HAN 477 Final Exam

What is adrenal insufficiency and how is it treated?

A condition in which the adrenal glands do not produce enough of certain essential hormones, primarily cortisol and in some cases aldosterone.

1. Hydrocortisone

2. Fludrocortisone acetate

3. Salt supplementation

4. Emergency steroid injections

What are the various forms of diabetes?

Type 1 and Type 2 diabetes mellitus

How is each form of diabetes treated?

Type 1: requires lifelong insulin therapy

Type 2: lifestyle changes, oral medications, and sometimes insulin

What tests help you narrow your differential diagnosis in abdominal pain?

1. Lab test; CBC, CMP, LFTs, urinalysis, pregnancy test, etc

2. Imaging studies; ultrasounds, CTs, MRIs, X-ray

3. Special tests; ECG, Endoscopy, and pelvic exam

What is the treatment for prancreatits?

depends on whether it is acute or chronic

- acute: fasting, IV fluids, pain management, electrolyte replacement

- chronic: treat underlying causes, pancreatic enzyme supplements, dietary changes, and sometimes surgery

- as well as nutritional support and pain management.

What is the cause of a splenic injury?

caused by trauma to the abdomen

1. Blunt trauma; car accidents, falls, etc

2. Penetrating trauma; stab/gunshot wounds

3. Medical conditions or procedures; surgical complications, cancers, etc.

What are the 5 toxidromes?

1. Sympathomimetics

2. Opiates

3. Anticholinergics

4. Cholinergics

5. Sedative hypnotics

Sympathomimetics and symptoms

- cocaine, methamphetamine/amphetamines, ecstasy (MDMA), and ADHD meds like Ritalin and aderral

- excessive sympathetic stimulation involving epinephrine, norepinephrine, and dopamine.

S/S: tachycardia, hypertension, confusion with agitation, seizures, and rhadbomyolysis

Opiates and symptoms

- derived directly from the opium poppy; morphine and codeine

S/S: coma, miosis, respiratory depression, peripheral vasodilation, orthostatic hypotension, flushing, bronchospasm, and pulmonary edema.

Anticholinergics and symptoms

- AcH receptors are either nicotinic or muscarinic

- the "anti-Cholinergic" drugs just block the muscarinic receptors

S/S:

CNS- confusion, agitation, myoclonus, tremor, abnormal speech, hallucinations, and coma.

PNS- mydriasis, anhidrosis, tachycardia, urinary retention, and ileus.

Cholinergics symptoms

dumbels, sludge

Diarrhea, urination, miosis, bradycardia, bronchospasm, emesis, lacrimation, and salivation.

Salivation, lacrimation, urination, diaphoresis, gastrointestinal upset, and eyes (miosis)

Sedative hypnotics symptoms

CNS depression, lethargy, can induce respiratory depression, and can produce bradycardia or hypotension.

How do you distinguish between DKA and HHNK?

both acute complications of diabetes

1. DKA is usually seen in Type 1 diabetes patients, HHNK is usually seen in Type 2 diabetes patients

2. DKA is rapid onset and HHNK is slower onset

3. DKA presents as moderate hyperglycemia while HHNK presents as severe hyperglycemia

4. Dehydration and mental status are mild/moderate in DKA patients and severe in HHNK patients.

What is the order of heat emergencies from least to most severe?

1. Heat stroke

2. Heat syncope

3. Heat exhaustion

4. Heat cramps

5. Heat tetany

How do you diagnose acetaminophen toxicity?

1. History taking; timing and dose, intentional vs accidental, past medical history

2. Symptoms; stage 1-stage 4

3. Lab evaluation; serum acetaminophen level, liver function tests, IR, and serum creatinine.

*4 hour level compared to the Rumack and Matthew's nomogram

What is the appropriate treatment for acetaminophen toxicity?

NAC 140 mg/kg then 70 mg/kg every 4 hours for 17 doses

How do you diagnose and treat TCA overdose?

- presents with altered mental status, tachycardia, hypotension, anticholinergic signs, and seizures.

- ECG findings and lab tests like TCA levels, electrolytes, ABG, and toxicology screen.

- activated charcoal and sodium bicarbonate.

What lab abnormalities might you see with liver failure?

1. Elevated liver enzymes

2. Elevated bilirubin

3. Decreased serum albumin

4. Decreased glucose

5. Elevated BUN and creatinine

What is the most significant life threat in chronic renal failure?

cardiovascular disease

At higher risk of...

- heart attacks

- heart failure

- arrhythmias

- strokes

Can also cause...

- anemia

- hypertension

- electrolyte imbalances

How do you treat Hyperkalemia?

depends on severity, presence of symptoms and ECG changes

1. Stabilize cardiac membranes

2. Shift potassium into cells; beta-agonists and sodium bicarbonate

3. Remove potassium from body

4. Stop ACE inhibitors, NSAIDs, etc

What are the body's natural buffering systems?

1. Bicarbonate buffer system

2. Phosphate buffer system

3. Protein buffer system

4. Hemoglobin buffer system

What are the routes of transmission for infectious diseases?

1. Direct contact transmission

2. Indirect contact transmission

3. Droplet transmission

4. Airborne transmission

5. Fecal-oral transmission

6. Blood borne transmission

What lab values are pertinent to chronic renal failure for a dialysis patient?

1. BUN; elevated

2. Creatinine; elevated

3. GFR; usually very low

4. Electrolytes

5. Acid-base balance

6. Hemoglobin

7. Bone mineral labs

8. Albumin

What is an allergic reaction and how does it differ from anaphylaxis?

- an exaggerated immune response to any substance; releases chemicals to combat stimulus caused by the body's immune system.

- differs from anaphylaxis because rather than involving 2 or more body systems, it only involves one

- anaphylaxis is an overreaction of the immune system and occurs when the immune system becomes hypersensitive to 1 or more substances.

What is the dose of epinephrine needed when using an Epi Pen?

- adult: 0.3 mg

- infant: 0.15 mg

What is a pneumothorax?

Collapsed lung

tension: pressure builds up and starts pushing onto the heart.

What are the signs and symptoms of a pneumothorax?

- air hunger

- respiratory distress

- tachycardia

- hypotension

- tracheal deviation

- unilateral absence of breath sounds

- JVD

- late onset cyanosis

How is a pneumothorax diagnosed and what is the definitive treatment?

Observation, needle aspiration, chest tube insertion and sometimes surgery.

What is capnography and how is it used to aid in diagnosis?

Measures carbon dioxide output and provides a waveform

Normal value= between 35-45 mmHg

What is the difference between a stroke and a transient ischemic attack?

- TIA symptoms resolve within hours (most within 1 hour)

- 10% of TIA patients suffer a stroke within 90 days of TIA

What are the different types of strokes?

Ischemic and hemorrhagic

brain attack- blood flow to the brain is obstructed or interrupted

Ischemic strokes

Thrombus or embolus obstructs a blood vessel in the brain

Hemorrhagic strokes

Diseased or damaged vessel ruptures within the brain.

Why is time a factor as it relates to strokes?

The brain rapidly loses brain cells when blood flow is interrupted.

time is brain

What techniques are used to diagnose a stroke?

- FAST: quick ID of stroke victim

- Cincinnati Stroke Scale: compares facial droop and arm drift as well as slurred speech

- NIH stroke scale: more detailed diagnosis technique

What body regions do strokes effect?

Face, arms, legs, and brain

Glasgow Coma Scale (GCS)

measures mental status; how alert and awake someone is

- 15= highest alert

- 3= dead; lowest it will get

Made up of eye response, verbal response, and motor response.

What is CPAP?

continuous positive airway pressure

- noninvasive ventilators support for respiratory distress

- therapy is delivered through a face mask held to the head with a strapping system.

When is CPAP indicated?

- patient is alert and able to follow commands

- patient displays obvious signs of moderate to severe respiratory distress

- patient is breathing rapidly

- pulse oximetry reading is less than 90%

What is the Pathophysiology behind how CPAP works?

- increases pressure in the lungs

- opens collapses alveoli

- pushes more oxygen across the alveolar membrane

- forces interstitial fluid back into pulmonary circulation

What is tidal volume?

The amount of air that moves in and out of the lungs during a breath. It's key measurement used in ventilation and can help determine how well the lungs are functioning.

Obstructive lung disease characteristics and examples

Hard to exhale all the air in the lungs

- air comes out slower than normal and high amount of air stays in the lungs after full exhalation.

Ex: COPD (emphysema and chronic bronchitis)

Restrictive lung disease characteristics and examples

Lungs are restricted from fully expanding.

- usually conditions that are affecting stiffness in lungs or chest wall, weak muscles, and damaged nerves.

Ex: interstitial lung disease, sarcoidosis, obesity, scoliosis, ALS, and MD.

What is carbon dioxide?

A waste gas produced by the body's cells which is transported through the bloodstream to the lungs where it is then exhaled into the air during the process of breathing.

exhaled gas

level in the body is the prime modulator of respiration

What role does carbon dioxide play in the respiratory system?

Serves as the primary trigger for the breathing process by signaling the body's need to expel it and inhale fresh oxygen; this exchange of gases is called gas exchange and is vital to life.

What are the signs and symptoms as it relates to increased intracranial pressure (ICP)?

Leads to...

- headache

- vision changes

- seizures

- vomiting

- behavior changes

- photophobia

can compromise brain perfusion and brain may herniated through foramen magnum if it gets too high

Parietal lobe

Function: speech, taste, reading; somatosensory associate area.

houses the somatosensory cortex

Occipital lobe

Function: vision; visual association area

Temporal lobe

Function: smell and hearing; auditory association area

Frontal lobe

Function: speech; frontal association area

holds the motor cortex

Cerebrum

major brain region

- conscious thought, memory storage and processing, sensory processing, and regulation of skeletal muscle contraction.

Cerebellum

major brain region

Coordination, balance, modulation of motor commands from cerebral cortex.

Diencephalon

major brain region

- link between cerebrum and CNS

Brain stem

major brain region

- processes visual and auditory information, maintains consciousness, somatic and visceral motor control, and regulates autonomic function.

Agnonal respirations

A patient may appear to be breathing after the heart has stopped.

Cheyenne-stokes respirations

Abnormal pattern of breathing varying between apnea and tachypnea

usually seen in stroke and head injury patients

Ataxic respirations

- irregular or unidentifiable pattern

- may follow serious head injuries

Kussmal's respirations

- deep, gasping respirations

- associated with metabolic/toxic disorders like diabetes mellitus.

patients may have a fruity smell to their breath

Stridor

A High pitched sound caused by obstruction of the airway passageway (around trachea)

Rhonchi

Coarse, low-pitched breath sounds heard in patients with chronic mucus in the upper airways.

Wheezing breath sounds

Suggest obstruction of lower airways, high pitched whistling sounds most prominent on expiration

Crackles (breath sounds)

Caused by air moving through liquid, presents in the air pouches and smaller airway in lungs

Ex: like blowing through a straw in your glass of milk

What is the antidote for organophosphates?

Atropine

What is the antidote for anticholinergics?

Physostigmine

What is the antidote for benzodiazepines?

Flumazenil

What is the antidote for beta blockers?

Glucagon

What is the antidote for calcium channel blockers?

Calcium

What is the antidote for carboxyhemoglobin?

100% O2

What is the antidote for opioids?

Naloxone

What is the antidote for salicylates (ASA)?

Alkalization

What is the antidote for TCA's?

Sodium bicarbonate

What is the antidote for warfarin?

FFP, vitamin K