Emergency Medical Scenarios and Treatments, Exams of Nursing

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What do you do for pin point pupils and low respirations? - ✔✔Manage airway first, then give Narcan. If a patient who has pin point pupils and low respirations is vomiting, what do you do first? - ✔✔Suction their airway COPD and Pulmonary Emphysema patients usually have a history of what? - ✔✔AFib What does AFib cause? - ✔✔Blood clots, which cause an increase risk for pulmonary embolisms What is the Renin-Angiotensin-Aldosterone system? - ✔✔Body's response to low BP. Renin, which is released primarily by the kidneys, stimulates the formation of angiotensin in blood and tissues, which in turn stimulates the release of aldosterone from the adrenal cortex. This causes the body to retain water and increase BP. What are the signs and symptoms of a pulmonary embolism? - ✔✔Sudden onset, SOB, chest pain, increased HR & RR, cool pale clammy skin, pink tinged sputum What are the risk factors for a pulmonary embolism? - ✔✔Bed ridden pt., trauma or surgical pt., prolonged sitting, recent c-section or traumatic delivery, <40 y/o taking oral contraceptives, smokers What causes respiratory alkalosis? - ✔✔Increased O Decreased CO What causes respiratory acidosis? - ✔✔Decreased O Increased CO

What causes metabolic acidosis? - ✔✔Kidneys aren't removing enough acid from the body, so there is a build up. RR increases to blow off excess. What are signs and symptoms of pericarditis? - ✔✔sharp pain, fever, and ST elevation in ALL leads In pericarditis, what leads have ST elevation? - ✔✔All of them What is the physiological event that comes from anaphylaxis? - ✔✔Vasodilation, swelling, itching How does ARDS effect the alveoli and capillaries? - ✔✔Fluids build up in the alveoli, causing less oxygen exchange at the capillaries What patients do CPAP work best on? - ✔✔COPD and pneumonia Pt. must be AO, maintain own airway, breathing on their own What are other names for normal saline? - ✔✔Isotonic crystalloid solution What drug do you give to an organophosphate poisoning? - ✔✔Atropine What do you give a patient who is actively seizing? - ✔✔Versed or Valium What is another name for Versed? - ✔✔Midazolam If a patient with low blood sugar is actively seizing, which do you fix first? - ✔✔the seizing, then treat the cause If a patient is postictal, do you treat their seizures or what caused the seizure? - ✔✔treat what caused the seizure, so it doesn't happen again

What are signs and symptoms of organophosphate poisoning? - ✔✔SLUDGE What type of breathing do you get with DKA? - ✔✔Kussmaul's Do you get Kussmaul's with Hyperglycemic Hyperosmotic Nonketotic Syndrome (HHNS)? - ✔✔No Anytime you see the word anxiety what type of respiratory problem do they have? - ✔✔Respiratory Alkalosis What is the problem with your lung compliance the older you get? - ✔✔It decreases and becomes more brittle What is Proximal Nocturnal Dyspnea? - ✔✔Can't lay down at night without getting shortness of breath What patients generally have PND? - ✔✔CHF What is another name for CHF? - ✔✔Left sided heart failure Fever and history of upper respiratory infection, that also has increased water intake, orthostatic hypotension, and increased urination - ✔✔THINK ABOUT THAT What is wrong if someone has increased urination, increased thirst, low BP, with warm, dry skin? - ✔✔DKA Can an infection increase your temperature? - ✔✔Yes Can an infection increase your blood sugar? - ✔✔Yes If you are a diabetic with an infection, what are you more likely to go into? - ✔✔DKA

If I have a fever, HR through the roof, tremors, low BP, and a history of Grave's Disease, how do i manage this? - ✔✔Fluids, continuous 12 lead monitoring, Beta Blockers What happens to Bicarb in metabolic acidosis? - ✔✔Increases What happens to pH in metabolic acidosis? - ✔✔Decreases What happens to CO2 in metabolic acidosis? - ✔✔Increases What is the second process in the pathway of AMLS assessment? - ✔✔Look for immediate life threats What is the first process in the pathway of AMLS assessment? - ✔✔Safety and initial observation What does observing a patient's body positioning indicate? - ✔✔If they are sick or not sick What is one of the most crucial things to do when you suspect a patient has a stroke? - ✔✔look at time, how long they've had symptoms What type of bleeding occurs in a subdural hemorrhage? - ✔✔slow What type of bleeding occurs in an epidural hemorrhage? - ✔✔fast What type of hemorrhage has a thunder clap? - ✔✔subarachnoid What type of hemorrhage has a person experienced if its fast onset, followed by a period of unconsciousness, waking up lucid? - ✔✔epidural

What type of hemorrhage has a person experienced that is slow onset, usually several days to a week? - ✔✔subdural If I have urticaria and can't breath, what is going on? - ✔✔anaphylaxis How do you treat anaphylaxis? - ✔✔Remove allergen, ABCs, Benedryl, Epi When does someone need Epi, based on their vital signs? - ✔✔Hypotension, cardiac arrest If someone has two cardiac stints and a family history, what information is most concerning? - ✔✔the two cardiac stints Chest pain, shortness of breath, bed ridden after recent hip surgery, indicates what? - ✔✔Pulmonary Embolosim Red rash and bumps after a knee replacement, indicates what? - ✔✔MRSA What is the number one infection that people get in the hospital after surgeries? - ✔✔MRSA What does a patient (or foreign exchange student) have with a flat rash, ill, fever, nuchal rigidity? - ✔✔Meningitis If a patient has been ill for three days with abdominal cramping and vomiting, not due to alcohol, an epigastric problem, or lower right quadrant, what is likely the problem? - ✔✔Gastroenteritis, or the stomach flu Involuntary leg movement when you flex your neck, or bend your knees your neck comes forward, is usually a sign of what? - ✔✔Meningitis (Brudzinski's sign) Extreme thirst, diabetes, low BP, with 14 respirations a minute, indicates what? - ✔✔Hyperglycemic Hyperosmotic Nonketotic Syndrome (HHNS)

A firefighter that was doing overhaul presents with a bitter almond odor on the breath, what do you suspect? - ✔✔Cyanide poisoning If someone has taken a lot of over the counter analgesic and now has abdominal pain, N/V, what over the counter pain med are they likely to have overdosed on? - ✔✔acetaminophen Dark tarry stools are indicative of a bleed where in relation to the stomach? - ✔✔Before Bright red stools are indicative of a bleed where in relation to the stomach? - ✔✔After A bent over patient who has RLQ pain, lower back pain, right leg hurts when it is extended, has what? - ✔✔Appendicitis What are signs/symptoms of appendicitis? - ✔✔Pain localized to right lower quadrant or right lower back. Pain classically begins in the periumbilical region than becomes more localized to RLQ and worse. Stretching can increase pain. Discoloration around the umbilicus is called what? - ✔✔Cullen's sign What is Cullen's sign? - ✔✔Periumbilical ecchymosis What is usually caused from tricyclic antidepressants? - ✔✔Cardiac Dysrhythmias (wide QRS) If I take all kinds of different meds and may have mixed them up, and my pulse is slow, respirations are slow and shallow, what type of medication did I overdose on? - ✔✔a BP medication What is the most common type of BP medication that would slow HR and RR, is what? - ✔✔Beta blocker What type of shock occurs in an untreated cardiac tamponade? - ✔✔Obstructive

What is Beck's Triad? - ✔✔Low BP JVD Muffled heart sounds What type of breath sounds occur in a cardiac tamponade? - ✔✔Clear Will a hemothorax have clear breath sounds? - ✔✔No On an elderly female with upper abdominal discomfort and indigestion, what should you check? - ✔✔ 12 Lead Females can have what type of MI's? - ✔✔Atypical What type of history do people with pancreatitis usually have? - ✔✔Alcoholism and Gallstones Where does pain radiate to with pancreatitis? - ✔✔Right upper quadrant Why does pain with pancreatitis radiate to the right upper quadrant? - ✔✔1. Phrenic nerve

2. Acid build up backs up into the Gall Bladder and causes Gallstones What is another name for Gallstones? - ✔✔Cholelithiasis Lower abdominal pain and sharp stabbing during palpation, can indicate what? - ✔✔Diverticulitis or ectopic pregnancy in females What type of shock might someone end up in if they've had a spinal cord surgery? - ✔✔Neurogenic or distributive

Quadrapolegic, high fever, dark foley, probably has what? - ✔✔UTI Why is it hard to illnesses and infections in old people? - ✔✔because they always have underlying issues What do night sweats and chest discomfort indicate? - ✔✔Tuberculosis There is a near drowning at a lake, the patient was treading water for 25 minutes and has uncontrollable shivering, nausea, and weakness, what is wrong? - ✔✔hypothermia What is severe hypothermia? - ✔✔Low temp with unconsciousness What is mild hypothermia? - ✔✔Low temp with normal LOC and shivering If I have fowl smelling diarrhea, abdominal cramping, post operation infection, and have been taking antibiotics for a long period of time, what could I have? - ✔✔Clostridium Difficile (C Dif) What can women get from antibiotics? - ✔✔Yeast infections Bronchitis has what signs and symptoms? - ✔✔Productive cough with a fever Asthma has what signs and symptoms? - ✔✔Non productive cough and no fever How do you treat bronchitis? - ✔✔Albuterol, Albuterol/Atrovent, SQ Epi in patient with no cardiac problems How do you treat asthma? - ✔✔Albuterol and Atrovent after first dose What population does bronchiolitis occur in? - ✔✔Young children (viral)

What population does bronchitis occur in? - ✔✔Both adults and kids What is Septic Shock? - ✔✔Elevated temp, increased HR, decreased BP How do you treat septic shock? - ✔✔Fluids, consider Dopamine What are signs/symptoms of Obstructive? - ✔✔Decreased BP, difficulty breathing, tachycardia,tachypnea,JVD,decreased breath sounds,muffled heart tones. What are signs/symptoms of Hypovolemic shock? - ✔✔Loss of fluid volume, Increased HR & RR, decreased BP, cool, pale, clammy What are signs/symptoms of Cardiogenic shock? - ✔✔Increased HR & RR, decreased BP, cool, pale, clammy, arrhythmias How do you immobilize a CHF patient with osteoporosis that caused their neck to break in a trauma? - ✔✔With a KED sitting upright Treatment for head injuries - ✔✔Don't hyperventilate above 24 Don't give Atropine Don't give sugar If several people are sick at the same time, what sort of problem is there? - ✔✔An environmental or food illness If several people get sick at different times, what sort of problem is there? - ✔✔Flu like problem due to an incubation period Anytime someone is acting weird, besides checking their sugar, what do you want to check? - ✔✔Pupils

What is the TKO rate of an IV? - ✔✔25 CC's/hr Pain, pinpoint pupils, low BP, low HR, indicates an overdose on what? - ✔✔Opiates If someone overdosed on opiates, do you tube or give Narcan to them first? - ✔✔Narcan What do you flush Narcan with? - ✔✔Normal saline Isotonic crystalloid solution Acting tired, going to the bathroom a lot, and eating a large meal, indicates what? - ✔✔High blood sugar How do we treat people with high blood sugar? - ✔✔Fluids After jogging, a female gets a sudden onset of abdominal pain, why? - ✔✔Rupture of ectopic pregnancy What do you ask a female who is of child baring age? - ✔✔Is there a chance you are pregnant? Anyone that tries to kill themselves usually takes what prior? - ✔✔Drugs or alcohol Anytime you have an attempted suicide, what is the most important thing to watch for? - ✔✔A secondary attempt What do you check on a postictal patient? - ✔✔Gag reflex first, then cause to prevent more seizures How do you check for a head bleed? - ✔✔Cincinnati Stroke Scale The Cincinnati Stroke Scale evaluates what? - ✔✔Fine motor and speech

If a Cincinnati Stroke test turns out negative, what type of hospital can a patient go to? - ✔✔Closest facility What is Mild Anaphylaxis? - ✔✔Itching without airway involvement What is Moderate Anaphylaxis? - ✔✔Itching with airway involvement, BP> What is Severe Anaphylaxis? - ✔✔Itching with airway involvement, BP< What are signs and symptoms of a thoracic aneurysm? - ✔✔Sudden onset, pain, ripping or tearing sensation, radiating to the neck and/or back, pulses in extremities are different What are signs and symptoms of an abdominal aneurysm? - ✔✔Lower abdominal pain, lower back or flank pain, palpable abdominal pulse, unequal or absent distal pulses How do we treat aneurysms? - ✔✔maintain BP, pt. needs surgery What size of an IV do you use with an aneurysm? - ✔✔?? Does an aneurism need an IV TKO or wide open? - ✔✔TKO, increasing BP could cause rupture How do we treat cocaine overdoses? - ✔✔Swab nose to remove residual if cocaine was snorted. Standard treatment. Be ready for erratic or violent behavior. Higher risk for cardiac ishemia and hypothermia. How do we treat heat stroke? - ✔✔Fluids, get them out of hot environment How do we treat heat exhaustion? - ✔✔Fluids, get them out of hot environment How do we treat hypothermia? - ✔✔Passive rewarming and gently handle them

How do you know sickle cell crisis is getting worse? - ✔✔More SOB and more pain What is the biggest thing you can do to put a chemo or leukemia patient at risk? - ✔✔Give them an IV because they can't fight infection from even a small amount of bacteria on the skin What does tetanus cause? - ✔✔lock jaw What do you do for anyone who is unconscious? - ✔✔Protect their airway What do you need to be prepared for in someone with a severe headache and altered LOC? - ✔✔Seize What can a raccoon give you? - ✔✔Rabies How do you treat a patient with a rattle snake bite? - ✔✔lay them flat and give them large amounts of fluids What is a pheochromocytoma? - ✔✔a tumor on the adrenal gland What can a tumor on the adrenal gland cause? - ✔✔increase in HR and BP Anyone who has been vomiting because of alcohol is at risk for what? - ✔✔Aspiration pneumonia and pancreatitis What are other options for a patient who as low blood sugar but you can't get an IV? - ✔✔Glucagon IM What are signs and symptoms of diabetic ketoacidosis? - ✔✔high blood sugar fruity odor on breath Kussmaul breathing

If someone is coughing up blood, what should you put on yourself? - ✔✔HEPA or N95 mask What goes on a patient that is coughing up blood? - ✔✔NRB If someone on blood thinners and chronic hypertension now has a headache, what type of stroke could they be having? - ✔✔Hemorrhagic stroke Diabetes and AFib put people with chronic hypertension at more risk for what type of stroke? - ✔✔Ischemic stroke What is Cushing Triad? - ✔✔High BP Low HR Irregular RR What are signs and symptoms of heat stroke? - ✔✔-early: dizziness, headache followed by psychotic behavior, seizures, and coma

• tachycardia with bounding pulse
• Temperature is extremely elevated (105 or greater) What are signs and symptoms of heat exhaustion? - ✔✔-light headedness, headache
• normal or decreased BP
• tachycardia
• Temperature normal or slightly elevated
• N/V What are signs and symptoms of heat cramps? - ✔✔BP & HR normal, cramping If you are rough with an unconscious hypothermic patient, what rhythm can you put them in? - ✔✔VFib

If you have a patient that is a hemophiliac that has fallen, what do you need to be ready for? - ✔✔bleeding Headache and dizziness in more than one person in a house indicates what? - ✔✔Carbon Monoxide poisoning