become_________________.
    independent
  154. Landmark for T5
    Nipple line
  155. Landmark of T10
    umbilicus
  156. Landmark for L3
    lower limbs and saddle area
  157. Symptoms of SCI below S3
    • no paralysis
    • possible loss of sensation of the saddle area
  158. Autonomic Dysreflexia
    • Excessive uncontrolled sympathetic activity
    • Caused by an noxious stimuli after SCI
    • Can occur years after injury
    • Raise HOB
    • Give Apresoline
  159. Baclofen
    Antispasmodic given in SCI and MS
  160. Do not administer warfarin with ________________ because ________________.
    • phenytoin
    • they are both highly protein bound
  161. What intervention is necessary if a patient is on Cerebyx?
    Heart monitor
  162. Common first line medication for myesthenia gravis
    Mestinon
  163. Surgical treatment for myesthenia gravis
    Thymectomy
  164. 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
  165. Spinal Cord Compression-Oncologic emergency

    Sx
    Tx
    • Parsthesia
    • Weakness
    • Pain

    • Palliative
    • Steroids
    • Radiation
    • Surgery
    • Braces
  166. Hypercalcemia

    Tx
    • Oral hydration
    • Normal Saline IV
    • Drug therapy
    • Dialysis
  167. Hypercalcemia

    Sx
    • Fatigue
    • Loss of appetite
    • Nausea/Vomiting
    • Constipation
    • Polyuria
    • Severe muscle weakness
    • Loss of deep tendon reflexes
    • Paralytic ileus
    • Dehydration
    • ECG changes
  168. 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
  169. Stoke's sign
    • Tightness of the shirt collar
    • Indicates superior vena cava syndrome
  170. Tumor Lysis Syndrome
    • follows destruction of tumor cells
    • cell contents dumped faster than the body can get rid of them
    • hyperkalemia and hyperuracemia
  171. Epgogen/procrit
    • Erythropoeisis stimulating drugs
    • goal is to return to acceptable levels of H&H to be able to continue treatment
  172. Signs of cervical cancer
    • often asymptomatic
    • painless vaginal bleeding
    • watery blood tinged vaginal discharge
    • leg and flank pain
  173. Bethesda System
    • Reporting System for PAP Smears
    • Cells placed in categories based on severity of problem
  174. Most common type of Ovarian cancer
    Adenocarcinoma
  175. 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
  176. When should PAP smears be started/repeated?
    Upon becoming sexually active or age 21 and every 2 years after
  177. Fibrocystic breast
    • benign
    • range of changes involving lobules, ducts, and stromal tissues
    • thought to be caused by estrogen-progesterone imbalance
  178. 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
  179. Ductal ectasia
    • Dilation and thickening of collecting ducts
    • Mass with irregular borders
    • Greenish brown nipple discharge
  180. Intraductal Papilloma
    • Epithelial lining of duct forms an outgrowth of tissue
    • Bloody or serous nipple discharge
  181. Post catheter care
    • burning on urination
    • frequency
    • dribbling
    • leagage
    • all normal

    Keep accurate I's and O's
  182. 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
  183. 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
  184. What happens to risk for cancer as age increases?
    It goes up
  185. Naming tumors
    Benign ending
    Cancerous ending
    Benign---oma

    • Cancerous---carcinoma
    •               ---sarcoma
  186. 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
  187. Cachexia
    • wasting sydrome r/t cancer
    • loss of muscle mass
    • anorexia
    • persistent erosion of host body cell mass in response to malignant growth
  188. Oncologic Emergency-Sepsis and DIC Tx
    • Prevention best
    • IV antibiotic therapy
    • Anitcoagulants and cryoprecipitated clotting factors in some cases
  189. Assess these to detect Sepsis/DIC
    • Watch vitals
    • skin bruising
    • pain-especially in joints
    • peripheral pulses
  190. Checking gag reflex tests cranial nerve
    X
  191. Sticking out tongue tests cranial nerve
    XII
  192. Shrugging shoulders tests cranial nerve
    XI
  193. Testing pupillary reflexes tests cranial nerves
    III, IV, and VI
  194. Smiling, raising eybrow, frown, closing eyelids against resistance test cranial nerve
    VII
  195. Testing the corneal reflex tests cranial nerve
    V

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