N212 Final

Barter and Gitelman syndrome? 

The electrolyte imbalance that they have in common is hypokalemia.

How does the respiratory buffer system compensate for pH imbalances? 

When the ph levels decrease, the pt is acidotic; the RR will increase and they will have an increase secretion of CO2 with lower HCO3 levels to help promote the acid-base balance. When the ph levels increase, the pt is alkalotic; there is a decrease in the RR which promotes CO2 retention and increases HCO3 levels. 

What is a buffer system? 

A buffer system is the immediate compensation of the body in response to pH imbalances; when the ph increases or decreases, the body wants to immediately compensate via buffer systems.

Retinopathy of prematurity? 

Blindness that occurs in premature babies; treatment includes the scleral buckle which is a treatment that helps to reduce traction and allows the retina to relax, this traction reduction helps to prevent further damage and prevent blindness. 

Menere’s disease? 

Pt will experience vertigo and tinnitus; can have some hearing loss as well

What is fibromyalgia? 

Tenderness without inflammation; no evidence of inflammation with pain in at least 12 out of 18 areas. 

How long is TB treatment? 

Six months to a year; up to two years if it becomes complicated or resistant. Will need to provide sputum samples every 2-4 weeks when home, since they remain contagious. Will need to still wear a mask and isolate themselves, even when at home with family members. 

If a pt is brought up to the floor from the ER after a quick exam and all of the sudden the pt starts coughing with productive mucus or has watery diarrhea or hemoptysis (coughing up blood), what should you do first? 

Isolate them; for any symptom that could potentially be an infectious agent, we want to isolate and prevent further exposure. Move to a private room, put up appropriate signage for isolation, notify PCP and ask for appropriate orders/tests. 

What type of infection is an HAI? 

Nosocomial infection; ex: pt gets a UTI while in the hospital

Cell-mediated immunity? 

mediated by T cells; cytotoxic T lymphocytes, destroy infected or abnormal cells

Humoral immunity?  

Medicated by B cells and antibodies; antibodies/memory cells

Adaptive immunity?  

Specific, acquired immunity; natural exposure, vaccination, or transfer of antibodies like with breastfeeding

Innate immunity?  

Non-specific, immediate defense mechanism; skin, mucous membranes, inflammatory response

When is HIV confirmed/diagnosed? 

HIV becomes diagnostic of AIDS when the CD4 count drops below 200

First thing you do for an anaphylactic reaction?

 Administer epinephrine

Most common symptom for Systemic Lupus Erythematosus (SLE)? 

Joint pain and swelling

Diabetes Insipidus? 

Associated with polyuria and dehydration

Symptoms of cushing’s disease? 

Moon face and buffalo hump, due to excess fat in upper chest and back area

Most common cause of hyperthyroidism? 

Graves Disease

Symptoms of hypoparathyroidism? 

Dry skin, seizures, and muscle cramps

Hypoparathyroidism? 

Will typically see low calcium levels; the parathyroid hormone is what mobilizes the stores of calcium from the bone into the bloodstream when needed

DKA?

Ketones come from fat metabolism; an overproduction of ketones due to excessive fat metabolism that’s occurring in the body for energy 

When trying to monitor renal damage? 

will need to check the albumin to creatinine ratio which is through urinalysis. 

Microvascular complications with diabetes?

Microvascular complications of diabetes are long-term health problems that affect the small blood vessels in organs such as the eyes, kidneys, and nerves.

Severely dehydrated? 

Rehydrate with IV fluids; even if pt is awake, alert, and able to swallow oral fluids the pt will not be able to rehydrate quickly enough

Mild to moderate dehydration? 

Requires oral rehydration

Non-retentive functional fecal incontinence? 

characterized by inappropriate for defecation, absence of underlying disorders of motility and anal-rectal sensory motor function, absence of excessive stool and fecal retention, symptom frequency is at least once per month, and the duration lasts about two months.

Retentive functional fecal incontinence? 

low, full and deliberate stool retention; might have a history of hard and painful bowel movements or a presence of a large fecal mass in the rectum, pt will hold on to it because they know it is going to be painful to pass. 

Diet for diverticular disease? 

Increased fiber to promote bowel movements and low fat. 

Diverticular Disease? 

typically occurs from chronic constipation; pockets of stool can become infected and inflamed causing diverticulitis

Resuscitation phase? 

The resuscitation phase is the initial fluid shift; when the body takes all the fluid from inside the cells and puts it outside the cells, leaving the body very dehydrated. Due to the fluid shift, sodium is also pulled out and potassium is retained, so pt will be hyponatremic and hyperkalemic.. They will also have hemoconcentration, meaning their hemoglobin and hematocrit are increased. They will be hyperglycemic, due to the stress.

How can you determine a pt has an inhalation injury? 

Singed nasal hairs, hoarseness, and a brassy cough

What type of medication is given for an asthma attack? 

Albuterol, which is a rescue inhaler and a short-acting beta 2 agonist 

Leading cause of COPD and Emphysema? 

Smoking

What is lobar pneumonia? 

Consolidation of the entire lobe

Treatment for DIC? 

Chronic DIC is treated with heparin.

What happens with cardiogenic shock? 

There is a decreased cardiac output which leads to a decrease in tissue perfusion. 

What type of medication is furosemide? 

Furosemide is a diuretic; give in the AM to decrease risk of falls overnight. Treats HTN.

Common symptoms with brain tumors? 

Will depend on where the tumor is; can include personality changes, visual disturbances, vomiting, headaches, and seizures 

PET scan?

 A PET scan of the brain differentiates metastasis from other brain lesions. 

Brain Tumors? 

Often a metastasis; while brain tumors can be a primary site it is more common to see it as a metastasis. 

Lymphoma? 

Reed-Sternberg cells, or Hodgkin’s cells, are diagnostic for Hodgkin’s Lymphoma; this will be the determining factor between Hodgkin’s vs Non-Hodgkin’s. 

Leukemia? 

Acute Lymphocytic Leukemia (ALL) is most common in kids. With Chronic Lymphocytic Leukemia (CLL) you will see lymphadenopathy, which is the enlargement of the lymph nodes, with dysfunctional B cells. 

Colorectal cancer? 

Screening starts at age 50 when there is no family history of colon cancer with a recommendation of repeat colonoscopies every ten years after age 50.

Lung cancer? 

Smoking is linked to small cell carcinoma. Diagnostic tests for lung cancer include a bronchoscopy and tissue biopsy.

What is metastasis?

 When the cancer spreads to different parts of the body and starts to grow there. 

When there is some type of trauma and has potentially damaged the spinal cord, most seen with sports injuries or car accidents, what should be done first? 

The EMTs and paramedics will first put a T-collar on the pt. The T-collar will hold both the neck and spine in place; it is a preventive measure to protect the pts spinal cord from further neurological damage occurring, like paralysis by immobilization. 

How does hydrocephalus look in newborns? 

Newborns have soft open areas called fontanels .. excess cerebral spinal fluid will escape into the fontanels since it is not trapped from a fully formed skull. Will need to measure their head circumference to determine hydrocephalus. Adults will have evidence of intracranial pressure since there is nowhere for the excess fluid to go; projectile vomiting, seizures, change in LOC

Criteria for cerebral palsy? 

Results from trauma during birth; will have an apgar score of less than 7 at five minutes after birth and will have evidence of hypoxic brain injury via MRI, organ failure, metabolic acidosis 

What is status epilepticus? 

The condition is life threatening; it is a continuous tonic-clonic seizure. Typically tonic-clonic seizures can last from 2-5 minutes, if the seizure persists and is not stopping with emergency seizure medications it could be status ellipticus. Without a break from the tonic-clonic seizure, pt can become hypoxic and go into a coma and die. 

Tonic Clonic seizures? 

most familiar type; complete loss of consciousness, will fall to the ground and have periods of convulsions, either a continuous state of muscle contraction (tonic) or rapid successions of alternating muscle contraction and relaxation (clonic)

Partial seizures? 

typically in one hemisphere; the simple partial stays within the hemisphere and the complex partial goes to both hemispheres, will involve either motor or sensory functional symptoms and will promote an altered LOC depending on what hemisphere is affected

Myoclonic seizures? 

characterized by sudden jerking movements; it is involuntary and not associated with a change in LOC

The relapsing-remitting type of MS? 

Periods of exacerbations of symptoms followed by periods of remission or relief from symptoms. 

Absence seizures? 

Characterized by very brief change in LOC with eye or mouth movements; body tone isn’t loss and will typically remain sitting or standing in place, will not fall or lose control of bowel/bladder; will have automatisms - eye movements like blinking, lip smacking, chewing, head bobbing, etc

Multiple Sclerosis? 

The immune cells that cause the demyelination process are the T and B lymphocytes and macrophages.

Fall risks with Parkinson’s Disease?

Educate to minimize clutter and maintain a clear walkway, have adequate lighting, getting rid of throw rugs which is a tripping hazard, installing hand rails in the bathroom near the toilet and the tub

Symptoms for Parkinson’s Disease? 

Different types of postures will be more hunched over, have a shuffling gait, bradykinesia (moving very slowly), will have tremors, decreased to no mobility in their facial features (will be unable to show facial expressions),trouble swallowing or speaking, vacant stare, can lose voice inflection and become very monotone, oftentimes head will be bent forward and stooped, will also be rigid

Restrictions for hemodialysis? 

Pt will be on diet; will have fluid restrictions to prevent fluid overload and becoming hypervolemic. Many pts have void minimally or not at all due to lack of kidney filtration. The only way to remove fluid from their body is through dialysis. Will need to monitor sodium, potassium, and phosphorus intake. Easy to overdose on medications due to lack of filtration. 

Time constraints for hemodialysis? 

Long procedure, typically 4-5 hours with 3-4 hours of treatment plus time for setup and deconstruction. Typically three times a week. Very exhausting. Will have to reach out to nearby centers to coordinate treatments when out of town or on vacation. Pt needs to understand time constraints and scheduling. 

Restrictions for AVF? 

Limb alert - meaning no BP, tourniquet, blood sticks, IVs on that limb. Have to be careful lifting items with that limb. 

What is hemodialysis? 

An AVF is inserted in one of their limbs, where they will attach an artery to a vein for good veinpuncture for dialysis treatments. It needs time to mature, so a temporary line will be placed for dialysis in the meantime. Usually visible and able to feel/hear the bruit and thrill

The biggest complication with peritoneal dialysis is? 

Peritonitis; sterile (aseptic) technique is encouraged to prevent infection from occurring both at home or at a facility

What is peritoneal dialysis?

Catheter goes into the peritoneal cavity in their abdomen; we instill fluid into the abdomen, let it dwell for a period of time, and then the peritoneal membrane acts as a filter to remove waste and toxins from the body, and then we remove the fluid out and discard it. 

Interventions for urge incontinence? 

Assist with toileting, bladder training, intravaginal support devices, strengthening pelvic floor exercises, anticholinergic medications, and a-adrenergic antagonists. 

Functional incontinence? 

Normal bladder, usually seen in pts who may have impaired mobility and may have a hard time transporting to the toilet; unable to make it to the toilet in time but not necessarily incontinent

Stress incontinence? 

incontinence caused by an external stimuli due to increase of internal pressure from sneezing, coughing, laughing, or lifting heavy objects

Overflow incontinence? 

Underactive bladder; occurs with too much pressure on the bladder and can be due to too much urine or internal complications. Will have detrusor muscle under activity or bladder output obstruction 

Urge incontinence? 

aka overactive bladder; sudden urge to void, nocturia, frequency, may have urine leakage  

Dietary instructions for calcium oxalate stones?

 Increase fluid intake, reduce dietary oxalate, regulate animal protein intake to 4-5oz, increase fruit and vegetable intake, limit sodium intake to 2-3g per day. Avoid beets, chocolate, coffee, cola, nuts, spinach, strawberries, tea, and wheat bran. 

What are risk factors for developing kidney stones? 

Dehydration, obesity, having multiple UTIs, genetics

What are the symptoms of Urolithiasis (kidney stones)? 

Varies depending on severity/stage. Severe flank pain which can radiate to the back, nausea, vomiting, diaphoresis, dysuria, urgency, gross and/or microscopic hematuria

What is Polycystic Kidney Disease? 

It is a condition where the kidney develops numerous cysts that can go into the thousands as the disease progresses. The cysts appear on both the outside and inside and are destroying the kidney as they form. Typically a genetic disease and cannot be prevented.