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173 Cards in this Set
- Front
- Back
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what is the essential preparation to do before any patient care procedure?
|
- educate the patient as to the need for the procedure
- obtain informed consent if cutting below the fascial layer - prepare all needed equipment - use blood borne pathogens protection appropriate |
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what might conservative therapy for small abscesses include?
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applying a warm pack to the area to attempt to allow the abscess to spontaneously drain
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|
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what is an indication for an incision and drainage?
|
an abscess that is not spontaneously resolving
|
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T/F
Wear eye protection when draining an abscess |
True
|
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Why would you consider giving a patient antibiotics if you had to drain an abscess?
|
to cover MRSA
|
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what would you pack an abscess with?
|
Idoform gauze
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what is a subungual hematoma?
|
blood trapped under a finger/toenail causes pressure pain that normal pain meds do not control well
It will slowly expand over several hours after an injury Throbbing and persistent pain. |
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How do you relieve pain from a subungual hematoma?
|
to relieve pain, blood needs to be removed
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what is the procedure to remove the blood from a subungual hematoma?
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educate
clean area choose method of hole creation create hold drain blood clean again apply absorbant bandage splint as necessary |
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when does a tick become able to transmit disease
|
ticks which remain on a person greater than 4 hours or becomes engorged can transmit disease
|
|
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what diseases can be carried by a tick?
|
Rocky mountain spotted fever
Q fever Typhus Tularemia Babesiosis Lyme disease |
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how does a tick transmit disease?
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disease is transmitted when tick regurgitates its contents into the host
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T/F
do not squeeze the body of a tick |
True
|
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|
t/f
do not burn off ticks |
True
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t/f
do no use chemicals to remove ticks |
true
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when do you use a NG tube?
|
aspiration of gastric contents
administration of feedings or medications |
|
|
what are the contraindications for an NG tube?
|
Poisoning with corrosive agents such as acid and alkali products
poisoning with hydrocarbons and petroleum distillates actively seizing patients maxillofacial or skull trauma |
|
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why are NG tubes contraindicated in skull trauma?
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do not want to accidentally put the tube in the brain
|
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how do you insert an NG tube?
|
prepare
educate coach the patient and warn about gagging place towels across the chest of the patient remove dentures if not fitting well view nares with light to look for obstruction spray with neo-synephrine estimate length of tube |
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|
how should the head be positioned when inserting an NG tube?
|
head back when going in nose
head forward to advance in esophagus |
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what are the potential complications of an NG tube?
|
submucosal, intracranial, or pulmonary passage
esophageal perforation mucosal ulcerations aspiration of stomach contents into lungs |
|
|
what can a nasal canula deliver?
|
minimum 2 mL/min
maximum 6 mL/min if the flow meter is set at 3 L/min the oxygen will be 21% + 3LPM X 4% |
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if the flow meter on a nasal canula is set at 3 L per minute what does this mean?
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the oxygen will be delivered at 21% + (3LPM X 4%)
|
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what is a Venturi mask?
|
oxygen passes through an air-enterinment device that regulates the concentration of the delivered oxygen and volume of gas delivered.
Dials in a specific percentage of oxygen delivered |
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|
describe a non-rebreather mask.
|
similar to face mask except oxygen inflow fills a bag which is attached to the mask by a one way valve flapper
Valves over perforations serve as one way ports of exhalation |
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what are the limits on a non-rebreather mask?
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minimum flow rate is whatever level will prevent complete collapse of the bag during inspiration
Maximum: excess of 60% O2 delivered |
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what is an Ambu-bag oxygen
|
inlet of a bag-valve-mask resuscitator attached to the flow meter nipple by a small bore tube
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what type of oxygen device can deliver oxygen at almost 100%?
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Ambu-bag-oxygen
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what is an Ambu-bag used for?
|
may be used to assist ventilation of pts breathing spontaneously or when no spontaneous respirations are occurring
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T/F
you should deflate the bag in an ambu-bag simultaneously with patients inspiratory efforts. |
True
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what can cause pain during an injection?
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Speed
pH not allowing alcohol to evaporate needle to big temperature of medication |
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does hot or cold medication in an injection burn more?
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cold
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what are the indications for a Subcutaneous injection?
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epinephrine
insulin some vaccines B12 saline |
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what angle should a SC injection be administered?
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45 degree angle
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what are the indications for an IM injection?
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irritating drugs
rapidly absorbed medications |
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where are IM injections performed?
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Deltoid
Mid-lateral thigh anterior thigh gluteal |
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what is the preferred site on an IM injection on a child?
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mid-lateral thigh
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what is the angle an IM injection is given?
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90 degrees
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what are complications associated with IM injection?
|
nerve injury
arterial injury abscess hematoma pain cellulites |
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what are the indications for an Intradermal injection?
|
Skin test
- TB - Allery - local anesthetic |
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what is the angle that a intradermal injection is give?
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15 degrees
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what are indications for peripheral IVs?
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Phlebotomy
delivery of medications delivery of fluids short term nutrition emergent venous access administration of contrast material |
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how often does a saline lock need to be flushed on an IV?
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Saline locks only need to be flushed every 12 hours
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how often does a peripheral IV site need to be changed?
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Site must be changed every 3 days
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what are the contraindications for a peripheral IV?
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extremity with massive edema
burns sclerosis phlebitis thrombosis local cutaneous infusion ipsilateral arm of pt with masectomy |
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If your patient has had a masectomy, where should an IV be placed?
|
contralateral arm of patient with masectomy
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what size of needle should you use for peripheral IVs?
|
smallest needle possible
|
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what size of needle is required for fluid resiscitation?
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16 or 18 gauge needle
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what are the potential complications of Peripheral IVs?
|
infiltration
phlebitis septicemia catheter embolus scarring |
|
|
T/F
Just getting someone's blood on your skin is not considered an exposure if skin is intact |
True
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T/F
being in a room that is well ventilated with a TB pt is not automatically considered an exposure |
true
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T/F
not every needle stick is a high risk event |
True
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what body fluids are not associated with HIV?
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urine
sweat feces tears saliva |
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what is implicated with HIV?
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semen
vaginal secretions any body fluid |
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what type of contact needs a clinical evaluation?
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any direct contact to concentrated virus (HIV) in a research laboratory is considered an exposure that needs to be clinically evaluated
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If you are bitten by a human that has HIV, what must be considered?
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human bites must include the possibility that both the biter and the bitee were exposed
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when you suspect that you have been exposed to HIV, how fast should you take post-exposure protocol?
|
within hours
IMMEDIATELY |
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does systemic infection of HIV occur instantly after HIV contact?
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NO
systemic infection does not occur immediately so if you test the source of exposure THAT day and they are negative there is zero change of transmission |
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T/F
If you test the source of exposure to HIV the same day as the exposure and the test is negative there is zero chance of transmission. |
True
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List ways to prevent HIV transmission
|
needle less systems for IV drugs
never recap a needle wear gloves wash hands |
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Who are least likely to be vaccinated against HBV?
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IV drug abusers
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is the adult population vaccinated against HBV?
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NO
it is the population of people in there early to mid 20s that had a requirement to enter school to be vaccinated against HBV |
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what health care workers are most at risk for HBV exposure?
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Inner city ER health care workers at high risk
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why are HBV infections rare among health care workers?
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rare because health care workers are required to be immunized
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what has decreased HCV transmission in some cities?
|
decrease has been seen in cities with needle exchange program
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T/F
the treatment for HCV exposure is very hard on the immune system |
True
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how long is the regimen of treatment for HCV exposure?
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48 weeks
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what are the risks of complications for patients with UTI?
|
sepsis to the kidney
|
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what are the complications/indications for BPH?
|
refractory urinary retention
high pressure chronic retention complications such as recurrent hematuria, bladder stones, UTI, and gladder diverticulae caused by outflow obstruction |
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what is a complication of cryptochicisim?
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increased risk of cancer
|
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what is a 5-alpha-reductase inhibitor ?
|
the enzyme 5-alpha-reductase is involved in the conversion of testosterone to the active form dihydrotestosterone by reducing 4,5 double bond.
In BPH, DHT acts as a potent cellular androgen and promotes prostate growth. therefore inhibiting it reduces the excessive prostate growth. |
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what is the best treatment of UTI, prostatitis?
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antibiotics, likely bactrim
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what is Silhoutte sign?
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when two structures of similar density abut one another
anatomical margins are lost |
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what is Rigler's sign?
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double wall sign
when air is seen present on both sides of the intestine |
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what are some common errors in prescription writing?
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non-legible writing
no standard refill instructions limit each RX to one med Lack of pt address no date on Rx leaving off pt age uncommon or local abbreviations |
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what is a Schedule I drug?
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no accepted medical use
will not be prescribed or dispensed very addictive potential |
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what is a schedule II drug?
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substance that has high potential of abuse
has a currently accepted medical use in the US currently accepted medical use with severe restrictions the abuse of the drug may lead to severe psychological or physical dependence |
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How is a schedule II drug prescribed?
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written prescription only
in an emergency situation may be dispensed with verbal permission from the doctor doc must provide written prescription confirming the verbal order within 24 hours NO refills on these |
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what is a Schedule III drug
|
substance has potential for abuse but less than schedules I and II
it has currently accepted medical use in the US abuse of the drug may lead to moderate or low physical dependence of high psychological problems |
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what are schedule IV drugs?
|
substances with low abuse potential relative to schedule III
may lead to limited physical or psychological dependence relative to those in schedule III |
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examples of Schedule III drugs:
|
phenobarbital
meprobamate Barbital Chloral betaine |
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what are schedule V drugs?
|
Robitussin
some states allow it to be sold OTC but others make it prescription only |
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what must be on the prescription for all controlled substances?
|
Rx must be dated and signed on day of issue
Bear the full name and address of the patient Bear full name, address, and registration number of the physician |
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what are the components of a Rx?
|
written in ink
pt name, address, & age date Rx is written Name of medicine strengths and amounts of meds directions for pt usage refill instructions labeling instructions if desired physician signature, phone number, name, address, DEA number |
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are abbreviations acceptable in prescription writing?
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NO
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what is the rationale for all the documentation required for a prescription?
|
to keep the health care provides on the same page
to document and refute false claims and to keep your clinic open and get paid |
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what are the components of a medical chart?
|
Name
CC ROS PE Vitals SOAP note medications sheets checkup sheets annual diabetic foot exam sheets labs |
|
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what is on a written admin note
|
CC
HPI PMH PSH FMH SocH Allergies MEDS PE Assessment Plan written immediately on admission serve as H&P until complete H&P is dictated Complete ROS is omitted Pertinent positives and negatives only |
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what is in the dictated H&P
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CC, HPI, PMH, PSH, SocH, All, Meds, ROS, PE, assessment, Plan
Admit notes used to guide dictations must be dictated within 24 hours of admission includes complete ROS |
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What is in the discharge summary?
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Summarizes hospital stay
dictated ASAP after D/C Emphasize key points Maps out decision making Admit date, D/C date, admissions dx, discharge dx, service, referring physician, consultations, procedures, hospital course, discharge condition, diposition, discharge meds, follow up instructions |
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Nasal canula
|
O2 is administered to the patient through 2 small tubular prongs with the tubes placed around the ears
|
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what is the minimal flow rate of the nasal canula?
|
2 L/min
|
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Venturi masks
|
oxygen passes through an air entrainment device that regulates the concentrations of delivered oxygen and volume of gas delivered
|
|
|
what concentration can a Venturi mask deliver?
|
24, 28, 35, 40%
|
|
|
Non-rebreather mask
|
similar to face mask except oxygen inflow fills a bag which is attached to the mask by a one way valve flapper
|
|
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what is the amount of oxygen that can be delivered with a non-rebreather mask?
|
in excess of 60%
|
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what iss the minimm flow rate in a non-rebreather mask?
|
whatever level will prevent collapse of the bag during inspiration
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what would cause an abnormal reading with a pulse oximetry?
|
with hypothermic and shock patients
NAIL POLISH may also cause inaccurate reading will produce falsely high readings in patients with CO poisoning |
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how do you calculate flow rates and oxygen delivery at sea level?
|
Nasal canula: oxygen delivered is ~ 21% + (LPM x 4%) per liter per minute
|
|
|
what are the goals of oxygen therapy?
|
the goal of oxygen therapy is to raise the blood oxygen content above 92-95%
|
|
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what are the complications of intubation?
|
broken teeth
right main stem bronchi intubation esophageal perforation hemorrhage, hematoma ruptured trachea |
|
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apnea
|
absence of breathing
|
|
|
hypoxia
|
is a condition in which there is a deficiency of oxygen reaching the tissues of the body
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Dyspnea
|
air hunger resulting in labored or difficulty breathing
this is a state of awareness of one's own breathing |
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Pulse oximetry
|
is a photoelectric device that monitors the amount of oxygen circulating in blood
|
|
|
how long does a tick have to be attached in order to transmit disease?
|
4 hours
|
|
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if you try to burn off a tick or use chemicals to get a tick off what might this cause?
|
this can cause tick to emit mass amounts of disease into the host
|
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how should a tick be removed?
|
gently slide a pair of curved hemostas or atraumatic forceps to the tick
avoid squeezing pull gently upward on the tick until it disengages the host MUST REMOVE THE HEAD |
|
|
T/F
Must use friction to clean hands for approximately 30 seconds |
True
|
|
|
what fills abscess and must be removed?
|
Pus
|
|
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how do you perform an incision of an abscess?
|
Clean area
administer field block but do not inject into the abscess Prep in sterile field Determine which instrument to use: #11 blade or 18 gauge needle Cut the abscess in a straight line push out the pus then swab with a Q tip to culture pack with iodoform gauze antibiotic regimen for MRSA is advised |
|
|
what are the indications for an NG tube?
|
aspiration of gastric contents
administration of feedings or medications |
|
|
what are the contraindications for an NG tube?
|
poisoning with corrosive agents such as acid and alkali products
poisoning with hydrocarbons and petroleum distillates actively seizing patients maxillofacial/skull trauma |
|
|
how do you determine the proper length for an NG tube?
|
tip of the nose to angle of the jaw + mouth to tip of xiphoid bone
|
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what are the 3 techniques for fish hook removal?
|
retrograde technique
string yank technique advance and cut technique |
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describe the retrograde technique for fish hook removal?
|
apply downward pressure to the shaft of the hook
back the barb out of the path of entry you may slide an 18 gauge needle over the barb |
|
|
describe the string yank technique for fish hook removal?
|
tie a string to the round part of the fishhook
grasp the string 3-4' from the hook Stabilize the hook by placing pressure downward to the shaft rapidly pull on the string |
|
|
describe the advance and cut technique for fish hook removal
|
advance the barb through the skin
cut the loop hole side off continue to pull hook through |
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Gauge of needle.
|
outside diameter of needle
|
|
|
Lumen of needle
|
inside diameter of needle
|
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if you have a large gauge needle how does the lumen compare?
|
large gauge needle
the smaller the lumen |
|
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how long is a needle?
|
5/8' to 3-1/2"
|
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what causes pain with injections and how do you prevent the pain?
|
giving the injection
hitting nerves causes pain avoid hitting nerves |
|
|
what are the relative contraindications for IV/injections?
|
extremity with massive edema
extremity with burns extremity with sclerosis extremity with thrombosis Ipsilateral arm of pt with mastectomy |
|
|
what are the absolute contraindications for IV/injections?
|
extremity with phlebitis
local cutaneous infection |
|
|
what is an intradermal injection used for?
|
TB
Allergy testing Local anesthetic |
|
|
describe the technique of Intradermal injection.
|
select volar surface of forearm
cleanse skin thoroughly short 25 gauge beveled needle hold syringe at 15 degree and inset tip just beneath the epithelium into the dermis Inject pale wheel DO NOT RUB site |
|
|
what are subcutaneous sites used for?
|
epinephrine
insulin some vaccines vitamins B12 Saline NO tetanus toxoid Technique: select dorsal aspect of upper arm or anterior thigh or abdomen |
|
|
Intramuscular injection- gluteal
|
located PSIS and greater trochanter
draw imaginary line between the two find the mid-point inject laterally and superiorly to the mid-point or upper outer quadrant |
|
|
what angle do you hold the angle at for an IM technique?
|
Always aspirate
|
|
|
T/F
Always aspirate an IM injection! |
True
|
|
|
what are some IM injection complications?
|
nerve injury
arterial injury abscess hematoma pain cellulitis |
|
|
what injections do you aspirate?
|
Intramuscular
sub Q |
|
|
what is the HIV risk of exposure with a needle stick?
|
HIV transmission rate is ~ 0.3% with a needle stick by a known HIV + source
|
|
|
T/F most recommendations indicate the need to start PEP within a few hours of exposure.
|
True
|
|
|
what is the greatest risk population for HIV?
|
Number of cases increasing in 1999 in the 16-25 age group fastest growing group
most cases are IVDA and homosexual men |
|
|
what is the fastest growing group of people with HIV infection
|
African Americans
Hispanics |
|
|
Who are the main group of people at risk for HCV?
|
now mainly in IVDA in which 2/3 are positive with 2 years of use
|
|
|
who are the main group of people at risk for HBV?
|
IVDA, male homosexuals, chronic dialysis, healthcare workers with exposure
|
|
|
who are at the greatest risk for HAV?
|
high risk patients are travelers, day care workers, raw shellfish consumers, and institutionalized populations including college campuses
|
|
|
who is the most likely person to get an HCV infection in the US population?
|
Housekeepers
|
|
|
who can write prescriptions?
|
physicians
vets dentists podiatrists Mid-levels: Nurse practitioners, PAs, Optometrists, Pharmacists |
|
|
when do non-controlled substances prescriptions expire?
|
1 year from date issued
|
|
|
when do controlled substances prescriptions expire?
|
Controlled drugs CIII-V expire 6 months from date of issue
CII expire 30 days from date of issue |
|
|
what are the rules for prescription writing for residents and interns?
|
all of the following may prescribe CIII-V drugs if acting in the course of employment for DEA registered hospital:
Interns/residents Physicians on staff at VA hospital Individual practitioner |
|
|
T/F
Take as directed on a prescription is okay |
False
avoid "take as directed" |
|
|
what populations are at risk for a UTI?
|
DM
elderly severe reflux in children younger than age 4 end stage renal failure immunosupressed patients |
|
|
What are the risks of BPH?
|
characterized by progressive enlargement of the prostate resulting in outlet obstruction
mostly age 60-65 affects transition zone |
|
|
What are 5-alpha reductase inhibitors?
|
blocks conversion of testosterone to DHT
|
|
|
describe bacterial prostatitis
|
sudden onset of chills, fever, back and perineal pain
frequency, urgency, dysuria Prostate is exquisitely tender Treatment: 4-6 weeks of quinolone or Bactrim |
|
|
describe non-bacterial prostatitis
|
most common prostatitis syndrome with no known etiology
possibly from spastic dysfunction of bladder neck from incomplete relaxation during voiding most often difficult to distinguish from bacterial prostatitis |
|
|
what is the treatment for non-bacterial prostatitis?
|
alpha-blockers to relax the bladder neck usually effective
|
|
|
UTI
|
inflammatory response to bacterial invasion of tissue
|
|
|
Cryptrchidism
|
testicle located in normal path of descent but has not reached scrotum
|
|
|
Phimosis
|
where the foreskin cannot be fully retracted over the glans
|
|
|
Paraphimosis
|
where the foreskin is trapped behind the glans of the penis
|
|
|
Rigler's sign
|
air on both sides of the bowel wall
|
|
|
Silhouette sign
|
when two structures of similar density abut one another, anatomical margins lost
|
|
|
when do you use contrast media?
|
typically use contrast when you do CT, CTA, MRI, MRA, prett much anytime you need to distinguish between two soft tissues on radiograph
|
|
|
imaging for pulmonary embolus
|
CT or MRI
|
|
|
imaging possible disruption of ligament
|
MRI
|
|
|
imaging for free air in abdomen
|
XR
|
|
|
imaging for fractured vertebra
|
CT
|
|
|
what is an absolute contraindication for IV placement?
|
infection on or just below the skin and phlebitis
|
|
|
Is epinephrine SubQ or IM injection?
|
IM injection
|
|
|
T/F
Highest risk for HepB by incidental needle stick as a health care worker |
True
|
|
|
T/F
HCV is 10x lower risk than HBV but has no prophylactic regimen |
True
|
|
|
T/F
HIV transmission rate by needle stick is 0.3% from a known HIV+ source |
True
|
|
|
who are the fastest growing HIV population?
|
african americans females and hispanics
|
|
|
what can happen if your leave a ring or piece of jewelry to remain around a digit that has been injured?
|
arterial and venous occlusion
the indication to remove ring is to prevent or alleviate circulatory occlusions |
|
|
Is oxygen flammable?
|
NO
it is a catalyst for flames |
|
|
what gives false pulse ox readings?
|
CO poisoning
nail polish sepsis hypothermia |
|
|
what are the two types of laryngoscopes?
|
straight blade = Miller
curved blade = Macintosh |
