MDC4 Final Exam - Questions with Complete Solutions, Exams of Medicine

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What does triaging do? - ✔✔️*️acts as gatekeeper* helps prioritize patient care based on illness and severity level According to triage, what patients would be seen firtst - ✔✔️h️ighest acuity patients will receive quickest intervention (Most ill/severe will get seen first) What is a good model for triaging patients? - ✔✔️A️BCs Is hospital triaging the same as mass casualty triaging? - ✔✔️N️O Which triage situation uses tags? - ✔✔️m️ass casualties what are the categories of triage? - ✔✔️-️ emergent - urgent - nonurgent - primary survey what classifies a patient as emergent according to triage - ✔✔️-️ life threatening injuries - needs immediate treatment what patient conditions warrant an emergent status of triage - ✔✔️-️ respiratory distress - chest pain with diaphoresis - stroke - active hemorrhage - unstable vitals what classifies a patient as urgent according to triage - ✔✔️p️atient should be treated quickly but there is not and immediate threat to life what patient conditions warrant an urgent status for triage - ✔✔️-️ severe abdominal pain - renal colic - displaced multiple fractures - new onset of respiratory infection (pneumonia) what classifies a patient as nonurgent according to triage - ✔✔️p️atient can wait several hours without a risk to life what patient conditions warrant a nonurgent status for triage - ✔✔️-️ skin rash if warranted during the secondary survey, what would a nurse likely do? - ✔✔️-️ insert NG tube - insert catheter - prep for diagnostics what does drowning lead to? - ✔✔️l️eads to loss of surfactant in lungs which causes alveolar collapse and pulmonary edema is dehydration common in heat exhaustion? - ✔✔️Y️ES what can major diaphoresis cause? - ✔✔️s️evere dehydration and hyponatremia if heat exhaustion goes untreated, what can it cause? - ✔✔️h️eat stroke what are the s/s of heat exhaustion - ✔✔️-️dehydration -decrease in blood volume -decrease in BP -tachycardia what is the first intervention for a person expected to have heat exhaustion? - ✔✔️s️top their physical activity and transfer to a cool place what is the quickest way to reduce someone's temperature? - ✔✔️-️ remove clothing - remove bed linen what interventions are there for cooling patients down? - ✔✔️-️ cold pack on the neck, chest, abdomen, and groin - soak in cool water when rehydrating someone with heat exhaustion, should you use water or a sports drink/oral reydration solution? - ✔✔️S️ports drink/oral hydration solution why is a sports drink better at rehydrating patients with heat exhaustion? - ✔✔️p️lain water can worsen sodium deficits nursing care for patients hospitalized with heat exhaustion - ✔✔️-️ monitor vitals - administer .9% NS in N/V is present - draw labs to check electrolytes how is heat stroke defined? - ✔✔️b️ody temperature greater than 104F T/F: heat stroke is a medical emergency - ✔✔️T️RUE T/F: if heat stroke is left untreated it becomes fatal - ✔✔️T️RUE s/s of heat stroke - ✔✔️-️ tachycardia - hallucinations - irregular pulse - decreased urin output - hot and dry skin nursing care for heat stroke - ✔✔️-️ 02 and .9% NS via IV - continuous cooling, IVF, and cooling blankets. when should continuous cooling, IVF, and cooling blankets be stopped? - ✔✔️w️hen core temperature reaches 102F what should you do if your patient is shivering while being cooled from heat stroke? - ✔✔️a️dminister benzos because they provide sedation, control convulsions, and control shivering what should you NOT administer for a person with a high body temperature - ✔✔️-️ aspirin - antipyretics at what temperature does hypothermia occur? - ✔✔️l️ess than 95F T/F: for a person with frostbite, the nurse should tightly wrap the patients wound - ✔✔️F️ALSE **compression should be avoided what are arthropods - ✔✔️-️ spiders - scorpions - bees - wasps nursing care for a patient injured by an arthropod - ✔✔️-️ remove stinger - cold compress - Epi pen and oxygen for anaphylaxis what is affected by a lightning injury? - ✔✔️h️eart and CNS who is most at risk for a lightning injury - ✔✔️y️oung adult males what nursing care is needed for a lightning injury - ✔✔️-️ immediate CPR - ECG - CT - tetanus prophylaxis what system is used during a mass casualty to sort patients into priority of care? - ✔✔️t️ag system what information do you write on the triage tags? - ✔✔️-️ color/priority - age/DOB (identifying characteristics) - treatment and meds already given - next of kin what is the color system for triage tagging - ✔✔️-️ green - yellow - red - black what does the color green mean in triage? - ✔✔️n️on-urgent/walking, talking what does yellow mean in triage - ✔✔️u️rgent but not life threatening what does the red tag mean in triage - ✔✔️e️mergent could die if not treatment but have better odds what does black mean in triage - ✔✔️d️o not attempt to treat them because their injuries are too extensive and will die regardless interventions to manage stress - ✔✔️-️ develop a buddy system w/ coworker - have well balanced meals - drink alot of water - take breaks - do not exceed more than 12hrs/day - stay in touch with friends/family - crisis debriefing - take a few minutes each shift to decompress MRC - ✔✔️M️edical Reserve Corps why is MRC a thing? - ✔✔️C️reated for volunteers in the community who want to donate their time ad expertise to prepare for and respond to emergencies on a local scale DMAT - ✔✔️D️isaster Medical Assistance Team what does DMAT do - ✔✔️t️hey are federal employees who make up a medical relief team made up of civilians who's license is valid in all states when working - agitated - incontinent - money issues late s/s of Alzheimer's disease - ✔✔️-️ bed ridden - agnosia (inability to recognize objects, people, or sounds) Medications used for Alzheimer's - ✔✔️C️holinesterase inhibitors - slow breakdown of Ach - Donepezil and Rivastigimine NMDA receptor antagonists - block excess amounts of glutamate - Memantine Nursing care for Alzheimer's - ✔✔️-️ safe environment (#1) good lighting, no clutter - stick with a routine - offer walks, exercise - reduce distractions - avoid use of restraints What is Parkinson's Disease - ✔✔️M️ovement disorder caused by the death of cells that generate dopamine in the basal ganglia and substantial nigra. Low levels of dopamine and high levels of Ach How does Parkinson's progress? - ✔✔️s️lowly, but will eventually lead to disability How is parkinson's diagnosed - ✔✔️h️istory and s/s s/s of parkinsons - ✔✔️-️ tremors - muscle rigidity - mak like facial expression - bradykinesia - shuffling gait - cogwheel rigidity in limbs - propulsive gait (head and neck forward, back is slouched) nursing care for parkinson's - ✔✔️-️ safe environment - sit up when eating, thick liquids - encourage ROM and exercise Medication for Parkinson's - ✔✔️-️ Sinemet - Levodopa (increases dopamine levels in CNS) and Carbidopa (prevents levodpa breakdown) - take at same time every day - know that increased protein can alter effectiveness - Benztropine - decreases Ach levels What are headaches? - ✔✔️v️asodilation of blood vessels in the brain What causes headaches - ✔✔️g️enetics, stress, hormones What can trigger a headache? - ✔✔️c️offee, yogurt, alcohol, MSG, marinated foods s/s of headache - ✔✔️h️ead pain for 4-72 hours, N/V, unilateral pain, may come with aura what are cluster headaches? - ✔✔️h️appen at night, stuffy nose treatment of headache - ✔✔️P️rophylactic = propranolol Mild = NSAID Severe = sumatriptan - motor score 1-6 Total score 3-15 **lower the score = more severe injury/status Eyes for Glasgow Coma Scale - ✔✔️E️SPN E - eyes open spontaneously (4) S - sound (3) P - pain (2) N - not open (1) Verbal for Glasgow coma scale - ✔✔️O️ur Country WIN O: oriented (5) C: confusion (4) W: words are inappropriate (3) I: incomprehensible sounds (2) N: nothing (1) Motor for Glasgow coma scale - ✔✔️C️an't Live Without FANs C: commands followed (6) L: localize to pain (5) W: withdrawal from pain (4) F: flexion - decorticate posturing (3) A: abnormal extension-decerebrate (2) N: nothing (1) what are seizure - ✔✔️a️bnormal and increase in firing of neurons what is epilepsy - ✔✔️c️hronic seizures what triggers seizures - ✔✔️s️tress, fatigue, coffee what are risk factors for seizures - ✔✔️i️nfection, trauma, fever, withdrawal, imbalances How do you diagnose siezures - ✔✔️E️EG (wash hair prior) Seizure Precautions - ✔✔️-️ padded bed rails - O2 and suction at bedside - IV access - lowest bed setting Types of siezures - ✔✔️a️bsence, atonic, tonic clonic, status epilepticus Absence Seizures - ✔✔️-️ day dreaming - LOC for a few seconds - s/s = pick at clothes, lip smack, blank stare Atonic Seizures - ✔✔️l️oss of muscle tone - fall Tonic Clonic seizure - ✔✔️-️ tonic = stiffening - clonic = rhythmic jerking - postictal phase = coming back to - confused/sleepy Status Epilepticus - ✔✔️-️ medical emergency! - 1 seizure that lasts > 5 mins - repeat of seizure w/in 30 min nursing care during siezure - ✔✔️-️ turn patient on left side (#1) - loosen restrictive clothing - note onset and duration - do NOT insert anything by mouth Nursing care after seizure - ✔✔️-️ take vitals - Hib for baby - MCV4 for teens Diagnosis of meningitis - ✔✔️C️SF analysis What does CSF analysis look like for viral meningitis? - ✔✔️c️lear, increased wbc and protein what does CSF analysis look like for bacterial meningitis - ✔✔️c️loudy, decreased glucose, increased wbc, and protein s/s of meningitis - ✔✔️n️uchal rigidity, n/v, photophobia, Brudzinski's sign, Kernig's sign What is Brudzinski's sign? - ✔✔️A️fter forced flexion of the neck there is a reflex flexion of the hip and knee and abduction of the leg. What is Kernig's sign? - ✔✔️A️fter flexing the hip and knee at 90 degree angles, pain and resistance are noted. Nursing care for Meningitis - ✔✔️-️ bacterial = antibiotics - viral = acyclovir - steroids (decrease inflammation, increased infection) - prophylaxis treatment for anyone in contact/exposed - implement droplet precautions for first 24 hours of treatment - Decrease ICP risk by elevating HOB, keep body midline, avoid straining activities, turn everything down What is MS? - ✔✔️A️utoimmune disease with chronic inflammation and no cure; just periods of relapse and remition what is patho of MS - ✔✔️-️ body attacking its own myelin sheath what causes MS - ✔✔️g️enetic, autoimmune, infection what are risk factors of MS - ✔✔️f️emale, white, 20-50 y/o diagnosis of MS - ✔✔️n️o 100% way - MRI - CSF analysis (increased WBC, proteins, IgG) S/S of MS - ✔✔️-️ muscle weakness - intention tremors - tinnitus - vision (diplopia, nystagmus) Nursing care for MS - ✔✔️-️ protect from injury - allow for periods of rest - help manage stress b/c this can lead to relapse/remit Meds for MS - ✔✔️-️Immunomodulators, immunosuppressants (decreased inflammation, increase infection) - muscle relaxant = baclofen what is Autonomic dysreflexia - ✔✔️F️iring of SNS with no PNS response what injury causes autonomic dysreflexia? - ✔✔️i️njury above T6 what causes autonomic dysreflexia? - ✔✔️-️ bowel, bladder, breakdown of skin s/s of autonomic dysreflexia - ✔✔️-️ severe htn - bradycardia - headache - diaphoresis - blurry vision - facial flush above injury - pale below injury Medications for spinal cord injuries - ✔✔️-️ corticosteroid = methylprednisolone - first given as IV bolus - then IV continuous drip for 24 hours - needs to be given w/in 8 hrs of injury -s/s hyperglycemia, poor wound healing, infection - education: increae Ca intake, ROM, deep breathing what is the number 1 thing to keep in mind with a spinal cord injury? - ✔✔️A️IRWAY and BREATHING Complications of Spinal cord injury - ✔✔️-️ autonomic dysreflexia - neurogenic shock (hypo, bready, edema, temp) what is a stroke? - ✔✔️a️lteration in blood flow to the brain TIA - ✔✔️t️ransient ischemic attack = mini stroke, warning sign diagnosis of stroke - ✔✔️C️T without contrast Etiology of stroke - ✔✔️-️ nonmodifiable = age, sex, history - modifiable = HTN, BC user, high cholesterol, smoker s/s of stroke - ✔✔️F️AST facial droop, arm drift, speech is slurred, time how much as passed General Left vs Right side stroke - ✔✔️L️eft = language Right = impulse & judgement Left-sided stroke s/s - ✔✔️-️ receptive aphasia (unable to verbally communicate back) - right sided hemiparesis (weakness) - agraphia (unable to right) - Aware of their deficits - anxiety and depression Right-sided stroke s/s - ✔✔️-️ poor impulse control and judgement - 1 sided neglect syndrome (unaware of deficits on left side of body, big safety concern) - short attention span - proprioception (depth) issues Broca's area - ✔✔️e️xpressive aphasia: unable to communicate/express back in speech Wernikies aphasia - ✔✔️r️eceptive aphasia: unable to receive/understand what is being said nursing care for both broca's and wernikies - ✔✔️-️ be patient - use short phrases - use gestures/point - limit distractions around Treatment of stroke - ✔✔️G️eneral - anticoagulants, stool softeners, benzo's Ischemic stroke aka clot - tPa = thrombolytics (must be w/in 3 hours, BP needs to be in range, neuro checks every 15 mins. NOT for bleeding, htn, >3hrs Hemorrhagic stroke - only treatment is surgery (BP must be in range, NOT for someone on blood thinners (coumadin), if blood is too thin, admin fresh plasma or Vit K) Nursing care for stroke - ✔✔️-️ safe environment (teach patient to scan before ambulating) - lots of eating concerns: - sit up - tuck chin - thick liquids - use dentures - hypotension how does the patient usually present with flail chest - ✔✔️-️ anxious - short of breath - in pain what are interventions for flail chest - ✔✔️-️ humidified oxygen - pain management - promotion of lung expansion through deep breathing and positioning - secretion clearance by coughing and tracheal suction can a person with flail chest recover - ✔✔️m️anagable with vigilant respiratory care when is mechanical ventilation needed for a patient with flail chest - ✔✔️-️ respiratory failure - shock - severe hypoxemia and hypercarbia nursing care for flail chest - ✔✔️-️ monitor ABGs - monitor vitals with flail chest, what causes increase the risk of respiratory failure - ✔✔️-️ lung contusion - underlying pulmonary disease how is flail chest usually stabilized - ✔✔️p️ositive pressure ventilation what interventions are needed for low BP - ✔✔️-️ fluid replacement - Trendelenburg - compression stockings - medication what causes a high pressure vent alarm - ✔✔️-️ thick mucus/secretions blocking the airway - coughing - biting on tube - fighting vent - wheezing - bronchospasms - pneumothorax - displaced tube - obstruction - water in vent circuit what causes a low pressure vent alarm - ✔✔️-️ leak in circuit - cuff leak - patient disconnected *apnea alarm* possible interventions for high pressure vent alarm - ✔✔️-️ check patient first! - check all tubing is connected and not kinked - suction patient - medication for pain, anxiety, sedation - change vent settings what causes increased or thick secretions/mucus in a patient who is intubated - ✔✔️n️ot enough humidity possible interventions for low pressure vent alarms - ✔✔️-️ check patient first! - manually bag patient - reconnect/unkink tubing nursing care of ventilated patient - ✔✔️-️ q2-4 respiratory assessment, oral care, suctioning if needed - q4 head to toe assessment and vitals what intervention is done for a healthy person who sustains an acute lung injury - ✔✔️m️echanical ventilation pathophysiology of ARDS - ✔✔️i️ncreased alveolar permeability + leaking of fluid = alveolar collapse what causes ARDS - ✔✔️-️ sepsis - burns - pancreatitis - transfusion - trauma - diffuse pulmonary infection - gastric aspiration - O2 toxicity - lung contusion s/s of ARDS - ✔✔️-️ persistent hypoxia (even with O2 therapy) - dyspnea - decreased pulmonary compliance - non cardiac pulmonary edema how to diagnose ARDS - ✔✔️-️ refractory hypoxia - chest x ray shows glossy + white out (diffuse patchy infiltrates) - normal wedge pressure - pO2/FIO2 < 200 phases of ARDS - ✔✔️-️injury (exudative) phase - alveolar collapse - refractory hypoxemia -reparative (proliferative) phase - decreased lung compliance -fibrotic phase - surfactant cells are damaged assessment of patient on vent - ✔✔️-️ vitals - O2 saturation - auscultate breath sounds - pain/anxiety - tube placement - vent settings nursing care for ARDS - ✔✔️-️ ET + Mechanical vent w/ PEEP or CPAP - light IV fluids, diuretics, antibiotics - start nutrition (TPN or tube feeds) risk factors for pulmonary embolism (PE) - ✔✔️-️ immobile, obese, advanced age, surgery - central venous catheter, embolic event history - pregnancy, oral contraceptives, estrogen therapy - heart failure, trauma, smoker assessment findings for PE - ✔✔️-️ sudden dyspnea - chest pain - feeling of impending doom - JVD - tachy - chest petechiae - ECG changes - abnormal heart sounds normal INR range - ✔✔️0️.8-1.2 normal INR range while on Warfarin (Coumadin) for PE - ✔✔️2️-3 normal PT range - ✔✔️1️1-12.5 seconds normal PT range while on Warfarin for PE - ✔✔️1️.5-2 times base, so 22- 25 - cold clammy skin - decreased CO = decreased tissue perfusion what is neurogenic shock - ✔✔️-️ Caused by spinal cord injury, usually as a result of a traumatic accident or injury - Common with T6+ - SNS disruption neurogenic shock assessment findings - ✔✔️-️ hypotensive and bradycardic - warm and dry skin - hypothermia neurogenic shock treatment - ✔✔️-️ establish circulatory blood volume - administer atropine for low heart rate - keep patient warm - prep to intubate what is DIC - ✔✔️d️isseminated intravascular coagulation what does DIC cause - ✔✔️a️bnormal coagulation involving fibrinogen - excessive clotting along with hemorrhage at the same time treatment of DIC - ✔✔️-️ blood transfusion - FFP (fresh frozen plasma) - fluid replacement lab values for lactate during hypovolemic shock - ✔✔️>️2 indicates shock medication for hypovolemic shock - ✔✔️v️asopressors what do vasopressors do - ✔✔️i️ncrease the workload of the heart what does vasopressin do - ✔✔️-️ causes vasoconstriction (increase BP) - reabsorption of water in the renal tube - increases blood flow to the heart and brain interventions for burns - ✔✔️-️ secure airway - support circulation (fluid replacement) - prevent infection - maintain body temperature - provide emotional support what causes dry heat burns - ✔✔️o️pen flames what causes moist heat burns - ✔✔️h️ot liquids what causes contact burns - ✔✔️h️ot metal, tar, or grease what causes chemical burns - ✔✔️a️lkali, acids, organic compounds *alkali burns are worse than acid burns* what causes electrical burns - ✔✔️e️lectrical current enters the body what causes radiation burns - ✔✔️s️unburns or radiation treatment for cancer Rule of 9's for burns - ✔✔️H️ead = 9% Arms = 18% (9% each) Back = 18%, Front/chest 18% Legs 36% (18% each) Genitalia = 1 what is an escharotomy - ✔✔️i️ncision through eschar relieves pressure from constricting force of fluid buildup under circumferential burns on the extremity or chest and improves circulation - deep: less moist, decreased blanching what is the appearance of a full thickness (3rd degree) burn - ✔✔️-️ dry with leathery eschar - charred vessels - no blanching what is the color of a superficial (1st degree) burn - ✔✔️r️ed what is the color of a partial thickness (2nd degree) burn - ✔✔️-️ superficial: pink - deep: pale mottle with dull white, tan, and cherry red areas what is the color of a full thickness (3rd degree) burn - ✔✔️-️ white - charred - dark tan - black - red what is the sensation of a superficial (1st degree) burn - ✔✔️p️ainful what is the sensation of a partial thickness (2nd degree) burn - ✔✔️p️ainful what is the sensation of a full thickness (3rd degree) burn - ✔✔️n️o pain what is the healing time for a superficial (1st degree) burn - ✔✔️-️ 2-5 days - usually dry and peeling what is the healing time for a partial thickness (2nd degree) burn - ✔✔️s️uperficial: 5-21 days deep: 22-35 days what is the healing time for a full thickness (3rd degree) burn - ✔✔️n️o healing potential what are treatment interventions for a superficial (1st degree) burn - ✔✔️-️ mild analgesia what are treatment interventions for a partial thickness (2nd degree) burn - ✔✔️d️eep burns may require grafting what are treatment interventions for a full thickness (3rd degree) burn - ✔✔️-️ excision and grafting - amputation parkland formula for burns - ✔✔️4️ ml x Kg x % burn surface area give 1/2 fluids in first 8 hours. remaining 1/2 in last 16 hours. what fluid is given for burns - ✔✔️L️R or NS how to calculate MAP - ✔✔️(️SBP + 2DBP)/3 what labs are used to measure nutrition after burns - ✔✔️-️ albumin - prealbumin - total protein What are the different types of shock - ✔✔️-️ cardiogenic shock - hypovolemic shock - anaphylactic shock - septic shock - neurogenic shock what is cardiogenic shock due to - ✔✔️h️eart problems what is hypovolemic shock cause by - ✔✔️t️oo little blood volume