Term
| ASSESSMENT OF LOC/SUPERFICIAL & DEEP PAIN/ |
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Definition
Assessment LOC:
auditory-if no response then -->tactile -(gently shake and try to get their attention)if no response then--> painful stimuli- trapezius squeeze, sternal rub, mandibular pressure, supraorbital pressure (all central processing); pencil on nail beds (peripheral processing-spinal arc reflex)
WHAT YOU may SEE IF USING PAINFUL STIMULUS: verbal, attempts to push away/withdraw form pain, grimace/non purposeful movement
POSTURING:
DECORTICATE-flexion; Upper arms held tightly to sides, elbows, wrists and fingers flexed with lower arms drawn across chest. Legs extended and internally rotated, feet plantar flexed.
Indicates destructive lesion of the corticospinal tracts within or near the cerebral hemispheres.
DECEREBRATE-extension; |
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Term
| General precautions/post-procedure care with a lumbar puncture. |
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Definition
Prevent CSF leakage!
•Vitals sign checks
•Neuro checks-watch for LOC/personality/neuro changes
PARESTHESIAS: may be caused by clot/edema-- BIG CONCERN
•Pt needs to lay flat from several hours(google says 1 to 24 hrs)
•Increase in fluid intake
•Watch for spinal headache: expected response: medicate and watch for CSF drainage |
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Term
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Definition
- Jaws are clenched and neck extended. Arms are adducted and stiffly extended at the elbows, with forearms pronated, wrists and fingers flexed. Legs are stiffly extended at the knees, with feet plantar flexed.
- Indicates a lesion in the diencephalon, midbrain or pons, but may also be seen in severe metabolic disorders such as hypoxia or hypoglycemia.
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Term
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Definition
-bradycardia, ^ systolic pressure=widened pulse pressure, change in LOC, unequal pupils, restlessness/agitation, n/v, HA, pain, changes in respirations
-WANT TO: decrease IICP: give osmotic diuretic (Mannitol), corticosteroids (Decadron)
-decrease stimuli/stress/movement, premed if needing suctioning to help avoid cough; avoid anything that ^ ICP, give stool softeners |
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Term
|
Definition
o head injury
o brain tumor
o subarachnoid hemorrhage
o toxic & viral encephalopathies
o CVA
o Activity
o Changing position- turning pts q2. need to do slow turning and gentle turning.
o Suctioning
o Gagging or sneezing
o Vomiting
o Noises- ICU noise
o Agitation |
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Term
|
Definition
o Restlessness
o Confusion
o Increasing drowsiness
o Stuporous
o Reacts only to pain or loud stimuli
o Earliest sign– decreased LOC
o Pupil dilation
1 side – opposite side herniation
Both sides – bilateral herniation
o Respirations
Irregular, apnea, shallow
o Thermoregulation
o Posturing
o Hyperactive reflexes decerebrate and decorticate
o Cushing’s Triad
o *Slight changes in any of these can mean IICP
o Life threatening signs
Dilated & fixed Pupils
Decorticate posturing
Total Body Flaccidity |
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Term
| MANAGEMENT/MEASUREMENT OF IICP |
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Definition
• Ventriculostomy
MOnitors pressures
Used to decrease and drain CSF to decrease ICP. Needs to be at a certain level. Very careful in keeping it at the right position • Subarachnoid Bolt Hollow, threaded bolt is inserted through a burr hole in the skull into the opening in the dura and into the subarachnoid space • Mannitol IV to decrease cerebral edema- used most often • Corticosteroids- used often, reduce inflamation in brain, decrease immune system function increase BP, increase fulids. • Anticonvulsants • Antibiotics- depending on what is causing the problem • Opioids/Sedatives (caution) • Barbiturate Coma- stops brain acticity to give brain rest so it can heal. It also decreases need for o2 . Will slowing bring out after some healing has occurred. Not responding to conventional methods used to treat IICP Pentobarbital drug used. • Remove mass, lesions, abscesses or hematomas. • If chronic hydrocephalus, a shunt from lateral ventricle to peritoneum. • Sometimes a decompression craniotomy performed.- remove part of skull allowing the brain to swell to keep for ICP. Need to be careful because brain tissue is exposed and bulging out. |
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Term
|
Definition
Protect patient's head
may be dusky/blue: not much you can do during seizure-check when it's over
how long? type? quality of movement?
longer than a minute or so can cause brain damage b/c lack of o2: may give dilantin, valium, phenobarb, klonopin, versed |
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Term
| INTRACRANIAL TUMORS: infratentorial sx |
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Definition
Maintain neck in straight alignment
Avoid flexion of neck to prevent tearing suture line
Position on either side |
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Term
| INTRACRANIAL TUMORS: trans-sphenoidal SX |
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Definition
Maintain nasal packing in place and reinforce as needed.
Instruct patient to avoid blowing nose, sneezing, coughing
Provide frequent oral care
Keep HOB elevated to promote venous and surgical site drainage. |
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Term
| NURSING CARE FOR ALL INTRACRANIAL SX |
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Definition
Reduce cerebral edema – Position, meds
Relieve pain
Prevent seizures (keep temperature down)
Monitor ICP and look for S/S impending increase in ICP
Neuro assessment frequently |
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Term
|
Definition
-brusing behind the ear (Battle sign), Racoon eyes
-CSF drainage from ear/nose: open to outside; may lead to meningitis
-management
Sterile packing in ear or nose/caution not to sneeze or blow nose
Keep HOB up 30 degrees to reduce ICP & promote spontaneous closure of leak.
Persistent rhinorrhea or otorrhea usually requires surgery.
Non-depressed fracture: watch closely for changes in LOC or drainage.
Depressed fracture: scalp shaved (usually in surgery), clean, debride in surgery, cover bone or artificial grafts, and administer antibiotics |
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Term
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Definition
A headache that gets worse or does not go away.
Repeated vomiting or nausea
Convulsions or seizures
An inability to awaken from sleep
Dilation of one or both pupils of the eyes
Slurred speech
Weakness or numbness in the arms or legs
Loss of coordination
Increased confusion
MAY NEED TO "BAG" 24-48 RESP/MIN |
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Term
| SPINAL CORD INJURY: EMERGENCY CARE |
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Definition
Assume a head injury if spinal injury and vice versa.
Immobilize cervical spine
Transport in body alignment on transfer board
4 people for transport; one at head
Maintain patent airway
Maintain oxygenation
Check for CV stability
If necessary use jaw thrust not head tilt for airway
High dose of corticosteroids within 8 hours of injury improves prognosis and reduces disability |
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Term
| SPINAL CORD INJURY: SPINAL/NEUROGENIC SHOCK |
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Definition
-Spinal shock: Loss of all neurological function below level of injury immediately after the injury
Flaccidity, atonia, areflexia due to LMN “shock” – loss of excitability of neurons
Replacement of flaccidity by spasticity denotes end of spinal shock - 48 hrs to 4 weeks
Ex: car accident some injury to spine- can’t move their legs no tone to extremities. The muscle tone changes to spasticity. All of a sudden they are having consistent spasms- tells you spinal shock injury has ended and moving into another phase
-Neurogenic Shock: Loss of sympathetic outflow
Can occur in any injury above L-2 (sympathetic ganglia exit between T1 and L2)
Unopposed parasympathetic tone
Hypotension, bradycardia, warm flushed
Hypothermic due to loss of body heat “poikilothermic”
Tx: pressors before volume. Constrict vessels again. Dopamine
Massive dilatation we don’t have sympathetic intervation so instead we have parasympathetic (big nerve is the vagus nerve- bp and pulse drops, vasodilates) severe hypotension not due to hypovolemia but to lack of vascular tone. The space the fluid is normally in is very large and there isn’t enough fluid to fill the space. Fluid isn’t low, just a much bigger space to fill. |
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Term
| SPINAL CORD INJURY: autonomic hyperreflexia |
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Definition
-Autonomic Hyperreflexia: Strong muscle spasms and autonomic dysfunction precipitated by cutaneous or visceral stimuli; Only after resolution of spinal shock (when reflexes have returned) and only in injuries at or above T-6
-s/s: Sudden severe hypertension (300/160)
Severe pounding headache
Nasal congestion and obstruction
SOB
Nausea
Blurred vision
bradycardia
Arrhythmias
Flushing, sweating vasodilation above injury level
Pallor, goose flesh and vasoconstriction below level of injury
Causes: Can be something as small as sheets in the bed not being smooth. cutaneous or visceral stimuli. Distended bladder-most common
Fecal impaction/constipation
Urinary calculus
Cystitis
Pressure on glans penis
Uterine labor contractions
Pressure ulcer
Ingrown toenail
Small objects left in bed
nursing care: A clinical emergency !
Identify at risk and PREVENT
remove stimulus
place in upright position, lower legs
remove support hose/binders
medicate w/ meds that block autonomic funct and lower b/p |
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Term
| MEDS FOR SPINAL CORD INJURY |
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Definition
-methypredisone protocol:
Reduces inflammation, amino acid neurotoxicity, reduces lipid peroxidation, increases blood flow to cord, slows shift of ions that occur post-injury, and suppresses immune cells that damage CNS
Improved motor and sensory function have been reported at 6 weeks, 6 months and 1 year for complete and incomplete injuries with early high-dose steroid administration
Best outcomes if started with 3 hrs of injury
All solutions mixed as 62.5 mg/ml
Bolus of 30 mg/kg given over 15 minutes
Pause for 45 minutes
Followed by maintenance infusion of 5.4 mg/kg/hr
If therapy begun within 3 hrs of injury, infuse for 23 hrs,
If begun 3 – 8 hrs, infuse for 47 hrs
Formula for calculating maintenance infusion:
ml/hr = wt in kg x0.0864 for either 23 or 47 hrs
-LOVENOX: DVT
-NUPERCAINE: PAIN
-NEURONTIN: NEUROPATHIC PAIN
-LIORESAL,ZANAFLEX,DANTRIUM: SPASTICITY |
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Term
| SPINAL CORD INJURY COMPLICATIONS |
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Definition
-SPINAL, neurogenic shock
-respiratory insufficieny: injuries C4 and higher-->mech ventilation necessary
-ascending cord edema: injury lower on the spinal cord and edema goes upward-->may cause resp insufficiency
-orthostatic hypotension; b/p unstable until around 2wks after injury
-loss of skin integrity
-paralytic ileus: loss of peristalsis w/ spinal shock, abdo distenstion interferes w/ respirations, immediate gastric decompression w/ NG tube
-Atonic bladder: bladder reflexes from higher brain lost; becomes distended, manage w/ indwelling/intermittent cath
-NUTRITION: maintain NPO until peristalsis returns, may need TPN, diet high in protein for tissure repair/wound healing; up to 3000mL fluid/day; prevent aspiration |
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Term
| Multiple Sclerosis: signs/symptoms |
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Definition
Vary with type
Usually occur & disappear
Sensory changes
Visual disturbances
Scotomas
Diplopia
Tinnitus
Vertigo
Hearing loss
Ataxia
Loss of balance
Tremor
Fatigue
Facial weakness
Dysphasia
Joint stiffness
Spasticity
Bladder or bowel dysfunction
Cognitive changes may occur late in course of disease
decrease in short term memory
decrease concentration
decrease calculation ability
inattention
impaired judgment |
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Term
| MULTIPLE SCLEROSIS: PHARMACOLOGIC THERAPY |
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Definition
Anti-inflammatory meds improve nerve conduction
Corticosteroids
Nonsteroidal Immunosuppressants
Imuran, Cytoxan, Cyclosporine, Copaxone
Interferons
Betaseron (beta 1b), Avones (beta 1a)
fewer exacerabations
Baclofen for spasticity
Symmetrel for fatigue (also anti-viral)
Prozac for depression
Cerebellar ataxia
Inderal, Neurotonin, Klonopin
Anticholinergics for bladder dysfunction
Ascorbic acid to acidify urine and prevent UTIs |
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Term
| MULTIPLE SCLEROSIS: PATIENT/FAMILY TEACHING |
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Definition
At this time there is no cure.
Assist to cope with life changes.
Needs clutter free environment
Eye patch for diplopia
Teach time management to prevent fatigue
Bowel/bladder training; learn self-cath
Combine rest with exercise
Exercise should include stretching, ROM, strengthening, ambulation
Adaptive devices for help with ADLs
Enlist help of other disciplines, such at PT, OT
Caregivers/ family members need support |
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Term
| AMYOTROPHIC LATERAL SCLEROSIS (ALS): SIGNS/SYMPTOMS |
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Definition
Atrophy of hands, forearms, legs leads to paralysis
No sensory or autonomic involvement
No mental changes
Fatigue while talking
Tongue atrophy
Dysphasia
Atrophy of trapezius & sternocleidomastoid
Flaccid quadriplegia
Paralysis of respiratory muscles |
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Term
| AMYOTROPHIC LATERAL SCLEROSIS (ALS):MEDICATIONS |
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Definition
Drugs for spasticity
Baclofen, Dantrium, Valium
Riluzole (Rilutek: early in disease acts as a NEuroprotective agent; extends lives by months; Delays the need for tracheostomy.
Discussion of end-of-life issues. |
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Term
| MYASTHENIA GRAVIS: SIGNS/SYMPTOMS |
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Definition
A chronic disease that affects the neuromuscular junction.
Autoimmune response that destroys a variable number of acetylcholine receptors.
Classic features: weakness and fatigue of selected voluntary muscles.
Weakness of Skeletal muscles.
Strength usually restored after rest.
Muscles used for moving the eyes and eyelids, chewing, swallowing, speaking and breathing most often involved.
Muscles are strongest in AM and are weak at the end of the day.
There is no sensory loss, reflexes are normal and muscle atrophy is rare |
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Term
| MYASTHENIA GRAVIS:MYASTHENIC CRISIS/CHOLINERGIC CRISIS |
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Definition
An acute exacerbation of muscle weakness triggered by infection, surgery, emotional distress or drug overdose.
-Major complications result in breathing problems, aspiration and respiratory infections.
-Cholinergic crisis
History and physical exam
EMG (Electromyogram)
Tensilon Test: test to determine which type of crisis it is
Acetylcholine receptor antibodies elevated in serum |
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Term
| MYASTHENIA GRAVIS: MEDICATIONS/THERAPY GOALS |
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Definition
-DRUGS: ANTICHOLINESTERASE AGENTS: PROSTIGMINT(NEOSTIGMINE); CORTICOSTEROIDS; IMMUNOSUPPRESANTS
-SURGERY: THYMECTOMY (remission in 40% of pts)
-PLASMAPHERESIS
*maintain adequate ventilation, continue drug therapy, schedule doses of drugs so that peak is reached at mealtime, monitor therapy |
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Term
|
Definition
Acute inflammatory polyneuropathy characterized by varying degrees of motor weakness or paralysis- Affects the peripheral nervous system and causes a loss of neurotransmission to the periphery.
Symptoms range from mild to severe.
Symptoms usually develop 1 to 3 weeks after upper respiratory infection or GI infection.
Weakness of lower extremities occur over hours to days and usually peak at about the 14th day.
Paresthesia is frequent.
Paralysis usually follows. |
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Term
| RENAL: COMPLICATIONS OF HEMODIALYSIS & PERITONEAL DIALYSIS |
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Definition
-hemodialysis: peritonitis (fever, cloudy dialysate, distended abdo-firm/taught, may feel sick, catheter may bulge out)-flush 3x w/ dextrose to see if it will clear
-Hemodialysis: dysrhythmias, muscle cramping, hypotension, tachycardia, air emboli dialysis disequilibrium (HA, n/v, restlessness, decreasd LOC, seizures) |
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Term
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Definition
-Listen to the bruit/palpate thrill many times throughout the day
-check radial pulse/extremities: compare sides
-*thrombus biggest complication, others: infection, skin erosion, etc
-*central lines only used for dialysis |
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Term
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Definition
-Prerenal: intravascular vol depletion; hypotension; cardiac failure (low CO), sepsis, systemic vasodilation
-Intrarenal: damage to kidneys
-Postrenal |
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Term
| ACUTE RENAL FAILURE: NURSING CARE |
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Definition
-Check for edema: pretibial, presacral
-lung sounds, heart sounds, I&O, weight, fluid gains over 1-2 day period, dehydration, abdominal girth-ascites, pitting edema, dysrhythmias, friction rub-uremic pericarditis |
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Term
| LITHOTRIPSY: ADVERSE EFFECTS |
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Definition
-hematoma, brusing
-pain, hematuria, kidney damage, GI effects: erosions of stomach/duodenum, damange to pancreas; stone recurrance, HTN |
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Term
| CARDIAC TAMPONADE: SIGNS/SYMPTOMS |
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Definition
Falling systolic b/p
Narrowing pulse pressure
Tachycardia
Distended neck veins/increased CVP
Diminisnhed heart sounds/point of maximal impulse
Pulsus paradoxus: a reduction in the amplitude of the arterial pulse during inspiration. Systolic b/p that is heard during expiration but not with inspiration |
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Term
| CARDIAC TAMPONADE: CAUSES |
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Definition
Medical emergency
Compression of the heart as a result of fluid w/n the pericardial sacthe compression decreases venous return to the heart, resulting in a decrease in stroke volumeleads to cardiac failure,shock and death
Normal pericardial fluid: 15-50cc
Tamponade may occur with 100cc |
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Term
|
Definition
-*mouth care: ventilator acquired PNA
-pulling ET tube out: restraints and sedation
-commuincation issues
-family awareness/education
-ASSESS PATIENT
-HOB elevated to 30degrees or reverse trendelenburg
-enteral/TPN nutrition |
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Term
| ASSESSMENT/NURSING CARE/TREATMENT: RIB FRACTURES/FLAIL CHEST |
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Definition
-Rib fracture:
Pain that increases w/ inspiration
Localized tenderness
Crepitus on palpation
Splinting of chest
Shallow breathing
-Flail Chest
paradoxical motion of the chest wall
inspiration
fixed segment is pulled inward
mediastinum shifts to unaffected side
expiration: fixed segment bulges outward
-complications: PNA, tension pneumothroax, shock secondary to hemothorax, ARDS
-management
CXR
ABGs
O2 sat
Pain control
IS q1h
Mechanical ventilation
sx |
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Term
| ARTERIAL BLOOD GASES: Normal values |
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Definition
-pH: 7.35-7.45
-PaCO2: 35-45
-HCO3: 22-26
-PaO2: 80-100 |
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Term
| PNEUMOTHORAX: DIAGNOSIS/TREATMENT |
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Definition
-occurs when air enters pleural space b/t the lung and chest wall
tension, closed, open/"sucking chest wound", sponaneous
-open wound: cover and tape only on 2-3 sides to allow air to escape |
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Term
| CHEST TUBE DRAINAGE: NURSING INTERVENTIONS, ASSESSMENTS, RESPONSIBILITES |
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Definition
-Documentation:
Chest tube size/insertion site
Who inserted tube
Whether drainage is present & amount, color, type
Pt tolerance of procedure
Meds received during procedure
Results of CXR
Pt and family teaching
-With suction:
Bubbling is normal; if not bubbling look for occulsion, air in pleural space is so large it may not be enough suction; amount of bubbling corresponds to size of air leak
-Monitoring:
Color, consistency, amount of drainage
Average draining for:
Pneumothorax
10-20ml/hr serosanguinous fluid
Hemothorax:
50-100ml/hr
Mediastinal
50-200ml/hr of bloody to serosanguinous
If drainage exceeds 100ml/hr note output hourly. Notify MD of the following:
400mL in 1hr
300ml/hr in 2 consecutive hours
200ml/hr for 3 consecutive hours
-Nursing Care
•Dressing
-Disconnected tube
•May be disconnected when transporting or ambulating
•If order specifically states to not disconnect then obtain a portable suction device
•Care for mobile devices
•Auscultate, VS, document physical activity, pain control
-Only clamp tube to
Assess for air leak
•Change collection device
•Assess if pt is ready to have tube removed
-Accidental removal:
•Cover site with dry sterile dressing
•Notify MD
•If you hear air leaking from site: tape the dressing on only 2 or 3 sides to let air escape
•Removing tube:
•After 48-72hrs
•No tidaling of fluid in water s
seal chamber
•Xray
-Nursing care:
•Pre medicate
•Sterile suture set
•Gauze
•May use telfa or petroleum gauze
tape |
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Term
|
Definition
-most common
-causes: loss of whole blood/plasma/interstitial fluid
-absolute: external loss of fluids
-relative: internal shift-3rd spacing |
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Term
|
Definition
-Impaired ability of heart to pump blood: decreased CO
-causes: LV/RV dysfucntion or both; valve dysfunction; dysrhythmias; ischemia from MI, bradycarida: decerased CO, tachycardias: decreased filling time/SV
-Treatment: Meds that ^ HR (dobutamine, digitalis-slwoer but stronger, lasix if too much fluid, Nitroglycerin); IABP, ventricular assist devices: take stress of heart |
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Term
| SHOCK: DISTRIBUTIVE/CIRCUALTORY |
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Definition
-inadequate vascular tone that lead to massive vasodilation
-Septic, Neurogenic, Anaphylactic
- |
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Term
| TYPES OF FLUID REPLACEMENT |
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Definition
-0.9% Sodium (normal saline
-Lactated Ringers: lactate ion helps buffer metabolic acidosis
-Hypertonic Saline (3%): small vol needed to restore intravascular vol
-Albumin (5, 25%): rapidly expands plasma vol
-dextran: synthetic plasma vol
-hetastarch: synthetic plasma expander |
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Term
| DEFIBRILLATION vs. CARDIOVERSION |
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Definition
-Cardioversion: synchronized with heart
start at 50-150 joules; patient have QRS/heart beat
-Defibrillation: emergency procedure; not synchronized with heart; 200-300 joules; dont have QRS/heart beat |
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Term
| DRUGS TO TREAT CARDIAC ARREST/DYSRHYTHMIAS |
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Definition
-for A fib, SVT, V Tach WITH pulse: amiodarone, adenosine, verapamil
-clients with A fib of unknown duration must receive adequate anticoagulation prior to cardioversion
-V tach WITHOUT pulse/V fib; amiodarone, lidocaine, epinephrine |
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Term
| DISCHARGE TEACHING: CABG PATIENT |
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Definition
-Activity
no lifting greater than 10lbs
No driving for 3-4 wks
No prolonged sitting
Activity as tolerated
Cardiac rehab
Resume sexual activity when comfort level allows
-Meds: stool softeners, pain meds, diuretics, other heart meds
-Women should wear a bra to support chest
-TED hose/ACE wraps
-Daily wts: notify MD if gain of 6lbs in 2days
-Incentive spirometry q2-4 hrs while awake
-Sternal precautions w/ CABG
Specific ACTIVITIES TO AVOID W/ CABG
Vacuuming, mopping, shoveling snow, gardening, or pulling weeds, playing golf, moving furniture, lifting groceries/child/pets/laundry basket, anything that requires pushing or pulling
ACTIVITES THAT ARE ALLOWED w/ CABG
Assist with meal preparations
Talk with friends as long as they do not tire you
Walk on a flat surface
Shave and shower
Go to a movie or to church
Go to the grocery store with someone |
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Term
| CARE OF POST-OP CARDIAC SURGERY PATIENT |
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Definition
Pt on vent for 4-18hr post op
Chest tubes
Hemodynamic monitoring: CO-measures how well heart is working
Contin. EKG monitoring
Temp epicardial pacing wires
Normalize body temp: warming blankets
Monitor neuro status: 1-2 hrs post op (o2 to brain)
Monitor for fluid balance: at least 30cc uop/hr
Diuretics: check electrolytes several times in first few hours; esp potassium
Glucose may be ^
May need blood transfusion
Will have IV fluids |
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Term
| PATIENT/FAMILY TEACHING FOR PERMANENT PACEMAKER/ICD |
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Definition
-When to call the doc:
Received a shock
Device emits a tone
Second shock in same day
Persistent dizziness, lightheadedness
Before medical or dental procedure involving surgery
Plans to travel or move
-Safety measures:
Patient should carry an ID card for a pacer & ICD
Good idea for a medi-alert bracelet
Physician phone # and ER #
-know how to take B/P, pulse, settings of pacemaker |
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Term
| ANGINA: DEFINITION, CLASSIFICATIONS |
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Definition
-Angina Pectoris: Symptom that reflects transient inadequate blood flow ot the myocardium->This transient inadequate blood flow to the myocardium then produces ischemic pain.->There is a discrepancy between oxygen supply and demand->Exertion or strong emotions that cause increased sympathetic activity which increases oxygen demands
-Stable:
Transient discomfort or distressing sensation that is typically provoked by exertion
Promptly relieved by rest and the use of nitrates
There is NO change in frequency, duration, or precipitating factors in the preceding 60 days
-Unstable:
Preinfarction or Crescendo Angina
Transitory syndrome that is most often caused by significant heart disease
Discomfort when resting, or awakens the patient from sleep
Sudden development of moderate or severe discomfort on exertion with no history of angina
Marked increase in frequency or severity of discomfort
May not be relieved with rest or Nitroglycerin
-Variant/Prinzmetal's:
Caused by coronary artery spasm
Chest discomfort that occurs at rest***
Usually longer in duration than other types
Appears to be cyclic
Often occurs at same time each day (usually at night)
May have reversible S-T segment elevation
-Other types
Intractable or Refractory Angina severe incapacitating chest pain
Silent Ischemia objective evidence of ischemia (such as EKG changes on stress test) but NO reports of chest pain |
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Term
|
Definition
-Angina
Uncomfortable pressure, squeezing or fullness in substernum, can radiate across chest or to the medial aspect of one or both arms and hands, or to the jaw, shoulders, back or epigastrium. Radiation to arms and hands is described as numbness, tingling, or aching
Duration: 5-15 minutes
Precipitating Events and aggravating Factors physical exertion, emotional upset, eating large meal, or exposure to extremes in temperature
Alleviating Factors Rest, Nitroglycerin, and oxygen
-MI
Similar presentation as in angina pectoris. Often associated with shortness of breath, diaphoresis, palpitations, fatigue, and N/V.
Duration >15 minutes
Precipitating events and aggravating factors Emotional upset or unusual physical exertion occurring within 24 hours of symptom onset. Can occur at rest or while asleep
Alleviating Factors Morphine sulfate, reperfusion of coronary artery with thrombolysis or percutaneous coronary intervention |
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Term
|
Definition
Classic symptom of ischemic pain is retrosternal
Dizziness
Dyspnea
N/V
Feelings of doom or feeling as though they are “going to die”
Changes in vital signs: tachycardia or bradycardia, change in B/P, shortness of breath
Dysrhythmias may develop from the ischemia (most often PVC, PAC, Tachycardia) |
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Term
| ANGINA: MANAGMENT OF STABLE |
|
Definition
Aspirin and antianginals (nitro)
Beta blockers and blood pressure meds
Cholesterol and cigarettes (STOP)->Vasoconstrictors
Diet and Diabetes
Education and exercise (improves heart muscle and improves heart response to stress) |
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Term
| ANGINA: MEDICATIONS/TREATMENT |
|
Definition
Administration of nitrates (vasodilator), beta adrenergic blocking agents, calcium channel blockers
Angioplasty
Stenting
Bypass surgery |
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Term
| PATIENT/FAMILY TEACHING: NITROGLYCERIN |
|
Definition
Sit or lie down at onset of angina/chest pain
Place tablet under tongue and allow tablet to dissolve; do not chew
If pain not relieved within 5 minutes, take a second tablet. A third tablet can be used after another 5 minutes
Continuing pain after 3 tablets indicates need for immediate medical evaluation
Tablet will cause tingling sensation under the tongue
Rest for 15-20 minutes after taking NTG to avoid faintness
Tablet may be taken 10 minutes before an activity known to trigger an angina attack
**Gives patient Headache, orthostatic hypotension, and flushing |
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|
Term
| MI: TREATMENT/NURSING CARE |
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Definition
-RELIEVE PAIN, PROVIDE ADEQUATE OXYGENATION TO MYOCARDIUM, PREVENT PLATELET AGGREGATION, RESTORE BLOOD FLOW
-MANAGEMENT
Start o2 at 4L/min, get vitals, ASA, establish IV access, start cardiac monitoring, administer IV morphine 2-4 mg q5 mins until pain is controlled (also dilates arteries)
IV nitroglycerin infusion 10-20 mcg/min titrating according to pain and BP
Possibly beta blocker to decrease myocardial contractility and HR
Monitor px for SOB or increased HR, administer stool softeners to prevent constipation and straining (could cause arrhythmia)
-ABC’s of acute myocardial infarction
o Aspirin w/in 24 hrs and at discharge; Beta blockers w/in 24 hurs and at discharge; Cholesterol treatment; Discontinue smoking; Enzyme (ACE) inhibitors; Fast re-perfusion |
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Term
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Definition
No caffeine, diet low in cholesterol and fats, stay on ACEI for at least 6 weeks.
Get them into walking/exercise programs (monitor pulse* during exercise and avoid exercise after meals)
Smoking cessation programs
Support groups
Encourage family members and px to learn CPR
Provide emotional support: fear, anxiety, depression are common reactions to MI |
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Term
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Definition
Myoglobin increases 1-2 hrs after Mi, peaks 4-6 hrs, returns to normal 20-24 hrs
Troponin I is a very sensitive and most specific cardiac marker. It rises 3-6 hours after MI, peaks at 10-24 hours, and returns to normal in 5-7 days
CKMB- increases 3-9 hours after MI, peaks 12-18, normal after 2-3 days |
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Term
| CIRRHOSIS: TREATMENT/NURSING CARE |
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Definition
1 gram of protein per kg body weight, ample carbohydrates, low fat
2000-3000 calories/day of small, frequent meals
Check glucose
Multi-vitamins and trace elements
Promote oral hygiene
Restrict sodium if ascites present
Avoid acetaminophen, give reduced dose of opioids due to inability of liver to metabolize
Give antihistamines for pruritus from jaundice |
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Term
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Definition
Portal hypertension resulting in esophageal varices
Peripheral edema and ascites
Hepatic encephalopathy (hepatic coma, rising ammonia/old wine breath, asterizis/flapping of hands/bad handwriting, hyper DTRs; lactulose given to decrease ammonia levels)
Hepatorenal syndrome
Renal failure |
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Term
| ACETOMINOPHEN OVERDOSE: SIGNS/SYMPTOMS |
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Definition
Vomiting
RUQ pain
Jaundice
Oliguria
Encephalopathy
Remember acetaminophen is in Percocet, tylox, lorcet, etc… so consider that amount
Mucomyst is antidote and can prevent severe damange when given w/in 8 hrs of overdose |
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Term
| CHOLECYSTITIS/CHOLELITHIASIS: RISK FACTORS/CAUSES |
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Definition
-5 F's
Fat
Fertile
Fortyish
Female
Family History
-Cholecystitis: acute/chronic; usually b/c of gallstone lodged in cystic duct causing gallbladder distension
pain, tenderness, rigidity RUQ, n/v
-cholelithiasis: caused by stones/calculi in gallbladder (pigment/cholesterol stones)
jaundice if common bile duct obstruction; dark urine-bile pigments, feces gray/clay colored to lack of bile |
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Term
| ESOPHAGEAL VARICES: MANAGEMENT |
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Definition
Main goal is to avoid bleeding
Prevent increase in intra-abdominal pressure (sneezing, coughing, straining)
Avoid alcohol, aspirin, irritating foods
-Managing bleeding:
Vasopressin drugs
Nitroglycerine
Beta-adrenergic blockers
Balloon tamponade
Controls hemorrhage by mechanical compression of varices
Minnesota or Sengstaken-Blakemore tube : have both esophageal and gastric balloons.; Suction is turned on to the NG lumen to provide gastric decompression and to reduce the amount of ammonia procedure from the digestion of blood. The esophageal balloon can be left in place for 48 hrs. Major complication from using the tube is esophageal ulceration
Mouth care & oral suction
Safety precautions with tube; proper positioning
Administration of fresh, frozen plasma; packed RBCs, Vitamin K, h2 blockers, lactulose and neomycin to prevent hepatic encephalopathy from the break-down of blood and release of ammonia in intestine |
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Term
| PATIENT/FAMILY TEACHING: POST-OP ILEOSTOMY |
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Definition
Should drain continuously, if not draining for 3-5 hours there is a problem
What the stoma should look like: Shiny, red, will decrease in size after surgery |
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Term
| COMPLICATIONS OF IRRITABLE BOWEL DISEASE |
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Definition
Fistulas—Inflammatory channels which contain blood, mucus, pus or stool may develop between the bowel and the surface of the skin.
Abscess formation
Toxic Megacolon- inflammation extends into the muscles of the colon this leads to the colon being unable to contract. This causes colonic distention. If patient does not respond to medical management in 72 hours they must have a colectomy.
Increased risk colon cancer
Bleeding GI tract |
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Term
| PANCREATITIS: TREATMENT ACUTE |
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Definition
Antibiotic therapy to prevent infections.
Pain management
NPO status
Nasogastric suctioning,
TPN or tube feedings
Fluid and Electrolyte replacement
Improve oxygenation |
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Term
| PANCREATITIS: TREATMENT CHRONIC |
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Definition
Directed toward prevention and management acute attacks, pain relief, and management of exocrine and endocrine insufficiency.
Hazard of severe hypoglycemia with alcohol use is stressed to the patient and family members.
Pancreatic enzyme replacement is indicated in the patient with malabsorption and steatorrhea. |
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Term
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Definition
NPO INITIALLY!!!!
Explain Importance of bland, low-fat, high carbohydrate, high protein diet.
Avoid large meals
Avoid alcohol and caffeinated beverages.
Aware of Signs & Symptoms of Pancreatitis ---seek immediate treatment |
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Term
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Definition
Heartburn
Regurgitation
Feelings of a lump in the throat or food stopping
Painful swallowing
Dysphagia (difficulty in swallowing)
Bleeding
Cough, esp. at night (aspiration risk) |
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Term
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Definition
Antacids
Histamine receptor antagonists (H2 blockers): Cimetidine (Tagamet), Ranitidine (Zantac), Famotidine (Pepcid).
Antacids and H2 blockers primary treatment for mild GERD
Proton pump inhibitors: Esomeprazole (Nexium), Omeprazole (Prilosec): Long term use may lead to decreased calcium (Osteoporosis), heart issues |
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Term
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Definition
Chew slowly and thoroughly.
Decrease acidic or troublesome foods
Decrease alcohol and caffeine intake
Avoid late meals at night. No eating 2hrs before bedtime)
Eat small meals 5-6 times/day.
Don’t eat within 2hr of bedtime
Low fat diet
Eat protein at every meal to increase LES tone.
Sleep with HOB elevated. (Use 2 pillows)
Weight reduction.
Avoid foods that exacerbate symptoms; fats, caffeine, NSAIDS, nicotine, estrogen, progesterone, alcohol, spicy foods |
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Term
| GASTRIC BYPASS SX: POST PROCEDURE INSTRUCTIONS |
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Definition
-NURSING INTERVENTIONS
HOB needs to be elevated at all times following surgery.
PCA’s and epidurals are useful since appropriate narcotic doses are more difficult to calculate in obese people.
Do Not manipulate the NG tube.
Other issues: IV access; IM injections
Promote early ambulation, incentive spirometer use |
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Term
| DIETARY GUIDELINES FOR WEIGHT LOSS SURGERIES |
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Definition
- oral intake resumed after bowel sounds return
- remember that stomach is only about the size of an egg
- proceed from ice-> clear liquids ->full liquids ->gradually proceeds to semi-normal diet
- educate to eat slowly
- No straws (air, pressure)o carbonation )
- Liquids are not to be consumed within 30 min before or after a meal because of volume limitations.
- Chewable vitamins & calcium supplements (Tums)
- Consume protein first
- Important if you eat too much or too fast you can stretch out your pouch resulting in less weight loss.
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Term
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Definition
illness raises blood sugar
take meds as usual
call MD w/ blood sugar reports and check urine for ketones
may need to supplement w/ reg insulin
oral intake depends on s/s
cortisol ^ blood sugar levels: go to ER if cant manage glucose at home: may need insulin if not already on it |
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Term
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Definition
Goal: provide essential nutrients & calories, achieve reasonable weight, prevent wide blood glucose fluctuations, decrease lipid levels
Food guide pyramid
Glycemic index – how quickly foods raise blood glucose levels
-For Type I---consistency in amounts of food, and time intervals between eating; snacks to prevent hypoglycemia
----with intensive insulin therapy there is more flexibility in eating.
-----for the young patient, enough calories for growth & development needs,& maybe for weight gain
-For Type II---limit calories to decrease weight
Regular meals more manageable for work of pancreas
Glucose control, within normal ranges, is the goal.
MUST MONITOR BLOOD GLUCOSE AFTER EATING NEW FOODS |
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Term
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Definition
-short term: hypoglycemia
-LONG TERM
Neuropathy, Retinopathy, Lipodystrophy, Nephropathy |
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Term
| DM: ORAL ANTIHYPERGLYCEMICS |
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Definition
| Oral diabetes medications -- diabetes pills -- help control blood sugar levels in people whose bodies still produce some insulin (the majority of people with type 2 diabetes). These diabetes drugs are usually prescribed to people with type 2 diabetes along with recommendations for making specific dietary changes and getting regular exercise. |
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Term
| INSULIN TYPES/PEAKS/DURATION |
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Definition
-FAST ACTING
Lispro (Humalog)
Aspart (Novolog)
Takes effect 5-10 minutes after injection.
Duration 3-5 hours
******** Regular was once the only insulin that was used for IV.
Lispro can be mixed with 0.9% saline or Dextrose and given the intravenous route.
Regular only insulin for IV Push
-REGULAR/SHORT ACTING
Regular
Analogs: Humulin R, Novolin R
Action within 30 minutes
Peak 2-4 hours
Duration 3-6 hours
Inject 30- 60 minutes before meals.
May be given IV
May be mixed with other insulins
-INTERMEDIATE
NPH – Humulin N
NPH – Novolin N
Lente – Humulin L
Lente - Novalin L
Onset 1.5 to 2.5 hours
Peaks: 4 to 12 hours
Duration: 18-22 hours
-LONG ACTING
Insulin glargine (Lantus)
High dose –Ultralente (Humulin U)
Effective for 18-24 hours
Does not peak
Do not mix in syringe with other insulins.
Typically given at bedtime or at the same time each day.
Used in conjunction with multiple dose insulin.
Sometimes referred to as the “poor man’s pump”
-COMBINATIONS
Mimic normal insulin secretion at meal time.
First on market were Humulin 70/30 (70 units NPH and 30 units regular) and Novolin 70/30.
Newer mixed insulin:
Humalog 75/25
Novolog 75/25
Both have a rapid onset and intermediate duration.
Inject immediately before a meal.
Do not give IV
Do not use with a pump.
Don’t mix with other insulin products
-INHALED
Rapid onset of action
Duration of action similar to regular
Requires 10 times the subcutaneous dose
Not to be used in children. |
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Term
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Definition
Reason to administer insulin, type of insulin, onset, duration & peak time(s).
Dosage of insulin
Rotate sites; lipodystrophy
Care of injection supplies & insulin
How to draw up insulin, how to inject
How to properly dispose of needles
-PUMP THERAPY
Most closely resembles how the body delivers insulin.
Allows more flexibility with the timing of meals.
Insulin absorption less variable day to day.
First pumps used only regular, now lispro (rapid acting) is also used.
Basal rate with bolus before meals. |
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Term
| ADDISON'S DISEASE: MANAGEMENT |
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Definition
Stress dosing
Fever > 100 and/or Vomiting and diarrhea
Double the glucocorticoid dose
Major trauma and/or Surgical procedures
200mg/day
Insufficient drug therapy
Anorexia, n/v, diarrhea, weakness, depression, dizziness, weight loss
Excessive drug therapy (CAN PUT PATIENT IN CUSHING'S LIKE STATE)
Rapid weight gain, round face, edema, hypertension
- give salt for to retain fluid to help w/ hypotension; corticosteroids
-Nursing care: promote fluid balance
-Medications
Take with food
Glucocorticoids: Take as directed
Mineralocorticoids: Take in am
Medic Alert Bracelet
Monitor for stressors |
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Term
| ADDISON'S DISEASE: PATIENT/FAMILY TEACHING |
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Definition
Life long replacement of adrenal cortex
Increase salt intake in times of illness, very hot weather, and other stressful events
Alert dentists and other health care members about the use of corticosteroids and wear a medical alert bracelet
The development of edema or weight gain may signify too high a dose of the hormone
Postural hypotension and weight loss frequently signify too low of a dose. |
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Term
| MANAGMENT OF HYPERCALCEMIC CRISIS |
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Definition
Serum Ca++ >15mg/dl life threatening
Can cause cardiac dysrhythmias
Medical management
Rehydrate with IVs
Diuretics to promote Ca++ excretion
Phosphate orally
Dialysis, calcitonin, cytotoxic agents
In emergency, Calcitonin & corticosteroids help move Ca++ to bone |
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Term
| CUSHING's: SIGNS/SYMPTOMS |
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Definition
Thinning hair
Facial plethora
Acne
Moon face
Buffalo hump
Supraclavicular fat pad
Increased body and facial hair
Proximal muscle wasting
Purple striae
Pendulous abdomen |
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Term
| CUSHING'S: NURSING CARE/MANAGMENT |
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Definition
-NURSING CARE
Dietary Alterations: Decrease sodium intake and increase intake of potassium, protein, and calcium
Monitor Intake and Output
Obtain a daily weight
Assess for signs of hypervolemia: edema, distended neck veins, shortness of breath, presence of adventitious breath sounds.
Maintain a safe environment to minimize the risk of pathological fractures and skin trauma
Prevent infection by performing frequent hand hygiene
Encourage physical activity within the client’s limitations
Monitor for and protect against skin breakdown and infection
-MANAGMENT
– Diet
Restrictions
Calories
Sodium
Lipids
Cholesterol
Activity
Usually obese if untreated
Muscle weakness
Chronic fatigue
Referrals for Cushing’s: Physical Therapy, Social Services, Psychologist |
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Term
| CUSHING'S: TREATMENT OF PITUITARY ADENOMAS |
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Definition
-Trans-sphenoidal adenomectomy
Surgical removal of tumor
Nostril approach for pituitary gland
80% successful
ACTH levels drop 2x
Given a synthetic form of cortisol for 1 year
-Radiotherapy
Trans-sphenoidal surgery failed
Not candidates for surgery
Radiation given over 6 weeks
40-50% see improvement |
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Term
| MANAGEMENT OF HYPERTHYROIDISM |
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Definition
-Radioactive Iodine ( preferred for elderly)
Destroys overactive thyroid cells
Poss. Thyroid storm – watch closely
-Anti-thyroid Medications---
PTU, Tapazole
Blocks utilization of iodine & synthesis of thyroid hormone à decreased thyroxin
Caution for agranulocytosis – sore throat
Thyroid hormone to rest thyroid gland—Synthroid, Cytomel
SSKI or Lugol’s Sol. (Iodine)
Decreases thyroid vascularity
Beta adrenergic blockers – propranolol
Decreases CNS effects esp. CV |
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Term
| POST-OP THYROIDECTOMY PATIENT CARE |
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Definition
BREATHING ISSUES: KEEP TRACH TRAY IN ROOM; WATCH FOR HYPOCALCEMIA (removal of parathyroid glands); CHECK BACK OF NECK FOR BLEEDING
Semi Fowler’s position, head supported
Analgesics for pain
O2
IV until PO – cold foods best then soft diet
Check dressing – under dsg: drainage, pressure, fullness
Check respirations – tracheotomy set
Check voice changes – rest voice, poss. nerve damage
Increased humidification
Surgical Complications – hemorrhage, hematoma, edema of glottis, injury to laryngeal nerve, parathyroid injury à laryngospasm à obstructed airway
•Post OP Instructions
Care of Surgical incision and drain
Thyroid Medications
Take artificial thyroid hormone (Synthroid) Labs will be checked to adjust dosage – Takes 6-8 weeks to get blood levels.
-Potential Surgical Risks And Side Effects
At risk for bleeding, infection, or development of scars.
Risk of damage to laryngeal nerves, which can cause a change in the voice, hoarseness and difficulty swallowing and/or eating.
Temporary low blood levels of calcium (about 30% of the time) Rarely permanent but may require supplements
Positive "frozen section" could require another surgery
•At Home
Eating: Most people prefer liquids or soft foods for 3-7 days following surgery.
Bathing: 24 hours following the removal of the drain, you may bathe or shower normally -- "pat dry" surgical site.
Medications: May take an antibiotic for 5 days post-op
Pain medication -- Tylenol® or prescription-strength medicine
No aspirin, Advil®, Motrin®, ibuprofen or NSAIDS until stitches are removed ( 7-10 days )
Driving: May not drive for at least 1-2 weeks following surgery for safety |
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Term
| SAFETY PRECAUTIONS/PATIENT TEACHING: SMALL POX |
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Definition
| To prevent the possibility of contracting smallpox, a chemoprophylactic injection was created in the late 1700’s. This vaccine is made from a living virus that is in the “pox” family. Since this vaccine is made from an actual living virus, the site will have to be cared for in order to prevent the chance spreading. It will not give you smallpox; it will simply help build your immunity to the “pox” viruses. This immunity will last for three to five years and then it will begin to decrease in the years following. A person can receive an additional vaccine increasing the immunity again when needed. If a person catches smallpox, this vaccine can also be given in order to minimize the severity of the disease process. The smallpox immunization is given differently than most others. A two-pronged needle (bifurcated) is dipped into the live vaccine solution. This needle is then used several times to prick the skin in the same area (usually the upper arm). If the vaccination is successful, a red and itchy bump will appear within four days. This lesion will then form a blister, fill with pus and then drain. During the next week, the site will dry up and scab over. After the scab falls off, a small scar will be seen. This preventative measure is usually not offered to the public since the disease was eradicated. The CDC states that enough smallpox immunizations are kept on hand to vaccinate everyone in the United States in the case of an emergency. |
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Term
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Definition
• There are three different types of anthrax with different sign’s and symptoms and courses of illness. Cutaneous Anthrax, which is in the skin occur when the actual spore get into a cut on the skin. Most anthrax infections happen when people make physical contact with contaminated animal products such as wool, bone, hair, and hide. The infection occurs once the bacteria enters through a scratch or cut in the skin. The infection begins after 3-5 days after exposure. It looks like an insect bite; it’s raised and itchy but doesn’t hurt. After 24 hours it then progresses to a vesicle, a fluid or air filled sac, which then progresses to an ulcer, opening of the skin. The distinct feature of this ulcer is that the middle is black because it’s dying. Also, lymph nodes may swell at this stage. If it is not treated then it will spread to the lymph nodes and the bloodstream.
• The second type of anthrax is inhalation anthrax. This occurs when the spores are inhaled into the lungs. Anthrax in the lungs spreads to the immune system and lymph nodes. It then causes bleeding in the chest as it spreads through the body. The first course of symptoms for inhalation anthrax is flu like symptoms that last a few hours- days. Also, fever, fatigue, a cough or chest pain may occur. After 3 days it gets worse with shortness of breath, chills and then death. The average time frame from signs of flu like symptoms to death was only 3 days. Inhalation anthrax is often fatal.
• The third type of anthrax is gastrointestinal anthrax. This occurs when you eat meat that has the spores in it and you digest it. Your digestive system then inflames. Signs and symptoms that occur during this time are dark stool, vomit that is blood tinged, tender abdomen, etc. The first set of symptoms include fever, severe abdominal pains, loose watery bowel movements, bloody diarrhea and vomiting with blood. Once these signs and symptoms are present after 2-4 days fluid spreads to the abdomen. If the patient lasts 10-14 days these signs and symptoms subside. |
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Term
| BOTULISM: PREVENTION/SIGNS/SYMPTOMS |
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Definition
o Prevention:
• To date, there is no vaccine for botulism. Our best means of treatment is prevention. Learning how to can and preserve the foods we eat is the most important step in preventing botulism. Honey should not be fed to infants because it has been identified as a common source of infant botulism. There is however an antitoxin that can be given by any health-care provider when they contact a State Health Dept or the CDC’s 24 hour hotline 1(404) 329-2888. The antitoxin can only deactivate the serum toxin that is unbound to nerve endings. The earlier the treatment is given the lesser the neurological tissue damage. There is a risk for sensitivity and testing needs to be performed before administration of the 10ml antitoxin via IV. Antitoxin has a half-life of 5-8 days, so only one dose is given. This antitoxin is of animal (equine) nature and because of fear that anaphylactic reaction may be worse in infants, a human derived form called Botulism Immune Globulin has been developed and is in trial in California
• Signs and Symptoms:
o All of the symptoms are related to the muscle paralysis caused by the bacterial neurotoxin. The classic signs are double vision, blurred vision, drooping eyelids, slurred speech, difficulty swallowing, dry mouth and muscle weakness. Constipation may also be a common symptom of botulism poisoning. Upon examination, the gag reflex and deep tendon reflexes may be decreased or absent.
o Infants may appear lethargic, weak and floppy, feed poorly, become constipated and have a weak cry. In infants, the constipation may be the first sign to appear.
o If untreated, symptoms may progress to paralysis of the respiratory muscles, arms, legs and trunk.
o In food borne botulism, the symptoms generally appear 18 to 36 hours after eating the contaminated food, but may be seen as early as 6 hours after eating or as long as 10 days.
• Treatment:
o Treatment – Treatment for patients with Botulism is supportive. There is an antitoxin to limit the amount of never damage that will occur. But it must be given quickly and if the patient is improving from the paralysis, it is held. Patients will probably be in the ICU. Standard precautions are used unless the patient has flaccid paralysis from suspected meningitis. They require droplet precautions. They are fed by parenteral nutrition, require a mechanical ventilator, and should be assessed for infections. There is a high chance for respiratory failure so infants should be placed in a reverse Trendelenburg position with cervical support. The position is thought to reduce the chance of oral mucus entering the airway. The study was inconclusive in adults, but it did reveal for adults that patients that a 45 degree angle had more respiratory complications than those places at the 20 degree Trendelenburg position. Botulism patients are at a great risk for aspiration therefore assessment of the cough and gag reflex is critical. Antibiotics have no effect on botulism, but may be given to prevent secondary infections from occurring. Clindamycin and Aminoglycosides antibiotics are contraindicated because they increase the neuromuscular blockade. There is an antitoxin that can be given for post exposure prophylaxis; however, there is a limited supply. There is an immunization for certain population. CDC workers who work with the toxin receive an investigative botulinum toxoid. It protects against types A, B, C, D, and E. Military personnel also receive the immunization. The general public is not immunized because of the use of medicinal botulinum toxin. It is not used to treat post exposure because several vaccinations are need for immunity. |
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Term
| RICIN INHALATION: SIGNS/SYMPTOMS/TREATMENT |
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Definition
Death can occur from 36 to 72 hours after exposure depending on route of absorption
Respiratory distress, fever, nausea, cough, pulmonary edema, which may lead to cyanosis of the skin
No antidote
Most important factor is prevention
Goal is to get it out of body as quick as possible—Decontamination**
Victims with symptomatic Ricin poisoning should be treated using supportive medical care to minimize the effects of the poisoning. The medical care would depend on the route by which the victim was poisoned. Care could include:
Respiratory support
IV fluid therapy
Medications for Seizures and Low Blood Pressure
Flushing the stomach with activated charcoal
Eye irrigation |
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Term
| SARIN: GENERAL ANTIDOTES/TREATMENT CHEMICAL NERVE AGENTS |
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Definition
Atropine and pralidoxime chloride (2-PAM Cl) are antidotes for nerve agent toxicity.
2-PAM Cl must be administered within minutes to a few hours in order to be effective.
Administer Atropine every 5 to 10 minutes until secretions are dry. Do not administer antidotes preventively.
Benzodiazepines are administered for seizures.
If the eye is exposed, immediately remove the person from the source of exposure, but do not administer antidote.
Instead, if liquid, flush the eyes with water for 5 to 10 minutes.
If vapor, do not flush eyes. Do not cover with bandages, and seek medical attention immediately.
If ingested, do not induce vomiting and do not give anything by mouth. If able to get medical attention within 30 minutes, consider gastric lavage. Administer antidotes as required.
If inhaled, do not administer antidotes. Ventilator will be needed for moderate to serious inhalations.
Administer O2 for dyspnea and shortness of breath.
Suction secretions from mouth, nose, and respiratory tract.
If skin is exposed, decontaminate hair and clothing. Antidote administered only if there is localized sweating and muscular twitching at exposed area. |
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Term
| TYPHOID: TRANSMISSION/TREATMENT |
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Definition
- Transmission: most common mode of transmission of Typhoid Fever is the fecal-oral route, usually result of drinking water being contaminated by sewage
- The main treatment-immediate antibiotic (broad spectrum antibiotics; Chloramphenicol was the original drug of choice for in the past, but because of rare serious side effects, chloramphenicol has been replaced by other effective antibiotics; Cipro, Ceftriaxone; ampicillin, trimethoprim-sulfamethoxazole)
- The choice of antibiotics needs to be guided by identifying the geographic region where the organism was acquired and the results of cultures once available. (Certain strains from South America show a significant resistance to some antibiotics.)
- If relapses occur, patients are retreated with antibiotics.
- Supportive therapy for Typhoid is aimed at managing symptoms. These supportive therapies include preventing/treating dehydration, which is a result of a prolonged fever and diarrhea, by IV fluid replacement therapy as well as drinking plenty of fluids with electrolytes such as Pedialyte or Gatorade. Also eating a healthy diet helps replace the nutrients that are lost as a result of the illness; non-bulky, high-calorie meals are recommended.
- Compliant patients with uncomplicated disease may be treated on an outpatient basis. They must be advised to use strict hand washing techniques and to avoid preparing food for others during the illness course. Hospitalized patients should be placed in contact isolation during the acute phase of the infection. Feces and urine must be disposed of safely.
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Term
| PLAGUE: TRANSMISSION/TREATMENT |
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Definition
It is caused by the bacterium Yersinia pestis.
The plague is transmitted via fleas that live on rodents. A human often becomes infected after being bitten by a rodent flea that is carrying the plague bacterium or by handling an infected animal.
Direct contact with infected tissues or fluids from handling sick or dead animals allows transmission. Respiratory droplets from cats and humans with pneumonic plague can also serve as a source of infection
Antibiotics are crucial. They need to be givin within the first 24 hours, as this reduces the chance of death.
The main ones for this are: streptomycin, gentamicin, tetracyclines, and chloramphenicoal, with streptomycin being the drug of choice.
Wear close fitting surgical mask, gowns, and gloves. Antibiotics for 7 days will protect those that had close contact with any infected person. The patient will ALWAYS be hospitalized upon diagnosis of plague or suspection of plague.
Lab tests and cultures are to be ran on the blood |
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Term
| VIRAL HEMORRHAGIC FEVER: MODE OF INFECTION |
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Definition
Most viruses that cause viral hemorrhagic fevers are zoonotic, meaning that the virus naturally lives inside an animal (reservoir host) or arthropod (vector.) The virus relies totally on the host for survival and replication. Viruses causing VHF are usually transmitted to humans when they come into contact with infected hosts, such as rodents. Most commonly this happens when humans come into contact with urine, feces, or saliva of the infected rodents. Spiders, mosquitoes, and ticks can be vectors, or carriers, that transmit the virus from one host to another. These spread the virus by biting humans or livestock.
Some viruses that cause VHF can be spread by secondary transmission, meaning from one person to another. This happens when one person is in close contact with an infected person or their body fluids. Also, they can be spread by someone using contaminated syringes or needles. Some examples of viruses that cause VHF and can be spread by secondary transmission are Ebola, Marburg, Lassa and Crimean-Congo viruses. |
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Term
| E.COLI: SIGNS/SYMPTOMS/PREVENTION |
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Definition
Acute abdominal pain
Diarrhea that is sudden and severe, may be bloody (cardinal sign)
Fever
Gas
Loss of appetite
Stomach Cramping
Vomiting (rare) |
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Term
| CHLORINE POISONING: SIGNS/SYMPTOMS/PREVENTION |
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Definition
Small Amounts:
Burning of eyes, nose, and throat
Shortness of breath
Cough and wheezing
Tearing of the eyes
Large Amounts:
Lining of the throat and lungs swell
Vaccine/prevention/chemoprophylaxis – If exposed to an inhaled nerve toxic agent you should leave the area immediately, dispose of any clothing that could be contaminated, wash the body with soap and water, and seek emergency help. There’s no specific antidote for chlorine poisoning and treatment is just supportive. Most exposed persons get well. Persons who have experienced serious symptoms may need to be hospitalized. Responders should wear self-contained breathing apparatus, respirators or faceshield, splash-proof safety googles, appropriate or chemical protective clothing, and butyl rubber gloves to decrease chance of exposure. |
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Term
| DEFINITION OF BRAIN DEATH |
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Definition
| Having irreversible loss of brain function as indicated by a persistent flat electroencephalogram; "was declared brain dead". |
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Term
| GENERAL INFO ABOUT ORGAN DONATION |
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Definition
Transplant success rates increase when organs are matched between members of the
same ethnic and racial group. A patient is less likely to reject a kidney if it is donated by an individual who is genetically similar. Therefore, a lack of organs donated by minorities can contribute to death and longer waiting periods for transplants for minorities.
Donation does not disfigure the body or prevent an open casket funeral.
Donated organs are removed in a sterile, surgical procedure, similar to open heart
surgery, in a hospital operating room by skilled surgeons.
Organ and tissue donation is considered only after all efforts to save the patient’s life
have been exhausted and death has been legally declared.
Organ recovery coordinators will always explain the donation options to the family
before requesting permission from the next of kin to recover the organs for
transplantation. They will never go against the wishes of the family.
There is no major religion in the U.S. that is opposed to organ and tissue donation. In
fact, many religions endorse organ and tissue donation as an act of charity.
Few people are too old or too young to donate. Currently there are no age limits for
donors. At the time of your death, medical professionals will determine whether your
organs are transplantable.
Organs that can be transplanted are the heart, kidneys, pancreas, lungs, liver and
intestine.
The organ allocation system is blind to wealth, celebrity and social status. Donated
organs are placed in recipients based on best medical match and most critical need. |
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Term
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Definition
– Lispro (Humalog)
– Aspart (Novolog)
– Takes effect 5-10 minutes after injection.
– Duration 3-5 hours
– Lispro can be mixed with 0.9% saline or Dextrose and given the intravenous route.
– Regular only insulin for IV Push |
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Term
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Definition
– Regular
– Analogs: Humulin R
Novolin R
– Action within 30 minutes
– Peak 2-4 hours
– Duration 3-6 hours
– Inject 30- 60 minutes before meals.
– May be given IV
– May be mixed with other insulins |
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Term
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Definition
– NPH – Humulin N
– NPH – Novolin N
– Lente – Humulin L
– Lente - Novalin L
– Onset 1.5 to 2.5 hours
– Peaks: 4 to 12 hours
– Duration: 18-22 hours |
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Term
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Definition
– Insulin glargine (Lantus)
– High dose –Ultralente (Humulin U)
– Effective for 18-24 hours
– Does not peak
– Do not mix in syringe with other insulins.
– Typically given at bedtime or at the same time each day.
– Used in conjunction with multiple dose insulin.
– Sometimes referred to as the “poor man’s pump” |
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Term
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Definition
– Mimic normal insulin secretion at meal time.
– Both have a rapid onset and intermediate duration.
– Inject immediately before a meal.
– Do not give IV
– Do not use with a pump.
– Don’t mix with other insulin products |
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