Adult-Gerontology Acute Care Nurse Practitioner Certification Review Flashcards

Comprehensive vocabulary flashcards generated from the Barkley & Associates AGACNP Certification Review manual covering key acute care definitions, diagnostics, equations, and management concepts.

Somogyi Effect

Nocturnal hypoglycemia that stimulates a surge of counter-regulatory hormones, raising blood sugar levels by morning, characterized by low blood glucose at $0300\,\text{AM}$ and elevated blood glucose at $0700\,\text{AM}$.

Dawn Phenomenon

Early morning hyperglycemia resulting from nocturnal desensitization to insulin, causing blood glucose levels to become progressively elevated throughout the night and peak at $0700\,\text{AM}$.

Anion Gap Formula

Calculated as $\text{Anion Gap} = [(\text{Na}^+) + (\text{K}^+)] - [(\text{HCO}_3^-) + (\text{Cl}^-)]$ to evaluate causes of metabolic acidosis.

Mean Arterial Pressure (MAP) Formula

$$\text{MAP} = \frac{\text{SBP} + 2(\text{DBP})}{3}$$

Parkland Formula

Calculates fluid requirements during the first $24\,\text{hours}$ of burn resuscitation as $\approx 4\,\text{ml/kg} \times \text{\%TBSA burned}$, delivering $\frac{1}{2}$ in the first $8\,\text{hours}$, $\frac{1}{4}$ in the next $8\,\text{hours}$, and $\frac{1}{4}$ in the remaining $8\,\text{hours}$.

Creatinine Clearance Formula (Cockcroft-Gault)

$$\text{Creatinine Clearance (ml/min)} = \frac{(140 - \text{age}) \times \text{body weight in kg}}{72 \times \text{serum creatinine in mg/dl}} \times (0.85 \text{ for females})$$

Systemic Vascular Resistance (SVR) Formula

$\text{SVR} = \frac{(\text{MAP} - \text{mean CVP}) \times 80}{\text{CO}}$ with a normal range of $800\text{--}1200\,\text{dynes/sec/cm}^{-5}$.

Delta Pressure in Compartment Syndrome

$\text{Delta Pressure} = \text{DBP} - \text{ICP}$; a delta pressure $\le 30\,\text{mm Hg}$ indicates inadequate tissue perfusion and signals the need for fasciotomy.

Acute Respiratory Distress Syndrome (ARDS)

A form of acute lung injury characterized by severe dyspnea, bilateral diffuse infiltrates ("white out") on CXR, and refractory hypoxemia managed with low tidal volume ventilation ($6\text{--}8\,\text{ml/kg}$ IBW) and positive end-expiratory pressure (PEEP).

Reed-Sternberg Cells

Characteristic multinucleated cells found on lymph node biopsy that differentiate Hodgkin's disease from Non-Hodgkin's lymphoma.

Philadelphia Chromosome

A specific chromosomal abnormality seen in leukemic cells that serves as a diagnostic hallmark of Chronic Myelogenous Leukemia (CML).

Chvostek's Sign

A clinical indication of hypocalcemia characterized by involuntary twitching of facial muscles elicited by tapping over the facial nerve.

Trousseau's Sign

A clinical indication of hypocalcemia characterized by carpopedal spasm induced by inflating a blood pressure cuff above systolic pressure for $3\,\text{minutes}$.

Grey Turner's Sign

Flank ecchymosis indicative of retroperitoneal hemorrhage in cases of severe acute hemorrhagic pancreatitis.

Cullen's Sign

Periumbilical ecchymosis indicative of retroperitoneal or intra-abdominal bleeding associated with acute hemorrhagic pancreatitis.

Murphy's Sign

Deep pain on inspiration while fingers are placed under the right rib cage during right upper quadrant palpation, indicative of acute cholecystitis.

Psoas Sign (Iliopsoas Test)

Right lower quadrant abdominal pain elicited by passive extension of the patient's right thigh, suggestive of appendicitis.

Obturator Sign

Right lower quadrant abdominal pain elicited by passive internal rotation of the flexed right thigh, suggestive of appendicitis.

Rovsing's Sign

Right lower quadrant pain elicited when pressure is applied to the left lower quadrant, indicative of acute appendicitis.

Kernig's Sign

Physical evidence of meningeal irritation where extension of the knee with the hip flexed at $90^{\circ}$ produces severe pain and spasms in the hamstring muscles.

Brudzinski's Sign

Physical evidence of meningeal irritation where involuntary flexion of the hips and knees occurs in response to passive flexion of the head and neck to the chest.

Cushing's Triad

A clinical sign of decompensating intracranial pressure consisting of widening pulse pressure (elevated systolic blood pressure), decreased respiratory rate, and bradycardia.

Autonomic Dysreflexia

An emergency clinical condition occurring in spinal cord injuries at or above $T4\text{--}T6$ caused by noxious stimuli below the injury, presenting with severe hypertension, bradycardia, headache, and diaphoresis above the injury level.

Cauda Equina Syndrome

Compression of nerve roots at the distal end of the spinal cord presenting with lower extremity weakness, numbness in the saddle region (buttocks, groin, perineum), and bowel or bladder dysfunction requiring emergency surgical decompression.

Brown-Séquard Syndrome

Damage to one half of the spinal cord resulting in ipsilateral upper motor neuron paralysis and loss of proprioception, paired with contralateral loss of pain and temperature sensation.

Myerson's Sign

Repetitive tapping over the bridge of the nose produces a sustained, involuntary blink response, commonly observed in Parkinson's disease.

Heberden's Nodes

Hard, non-tender bony enlargements located at the distal interphalangeal (DIP) joints of the fingers in patients with osteoarthritis.

Bouchard's Nodes

Bony enlargements located at the proximal interphalangeal (PIP) joints of the fingers, seen in osteoarthritis.

Light's Criteria for Exudative Pleural Effusion

Pleural fluid is classified as an exudate if it meets any of the following: ratio of pleural fluid protein to serum protein $> 0.5$, ratio of pleural fluid LDH to serum LDH $> 0.6$, or pleural fluid LDH $> \frac{2}{3}$ the upper limit of normal serum LDH.

CURB-65 Criteria

A clinical scoring tool for pneumonia severity assigning 1 point each for Confusion ($\le 8$ AMTS), BUN $> 19\,\text{mg/dl}$, Respiratory rate $\ge 30\,\text{breaths/min}$, Blood pressure (SBP $< 90\,\text{mm Hg}$ or DBP $\le 60\,\text{mm Hg}$), and Age $\ge 65\,\text{years}$.

Monro-Kellie Doctrine

The principle that the total intracranial volume (blood, brain tissue, CSF) is constant, so an increase in one component requires a compensatory decrease in another to maintain normal ICP.

Incident-to Billing

Medicare billing process allowing non-physician provider services furnished under direct physician supervision in an office setting to be reimbursed at $100\%$ of the Physician Fee Schedule rate.

Root Cause Analysis

A structured, multidisciplinary quality assurance tool that identifies systemic flaws and prevention strategies by continually asking why at each level of cause and effect.

Sentinel Event

An unexpected occurrence involving death, permanent harm, or severe temporary harm (or the risk thereof) that signals an urgent need for institutional investigation and root cause analysis.

Nonmaleficence

The foundational ethical principle defining the healthcare provider's duty to do no harm.

Beneficence

The ethical duty to act in the patient's best interest to prevent harm and promote good.

Utilitarianism

The ethical principle stating that the right act is the one that produces the greatest good for the greatest number of people.

Veracity

The ethical obligation of healthcare providers to tell the truth.

Fidelity

The ethical duty to be faithful, loyal, and keep commitments made to patients and institutions.

Primary Prevention

Health promotion measures implemented prior to the onset of illness to prevent recognizable problems (e.g., immunizations, healthy diet, seatbelts).

Secondary Prevention

Measures focused on early screening, identification, and prompt treatment of existing asymptomatic conditions (e.g., Pap smears, mammography, blood pressure screening).

Tertiary Prevention

Interventions aimed at rehabilitation, restoration, and symptom management following an established illness or injury (e.g., cardiac rehab after MI, physical therapy after CVA).

qSOFA (Quick SOFA)

A bedside scoring tool to identify patients with suspected infection at higher risk for poor outcome, assigning 1 point each for SBP $\le 100\,\text{mm Hg}$, Respiratory rate $\ge 22\,\text{breaths/min}$, and altered mentation (GCS $< 15$).

Pre-Exposure Prophylaxis (PrEP)

Antiretroviral medication regimen (e.g., emtricitabine/tenofovir) taken consistently by HIV-negative individuals at risk to prevent HIV acquisition.

Giant Cell Arteritis

An inflammatory condition affecting temporal arteries in adults $> 50\,\text{years}$ presenting with headache, scalp tenderness, visual complaints, jaw claudication, and a very high erythrocyte sedimentation rate (ESR).

Pheochromocytoma

A rare catecholamine-releasing tumor of the adrenal medulla causing paroxysmal severe hypertension, diaphoresis, headache, and palpitations, diagnosed via $24\text{-hour}$ urine metanephrines and VMA.

Status Epilepticus

A medical emergency characterized by a series of grand mal seizures lasting $> 10\,\text{minutes}$ or recurring seizures without recovery of consciousness between attacks.

Guillain-Barré Syndrome

An acute, rapidly progressive demyelinating polyneuropathy characteristically presenting with symmetrical ascending flaccid paralysis and hyporeflexia, often following a recent viral illness.

Myasthenia Gravis

An autoimmune disorder characterized by a reduced number of acetylcholine receptor sites at the neuromuscular junction, leading to fluctuating muscle weakness that worsens with exercise and improves with rest.

CAGE-AID

A self-report screening tool adapted to assess both alcohol and drug use disorders, where an answer of "yes" to 2 or more questions warrants a complete clinical assessment.