Pathology flashcard

A benign anechoic structure in wall of cervix with posterior enhancement?

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nabothian cyst

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Which cancerous tumor most associated with vagina?

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Adenocarcinoma

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Is dysgerminoma benign or malignant?

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malignant

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Is a peritoneal inclusion cyst considered functional ovarian cyst?

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No

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Who are fibroids most common in?

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African american women

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Ice burg sign associated with what?

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Demoid

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True or false leiomyosarcoma is a malignant counterpart of a leiomyoma

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True

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What is the most common gynecological cancer in north america, most commonly occurs post menopausal?

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Endometrial carcinoma

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What is ectopic endometrial tissue?

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Endometriosis

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What kind of cyst occurs in endometriosis that ultrasound can see?

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Chocolate cyst, endometrioma

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Name of cyst associated with ovarian hyperstimulation and stationary atrophic disease (functional cyst)?

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Theca lutein cyst

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Hormone that can benefit women by reducing risk of endometrium but can cause breast cancer?

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progesterone

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Which benign ovarian stromal tumor is most often associated with ascites?

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Fibroma

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Fibroid that bulges outwards for uterine peritoneum?

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Subserosal

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Which uterine fibroid push into endometrium and cause endometrium to be displaced?

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Submucosal

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What kind of uterine fibroid is attached by a stock?

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Pedunculated

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Uterine fibroid going within myometrium?

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Intramural

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Inflammation of the ovaries?

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Oophoritis

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Uterine fibroid within endometrium typically on stock?

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Intracavitary

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String of pearl sign associated with what?

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PCOS

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Carbon monoxide (CO)

Carbon monoxide (CO) has a much stronger bond to Hgb than oxygen does.  Consequently, CO displaces oxygen from Hgb, causing hypoxia that is not reflected by a pulse oximeter reading.  The nurse's primary action is to administer highly concentrated (100%) oxygen using a nonrebreather mask at 15 L/min in order to reverse this displacement of oxygen.

The rule of nines

The rule of nines is an estimated percentage of total body surface area burned in an adult.  The head is 9%, anterior torso 18%, posterior torso 18%, each arm 9%, each leg 18%, and groin 1%.  The rule of nines is often used at the initial evaluation and should be recalculated within the first 72 hours

external beam radiation therapy

Key measures of skin care that clients receiving teletherapy should take include:

Protect the skin from infection by not rubbing, scratching, or scrubbing

  • Wear soft, loose-fitting clothing
  • Use soft, cotton bed sheets and towels
  • Pat skin dry after bathing
  • Avoid applying bandages or tape to the treatment area

Cleanse the skin daily by taking a lukewarm shower

  • Use mild soap without fragrance or deodorant
  • Do not wash off any radiation ink markings

Use only creams or lotions approved by the health care provider (HCP)

  • Avoid over-the-counter creams, oils, ointments, or powders unless specifically recommended by the HCP as they can worsen any irritation

Shield the skin from the effects of the sun during and after treatment

  • Avoid tanning beds and sunbathing
  • Wear a broad-brimmed hat, long sleeves, and long pants when outside
  • Use a sunscreen that is SPF 30 or higher

Avoid extremes in skin temperature

  • Avoid heating pads and ice packs
  • Maintain a cool, humid environment for comfort

Methadone

Early signs of toxicity include nausea/vomiting and lethargy. A client who falls asleep with stimulation (is obtunded) requires additional observation/monitoring.  Sedation precedes respiratory depression, a life-threatening complication of severe toxicity. A reading of 90% is low and indicates inadequate depth or rate of respiration with possible respiratory depression. Itching sensation (pruritus) is an expected finding.

EpiPen

The EpiPen is designed to be administered through clothing with a swing and firm push against the mid-outer thigh until the injector clicks.  The position should be held for 10 seconds to allow the entire contents to be injected.  The site should be massaged for an additional 10 seconds.  Timing is essential in the delivery of epinephrine during an anaphylactic reaction.  The nurse should administer the medication immediately on the playground without removing the child's clothing.  Any delays can cause client deterioration and make maintenance of a patent airway difficult. IV epinephrine is not administered outside the hospital setting.  It requires cardiac monitoring and is indicated in clients with profound hypotension (shock) or those who do not respond to intramuscular epinephrine and fluid resuscitation.

To perform wound irrigation

To perform wound irrigation:

  • Administer the analgesic 30-60 minutes before the procedure to allow medication to reach therapeutic effect.
  • Don a gown and mask with face shield to protect from splashing fluid and sterile gloves to maintain surgical asepsis and prevent infection.
  • Fill a 30- to 60-mL sterile irrigation syringe with the prescribed irrigation solution.
  • Attach an 18- or 19-gauge needle or angiocatheter to the syringe and hold 1 in (2.5 cm) above the area.
  • Use continuous pressure to flush the wound, repeating until drainage is clear.
  • Dry the surrounding wound area to prevent skin breakdown and irritation.

Immunization history is reviewed to determine tetanus vaccination status. Typically, a tetanus vaccination is administered if the client has not had one within the last 5-10 years, depending on the contamination level of the wound.

Cardiopulmonary resuscitation (CPR)

For high-quality adult cardiopulmonary resuscitation, compressions should be in the center of the chest; at a rate of 100-120/min; and at least 2 in (5 cm) but no more than 2.4 in (6 cm) deep for adequate perfusion without unnecessary client injury.  Compression interruption should be minimized (eg, 30 compressions to 2 rescue breaths).

The sequence of basic life support includes assessing responsiveness by tapping or gently shaking the client, activating the emergency response system (eg, calling a code), simultaneously assessing pulse and breathing for no more than 10 seconds, initiating chest compressions if no pulse is felt, and notifying the health care provider.

Two important modifications for cardiopulmonary resuscitation of a pregnant client include performing chest compressions slightly higher on the sternum and displacing the uterus to the client's left side.

 

** Norepinephrine (Levophed) is a vasopressor used to increase stroke volume, cardiac output, and MAP.  Titrating a norepinephrine infusion upward to maintain the MAP within normal limits (>65 mm Hg) is an appropriate nursing action for a client in anaphylactic shock.

 

**During mass casualty events, the goal is the greatest good for the greatest number of people.  Priority is given to clients with life-threatening injuries who have good prognoses after minimal intervention.

 

** A low pressure alarm for an arterial line can indicate the presence of hypotension or disconnected tubing.  Hemorrhage can rapidly occur with a disconnected arterial catheter line.  The nurse should check the client for the presence of hypotension and its causes before troubleshooting the system.

           

** Indications of a need for IV isotonic fluids include capillary refill more than 3 seconds and mottling, prehydration before an epidural anesthesia, and inadequate urine output and tachycardia due to hyperemesis gravidarum.

priority action after placing a subclavian central venous catheter

The priority action after placing a subclavian central venous catheter is to check the results of the chest x-ray to ensure that the catheter tip is placed correctly in the superior vena cava.  Obtain verification before using the catheter as perforation of the visceral pleura can occur during insertion and lead to an iatrogenic pneumothorax or hemothorax.  Although these complications are rare, due to the use of ultrasound to guide insertion, if present, the TPN would infuse into the pleural space.

Incorrect placement of a subclavian central venous catheter can result in an iatrogenic pneumothorax or hemothorax.  The priority is to check the results of the chest x-ray to verify that the catheter tip has been placed correctly in the superior vena cava.  Other appropriate actions include attaching a filter to the IV tubing, monitoring baseline and fingerstick BG levels every 6 hours, and programming the electronic infusion device to ensure an accurate and consistent hourly infusion rate.

monitor the baseline blood glucose (BG) level and fingerstick BG every 6 hours while the client is receiving TPN; it should be maintained in the range of 140-180 mg/dL (7.8-10.0 mmol/L) for a hospitalized adult client.

Third-spacing 

Third-spacing of fluids can occur 24-72 hours after extensive abdominal surgery as a result of increased capillary permeability due to tissue trauma.  It occurs when too much fluid moves from the intravascular into the interstitial or third space, a place between cells where fluid does not normally collect (ie, injured site, peritoneal cavity).  This fluid serves no physiologic purpose, cannot be measured, and leads to decreased circulating volume (hypovolemia) and cardiac output.

The priority intervention is to assess vital signs as the manifestations associated with third-spacing include weight gain, decreased urinary output, and signs of hypovolemia, such as tachycardia and hypotension.  If third-spacing is not recognized and corrected early on, postoperative hypotension can lead to decreased renal perfusion, prerenal failure, and hypovolemic shock

tachycardia and hypotension, which are classic signs of hypovolemia.

ventricular tachycardia (VT)

ventricular tachycardia (VT) can be pulseless or have a pulse.  Treatment is based on this important initial assessment.  VT with a pulse should be further assessed for clinical stability or instability.  Signs of instability include hypotension, altered mental status, signs of shock, chest pain, and acute heart failure.

The unstable client in VT with a pulse is treated with synchronized cardioversion.  The stable client in VT with a pulse is treated with antiarrhythmic medications (eg, amiodarone, procainamide, sotalol).

Neurogenic shock, a distributive shock. 

Neurogenic shock, a distributive shock. 

Vascular dilation with decreased venous return to the heart is present due to loss of innervation from the spine.  Classic signs/symptoms are hypotension, bradycardia, and pink and dry skin from the vasodilation.  Neurogenic shock usually occurs in cervical or high thoracic injuries (T6 or higher).

Systolic blood pressure should remain at 80 mm Hg or above to adequately perfuse the kidneys.  Administration of fluids is a priority to ensure adequate kidney and other organ perfusion.

Positive end-expiratory pressure (PEEP)

Positive end-expiratory pressure (PEEP) applies a given pressure at the end of expiration during mechanical ventilation.  It counteracts small airway collapse and keeps alveoli open so that they can participate in gas exchange.  PEEP is usually kept at 5 cm H2O (3.7 mm Hg).  However, a higher level of PEEP is an effective treatment strategy for acute respiratory distress syndrome (ARDS), a type of progressive respiratory failure that causes damage to the type II surfactant-producing pneumocytes that then leads to atelectasis, noncompliant lungs, poor gas exchange, and refractory hypoxemia.

High levels of PEEP (10-20 cm H2O [7.4-14.8 mm Hg]) can cause overdistension and rupture of the alveoli, resulting in barotrauma to the lung.  Air from ruptured alveoli can escape into the pulmonary interstitial space or pleural space, resulting in a pneumothorax and/or subcutaneous emphysema.

Rapid response team

Recommended criteria to consider:

  • Any provider worried about the client's condition OR
  • An acute change in any of the following:
    • Heart rate <40 or >130/min
    • Systolic blood pressure <90 mm Hg
    • Respiratory rate <8 or >28/min 
    • Oxygen saturation <90 despite oxygen
    • Urine output <50 mL/4 hr
    • Level of consciousness

Nursing interventions to control ICP

Nursing interventions to control ICP include:

  • Elevating the head of the bed to 30 degrees with the head/neck in a neutral position to reduce venous congestion 
  • Administering stool softeners to reduce the risk of straining (eg, Valsalva maneuver)
  • Managing pain well while monitoring sedation
  • Managing fever (eg, cool sponges, ice, antipyretics) while preventing shivering
  • Maintaining a calm environment with minimal noise (eg, alarms, television, hall noise) 
  • Ensuring adequate oxygenation
  • Hyperventilating and preoxygenating the client before suctioning; reducing CO2 (a potent cerebral vasodilator) by hyperventilation induces vasoconstriction and reduces
  •  Stimulation increases oxygen metabolism within the brain, increasing the risk for irreversible brain damage in increased ICP.  Limit performing interventions unless absolutely necessary and avoid performing interventions in clusters.

Suction a maximum of 10 seconds and only as necessary to remove secretions.  Prolonged suctioning increases ICP.

Recently extubated clients

Recently extubated clients are at high risk for aspiration, airway obstruction (laryngeal edema and/or spasm), and respiratory distress.  To prevent complications, clients are placed in high Fowler position to maximize lung expansion and prevent aspiration of secretions Warmed, humidified oxygen is administered immediately after extubation to provide high concentrations of supplemental oxygen without drying out the mucosa.  Oral care is provided to decrease bacteria and contaminants as well as promote comfort. Clients are instructed to frequently cough, deep breathe, and use an incentive spirometer to expand alveoli and prevent atelectasis.

Clients are kept NPO after extubation to prevent aspiration.  They may have either a bedside swallow screen or a more formal swallow evaluation by a speech therapist prior to swallowing any food, drink, or medication.

Exacerbation of COPD

Exacerbation of COPD is characterized by the acute worsening of a client's baseline symptoms (eg, dyspnea, cough, sputum color and production).  NIPPV is often prescribed short-term to support gas exchange in clients who have moderate to severe COPD exacerbations and acidosis (pH <7.3) or hypercapnia (PaCO2 >45 mm Hg).  NIPPV can prevent the need for tracheal intubation and is administered until the underlying cause of the ventilatory failure is reversed with pharmacologic therapy (eg, corticosteroids, bronchodilators, antibiotics).

BIPAP involves the use of a mechanical device and facemask in a conscious client who is breathing spontaneously.  BIPAP delivers oxygen to the lungs and then removes carbon dioxide (CO2).  CO2 retention causes mental status changes.  If the client becomes drowsy or confused, it is likely that more CO2 is being retained than what BIPAP can remove; this should be reported to the HCP.  Arterial blood gas evaluation should be obtained to determine CO2 level and BIPAP effectiveness.

In a client with COPD exacerbation, it is most important for the nurse to monitor mental status frequently and report changes such as restlessness, decreased level of consciousness, somnolence, difficult arousal, and confusion to the HCP.  These signs may indicate increased CO2 retention and worsening hypercapnia, which would necessitate an immediate change in therapy.

Dopamine (Intropin)

Dopamine (Intropin) a sympathomimetic inotropic medication used therapeutically to improve hemodynamic status in clients with shock and heart failure.  It enhances cardiac output by increasing myocardial contractility, increasing heart rate, and elevating blood pressure through vasoconstriction.  Renal perfusion is also improved, resulting in increased urine output.

The lowest effective dose of dopamine should be used as dopamine administration leads to an increased cardiac workload.  Significant adverse effects include tachycardiadysrhythmias, and myocardial ischemia.

increases heart rate, blood pressure, cardiac output, and urine output

Tension pneumothorax

This is a life-threatening emergency

causes marked compression and shifting of mediastinal structures (tracheal deviation), including the heart and great vessels, resulting in reduced cardiac output and hypotension.  This is a life-threatening emergency.  The client should have emergency large-bore needle decompression, followed by chest tube placement, to relieve the compression on the mediastinal structures.

Therapeutic hypothermia

Neurologic injury is the most common cause of mortality in clients who have had cardiac arrest, particularly ventricular fibrillation or pulseless ventricular tachycardia. 

Inducing therapeutic hypothermia in these clients within 6 hours of arrest and maintaining it for 24 hours has been shown to decrease mortality rates and improve neurologic outcomes.  It is indicated in all clients who are comatose or do not follow commands after resuscitation.

The client is cooled to 89.6-93.2 F (32-34 C) for 24 hours before rewarming.  Cooling is accomplished by cooling blankets; ice placed in the groin, axillae, and sides of the neck; and cold IV fluids.  The nurse must closely assess the cardiac monitor (bradycardia is common), core body temperature, blood pressure (mean arterial pressure to be kept >80 mm Hg), and skin for thermal injury.  The nurse must also apply neuroprotective strategies such as keeping the head of the bed elevated to 30 degrees.  After 24 hours, the client is slowly rewarmed.

 Clients are generally kept NPO during therapeutic hypothermia and rewarming.

Near-drowning

Near-drowning occurs when a client is under water and unable to breathe for an extended period.  In a matter of seconds, major body organs begin to shut down from lack of oxygen and permanent damage results.  Decerebrate posturing (arms and legs straight out, toes pointed down, head/neck arched back) is a sign of severe brain damage.  During assessment, the nurse would observe arms and legs straight out, toes pointed down, and the head/neck arched back.  These assessment findings indicate that severe injury has occurred.

 Hypothermia is generally seen in near-drowning victims.  One of the first goals of treatment is to warm the client.  This is done using warmed IV fluids, blankets, and air.  Sustained hypothermia will eventually lead to organ failure, making this an urgent finding but not initially life-threatening.

A weak and thready pulse is generally detected in near-drowning victims due to hypothermia.  Once the client is properly warmed, the pulse generally returns to normal.  Sometimes the client is so cold that a pulse cannot be detected; this is why a client is not dead until warm and dead.  Such clients may require prolonged resuscitation.

When wheezing is heard on auscultation after a near-drowning, the first observation would be that the client is still moving air and providing oxygen to the body.  The wheezing may indicate that the client has bronchospasm.  If the client has aspirated fluid, crackles would be heard.  Most such clients will develop acute respiratory distress syndrome.

The initial management of a near-drowning victim focuses on airway management due to potential aspiration (leading to acute respiratory distress syndrome), pulmonary edema, or bronchospasm (leading to airway obstruction).  Hypoxia is managed and prevented by ensuring a patent airway via intubation and mechanical ventilation as necessary 

Careful handling of the hypothermic client is important because as the core temperature decreases, the cold myocardium becomes extremely irritable.  Frequent turning could cause spontaneous ventricular fibrillation and should not be performed during the acute stage of hypothermia.  Continuous cardiac monitoring should be initiated

There are passive, active external, and active internal rewarming methods.  Passive rewarming methods include removing the client's wet clothing, providing dry clothing, and applying warm blankets.  Active external rewarming involves using heating devices or a warm water immersion.  Active internal rewarming is used for moderate to severe hypothermia and involves administering warmed IV fluids and warm humidified oxygen

Hypovolemic shock

Hypovolemic shock is the most common type of shock, occurs when blood volume decreases through hemorrhage or movement of fluid from the intravascular compartment into the interstitial space (third-spacing).

Treatment involves preventing additional fluid lossrestoring volume through IV fluids, and improving hemodynamic stability through vasoactive medications (eg, norepinephrine, dopamine).  Norepinephrine causes vasoconstriction and improves heart contractility/output, but the effects end quickly.  It should be tapered slowly and cautiously to avoid the progression or relapse of shock.

Narrowing pulse pressure (the difference between systolic and diastolic) is a sign of hypovolemic shock

Hypovolemic shock occurs when blood volume decreases via hemorrhage or third-spacing.  Stopping the source of blood loss, increasing blood volume through IV fluids, and improving blood pressure with vasoactive medications are the first steps in treating this condition.  Abruptly discontinuing vasoactive medications can cause hemodynamic instability; these medications should always be tapered slowly.

Normal saline is the fluid of choice for rapid correction of hypotension in most situations, including hypovolemic and septic shock.  It can be administered in large quantities rather rapidly and is inexpensive.

chemical contamination emergency response plan

Nursing priorities when implementing a chemical contamination emergency response plan include the following:

  1. Restricting other clients, staff, and bystanders from the victims' vicinity to protect non-affected individuals and the health care facility from the contaminant
  2. Donning personal protective equipment to protect the nurse when providing care 
  3. Decontaminating the clients outside the facility before initiating treatment.  If the chemical is not removed, it will continue to cause respiratory distress; contaminated clothing is left outside the facility to reduce the risk of contaminating staff and other clients 
  4. Assessing and providing treatment of symptoms.  Initial treatment is for the symptoms (eg, wheezing), regardless of the specific cause

Hypovolemic (hemorrhagic) shock 

Hypovolemic (hemorrhagicshock 

may occur after abdominal trauma or surgery as mesenteric edema resolves and previously compressed sites of bleeding reopen.

The shock continuum is staged in severity from initial (I) to irreversible (IV).  During the initial stage, there is inadequate oxygen to supply the demand at the cellular level and anaerobic metabolism develops.  At this point, there may be no recognizable signs or symptoms.  As shock progresses to the compensatory stage, sympathetic compensatory mechanisms are activated to maintain homeostasis (eg, oxygenation, cardiac output).

Cold, clammy skin indicates failing compensatory mechanisms (ie, progressive stage), and immediate intervention is necessary to prevent irreversible shock and death

Defibrillation

Defibrillation is indicated in clients with ventricular fibrillation (Vfib) and pulseless ventricular tachycardia.  Cardiopulmonary resuscitation (CPR) should be initiated and compressions continued until the shock is ready to be delivered.  Certain pulseless rhythms (asystole and pulseless electrical activity) do not need defibrillation.

Steps to perform defibrillation are as follows:

  1. Turn on the defibrillator
  2. Place defibrillator pads on the client's chest 
  3. Charge defibrillator.  Chest compressions should continue until defibrillator has charged and is ready to deliver the shock.
  4. Before delivering the shock, ensure that the area is "all clear."  Confirm that no personnel are touching the client, bed, or any equipment attached to the client
  5. Deliver the shock
  6. Immediately resume chest compressions

 Synchronized cardioversion delivers a shock on the R wave of the QRS complex

Rhythms that are ideal for synchronized cardioversion are supraventricular tachycardia, ventricular tachycardia with a pulse, and atrial fibrillation with rapid ventricular response.  If the defibrillator is not synchronized with the R wave in a client with a pulse, the shock may be delivered on the T wave and can cause a lethal arrhythmia (eg, Vfib).

Sepsis-induced hypotension

Sepsis-induced hypotension despite adequate fluid resuscitation (30 mL/kg) is defined as "septic shock." 

 MODS is the failure of 2 or more body organs (eg, acute kidney injury, acute respiratory distress syndrome).  Septic shock can progress to multiorgan dysfunction (ie, severe end of sepsis and septic shock).

Sepsis

Sepsis is a systemic inflammatory response (ie, increased heart rate, respirations, temperature, and decreased systolic blood pressure) to a documented or suspected infection and is present in this client. Sepsis is a potentially life-threatening condition.  Physiologic changes related to the aging process, including decreased immune function and inflammatory response (immunosenescence) and altered febrile response to pyrogens, increase the risk for sepsis.  Although evidence indicates that early recognition of sepsis is critical to survival, atypical presentation associated with immunosenescence and absence of fever can delay diagnosis and treatment.  Hypothermia in the presence of altered mental status, tachycardia, and borderline low blood pressure should alert the nurse to the possibility of early sepsis.  Transfer to the intensive care unit for evaluation, continual monitoring, and evidenced-based treatment measures (ie, sepsis bundles) should be anticipated.  Pressure injury could be the likely source of bacteremia in this client.

SIRS

SIRS is a generalized inflammatory response to an infectious or noninfectious insult to the body.  It is often difficult to distinguish from early sepsis.  When SIRS is suspected, a source for sepsis should be sought.

Diagnostic criteria for SIRS include 2 or more of the following manifestations:

  • Hyperthermia (temperature >100.4 F [38 C]) or hypothermia (temperature <96.8 F [36 C])
  • Heart rate >90/min
  • Respiratory rate >20/min or alkalosis (PaCO2 <32 mm Hg [4.3 kPa])
  • Leukocytosis (WBC count >12,000/mm3 [12.0 x 109/L] or 10% immature neutrophils [bands])

Hemodynamic Monitoring

Hemodynamic Monitoring  is an invasive arterial line and manual cuff readings measure BP via 2 different methods.  The arterial line measures flow of the blood past a catheter, and the manual cuff measures pressure based on compression of the artery.  Because of the differences, the 2 pressures may not match.  The arterial line can be highly useful to the clinician as it gives a continuous measurement of accurate BP.  The manual cuff will give a reading of the pressure only at the moment the pressure is measured.  The following steps should be instituted to ensure accuracy of invasive pressure readings:

  1. Position the client supine, flat, prone, or with the head of the bed <45 degrees
  2. Confirm zero reference stopcock (port of the stopcock nearest to the transducer) to be at the level of the phlebostatic axis (4th intercostal space, midaxillary line), which approximates the level of the atria of the heart
  3. Zero the system after initial setup, with disconnection of the transducer or when accuracy of the measurements is questioned
  4. Perform a dynamic response test (square wave test) every 8-12 hours, when the system is opened to air or when accuracy of measurements is questioned
  5. Measure pressures at the end of expiration

Ventilator-associated pneumonia (VAP)

Ventilator-associated pneumonia (VAP) is classified as a diagnosis of pneumonia more than 48 hours post-endotracheal intubation, is a key area of preventable morbidity and mortality in the hospitalized client.  Assessment of suspected pneumonia would denote fever, elevated white blood cell count, purulent or odorous sputum, crackles on auscultation, and pulmonary opacities on x-ray.

Prevention of pneumonia in a client on ventilation focuses on minimizing time spent on ventilation, reducing bacterial colonization with sterile equipment, regular oral hygiene, and aspiration prevention protocols.

Proton pump inhibitors (eg, omeprazole) and histamine-2 antagonists (eg, ranitidine) are commonly prescribed during inpatient client care, but the natural acidity of stomach acid is important in killing bacteria.  Prophylaxis should be prescribed only to clients at clear risk for developing stress ulcers.

Specific steps include sealing the endotracheal tube cuffing with ≥20 cm H2O (15 mm Hg), routine oral hygiene with chlorhexidine, elevating the head of the bed, minimizing sedation, and extubating as soon as possible.

Cerebrospinal fluid (CSF) rhinorrhea

Cerebrospinal fluid (CSF) rhinorrhea can confirm that a skull fracture has occurred and transversed the dura.  If the drainage is clear, dextrose testing can determine if it is CSF.  However, the presence of blood would make this test unreliable as blood also contains glucose.  In this case, the halo/ring test should be performed by adding a few drops of the blood-tinged fluid to gauze and assessing for the characteristic pattern of coagulated blood surrounded by CSF.

Identification of this pattern is very important as CSF leakage places the client at risk for infection.  The client's nose should not be packed.  No nasogastric or oral gastric tube should be inserted blindly when a basilar skull fracture is suspected as there is a risk of penetrating the skull through the fracture site and having the tube ascend into the brain.  These tubes are placed under fluoroscopic guidance in clients with such fractures.

Guillain-Barré syndrome (GBS)

This is an acute, immune-mediated polyneuropathy that is most often accompanied by ascending muscle paralysis and absence of reflexes.  Lower-extremity weakness progresses over hours to days to involve the thorax, arms, and cranial nerves (CNs).  Neuromuscular respiratory failure is the most life-threatening complication.  The rate and depth of the respirations should be monitored

Measurement of serial bedside forced vital capacity (spirometry) is the gold standard for assessing early ventilation failure.

Absence of knee reflexes is expected early in the course of GBS due to the ascending nature of the disease.  Absence of gag reflex indicates GBS progression.

orthostatic hypotension, paralytic ileus, urinary retention, and diaphoresis.  These complications need to be assessed but are not a priority.

ascending nature of GBS

Positive pressure ventilation (PPV)

PPV delivers positive pressure to the lungs using a mechanical ventilator (MV), either invasively through a tracheostomy or endotracheal tube or noninvasively through a nasal mask/facemask, nasal prongs, or a mouthpiece.  The most common type used in the acute care setting for clients with acute respiratory failure is the volume cycled positive pressure MV, which delivers a preset volume and concentration of oxygen (eg, 21%-100%) with varying pressure.

Positive pressure applied to the lungs compresses the thoracic vessels and increases intrathoracic pressure during inspiration.  This leads to reduced venous return, ventricular preload, and cardiac output, which results in hypotension.  The hypotensive effect of PPV is even greater in the presence of hypovolemia (eg, hemorrhage, hypovolemic shock) and decreased venous tone (eg, septic shock, neurogenic shock).

Fluid and/or sodium retention usually occurs about 48-72 hours after initiation of PPV

Arterial blood gases (ABGs)

It is common to measure ABGs after a ventilator change to assess how well the client has tolerated it.  Factors such as changes in the client's activity level or oxygen settings, or suctioning within 20 minutes prior to the blood draw can cause inaccurate results.  Unless the client's condition dictates otherwise, the nurse should avoid suctioning as it will deplete the client's oxygen level and cause inaccurate test results.

Frostbite

Involves tissue freezing, resulting in ice crystal formation in intracellular spaces that causes peripheral vasoconstriction, reduced blood flow, vascular stasis, and cell damage.  Superficial frostbite can manifest as mottled, blue, or waxy yellow skin.  Deeper frostbite may cause skin to appear white and hard and unable to sense touch.  This can eventually progress to gangrene.

Treatment of frostbite should include the following:

  • Remove clothing and jewelry to prevent constriction.
  • Do not massage, rub, or squeeze the area involved.  Injured tissue is easily damaged 
  • Immerse the affected area in water heated to 98.6-102.2 F (37-39 C), preferably in a whirlpool.  Higher temperatures do not significantly decrease rewarming time but can intensify pain 
  • Avoid heavy blankets or clothing to prevent tissue sloughing.
  • Provide analgesia as the rewarming procedure is extremely painful
  • As thawing occurs, the injured area will become edematous and may blister.  Elevate the injured area after rewarming to reduce edema 
  • Keep wounds open immediately after a water bath or whirlpool treatment and allow them to dry before applying loose, nonadherent, sterile dressings
  • Monitor for signs of compartment syndrome.

Hypothermia

occurs when the core temperature is below 95 F (35 C) and the body is unable to compensate for heat loss.  As the core temperature decreases, the cold myocardium becomes extremely irritable and prone to dysrhythmias.  The client should be handled gently as spontaneous ventricular fibrillation could develop when moved or touched. 

Therefore, placing the client on a cardiac monitor is a high priority; the nurse should anticipate defibrillation in these clients.

Gastric lavage (GL)

This is performed through an orogastric tube to remove ingested toxins and irrigate the stomach.  GL is rarely performed as it is associated with a high risk of complications (eg, aspiration, esophageal or gastric perforation, dysrhythmias). 

GL is only indicated if the overdose is potentially lethal and if GL can be initiated within one hour of the overdose.  Activated charcoal administration is the standard treatment for overdose, but it is ineffective for some drugs (eg, lithium, iron, alcohol).

Activated charcoal is an important treatment in early acetylsalicylic acid (ASA) toxicity; it is recommended for gastrointestinal decontamination in clients with clinical signs of ASA poisoning (disorientation, vomiting, hyperpnea, diaphoresis, restlessness) as well as in those who are asymptomatic. 

IV sodium bicarbonate is an appropriate treatment for aspirin toxicity after the administration of activated charcoal.  It is given to make the blood and urine more alkaline, therefore promoting urinary excretion of salicylate.

Similar to syrup of ipecac, gastric lavage is associated with risk of aspiration.  In addition, there is no convincing evidence that it decreases morbidity.  It is not routinely recommended but may be performed for the ingestion of a massive or life-threatening amount of drug. 

If necessary, it should be administered within 1 hour of ingestion and requires a protected airway and possible sedation.

Intubation and suction supplies should always be available at the bedside during GL in case the client develops aspiration or respiratory distress

performed through a large-bore (36 to 42 French) orogastric tube so that a large volume of water or saline can be instilled in and out of the tube.

Clients should be placed on their side or with the head of bed elevated to minimize aspiration risk.

should be initiated within one hour of overdose ingestion to be effective.  The client's stomach should be decompressed first, but lavage should be initiated as soon as possible afterwards.

Malignant hyperthermia (MH)

a rare and life-threatening condition precipitated by certain medications used for anesthesia, including inhaled anesthetics (eg, desflurane, isoflurane, halothane) and succinylcholine (a paralytic used adjunctively for intubation and general anesthesia).  Skeletal muscles become unable to control calcium levels, leading to a hypermetabolic state manifested by contracture and increased temperature.  Early signs of MH include tachypneatachycardia, and a rigid jaw or generalized rigidity.  As the condition progresses, the client develops a high fever Muscle tissue is broken down, leading to hyperkalemia, cardiac dysrhythmias, and myoglobinuria.

MH requires emergent treatment with IV dantrolene to reverse the process by slowing metabolism.  Succinylcholine should be discontinued.  Other interventions include applying cooling blankets to reduce temperature and treating high potassium levels.

triggered by certain drugs used to induce general anesthesia in susceptible clients.  T

signs and symptoms of MH include hypercapnia (earliest sign), generalized muscle rigidity (eg, jaw, trunk, extremities), and hyperthermia.  Hyperthermia is a later sign and can confirm a suspicion of MH.  The nurse monitors the temperature as it can rise 1 degree Celsius every 5 minutes and can exceed 105 F (40.6 C).

The nurse would notify the health care provider, indicating the need for immediate treatment (eg, dantrolene, cooling blanket, fluid resuscitation)

Mechanical ventilation

Clients are at risk for a variety of ventilator-associated complications (eg, aspiration, pneumonia).  When caring for a client receiving mechanical ventilation, the nurse should:

  • Monitor respiratory status (eg, lung sounds, breathing pattern), airway patency, and ventilator functionality (eg, settings, alarm parameters).
  • Maintain the head of the bed at 30-45 degrees to reduce aspiration risk 
  • Use the minimum amount of sedation necessary for client comfort (eg, compliant with ventilator, opens eyes to voice).  Continuous IV sedation should be paused daily for evaluation of spontaneous respiratory effort and appropriateness for weaning off the ventilator 
  • Perform oral care with chlorhexidine oral solution every 2 hours, or per facility policy Perform tracheal suctioning as needed.
  • Monitor correct endotracheal tube placement by noting insertion depth.
  • Place emergency equipment at bedside (eg, manual resuscitation bag)

drop in oxygen saturation signifies a problem with ventilation.  When an artificial airway is present, the nurse should assess the client to determine the cause of hypoventilation.  Auscultating lung sounds is the first step and quickest intervention to confirm proper tube placement.  It is not uncommon for the tube to become displaced in the hypopharynx, which would not allow proper ventilation.

Another important complication is pneumothorax, which can cause hypotension and a drop in oxygen saturation.  Lung auscultation would help diagnose this as well.

Suspected cervical spine injury

The priorities for a client with a suspected cervical spine injury are maintaining a patent airway and spinal immobilization. 

Interventions include application of a rigid hard collar, placing the client on a firm surface, logrolling the client during movement and transfers, and continued assessment of need for an advanced airway.

Further stabilization is achieved by taping down the client's head and using straps to immobilize the arms, especially if the client is not cooperating.

Implantable cardioverter defibrillator (ICD)

The client with an ICD that is firing is receiving electrical shocks from the internal defibrillator to interrupt the dysrhythmia. 

It is still imperative that the client receive chest compressions in the form of cardiopulmonary resuscitation (CPR) to provide circulation of blood to the vital organs. 

The nurse should implement the pulseless arrest algorithm, allowing 30-60 seconds for the ICD to complete its therapy cycle before applying external defibrillation pads/paddles.

 

Allen's test

To assure adequate circulation to the hand before proceeding with the arterial blood gas collection.

The radial artery site at the wrist is preferred for collecting an arterial blood gas sample because it is near the surface, easy to palpate and stabilize, and has good collateral supply from the ulnar artery.  The patency of the ulnar artery must be confirmed.

The modified Allen's test includes the following steps:

  • Instruct the client to make a tight fist (if possible)
  • Occlude the radial and ulnar arteries using firm pressure
  • Instruct the client to open the fist; the palm will be white if both arteries are sufficiently occluded
  • Release the pressure on the ulnar artery; the palm should turn pink within 15 seconds as circulation is restored to the hand, indicating patency of the ulnar artery (positive Allen's test)

When caring for a client with a radial, brachial, or femoral arterial line in place, the nurse must be able to assess for complications.  These include hemorrhage, infection, thrombus formation, and circulatory and neurovascular impairment.

 

To measure pressures accurately using continual arterial and/or pulmonary artery pressure monitoring, the zeroing stopcock of the transducer system must be placed at the phlebostatic axis. This anatomical location, with the client in the supine position, is at the 4th ICS, at the midway point of the AP diameter (½ AP) of the chest wall.  If the transducer is placed too low, the reading will be falsely high; if placed too high, the reading will be falsely low.  This concept is similar to the positioning of the arm in relation to the level of the heart when measuring blood pressure indirectly using a sphygmomanometer or noninvasive blood pressure-monitoring device.  The upper arm should be at the level of the phlebostatic axis.

Barbiturate overdose

Typical signs and symptoms of baribiturate abuse include sluggishness, difficulty walking, and irritability. Judgement and understanding are impaired, and speech is slurred and confused.

Anticoagulation monitoring

The nurse should adjust the heparin dose to maintain the client's partial thromboplastin time between 1.5 and 2.5 times the normal control.

The prothrombin time and International Normalized Ratio are used to maintain therapeutic levels of warfarin, oral anticoagulation therapy.

The thrombin clotting time is used to confirm disseminated intravascular coagulation.

Thrombin clotting time

The thrombin clotting time is used to confirm disseminated intravascular coagulation.

Fundus palpation

The uterus would be palpable at the level of the umbilicus between 4 and 24 hours after birth.

PPH and placenta praevia

The client with placenta previa is at greatest risk for postpartum hemorrhage. In placenta previa, the lower uterine segment doesn't contract as well as the fundal part of the uterus; therefore, more bleeding occurs. 

Post partum hemorrhage

A postpartum client who saturates a pad in an hour or less at any time in the postpartum period is considered to be hemorrhaging. As the normal postpartum client heals, bleeding changes from red to pink to off-white. It also decreases in amount each day. It is also normal to have some increases in lochia early on with breastfeeding, which causes uterine contractions

Post partum depression

During the depression stage of grief, hopelessness, powerlessness, and despair are common.

Some depressed people put their feelings into words; others withdraw, becoming noncommunicative and indicating a wish to be left alone.

A parent in denial would postpone recognizing the child's condition and attempt to ignore its reality or seriousness.

A parent in the anger stage would exhibit resentment, bitterness, or rage and might blame the health care team for the child's condition.

Duration of blood transfusion

A unit of packed RBCs may be transfused over a period of 1 to 4 hours. It shouldn't infuse for longer than 4 hours because the risk of contamination and sepsis increases after that time.

Meperidine

The equianalgesic dose of oral meperidine hydrochloride is up to four times the IM dose. Meperidine hydrochloride can be given orally, but it is much more effective when given IM.

Nordiazepam

Nordiazepam is an active metabolite of pinazepam, medazepam, chlorazepate, diazepam, prazepam and chlordiazepoxide

Functions of a kidney

An easy way to memorize the 7 different roles that the kidneys play in human health, medical students all around the world often use a simple and funny mnemonic formula: A WET BED.

  • A - controlling ACID-base balance
  • W - controlling WATER balance
  • E - maintaining ELECTROLYTE balance
  • T - removing TOXINS and waste products from the body
  • B - controlling BLOOD PRESSURE
  • E - producing the hormone ERYTHROPOIETIN
  • D - activating vitamin D

What is Telangiectasia?

Telangiectasia is a condition where blood vessels near the surface of the skin are dilated and cause threadlike lines or patterns on the skin. They are sometimes called spider veins. It can be caused by a variety of conditions such as rosacea or liver disease.

What is a burrow?

Burrows are tunnels formed in the skin that appear as linear marks. They are a result of an infestation of the skin by parasites such as scabietic mites.

What is a wheal?

A wheal is a red, swollen mark that is often itchy and changes shape. They usually occur in response to a stimulus like a bug bite or food allergies. They are also known as welts or hives.

What is a pustule?

A pustule is a small bump on the skin that contains pus. They can be infected but not always, as in the case of pustular psoriasis.

What is a bullae?

Bullae are fluid-filled sacs that form when fluid is trapped under a thin layer of skin. They are similar to blisters and vesicles except that bullae have a diameter larger than 1 centimeter.

What is a vesicle?

A vesicle is a raised bump less than 1 centimeter in diameter filled with air or clear liquid.

What is a plaque?

A plaque is a flat-topped, raised lesion larger than 1 centimeter. It is often red, scaly and itchy. Plaques are typically found on the scalp, elbows, and knees.

What is a tumour?

A tumor is a solid mass on the skin or subcutaneous tissue (under the skin). It is firm and usually larger than 2 centimeters.

What is a nodule?

A nodule is an elevated bump on the skin that is larger than a papule (greater than 1 centimeter in diameter). It may occur in all layers of the skin including the epidermis, dermis and subcutaneous tissue.

What is a papule?

A papule is a raised skin area with no visible fluid and sized up to 1 centimeter in diameter. They have distinct borders and come in a variety of shapes.

What is a macule?

A macule is a distinct discoloration of the skin that is flat and smaller than 1 centimeter in diameter. It does not cause a change in skin texture or thickness. Macules are noticed visually.

Grandiosity

Grandiosity is a symptom experienced by individuals who have bipolar disorder, during manic and hypomanic episodes. With bipolar disorder, this causes individuals to have extreme mood swings that include emotional lows (depression), and highs (mania or hypomania).

Nasogastric/Nasoenteric Tubes

A nasoenteric tube is passed through the nares into the duodenum or jejunum when it is necessary to bypass the esophagus and stomach.

Nasoenteric tubes have a decreased risk of aspiration compared with nasogastric tubes; however, a nasoenteric tube can become dislodged to the lungs, causing aspiration of enteral feedings.
If a client with a feeding tube develops signs of aspiration pneumonia (diminished or adventitious lung sounds [eg, crackles, wheezing], dyspnea, productive cough), the feeding should be stopped immediately and tube placement checked (eg, measure insertion depth, obtain x-ray, assess aspirate pH).

Some facilities use capnography to determine placement; if a sensor detects exhaled CO2 from the tube, it is in the client's airway and must be removed immediately

Chronic obstructive pulmonary disease (COPD)

Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory lung disease that causes obstructed airflow from the lungs. Symptoms include breathing difficulty, cough, mucus (sputum) production and wheezing.

Seborrheic dermatitis

Seborrheic dermatitis is a non-contagious skin condition. It leads to scaly patches of skin with oily, dandruff-like flakes, especially on your face and scalp. It is only rarely itchy.

Signs of Cushing's syndrome.

  • Weight gain in face (moon face)
  • Weight gain above the collar bone (supraclavicular fat pad)
  • Weight gain on the back of neck (buffalo hump)
  • Skin changes with easy bruising in the extremities and development of purplish stretch marks (striae) particularly over the abdomen or axillary region
  • Red, round face (plethora)
  • Central obesity with weight gain centered over the chest and abdomen with thin arms and legs
  • Excessive hair growth (hirsutism) on face, neck, chest, abdomen and thighs
  • Female balding
  • Generalized weakness and fatigue
  • Blurry vision
  • Vertigo
  • Muscle weakness
  • Menstrual disorders in women (amenorrhea)
  • Decreased fertility and/or sex drive (libido)
  • Hypertension
  • Poor wound healing
  • Diabetes mellitus
  • Severe depression
  • Extreme mood swings

Cushing's syndrome.

Cushing's syndrome is a disorder caused by the body’s exposure to an excess of the hormone cortisol. Cortisol affects all tissues and organs in the body. These effects together are known as

Cushing’s syndrome can be caused by overuse of cortisol medication, as seen in the treatment of chronic asthma or rheumatoid arthritis (iatrogenic Cushing’s syndrome), excess production of cortisol from a tumor in the adrenal gland or elsewhere in the body (ectopic Cushing’s syndrome) or a tumor of the pituitary gland secreting adrenocorticotropic hormone (ACTH) which stimulates the over-production of cortisol from the adrenal gland (Cushing’s disease).

Rate limiting enzymes

A rate-limiting enzyme is a key enzyme of which the activity determines the overall rate of a metabolic pathway.

1. Glycolysis : phosphofructokinase

2. Gluconeogenesis : PEP (phosphoenol pyruvate) carboxylase

3. Glycogenesis : glycogen synthase

4. Glycogenolysis : glycogen phosphorylase

5. Kreb cycle : isocitrate dehydrogenase

6. Ketone body synthesis : HMG co A synthase

7. Cholesterol synthesis : HMG co A reductase

8. Porphyrin synthesis : ALA synthase

9. Fatty acid synthesis : acetyl CoA carboxylase

10. Uric acid synthesis : xanthine oxidase

Bone density testing

A bone density test uses x-rays to measure how many grams of calcium and other bone minerals are packed into a segment of bone. The bones that are tested are in the spine, hip and forearm.

Bone density test results are reported in 2 numbers: T-score and Z-score.

The T-score is the bone density compared with what is normally expected in a healthy young adult of the same sex. The T-score is the number of units—standard deviations—that bone density is above or below the average. T-score >2.5 SD indicates the likelihood of osteoporosis and increased risk of fracture. The diagnosis of osteoporosis by DEXA scan also means that treatment
should be initiated with bisphosphonates, oral daily calcium supplementation, and vitamin D.

The Z-score is the number of standard deviations above or below what is normally expected for someone of the same age, sex, weight, and ethnic or racial origin. Z-score -2 may suggest that
something other than aging is causing abnormal bone loss (consider drugs causing osteoporosis such as corticosteroids). The goal in this case is to identify the underlying problem.

Electroconvulsive Therapy

Electroconvulsive Therapy is the induction of a grand mal (generalized) seizure through the application of electrical current to the brain.

Type 1 familial hyperlipidemia

Lipoprotein lipase helps breakdown triglycerides into fatty acids and glycerol so they can be absorbed by tissue. A defect in this enzyme leads to type I familial hyperlipidemia, which causes pancreatitis and eruptive xanthomas.

Sudden deterioration of an intubated baby (DOPES)

Sudden deterioration of an intubated baby (DOPES)
Displacement of the tube

Obstruction of ET tube

Pneumothorax

Equipment failure

Stomach distension

Identify and rectify the problem urgently

The PHC elements listed at the Alma Ata Declaration

The PHC elements listed at the Alma Ata Declaration were as follows:
1. Education concerning prevailing health problems and the methods of preventing and controlling them
2. Local disease control
3. Expanded programme of immunisation
4. Maternal and child health care and family planning
5. Essential drug supply
6. Nutrition and adequate food supply
7. Treatment and prevention of common diseases and injuries
8. Safe water supply and good sanitation Use the acronym 'ELEMENTS' to help you remember these eight elements.
The Kenyan government has added additional PHC elements to the ones identified at the Alma Ata conference These are:
• Mental health
• Dental health
• Community based rehabilitation
• Malaria control
• STI and HIV/AIDS prevention and control
#communityhealth #nursing #primaryhealthcare
https://medcrine.com

Enterohepatic circulation, Extracorporeal circulation, The mesenteric circulatio, collateral circulation

 Enterohepatic circulation involves substances that are metabolized in the liver, excreted into the bile, and passed into the intestinal lumen; there they are reabsorbed across the intestinal mucosa and returned to the liver via portal circulation

Extracorporeal circulation is a procedure in which blood is taken from a patient's circulation to have a process applied to it before it is returned to the circulation

The mesenteric circulation refers specifically to the vasculature of the intestines, whereas the splanchnic circulation provides blood flow to the entire abdominal portion of the digestive system that includes the hepatobiliary system, spleen, and pancreas.

collateral circulation is a network of tiny blood vessels, and, under normal conditions, not open. ... This allows blood to flow around the blocked artery to another artery nearby or to the same artery past the blockage, protecting the heart tissue from injury

Positive symptoms of schizophrenia

Positive symptoms of schizophrenia respond to drug therapy more readily than negative symptoms. The secondgeneration “atypical” nonphenothiazine drugs may be slightly more effective in treating negative symptoms of schizophrenia

Mechanism of CD4 Cell Depletion

HIV-mediated direct cytopathicity (single cell killing) – infected CD4 cells die
HIV-mediated syncytia formation
Defect in CD4 T-cell regeneration in relation to the rate of destruction
Maintenance of homeostasis of total T-lymphocytes (decreased CD4, increasedCD8)
HIV-specific immune response (killing of virally infected and innocent cells)
Auto-immune mechanism
Programmed cell death (apoptosis)
Qualitative abnormalities (even the existing CD4 cells are dysfunctional)
Impaired expression of IL-2
Defective IL-2 and INF-Alfa production
Decreased help to B-cells in production of immunoglobulins

Scalp layers medical mnemonic

SCALP:
From superficial to deep:
Skin
Connective tissue
Aponeurosis
Loose areolar tissue
Pericranium

Predisposing Factors For Acute Pyelonephritis Medical Mnemonic

Acute pyelonephritis is a bacterial infection that affects the renal pelvis and kidney. Use the mnemonic SCARRIN' UP to memorize the predisposing factors for acute pyelonephritis.

SCARRIN' UP mnemonic stands for;

Sex (females <40 years, males >40 years)
Catheterization
Age (infant, elderly)
Renal lesions
Reflux (vesciouteral urine relux)
Immunodeficiency
NIDDM, IDDM (Non-insulin dependent diabetes mellitus and insulin dependent diabetes mellitus)
Urinary obstuction
Pregnancy

Inferior venacava tributaries medical mnemonic

"I Like To Rise So High":
Illiacs
Lumbar
Testicular
Renal
Suprarenal
Hepatic vein.
 Think of the IVC wanting to rise high up to the heart.

Features of Kallman Syndrome

Kallmann syndrome is a genetical disorder that prevents a person from starting or fully completing adolescence. It is a form of a group of conditions known as hypogonadotropic hypogonadism.

To distinguish it from other forms of hypogonadotropic hypogonadism, Kallmann syndrome has the additional symptom of a total lack of sense of smell or a reduced sense of smell

The mnemonic to master Kallman syndrome features is : KALMAN

   Color blindness (K sounds like C)
   Anosmia
   Low LH, FSH, Sex hormones → delayed puberty
   Midline defects (cleft palate, cleft lip)
   Ataxia (cerebellar ataxia)
   Nerve deafness

Imaging of Kallman Syndrome

 It is easiest to appreciate the anatomical anomalies present in Kallman syndrome by comparing it to a normal patient.

The normal anatomy of the region consists of the olfactory bulbs (blue arrows) located in the olfactory grooves of the anterior cranial fossa.

The inferior surface of the frontal lobes usually consists gyrus rectus (aka straight gyrus) (R) separated from the medial orbital gyrus (M) by the olfactory sulcus (yellow arrow). These are absent in Kallman syndrome. 

Duodenum: lengths of parts

The duodenum has four parts; superior, descending, inferior and ascending part. Together these parts form a 'C' shape, that is usually around 25cm long, and wraps around the head of the pancreas

To rememner the length of these parts use the mnemonic;

"Counting 1 to 4 but staggered":
1st part: 2 inches
2nd part: 3 inches
3rd part: 4 inches
4th part: 1 inch

Differentials of Testicular Atrophy Mnemonic

Testicular atrophy is a condition wherein the testicles gradually shrink in size. It may be caused by a number of factors

Mnemonic to master the differentials of testicular atrophy is : TESTES SHRINK:

Trauma
Exhaustional atrophy
Sequelae
Too little food
Elderly
Semen obstruction
Sex hormone therapy
Hypopituitarism
Radiation
Inflammatory orchitis
Not descended
Kleinfelter's

Differential Diagnoses of Hydronephrosis Medical Mnemonic

Hydronephrosis is a distention of the renal calyces and pelvis with urine as a result of a urinary outflow obstruction.

Use this mnemonic 'PACT SUPER' to memorize the differential diagnoses of hydronephrosis.

Unilateral is PACT:

Pelvic-uteric obstruction (congenital or acquired)
Aberrant renal vessels
Calculi
Tumours of renal pelvis

Bilateral is SUPER:

Stenosis of the urethra
Urethral valve
Prostatic enlargement
Extensive bladder tumour
Retro-peritoneal fibrosis

Diaphragm apertures spinal levels Medical mnemonic

Diaphragm apertures: spinal levels Medical mnemonics

Aortic hiatus = 12 letters = T12
Oesophagus = 10 letters = T10
Vena cava = 8 letters = T8

Causes of Urinary incontinence Medical mnemonic

Urinary incontinence is an involuntary leakage of urine due to loss of bladder control. To master the causes of acute and reversible urinary incontinence is DRIP:
The mnemonic DRIP atands for;

Delirium
Restricted mobility/ Retention
Inflammation / Infection/ Impaction [fecal]
Pharmaceuticals / Polyuria

Causes Of Secondary Nephrotic Syndrome Medical Mnemonic

Nephrotic syndrome is kidney disease characterized by proteinuria, hypoalbuminemia, and edema. Use the mnemonic DAVID to memorize the cayses of secondary nephrotic syndrome

The mnemonic DAVID stands for;

Diabetes mellitus
Amyloidosis
Vasculitis
Infections
Drugs

Bowel Component Anatomy mnemonic

"Dow Jones Industrial Average Closing Stock Report":
 From proximal to distal:

Duodenum
Jejunum
Ileum
Appendix
Colon
Sigmoid
Rectum

To include the cecum, the mnemonic will be; "Dow Jones Industrial Climbing Average Closing Stock Report".

Atrioventricular valves Medical mnemonic

Atrioventricular valves
"LAB RAT":
Left Atrium: Bicuspid
Right Atrium: Tricuspid

Abdominal muscles medical mnemonic

Abdominal muscles 
"Spare TIRE around their abdomen":
Transversus abdominis
Internal abdominal oblique
Rectus abdominis
External abdom

5-F risk factors for cholelithiasis Medical mnemonic

The 5-F rule refers to the mnemonic of risk factors for the development of cholelithiasis in the event of upper abdominal pain:

  • Fair: more prevalent in the Caucasian population 1
  • Fat: BMI of more than 30
  • Female sex
  • Fertile: one or more children
  • Forty: age of more than 40 years.
cholelithiasis can occur in yo

Thoracoacromial artery branches medical mnemonics

Thoracoacromial artery branches
ABCD:
Acromial
Breast (pectoral)
Clavicular
Deltoid

Neuroleptic Malignant Syndrome.

This is an idiosyncratic reaction to a wide variety of phenothiazines or butyrophenones such as haloperidol.

Muscular rigidity and rhabdomyolysis may occur as well. Treatment, besides stopping the drug, is with bromocriptine or dantrolene.

Central Core Disease (CCD)

Central Core Disease (CCD) is a rare non progressive myopathy with autosomal dominant inheritance, presenting in infancy and characterized by hypotonia and proximal muscle weakness.

Five ‘Rs’ of intravenous fluid administration

Five ‘Rs’ of intravenous fluid administration

  • Resuscitation
  • Routine maintenance
  • Replacement
  • Redistribution
  • Reassessment

Diloxanide

Diloxanide furoate is the drug of choice for asymptomatic patients with E. histolytica cysts in the faeces. Metronidazole and tinidazole are relatively ineffective.
Diloxanide furoate is relatively free from toxic effects and the usual course is of 10 days, given alone for chronic infections or following metronidazole or tinidazole treatment.

Biphasic Pills

Biphasic pills are forms of COC pills containing two different dose combinations of oestrogen and
progestin usually in packets of 21 or 28 tablet e.g. in 21 active pills, 10 may contain one combination,
while 11 contain another. Examples include Biphasil, Ovanon, and Normovlar

Chvostek’s sign

Chvostek’s sign consists of twitching of muscles supplied by the facial nerve when the nerve is tapped about 2 cm anterior to the earlobe, just below the zygomatic arch.

When hypocalcemia develops from parathyroid disease, Chvostek’s sign, a facial spasm, may be an early symptom

Atopic dermatitis

Atopic dermatitis is a pruritic disease of unknown origin that usually starts in early infancy; approximately 85% of cases occur within first year of life. Usually presents with pruritus, eczematous lesions, xerosis (dry skin) and lichenification (thickening of skin)

Tactile or vocal fremitus

Tactile or vocal fremitus is the palpable vibration you feel when the patient speaks (says ‘99’).

Assessment of tactile fremitus is used to evaluate airflow and density of underlying tissue. Normally, the thicker the chest wall, the more diminished the fremitus; the lower the voice pitch, the greater the fremitus.

Increased fremitus (low voice pitch): conditions causing fluid or exudates in lungs (e.g consolidating pneumonia, atelectasis, pulmonary fibrosis, pulmonary edema, or pulmonary infarction) and sometimes lung tumor depending on size and mobility.

Decreased or absent fremitus (high pich): air trapping, solid tissue, or decreased air movement (e.g. emphysema, asthma, pleural effusion, pneumothorax, or distal to airway obstruction)

hypotonic uterine action

In this condition the contractions of the uterus are irregular, infrequent and ineffectual.

The diagnosis is made by palpation and timing the length of contractions. Repeated vaginal examination will demonstrate a cervix which fails to dilate.

Contractions may be strengthened by rehydration, relaxation (e.g. by epidural anaesthesia), rupture of the membranes and the use of intravenous syntocinon.

The dose of syntocinon must be titrated against the strength and duration of uterine contractions to prevent hypertonic uterine action or the formation of a constriction ring

Immunoglobulins and their roles

Ig G
-O
nly antibody that pass placental circulation causing passive immunity.
-
Short term protection.
-Has an Immediate action.
Ig A
–Present in all bodily secretions (tears, saliva, colostrums).
Ig M
–Acute in inflammation.
Ig E
–For allergic reaction.
Ig D
–For chronic inflammation

Growth Factors

These are substances that promote cell division.
Many act locally as autocrines or paracrines

  • Epidermal growth factor (EGF)
  • Platelet-derived growth factor (PDGF)
  • Fibroblast growth factor (FGF)
  • Nerve growth factor (NGF)
  • Tumor angiogenesis factors (TAFs)
  • Insulin-like growth factor (IGF)
  • Cytokines

Pancreatic islets (islets of Langerhans)

Pancreatic islets (islets of Langerhans)

  • Alpha cells (20%) produce glucagon
  • Beta cells (70%) produce insulin
  • Delta cells (5%) produce somatostatin
  • F cells produce pancreatic polypeptide

Posteriour pituitary gland hormones

Posterior pituitary gland does not synthesize hormones, but it does store and release two hormones made by the hypothalamus.

  • Oxytocin (OT)
  • Antidiuretic hormone (ADH)

Hormones of the anterior pituitary gland are;

Hormones of the anterior pituitary gland are;

  • Human growth hormone (hGH)
  • Thyroid-stimulating hormone (TSH)
  • Follicle-stimulating hormone (FSH)
  • Luteinizing hormone (LH)
  • Prolactin (PRL)
  • Adrenocorticotrophic hormone (ACTH)
  • Melanocyte-stimulating hormone (MSH)

Medications That Can Cause Acne

    Medications That Can Cause Acne Hormonal:

    ACTH Cortisone

    Anaboilc steroids

    High progesterone oral contraceptive pills

    Non-hormonal:

    Azathioprine

    Phenytoin

    Cyclosporine

    Lithium

    Isoniazid

    Fetal and Delivery complications of gestational diabetes mellitus

    Stillbirth
    Lung immaturity
    Intrauterine growth restriction
    Macrosomia
    Prematurity
    Underdevelopment (ie, sacral agenesis, ventricular septal defect, neural tube defect, cerebral palsy)
    Shoulder dystocia
    Hypoglycemia, Hypocalcemia, Hyperbilirubinemia

    Causes of dystocia

    Power(ie, poor or uncoordinated uterine contractions)
    Passenger(ie, fetus too large or malpresentation)
    Passage (ie, pelvis too small or unusual shape)

    Risk factors for ectopic pregnancy

    Ectopy( ie, previous ectopic pregnancy)
    PID(ie, pelvic inflammatory disease)
    IUD(ie, intrauterine device)
    Surger
    y (ie, previous lower abdominal surgery)
    Endometri (ie, endometriosis)

    HELLP Syndrome

    HELLP Syndrome is a severe variant of pre-eclampsia

    Hemolysis
    Elevated Liver enzymes
    Low Platelets

    Prerequisites for forceps Delivery

    Analgesia is adequate
    Bladder empty
    Cervix is dilated
    Descent past ischial spines
    Ead (ie, head) presentation

    Complications of polyhydramnios

    Prolapse of umbilical cord
    Placental abruption
    Preterm labour
    Presentation (ie, malpresentation)

    Causes of postpartum pyrexia

    Wind(ie, lung atelectasis)
    Water ie, urinary tract infection)
    Womb(ie, endomyometritis)
    Wow (ie, mastitis)
    Wind (ie, pneumonia)
    Wound (ie, C-section or episiotomy site)
    Walk (ie, deep venous thrombosis)

    Risk factors of preeclampsia

    Multiple gestation
    Age extremes (mother is younger or older)
    Diabetes mellitus
    Primigravida
    Renal disease
    Intrauterine growth restriction
    Mole (ie, hydatidiform mole)
    Increased blood pressure (ie, chronic hypertension)

    Common causes of bone metastases

    Malignant melanoma
    Breast
    Thyroid
    Kidney
    Lung
    Pants

    Causes of proptosis

    Tumour (eg, retinoblastoma)
    Hemorrhage (eg, traumatic posterior orbital hematoma)
    Endocrinopathy (eg, Graves' disease)
    Infection (eg, orbital cellulitis)

    Causes of persistent Pupillary dilatation

    3rd nerve palsy
    Anti-muscarinic eye drops (eg to facilitate fundoscopy)
    Myotonic pupil (Holmes Adie pupil):most commonly in young women, with absent/delayed reaction to light and
    convergence, and of no pathological significance.

    Innervation of the Extraocular Muscles

    All extraocular muscles are innervated by the third cranial nerve except the Lateral Rectus by the 6th cranial nerve and the Superior Oblique by the 4th cranial nerve

    Clinical Characteristics of Myopia

    Long eyeball is ...
    Myopic, requiring ...
    Minus diopter lens for correction, and the patient is ...
    Nearsighted

    Carpal Tunnel Syndrome Causes: TENS

    Trauma (eg, Colles' fracture, daily overuse at typing keyboard)
    Endocrinopathy (ie, pregnancy, hypothyroidism, diabetes
    mellitus, acromegaly)
    Neurological (C5-C6 disk herniation can mimics a CTS)
    Synovitis (eg, rheumatoid arthritis)

    Signs of compartment syndrome

    Passive stretching causes severe pain (moat reliable sign)
    Pain
    Pallor
    Paresthesiae
    Poor capillary refill
    Pulselessness (late sign)

    Epiphyseal Injury, Salter-Harris Classification: SALTER

    Type I: Straight through the epiphyseal growth plate
    Type II:
    Above the epiphyseal growth plate (ie, in a fragment of metaphysis attached to the epiphysis)
    Type III:
    Lower (ie, through and below the epiphyseal growth plate)
    Type IV:
    Through the epiphysis and metaphysis
    Type V:
    Emergency (ie, crush of the epiphyseal growth plate

    Neuromuscular causes of scoliosis

    Muscular dystrophy
    Muscular atrophy (i.e., spinal muscle atrophy)
    Myelodysplasia
    Mcocutaneous syndromes (e.g., neurofibromatosis)
    Arthrogryposis multiplex congenita
    Cerebral palsy

    Causes of Referred Ear ache (Otalgia)

    Teeth
    Temporomandibular joint syndrome
    Trismus
    Trachea
    Tube (ie, eustachian tube
    Tic douloureux (ie, trigeminal neuralgia)
    Tonsilar (ie, tonsillitis, cancer)
    Tongue
    Throat (laryngeal carcinoma)
    Thyroiditis

    Differentials for uncounciousness

    Fainted
    Illness/ Infantile febrile convulsions
    Shock
    Head injuries
    Stroke (CVE)
    Heart problems
    Asphxia
    Poisons
    Epilepsy
    Diabetes

    Criteria for Diagnosis of Cerebral Palsy,

    Posturing (especially abnormal extensor thrusting)
    Oropharyngeal problems (tongue thrusts, grimacing, W swallowing difficulties)
    Strabismus
    Tone increased or decreased in muscles
    Evolutional responses (ie, persistent primitive reflexes or failure to develop equilibrium and protective responses)
    Reflexes (ie, deep tendon reflexes are increased and plantar reflexes are up going.

    In order to diagnose CP require four criteria in a child older than one year who has no evidence of a progressive disease by history

    Organic causes of cinstipation in childhood

    Hirschprung's disease, Hypothyroidism, Hypercalcemia
    Anal fissure
    Neurogenic bowel (eg, spina bifida)
    Diabetes mellitus

    Causes of failure to thrive -7Cs

    Congenital abnormalities (eg, ventricular septal defect)
    Chromosomal abnormalities (eg, Down's syndrome)
    Cystic fibrosis
    Celiac disease
    Cow's milk protein intolerance (allergy)
    Calorie-protein malnutrition
    Cruelty (eg, parental neglect, abuse, environmental deprivation)

    Symptoms and Signs of Henoch-Schonlein Purpura,

    Rash (ie, purpuric rash over buttocks, estensor surfaces of legs, pre-tibial region)
    Arthralgia
    Sore abdomen
    Hematuria
    Hematochezia

    Complications of obesity in childhood

    Furunculosis
    Acanthosis nigricans
    Triad (1. diabetes mellitus, 2. atherosclerosis, 3. hypertension)
    Slipped femoral capital epiphysis
    Obesity in adulthood

    Causes of seizures in neonates- 5Hs

    Hypoxia
    Hypoglycemia
    Hypocalcemia
    Hypomagnesemia
    Hemorrhage (ie, periventricular, subarachnoid, subdural)
    Infection (ie, fever, meningitis, TORCH organisms)

    Components of Tunner syndrome

    Cardiac abnormalities (specifically Coartication)
    Lymphoedema
    Ovaries underdeveloped (causing sterility, amenorrhea)
    Webbed neck
    Nipples

    Kwashiorkor distinguishing features from Marasmus

    Fatty Liver
    Anemia
    Malabsorption
    Edema

    Components of APGAR score

    Skin color: blue or pink
    Heart rate: below 100 or over 100
    Irritability (response to stimulation): none, grimace or cry
    Respirations: irregular or good
    Tone (muscle): some flexion or active

    Features of potter syndrome

    Pulmonary hypoplasia
    Oligohydrominios
    Twisted skin (wrinkly skin)
    Twisted face (Potter facies)
    Extremities defects
    Renal agenesis (bilateral)

    Symptoms and Signs of epiglotitis

    Distressed
    Drooling
    Dysphagia
    Dysphonia
    Dyspnea

    Stages of Sexual Development in the Female ABCDE

    Accelerated growth (ie, height)
    Breast development
    Cunnus (vaginal) hair
    Distal hair growth (ie, axillae)
    Endometrial sloughing (ie, menarche)

    Metabolism enzyme inducers

    Mnemonic - "Randy's Black Car Goes Putt Putt and Smokes"

    Rifampin
    Barbiturates
    Carbamazepine
    Grisoefulvin
    Phenytoin
    Phenobarb
    Smoking cigarettes

    Effects of nicotine

    Nicotinic effects: MTWTF (days of week):
    Mydriasis/ Muscle cramps
    Tachycardia
    Weakness
    Twitching
    Hypertension/ Hyperglycemia
    Fasiculation

    Direct sympathomimetic catecholamines

    Dopamine
    Isoproterenol
    Norepinephrine
    Epinephrine
    Dobutamine

    ACE Inhibitor contraindictions

    Pregnancy
    Allergy
    Renal artery stenosis
    K increase (hyperkalemia)

    Burns, initial resuscitation: SAVE A PATIENT

    Stop the burning process
    ABCs of basic life support
    Visualize the patient for all injuries
    Estimate burn size and begin fluid resuscitation
    Airway (intubate if inhalation injury present)
    Penicillin (i.e., start antibiotics)
    Analgesic
    Topical therapy (e.g., flumazanine cream)
    Intoxicants/Inhalants
    Nasogastric tube
    Tetanus toxoid

    Carpal tunnel syndrome treatment

    Wear splints at night
    Rest
    Inject steroid
    Surgical decompression
    Take diuretics

    Burn Size Estimation by Total Body Surface Area: Rule of 9's

    Entire Head: 9%
    Entire trunk: 18% + 18% = 36%
    Entire arm: 9%
    Entire leg: 18%
    Whole body: 100%

    Alcoholism Screening Questions: CAGE

    Have you ever tried to Cut down on your drinking?
    Do people ever
    Anger you about your drinking?
    Do you ever feel
    Guilty about your drinking?
    Do you ever require an
    Eye opener (ie, drink of alcohol) to get going in the morning?

    Side effects of anticholinergic drugs

    Confusion
    Blurred vision
    Reduced lacrimation
    Reduced salivation
    Heart acceleration (tachycardia)
    Urinary retention
    Constipation

    Signs of delirium

    Acute onset, then fluctuation over days
    2. Inattentiveness (especially to conversation)
    3. Disorganized thinking (ie, incoherent speech)
    4. State of consciousness either reduced or hypervigilant


    For diagnosis of delirium need both 1 and 2 + either 3 or 4 (sensitivity 94-100%, specificity 90-95%)

    Signs and symptoms of depression

    Appetite diminished +/- weight loss
    Sleep disturbance (especially diminished number of sleep hours)
    Sexual libido diminished
    Energy diminished
    SuicidalitySelf-worthlessness and guilt
    Psychomotor agitation
    Anhedonia
    Thought process impaired

    Symptoms of Generalized Anxiety Disorder

    Scanning and vigilance
    Two or more worries
    Organic causes should be ruled out
    Motor tension
    Anxiety unrelated
    Course of mood or psychotic should be ruled out
    Hyperactive autonomics

    Side effects of lithium

    Vertigo
    Ataxia
    Nystagmus
    Intention tremor
    Stupor
    Hperreflexia
    Leukocytosis
    Insipidus (ie, nephrogenic diabetes insipidus)
    T-wave inversion on the electrocardiogram
    Heaviness (ie, weight gain), Hypothyroidism, Hyperparathyroidism

    Symptoms of mania

    Grandiosity
    Racing thoughts
    Euphoria
    Activities, goal-directed
    Talkative
    Sleep deprived
    Activities, reckless
    Disractibility

    Mental status examination

    Cognitive function (calculation, concentration, insight, judgment)
    Overview (appearance, attitude, level of consciousness, movements)
    Memory (recent and remote)
    Orientation (to person, place & time)
    Emotion (affect & mood)
    Speech (fluency, form, & comprehension)
    Thought (process, content, & perceptual disturbances)
    Attention (abstract thinking, recall, and intelligence)
    Something else (that might be important to the patient)

    Symptoms of Post-Traumatic Stress Disorder

    Insomnia and nightmares
    Re-experiences of traumatic event at a later date
    Arousal is increaseda
    Numbing of general responsiveness to the real world

    5 Drugs causeing depression

    Propranolol
    Reserpine
    Oral contraceptives
    Methyldopa
    Steroids

    Differentials of Dementia, Alzheimer's

    Drugs
    Encephalitis
    Metabolic (eg, electrolyte or liver abnormality, dehydration, acute intermittent porphyria)
    Endocrine (thyroid disease, diabetes mellitus)
    Normal-pressure hydrocephalus
    Trauma (eg, chronic subdural hematoma)
    Infection (eg, of lung or urine, AIDS, syphilis)
    Affective disorder (ie, depression manifesting as pseudodementia)
    Structural defect of brain (eg, infarction, tumour, abscess)

    Side effects of Tricyclic Antidepressants

    Anticholinergic (see above for Anticholinergic Drug Side Effects)
    Antihistaminic (eg, sedation, weight gain)
    Ani-alpha 1 adrenergic (eg, orthostatic hypotension)
    Arrhythmogenic (eg, quinidine-like ventricular cardiac effects)

    Causes of dyspnea of sudden onset

    Mucous plug
    Asthma,
    Aspiration, RDS
    Pulmonary embolus,
    P
    neumonia,
    P
    neumothorax,
    P
    ulmonary edema,
    P
    sychogenic
    Sepsis

    Causes of finger clubbing

    Fibroses of lung
    Infections (e.g., lung abscess, bronchiectasis, infective endocarditis)
    Neoplastic (e.g., lung adenocarcinoma)
    Gastrointestinal (e.g., chronic liver disease, inflammatory bowel disease, celiac disease)
    Endocrine (e.g., hyperthyroidism)
    Renal disease (chronic)
    Cardiac (i.e., cyanotic congenital cardiac disease)

    Differentials of chronic cough

    When cough in nursery, rock the "CRADLE"
    Cystic fibrosis
    Rings, slings, and airway things (tracheal rings)/ Respiratory infections
    Aspiration (swallowing dysfunction, TE fistula, gastroesphageal reflux)
    Dyskinetic cilia
    Lung, airway, and vascular malformations (tracheomalacia, vocal cord dysfunction)
    Edema (heart failure)

    Classification of arthritis

    Metabolic (ie, gout, pseudogout, hemochromatosis)
    Endocrine (ie, acromegaly)
    Degenerative (ie, osteoarthritis)
    Infectious (ie, septic joint, infectious synovitis, rheumatic fever)
    Connective tissue disorders (rheumatoid factor-positive) (i.e, systemic lupus erythematosus, rheumatoid arthritis, progressive systemic sclerosis/scleroderma, polymyositis/dermatomyositis)
    Inflammatory vasculitides (ie, polyarteritis nodosa, Wegener's granulomatosis, hypersensitivity vasculitis, giant cell arteritis)
    Seronegative spondyloarthropathies (rheumatoid factor-negative) (ie, ankylosing spondylitis, Reiter's syndrome, psoriatic arthritis, inflammatory bowel disease)

    Causes of joint pains

    Sepsis
    Osteoarthritis
    Fractures
    Tendon/muscle
    Epiphyseal
    Referred
    Tumor
    Ischaemia
    Seropositive arthritides
    Seronegative arthritides
    Urate
    Extra-articular rheumatism (such as polymylagia)

    Causes of drug induced lupus

    Chorpromazine
    Hydralazine
    Isoniazid
    Methyldopa
    Procainamide

    Radiological Features of Osteoarthritis

    Osteophytes
    Subchondral sclerosis
    Subchondral cysts
    Space between joint diminished

    Three Necessary Tests for Synovial Fluid Analysis

    Cell count and differential
    Crystal examination
    Culture and Gram's stain

    Systemic Lupus Erythematosus (SLE), Eleven Diagnostic Criteria:

    1. Photosensitivity
    2. and 3.
    Rashes (ie, 2. Discoid rash; 3. Malar rash)
    4.
    Ulcers in mouth
    5.
    Neurologic (ie, seizures, psychosis)
    6. and 7.
    Elevated blood tests (ie, 6. raised antinuclear antibody; 7. positive SLE cells seen, positive anti-double-stranded DNA antibody, positive antismooth muscle antibody, false-positive VDRL test)
    8.
    Renal (ie, proteinuria, hematuria, cellular casts)
    9.
    Arthritis (non-erosive)
    10.
    Serositis (ie, pleuritis, pericarditis, peritonitis)
    11.
    Hematologic (ie, hemolytic anemia, leukopenia, thrombocytopenia)

    Note: Need 4 of 11 criteria for diagnosis of SLE

    Incontinence, Causes of Transient Form

    Delirium
    Infection of urinary tract
    Atrophic urethritis
    Pharmacologic agents
    Endocrine (e.g., glycosuria)
    Restricted mobility ("geographic incontinence" of new setting)
    Stool impaction

    Urinary incontinence: causes of acute and reversible

    Delirium
    Restricted mobility/ Retention
    Inflammation / Infection/ Impaction [fecal]
    Pharmaceuticals / Polyuria
    "Drip" is convenient since it is urinary incontinence, so urine only drips out.

    Indications of dialysis - AEIOU

    Acid-base problems (severe acidosis or alkalosis)
    Electrolyte problems (hyperkalemia)
    Intoxications
    Overload, fluid
    Uremic symptoms

    Causes of enlarged kidneys

    Sclerderma
    HIV nephropathy
    Amyloidosis
    Polycystic kidney disease
    Endocrinophathy (diabetes)

    Causes of impotence

    Mnemonic - PLANE

    Psychogenic: performance anxiety
    Libido: decreased with androgen deficiency, drugs
    Autonomic neuropathy: impede blood flow redirection
    Nitric oxide deficiency: impaired synthesis, decreased
    blood pressure
    Erectile reserve: can't maintain an erection

    Penile Pain, Differential Diagnosis: P^8

    Priapism
    Phimosis
    Paraphimosis
    Peyronie's disease
    Penile tumour
    Purulence (ie, venereal disease)
    Prostatitis
    Push (ie, coitus-related trauma/overuse)

    NAMED ULCERS

    • CURLING- burns > 35% in body and fundus
    • PHAGEDENIC ULCER/TROPICAL: vincets organism
    • TROPHIC/PRESAURE SORES/NEUROGENIC MARTORELLES: hypertension
    • BURILLIS: m.ulcerans/m.marinum
    • MELENEYS: postoperative gangerene
    • BAZINS:  localised fat necrosis
    • CUSHINGS: raised ict
    • CAMERON ULCERS- linear gastfic erosikns in hiatal hernia
    • KISSING ULCER-both ant and post duodenal ulcers are present( seen in urinary bladder too)
    • HUNNERS ULCER- interstitial cystitis
    • MALENEYS ULCER- squamous cell cancer
    • MARJOLINS ULCER-squamous cell cancer
    • RODENT ULCER- basal cell cancer
    • MOORENS ULCER- Moorens ulcer-corneal ulcer
    • SEPTIC ULCER: slopping edge
    • TB ULCER: undermined edge
    • MALIGNANT ULCER-everted edge
    • RODENT ULCER: pearly edge
    • SYPHILITIC ULCER: puncuated edge

    Causes of Hypocalcemia in Surgical Patients

    1. Artifactual as a result of hypoalbuminemia
    2. Acute pancreatitis
    3. Surgically induced hypoparathyroidism (transient or permanent)
    4. Necrotizing fasciitis
    5. Inadequate intestinal absorption
    6. Excessive fluid losses from pancreatic or intestinal fistulae
    7. Chronic diarrhea
    8. Renal insufficiency with impaired calcium resorption
    9. Hypomagnesemia
    10. Hyperphosphatemia

    Vincristine

    Vincristine has a high neurotoxicity level and so must never be administered intrathecally, as it can cause ascending radiculomyeloencephalopathy -- which is almost always fatal.

    Side Effects of corticosteroids

    Side Effects of corticosteroids

    C - Cushing's syndrome

    O - Osteoporosis

    R - Retarded growth

    T - Thin skin I - Immunosuppression

    C - Cataracts

    O - Oedema

    S - Suppressed HPA axis

    T - Thin gastric mucosa

    E - Emotional

    R - Rise in BP

    O - Overweight

    I - Increased hair

    D - Diabetes

    S - Striae

    Metformin and IV contrast

    Metformin must be withheld before and for 48-hours after injection of IV contrast media - due to the increased risk of renal impairment, metformin accumulation, and lactic acidosis

    Impertigo

    Group A streptococci and S. aureus are the most common causes of impetigo

    Necrotizing fasciitis

    Necrotizing fasciitis is commonly associated with varicella infection, where the skin lesions are infected by Streptococcus or Staph

    Interstitial Syndromes of the Lung

    Interstitial Syndromes of the Lung include:
    Sarcoidosis
    Histiocytosis X
    IPF (interstitial pulmonary fibrosis)
    Tumor
    Failure
    Asbestosis
    Collagen disorders
    Environmental
    Dust
    Drugs

    Tetracycline

    Tetracycline is an antibiotic.

    Don't take with milk or other things containing calcium, bc will cause chelation and change absorption.

    Also: Cholesteramine causes decreased absorption.

    Quinidine

    Quinidine is an anti-arrythmic drug.

    It impairs Warfarin liver metabolism, so increases the amount of active Warfain, thus increasing INR and bleeding risk.

    Also may be caused by decreased production of VitK in the gut.

    Also: if taken with digoxin, binds to muscle tightly, so causes Dig Tox.

    Probenecid

    Probenecid inhibits uptake of uric acid in renal tubules.

    Used in treatment of gout and to increase the action of penicillin and methotrexane (decrease excretion).

    Phemobarbital

    Phenobarbital is a barbituate.

    It induces liver P450 enzymes that metabolize Warfarin. Thus, need to take more Warfarin when on this drug.

    However, if taken patient off Penobarbital, INR rises, too much Warfarin effect.

    Also: cholesteramine causes decreased abosorption.

    Also: renal clearance is increased by alkalinization.

    Penicillin and warfarin

    Penicillin use increase risk of bleeding when taking Warfarin.

    2 possibilities

    1) change gut flora, so decrease amt of VitK, so increase action of Warfarin.

    2) inhibit liver enzyme responsible for Warfarin metabolism.

    Also: cholesteramine causes decreased abosorption.

    Also: excretion decreased by Probenecid and salicylate.

    Methotrexate

    Methotrexate is used as chemo,

    It can cause gout like symptoms from cell breakdown.

    However, the drug is metabolized by xantine oxidase, so dont give with Allopruinol, as that would increase the effects of chemo.

    Also: renal excretion decreased by Probenecid and Salicylate.

    Lidocaine

    Lidocaine is given  with epinepherine to vasoconstrict and keept drug local.

    Also: in CHF, increased action of the drug because decreased blood flow.

    Erythromycin and other macrolides

    Erythromycin and other macrolides increase risk of bleeding when taking Warfarin. 2 possibilities 1) change gut flora, so decrease amt of VitK, so increase action of Warfarin. 2) inhibit liver enzyme responsible for Warfarin metabolism.

    Also: increases Digoxin bioavailability by the above 2 mechanisms and also maybe inhibitin p-glycopritein transport system in kidney for Dig.

    Epinephrine

    Epinephrine is given with lidocaine to vasoconstrict and keep the drug local.

    Ditropan

    Ditropan is an anticholinergic.

    When taken with Amitriptyline, causes abdominal distension and constipation.

    Because of a pharmacodynamic interaction : tricyclics inhibit the cholinergic system via a different mechanism.

    Digoxin

    Digoxin binds to muscle tissue, Vd=400.

    If something else binds to muscle tissue, digoxin is displaced, leading to higher blood levels and lower Vd. = Digoxin toxicity. (eg, quinidine)

    Also: Can cause increased bleeding if taken with Warfarin.

    Also: Cholestyramine causes decreased absorption. Also: Erthromycin increases bioavail by 3 mechanisms.

    Warfarin effects and interaction

    Warfarin is an anti-coagulant, b/c reduces VitK dependent clotting factor production in the plasma.

    It has a narrow therapeutic index: with a little Warfarin, the INR = 2, but with a little more, INR = 6+. Highly bound to plasma (95%).

    Too much Warfarin leads to bleeding.

    Interactions: Increased bleeding (asprin), GI bleeding (NSAIDS), Impairment of Warfarin metabolism and increased bleeding (Quinolone or phenytoin), increased bleeding, maybe bc less VitK (sulfa drugs). Bartituates like phenobarbital increase metabolism, so need more Warfarin.

    Also: cholesteramine causes decreased abosorption.

    Cholestyramine

    Cholestyramine is an ion exchange binding resin. Used to lower cholesterol by disrupting enterohepatic circulation. It is a charged molecule, so it just sticks to the wall and blocks cholesterol absorption. Will also block the absorption of other drugs (decreased bioavail): such as digitalis, Warfarin, phenobarbitol, tetracycline, penicillin.

    Calcum

    Calcium is found in milk etc. Ion, so can cause chelation. Ion binds to drug, gets trapped inside drug in a wierd shape.

    It changes absorption of the drug (eg, Tetracycline).

    Asprin

    Asprin works by inhibiting platlet function/ anti-thrombosis/ decreases vasoconstriction. 

    Pharmacokinetic: Also, is highly bound to plasma (99%), so displaces Warfarin, leading to increased levels of Warfarin that is active. Therefore increases bleeding if taken with Warfarin.

    Also: decreases renal excretion of Penicillin and Methotrexate by competing for the transport mechanism.

    Amitriptyline and Ditropan

    Amitriptyline is a tricyclic antidepressant. If taken with Ditropan (an anticholinergic), causes abdominal distension and constipation. Because of a pharmacodynamic interaction: tricyclics inhibit the cholinergic system also via diff mech. Also: tricyclics affect membrane pump that moves nts and antihypertensive drugs into intracellular storage sites. So may alter anti-HTN treatments. Also: metabolized via CYP 2D6, inhibited by Prozac.

    Allopurinol

    Allopurinol is used in gout, xanthine-oxidase inhibitor. Xanthane-oxidase creates uric acid, but also metabolizes methotrexane. So, dont give this with methotrexane, even though it might be tempting to decrease gout symptoms in chemo. Also: Increased absorption if taken with iron.

    Alcohol and CYP

    Alcohol Induces cytochrome 2E1, increasing acetaminophen toxicity.