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410 Cards in this Set
- Front
- Back
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what are some techniques for a Line insertion |
over the wire and over the needle |
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When is a line indicated
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Continuants are to be blood-pressure monitoring and arterial blood sampling
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Where's the radio Artley palpated
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Between the distil radialis and flexor carpi radialis tendon
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how do you perform and Allen test |
Occlude the ulnar and radial while the patient clinches fist open hand and release pressure from ulnar artery you should see return of circulation within five seconds if there is a delay this indicates poor circulation repeats releasing the radio art
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contraindication's to a line insertion
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Coactivation problems
Advanced atherosclerosis Reynards disease Thromboangiitis obliterans |
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Equipment needed for a life insertion
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Sterile prepped and field
Needle catheter and wire 1% lidocaine 25 gauge needle and syringe Scalpel or large word needle Suture and needle driver wrist board and roll |
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Before sterile field is prepped what must you do in a line
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Proper positioning Dorcy flexion of the wrist
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What does Dorcy flexion of the risk do when starting a line
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It brings the radio are any closer to the surface of the skin is very important to the success of the procedure
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Described the steps in the over the wire technique
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Check the needling catheter making sure that it glides easily
Advanced to work party at 30 to 45° angle When blood Veterens the catheter is advanced through the vessel and the needle is removed Slowly pulled back the catheter until pulsatile bloodflow is seen Advance the wire into the vessel When in the vessel advanced the catheter Hold pressure on the artery distal to the catheter and remove the wireAnd attach the catheter to transducer |
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Describe the steps in the over the needle technique
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Advance the catheter at 8:30 to 45° angle
Went Blood return is seen advanced the needle little further to make sure the catheter has into the vessel Lower the needle angle to 10 to 15° and Advanced the catheter into the vessel Removed the needle Attached the catheter to the transducer |
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What is the best way to secure an A-line catheter
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Using sutures
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with sutures are best for securing a line |
Moderate diameter
Nonabsorbable Like silk or lonNylon |
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Once the A- in place in the place and transducer is connected what is the next
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Check perfusion to extremities and check it periodically
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If during the over the needle technique you do not see blood return after the flash what can you
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do advance the catheter through the vessel and use the over the wire technique
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Sometimes free flow of blood is observed but the wire won't pass easily what can we do
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Maybe the tip of the needle is in the vessel but the catheter is outside so you can try advancing Venido a little bit more after the initial flash of blood to the catheter can into the Arty
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Catheter gets hung up on skin making it Hard to Advance what can we do
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Make a skin Nick using a scalpel or large bore needle at the start of the procedure
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After multiple attempts at cannulation of the artery what can happen
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The artery can go into spasms making it hard to cannulae so you have to stop that attempt and choose another site for the A-line placement
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What are some indications of lumbar puncture
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Diagnostic and therapeutic purpose
Administration of spinal and epidural anesthesia Analysis of CSF for infection inflammatory diseases oncology and metabolic processes Intrathecal administration of antibiotics And chemotherapy |
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Contraindications to lumbar puncture
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Cardiorespiratory compromise because the petitioning needed to assume the procedure can make it worse
Signs of herniation or increased ICP like Cushing's Triad focal neurologic signs like papilledema |
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Before you doing lumbar puncture what do you have to do
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CT scan even if it may not show signs of increased intracranial pressure
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What are risk factors for spinal hematoma during lumbar puncture
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Patient on anticoagulant therapy or patient has a coactivation disorder
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If patient has had a previous lumbar surgery what should you do before considering lumbar posture
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You should refer to interventional radiologist instead
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What equipment do you need from lumbar puncture
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Lumbar puncture tray
Spinal needle and Stylet Skin prep drape Collection tubes Manometer Sterile gloves |
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What size needle is used for lumbar puncture
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20-22 gauge needle
1.5 inches for infants 2.5 inches for children 3.5" is For adults |
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What is the proper positioning for lumbar puncture
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Lateral recombinant or sitting
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Which position is preferred for lumbar puncture
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Lateral become bit because you can get a good opening pressure and it will prevent posts puncture headache
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How do you help keep the needle at midline when prepping for a lumbar puncture
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If the patient is sitting make sure they're perpendicular to the table if they're laying make sure they're parallel to the table
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How do you estimate the landmark for lumbar puncture
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Draw and imaginary line between superior aspect of ileac crest and intersect midline at L4
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Where is that a needle insertion site for lumbar puncture
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Between L3 and L4 or between L4 and L5 this is where the spinal cord ends
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When you insert your needle where do you insert between the vertebra
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At the superior aspect of inferior spinous process 15° angle two words umbilicus
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How can we help decrease leakage of cerebrospinal fluid during lumbar puncture
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Use a pencil tipped needle or make sure the bevel of the needle isn't sagittal planethis will this will spread the fibers and not cut them because they run parallel to the spinal access
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When inserting a needle for lumbar puncture List the layers before you get to the destination
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Skins
Soft tissue supraspinous ligament Interspinous ligament Ligamentum flavum Posterior epidural space dura Arachnoid Subarachnoid space |
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What is the destination when performing a lumbar puncture
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Subarachnoid space between the nerve roots of the cauda equina
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When will you feel a popping sensation when doing a lumbar puncture
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When you go through the ligamentum flavum
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After feeling the popping sensation what do you do lumbar puncture
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Stop and advance the needle by 2 millimeter increments removed the stylus until you see Csf
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If you advance the needle during a lumbar puncture and you do not CC people spinal fluid and you feel bone what should you do
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Withdraw the needle to the subcutaneous tissue without exiting the skin and redirect the needle
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When will see csfl fluid flow
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When you are in the subarachnoid space
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Is the flow of cerebrospinal fluid is poor what should you do
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A nerve root may be obstructing the flow so rotate the needle 90°
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If you see drops of blood while getting cerebra spinal fluid what can this indicate
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This can indicate a Trumatic lumbar puncture if this CSF is tinged with blood but it will become clear as it flows unless the source of blood is from a subarachnoid hemorrhage
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It drops of blood into the needle and the needle becomes clogged what should you do
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You must remove the needle and replace it with the new one and insert at a different site
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What position should the patient be to get an opening pressure
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Lateral recumbent
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When measuring opening pressure you start to see pulstations from the fluid what it does this indicate
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This is a normal indicator of cardiovascular or respiratory motion
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What level is concerning when measuring opening pressures
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Over 25 you should monitor for herniation and determine the cause of elevated ICP
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What will happen if you tried to aspirate the CSF and not allowed to trip
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The negative pressure will cause a hemorrhage
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How many ML's of fluid is enough for CSF analysis
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3 to 4 ML
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If you want to collect CSF from the manometer where should you turn the stopcock
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To work the patient
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Which patients will be difficult to obtain a lumbar puncture
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Obese
Kyphoscoliosis Osteoarthritis Ankylosis spondoylitis Previous surgery Degenerative disc disease |
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If you're patient has had previous surgery and you really need to obtain cerebrospinal fluid by lumbar puncture what should you do
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You should consult an anesthesiologist and radiologist to try to get fluoroscopy guided lumbar
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complication of lp
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Pain headache herniation bleeding infection subarachnoid epidermal cysts CSF leakage
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What is the subarachnoid epidermal cyst
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Skin plug introduced in the subarachnoid space can be avoided by using the needle with the stylet
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How can we prevent CSF leakage
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Uses small bore needle
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Is persistent leakage occurs during lumbar puncture what can we do
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Consultant anesthesiologist to possibly get a blood patch
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How can we avoid complications of lumbar puncture
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Do a detailed assessment including neurologic assessment and retinoscopy exam
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Is an unstable cervical spine injury a complete contraindications intubation
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No but i intubation must be done with strict in-line stabilization of the spine
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What size blades are use during intubation
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3-4 mack
2-3 miller |
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What size ET tube is normal for adults
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7,7.5,8
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What is the purpose of the balloon at the end of the ET tube
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It creates a seal between the tube and tracheal movement it prevents air leaks and aspiration of G.I. contents
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What is proper positioning before you intubate
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Make sure the patients head is level with the lower portion of your sternum
Sniffing position unless contraindicatedUsing a towel or pillow flextion of the neck Extension of the headThis improves the alignment of the oral cavity pharynx and larynx |
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How can we improve the alignment of the patient's oral cavity to better visualize the local courts before intubation
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flextion of the neck extension of the head
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What is the Sellick maneuver
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This is applying cricoid pressure compressing the soft wall esophagus between the cricoid and the vertebra to prevent passive regurgitation
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What is the proper positioning when using the Mac blade
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It goes into the vallecula between the base of the tongue in the epiglottis
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What is the proper positioning when using the Miller blade
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It goes past the epiglottis
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How far do you have advanced ET tube
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3 to 4 cm pass the vocal chords
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Should you maintain crackly pressure until the two placement is confirmed
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Yes
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Where should tube be at the lip
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About 22 centimeters
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What is the point of radiographic evidence after intubation
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It does not confirm placement it cannot be used to detect esophageal intubation it just make sure that you are not in the right mainstem and make sure that you're above the Carina
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Most serious complication of intubation
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Accidental esophageal intubation leading to hypoxemia and death
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Define meningitis
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Infectious process of the meninges of the brain specifically arachnoid matter and the CSF in the ventricles and subarachnoid space
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Where does meningitis most specifically occur
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Arachnoid matter and the CSF in the ventricles and subarachnoid space
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What is another word for aseptic meningitis
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Viral
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Was a high risk the meningitis
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Lupus diabetes immunocompromise young old pneumonia recurrent sinusitis
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What a common bacteria is that causes meningitis
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Streptococcus pneumonia
Neisseria meningitidis Haemophilus influenza |
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A very young or very old patient with meningitis what is the likely bacteria
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Streptococcus pneumonia
Haemophilis influenza (infant) |
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Students in college jail and nursing homes what is most common bacteria that causes meningitis
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Neisseria meningitis
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When will you indicate the meningitis is aseptic I supposed bacteria
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When you have meningitis without lab results and negative CSF analysis
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Causes of aseptic meningitis
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virus: Mumps
Enterovirus Herpes Adenovirus Epstein-Barr Fungal Tuberculosis Mycobacterium tuberculosis Syphilis |
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Manifestations of meningitis
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fever
Nuchal rigidity Altered sensorium Severe headache Photophobia Chills Myalgias kernig sign Rudzinski sign Nausea vomiting Purpura or petechiae |
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What are the four main hallmarks of meningitis
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Fever high101
Nucal rigidity Altered sensorium Severe headache |
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What is positive kernig sign
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Flexion of the knee and hip causes pain and spasms
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what is a positive bruszinski sign
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Patient lays flat try to flex the head and neck causes flexing at the hip and knee
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What is the CSF analysis of bacterial meningitis
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Cloudy CSF
Opening pressure greater than 180 Increased WBC Increase protein Decrease glucose Bacteria present on Gram stain and culture |
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What is the CSF analysis of viral meningitis
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Fiesta is usually clear candy cloudy
PressureCan be normal or high Mostly variable White count will be high but can be normal Proteins will be normalor slightly increased Glucose will be fine No bacterial culture |
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In reference to meningitis when is a CT of the head indicated
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Before lumbar puncture
Patients with focal neurologic signs or diminished level of consciousness Patients with signs and symptoms of CSF findings typical of bacterial meningitis but no organisms fpund |
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What is jolt accentuation
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Shaking the patient's head really fast at the head of worsens then it's a positive meningitis
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What diagnostic exams will you do for meningitis
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Assessment ears sinuses and respiratory system
Obtain blood cultures CBC electrolytes Liver renal panel Chest skull sinus films CT scan |
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Community acquired meningitis less than 50 years old
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Vancomycin
Third-generation cephalosporin |
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Community acquired meningitis greater than 50 years old
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Vancomycin
Third-generation cephalosporin Ampicillin |
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Vancomycin covers what bacteria in meningitis
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Streptococcus
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Cephalosporin covers what bacteria in meningitis
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Neissera
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Ampicillin covers what antibiotic in meningitis
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Listeria
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Meningitis treatment for healthcare associated
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Vancomycin
Third-generation cephalosporin For beta-lactamSpecifically meropenem |
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When will given dexamethasone the helpful in cheating meningitis
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If you give it early it decreases the rate of neurologic complication
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When is dexamethasone given during meningitis
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0.15 mg per kilogram every six hours for four days prior to or during first antibiotic use
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Different speaking meningitis and encephalitis
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Meningitis you will still have cerebral function encephalitis you will have motorspeech sensory deficiency
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What is encephalitis
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Viral infection of the central nervous system results and clinical syndrome of aseptic meningitis or encephalitis
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What is the primary cause of encephalitis
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A viral infection specifically herpes simplex virus number one
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Which gets the worst presentation meningitis encephalitis
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Encephalitis because it can effect brain tissue and spinal column
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Manifestations of encephalitis
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Changes in level of consciousness
Sensorimotor speech dysfunction Seizures |
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CSF examination for encephalitis
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Will be similar to viral meningitis
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What will brain scans show for encephalitis |
It will show more hypodensity and brain edema with encephalitis |
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What will MRI show for encephalitis
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Hemorrhagic in certain areas of the brain
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Treatment of encephalitis
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Since it is caused by HSV one treatment will be a Acyclovir 10 mg per kilogram IV every eight hours
Anticonvulsant therapy ICP management because of cerebral edema Cardiovascular support Ventilatory support DTE prophylaxis |
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If you suspect encephalitis but the HSB panel is negative
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Stop treatment with acyclovir
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What is the prognosis after encephalitis
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Death occurs in 5 to 20% of patients
Mental deterioration Amnesia Personality changes Return seizures Hemiparesis foreseen in another 20% |
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What is guillian barre syndrome
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It's an autoimmune disease that destroys the mileage sheets around axon is usually followed by an acute infectious illness 1-3 weeks before
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Your patient presents with paresthesia and limb weakness and states two weeks ago we were treated for mycoplasma pneumonia, ebv, cmv what is your likely diagnosis
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guillian barre |
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Clinical features of guillian barre
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Paresthesia
Diminished reflexes Symmetric limb weakness that is a sending Preceded by infection\ Cranial nerve involvement |
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How does guilian barre resolve
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It resolve spontaneously in 80% of cases
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How can we diagnose Gbs
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Progressive symmetric limb weakness following acute infectious illness A sending
Nerve conduction studiesWill help with prognosis CSF analysis elevated protein |
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CSF analysis of Gbss
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Elevated protein
Normal Wbc |
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Nerve conduction studies of GBS
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Will help with prognosis and help slow nerve conduction you to demyelination??
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If you suspect GBS and after get your CSF analysis which shows elevated white count
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It is not GBS
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Treatment of GBS
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There is no cure
Plasmapheresis IV Ig 0.4 g per kilogramPer day for five days Usually Resolve spontaneously |
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Gold standard for treatment of GBS
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Plasmapheresis
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Should you change GBS with both plasmapheresis and IV IG
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No
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To patients with GBS fully recover
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Yes full recovery with functional recovery within 6 to 12 months
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Although plasmapheresis is the gold standard for GPS why is IV IG usually given
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Plasmapheresis may not be available and maybe contraindications placing a central line for the administration of plasmapheresis on the other hand IV IG is easy to administer
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What is myasthenia gravis
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Autoimmune disease characterized by anti-body mediated destruction of acetylcholine receptors located at the postsynaptic side of neuromuscular junction may also be caused by a thymus tumor
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Who would benefit from a thymectomy
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Patients with myasthenia gravis were young
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Manifestations of myasthenia gravis
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Ptosis
diplopia Dysphasia Difficulty chewing and speaking Muscle fatigue and weakness Thymus gland is abnormal and often hyperthyroid |
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What is multiple sclerosis
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Myelin sheath is damaged and forms scar tissue can be viral immunologic or genetic
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Rapid progression of respiratory Ffailure and ventilator dependence is called
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myasthenic crisis |
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With myasthenia gravis the deficiency is motor or sensory
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Is purely motor there no sensory involvement
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Deep tendon reflex of myasthenia gravis
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Usually preserved
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First symptoms of multiple sclerosis
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Optic nerve involvement
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Presentation of multiple sclerosis
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Fatigue
Stiffness in the legs Flexor spasms at night Hyperactive deep tendon reflexes Unsteady gait Tremor clumsiness poor coordination tinnitus vertigo Dysphasia speach problems Paresthesia tingling burning Balling bladder dysfunction Anxiety emotional lability |
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Main manifestations that differentiates multiple sclerosis from other neuromuscular disorders
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Present of increased deep tendon reflexes spastic
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CSF of multiple sclerosis
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Elevated protein elevated white blood cell
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CT scan of multiple sclerosis
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Increased density in white matter MS plaques
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CT scan shows increased density in white matter
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Multiple sclerosis
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Increased deep tendon reflexes and spasticity
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Multiple sclerosis
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Manifested by episodes of relapse in remission
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Multiple sclerosis
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treat of multiple sclerosis
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Immunosuppressant or immunomodulating drugs plasthma exchange
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Characterized by trimmer rigidity slow movements and postural instability
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Parkinson's
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Pathophysiology of Parkinson's disease
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Acetylcholine produced and secretedby basal ganglia transmits excitatory messages
Dopamine inhibits the function of these Meuron Allowing for control of voluntary movement In Parkinson's disease there is a decrease in dopamine production resulting in excessive excitation and loss of control of voluntary movement |
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Stage one of Parkinson's
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Initial disease
Unilateral limb involvement Minimal weakness Hand and arm trembling |
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Stage 2 Parkinson's
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Mild
Bilateral limb movement Mask like face Slow shuffling gait |
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Stage III Parkinson's
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Moderate disease increased in gait disturbance
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Stage for Parkinson's
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Severe disability
Akinesis Rigidity |
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This stage of Parkinson's manifests with masklike face slow shuffling gait bilateral limb involve
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2 |
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This stage of Parkinson's manifests with unilateral live involvement
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Stage one
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presentation of Parkinson's |
Masklike face
Shuffling gait pills rolling Slow speech Jdrooling difficulty swallowing Orthostatic hypotension echolalia |
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This your muscular disorder is manifested by shuffling gait masklike face slow speech orthostatic hypotension
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Parkinson's
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Pharmacological interventions for Parkinson's disease
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Anti-cholinergics used for younger patients with tremor carbex
Dopamine agonistHelp to stimulate dopamine receptors sinemet |
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This is associated with sepsis and multiorgan failure in ICU and can also occur after neuromuscular blockers are used
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Critical illness Polyneuropathy
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Manifestations of critical illness polyneuropathy
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Limb weakness
flAcidity Decreasing reflexes |
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Diagnostics of critical illness polyneuropathy
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Elevation CK rhabdo myoglobin urea
EMG so slow motor and sensory Amplitude with preserved conduction velocity |
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Elevations in Ck, rhabdo, myoglobin
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Critical illness polyneuropathy
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How do you treat critical illness polyneuropathy
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There's no treatment you just treat the underlying disease and support with nutrition Multi POTUS boots to prevent. foot drop
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Hemodynamics assesses the adequacy of
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Circulation perfusion and oxygenation
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Methods of monitoting hemodynamics
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Arterial blood pressure and noninvasive and invasive
Central venous pressure Pulmonary artery catheter cardiac output measurements Tissue oxygenation |
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Complications of arterial line
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Hemorrhage
Hematoma Thrombus Embolization Pseudoaneurysm Infection |
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Main complication of arterial line
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Thrombus
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How does an a line
Measure wave forms |
When the left vent contracts there's a rapid ejection of blood this generates the pressure that creates a waveform caddied back to the monitoring device and read by transducer
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What is the dichotic not indicate
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Closure of the AV valves
When blood is injected into the aorta at the end of sisterly vents Begin to laugh and blood starts toflow backThe valves close to snapping back of the valve creates a dicrotic notch |
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How do you know if you're arterial blood pressure measurements are reliable
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When you see a dicrotic notch
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How do you calculate map
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Systolic blood pressure plus twice the diastolic blood pressure divided by three
sbp+2dbp/3 |
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How do you calculate the pulse pressure
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Systolic blood pressure minuteness diastolic pressure
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What should the normal Map
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65-95
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define map
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Average arterial blood pressure during a single Cartiac cycle
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What will and Overdamp been waveforms look like
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Short and wide diastolic is high systolic and slow
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What under dampened waveform look like
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Skinny and long systolic is higher diastolic is low
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What is the main reason for an under dampened waveform
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Mechanical reasons
Bubbles sfailure of transducer tubing is too long |
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Reasons for over dampened waveform
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Kinks bubbles transducer failure failure to flush the line causing clots
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Is the PA catheter therapeutic
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Know if you Stickney diagnostic
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What are the advantages of PA catheters
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Measures left vent filling as an estimate
Samples mixed venous blood Measures cardiac output |
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What are contraindications for APA catheter
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Mechanical prosthetic
Rights heart Mass thrombus or tumor Endocarditis Atherosclerosis Angioplasty or other interventional procedures |
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How you calculate cardiac output
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Heart rate times stroke volume
hrxsv |
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When will you get it in accurate cardiac output from APA catheter
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If the patient is hypothermic
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What is the first tracing you see when you're inserting the PA catheter
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Right atrial
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When advancing the catheter the balloons should be
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Inflated to protect from perforation and to help guide the catheter
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When do you stop advancing the PA catheter
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When you get a wedge tracing
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How do you differentiate if you are in the right atria or the pulmonary artery based on waveform
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Pulmonary artery will have a higher pressure of 4-12
Right atriumWill have a low pressure 2 to 6 |
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When advancing the PA catheter how do you know you have gone from the right ventricle to the pulmonary artery
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There will be a dicrotic notch and the diastolic pressure will be elevated
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Complications of PA catheter
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Pneumothorax vessel injury
InfectionInability to place the PA catheter Arrhythmias Pulmonary artery rupture |
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When facing the PA There when you get past 50 cm and you do not see a wave change what is going on
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You maybecoiling you have to deflate the balloon pull back and try to a dance again
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Water some medications that can help you when you are placing APA catheter
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Calcium chloride to help decrease the force of contraction and help guide the tip of the catheter
Lidocaine for arrhythmias |
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Normal CVP
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1 to 8
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Central venous pressure can be used interchangeably with
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Right atrial pressure
Right vent end diastolic pressure |
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Three factors that contribute to the regulation of Cvp
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Capacitance of the Venus system
Total blood volume Pumping ability of the right side of the heart |
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How do you measure CVP
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It is measured at the level of the right atrium or phlebostatic axis
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When assessing right atrium pressure what does a c x v Y correspond to
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A atrial contraction
c- Closer of the tricuspid valve x- Atrial diastole v- passive atrial filling/ vent Contraction y- Atrial Emptying |
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When will you get a false wedge pressure
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If the pressure in the alveoli is high it may be a reflection of the long and not the leftatria
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How can you preevent from measuring alveolar pressures with a P a catheter
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The tip of the catheter should be below the left atrium for lung zone three
Measures at the end of expiration Close to atmospheric pressure |
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Normal wedge pressure
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4 to 12
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Defined cardiac output
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Amount of blood ejected from the left testicle into the aorta in one minute
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How can we alter cardiac output
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Cardiac output equals heart rate times sv, if you alter heart rate with beta blockers catecholamines and pacemakers, or stroke volume by giving fluid your cardiac output will be affected
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Cardiac output normal
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4-8 |
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What is stroke volume
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Amount of blood pumped with each beats
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Normal stroke volume
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Before contraction at the end of diastole the volume in the ventricle is about 120 this is when the heart is most full at the end of diastole after the heart contracts what is the left is the end systolic volume which is around 50 so 120-50 = 70 is the amount that was ejected out
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How do you calculate Stroke volume
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Cardiac output times 1000 divided by the heart rate
co x 1000/ hr |
|
|
If the cardiac output is 5.4 and the patient's heart rate is 76 what is the Sroke volume
|
5.4 x 1000/ 76 5400/76 71ml/beat |
|
|
What are the determinants of cardiac output
|
Preload
Afterload Contractility |
|
|
The load imposed on resting heart muscle that stretches the muscle to a new length
|
Preload
|
|
|
How do you estimate preload
|
End-diastolic volume CVP for right wedge pressure for left
|
|
|
The total load that must be moved by a muscle when it contracts for the pressure the pentacles must generate in order to check blood into the aorta
|
Afterload
|
|
|
How do you calculate Svr
|
map-cvp/co x 80 |
|
|
Normal SBR
|
800- 1200
|
|
|
How do you calculate PVR
|
pap-pcwp/co x 80 |
|
|
Normal PVR
|
Less than 250
|
|
|
What are ways to measure afterload
|
SBR PVR
|
|
|
The velocity of muscle contraction when muscle loadr is fixed
|
Contractility
|
|
|
Contractility depends on
|
Strength of the construction
Force and velocity Cardiac stroke Volume |
|
|
What are factors that affect preload
|
Intravascular volume peep Increases intrathoracic pressure which increases preload Afib Causes you to miss cardiac output from atria kick |
|
|
Drugs that increase afterload
|
Levo fed epinephrine catecholamines
|
|
|
drugs decrease afterload
|
Vasodilators Nitro cardene
|
|
|
Normal cardiac index
|
2.2 to 4.0
|
|
|
What is a critical cardiac index
|
Less than 2.0
|
|
|
What is SvO2
|
Balance between oxygen delivery and oxygen consumption
|
|
|
Normal svo2
|
60 to 80
Less than 60 is affected tissue oxygenation Greater than 80Is also a threat to tissue oxygenation |
|
|
Components of oxygen content
|
Hemoglobin
Saturation ofhemglobin with oxygen sao2 Dissolved oxygen pao2 |
|
|
What is pao2
|
Dissolved oxygen
Pressure that oxygen exerts in the dissolve stay in the plasma |
|
|
Components of oxygen delivery
|
Oxygen content(hemoglobin, oxygen saturation, dissolved oxygen) cardiac output
|
|
|
sao2 |
The percentage of hemoglobin saturated with oxygen in the blood
|
|
|
What is the most important component of oxygen delivery
|
Cardiac output
|
|
|
Good way to affect oxygen delivery to tissues
|
Hemoglobin
|
|
|
vo2 |
Oxygen consumption
|
|
|
vo2 calculations |
Arterial oxygen delivery (hemoglobin cardiac output and saturation) minus venous oxygen delivery
|
|
|
Normal vo2
|
200 to 250ml o2/min
|
|
|
When will you see a decrease in sv02
|
Decreased in delivery of oxygen
Anemia hemorrhageHypoxia Decreasing cardiac output Decreases in Hemoglobin Increase in consumption from hypermetabolic stateLike shivering seizuresFever |
|
|
Reasons for elevated svo2
|
Shunting from septic shock
Arterial blood Diverted to Venus Catheter that is whichThe tip is going to be reading oxygenated blood from pulmonary Circulation |
|
|
What is important to understand when wedging the plumbing a catheter
|
In acts like embolus so do not wedge for more than 10 seconds
|
|
|
Components of svo2
|
Cardiac output
Hemoglobin Oxygen saturation Sao2 Oxygen consumption Vo2 |
|
|
What is scvo2
|
Mixed venous blood from head shoulders legs dumped into the right ventricle used to identify changes in patients tissue oxygen extraction
|
|
|
What does the oxygen dissociation curve show
|
Ability of oxygen to the associate from hemoglobin this is important because we need oxygen to the associate so that we can use it
|
|
|
What causes the shift to the left in the oxyhemoglobin dissociation
|
Shift to the left indicates increased affinity
Harder for oxygen to leave Alkalosis Low-temperature Low 23dpg Hypocarbia Low bicarb Cold weather Hemoglobin is going to hold on oxygen |
|
|
What causes the shift to the right in the oxyhemoglobin dissociation curve
|
Sits to the right makeseasier for oxygen to leave
Acidosis Hyperthermia Hypercarbia high 23pdg Exercise Increased body temperature |
|
|
svo2 monitoring is used for what two things |
To determine oxygen consumption vo2
ANSIDetermine venous oxygen return/Reserve |
|
|
Used to provide a continuous reflection of the adequacy of oxygen supply Dynamics
|
svo2 monitoring |
|
|
When does the lactate accumlate
|
As a consequence of oxygen delivery falling below oxygen consumption needs
|
|
|
What is abnormal lactate level
|
Greater than 2 60% mortality rate
Greater than 4 80% mortality rate |
|
|
Lactate levels may be elevated with
|
Hepatic insufficiency
thiamine deficiency Severe sepsis Intracellular alkalosis |
|
|
Normal stroke index
|
40-70ml/beat
|
|
|
what are the two main diseases you're looking for when doing a lumbar puncture |
Subarachnoid bleed and meningitis
|
|
|
Cosh indications so lumbar puncture
|
Localized skin infection over the area
Increase intercranial pressure Suspected spinal cord mass Uncorrected coagulopathy Spinal column to fomites which may require flouroscopy Lack of patient coordination |
|
|
If there is a high suspicion for meningitis too we still do a lumbar puncture
|
Yes we still do the lumbar puncture but we do not delete treatment for the lumbar puncture
|
|
|
Which patients would benefit from the sitting position to do a lumbar puncture
|
Patients were obese
|
|
|
What are the cons of the sitting position for lumbar puncture
|
Increased risk of herniation I'll see you cannot measure the opening pressure in this position
|
|
|
What does the opening pressure during the lumbar puncture tell you
|
It tells you doesn't increased intracranial pressure
|
|
|
If you want to perform a lumbar puncture and the patient shows signs of inch increased intracranial pressure
|
You have to do a CT scan first and do not to the lumbar puncture
|
|
|
What lab values are you looking for before you do a lumbar puncture
|
Coagulation factors
|
|
|
How can we prevent bleeding from the puncture site during the lumbar puncture
|
Positioning and proper landmark
|
|
|
How do you prevent Post tap persisting headache during a lumbar puncture
|
Use the pencil tip needle if possible insert the needle Bevel up
|
|
|
What do we do if the patient has a headache after lumbar puncture
|
nsaids IV fluids Caffeine If this doesn't help you may need to consult anesthesiologist for a blood patch |
|
|
What is the purpose of the white sheet for lumbar puncture
|
It's used to provide a sterile serface along the bed as well as to take the bed from spoiling
|
|
|
Before you set up you sterile field and get anesthesia for a lumbar puncture what should you do
|
You should mark your site because once you set up sterile fields and give local anesthesia your site Will be less visible
|
|
|
What is the purpose of the blue sheets for lumbar puncture
|
Provide a sterile fields for performing the lumbar puncture
the adhesive is applied to the patient to hold the sheet In place it also has an opening in the middle through with the lumbar punctures performed |
|
|
Tube number one and lumbar puncture is for
|
Cell count
|
|
|
Tube number two from them or puncture is for
|
Gram stain and culture C$S
|
|
|
Tube number three for lumbar puncture for
|
And glucose and protein
|
|
|
Two number four and lumbar punctures for
|
Cell count to compare it to tube number one
|
|
|
WBCs of viral versus bacterial meningitis
|
Lymphocytes mainly in viral and polymorphic and increase leukocytes in bacteria
|
|
|
rbc in the tubes of lumbar pointer
|
There maybe some red blood cells in the first tube but there should not be any in 4
|
|
|
What is the purpose of the manometer
|
Used to measure the opening pressure of CSF
|
|
|
Is pain one of the side effects of lumbar puncture
|
No that should be a painless procedure
|
|
|
18 gauge needle during lumbar puncture
|
Is used to mark site by pressing the blunt end of the needle into the patient's back a small circular mark is left on the skin
|
|
|
This needlel is used to minister at local anesthesia to the deeper structures of the back doing lumbar puncture
|
20 gauge
|
|
|
How do you assess for landmarks in an obese patient afford to in the lumbar puncture
|
Find a sacral promontory the end of this structure is L5 to S1 interspace
|
|
|
Defined lumbar puncture
|
Insertion of a needle into the subarachnoid space of the lumbar region for diagnostic or therapeutic purposes this also allows access so cerebrospinal fluid
|
|
|
Normal CSf fluid analysis
|
Opening pressure 5 to 20cm
Appearance clear RBCs less than five WBCs less than five Mainly lymphocytes and monocytes Glucose50 to 80Or 60 to 70% of Serum value Protein15 to 45 Negative Gram stain |
|
|
Causes of increased opening pressure during the lumbar puncture
|
Bacterial meningitis
Neoplasms Hemorrhage Cerebral edema Overproduction of CSf choroid plexus papilloma Defective outflows through the ventricles Pseudo tumor cerebri |
|
|
Causes of CSF hypoglycemia
|
Meningitis bacterial
Tuberculosis meningitis Fungal meningitis Mumps meningitis Syphilis Herpes encephalitis Subarachnoid hemorrhage Sarcoidosis Hypoglycemia |
|
|
What is the predominant WBC in bacterial and viral meningitis
|
Bacterial will be neutrophils
Viral early-stage neutrophil late state lymphocytes |
|
|
High leukocytes and low glucose csf
|
Bacterial meningitis
|
|
|
CSF analysis of subarachnoid hemorrhage
|
Elevated opening pressure
Clear some bloody appearance Elevated RBC Presence ofXanthochromia Slightly increased at UBC's Normal glucose Elevated protein Negative Gram stain |
|
|
Triad specific to bacterial meningitis
|
High fever
Nuchal Rigidity Headache |
|
|
Signs of meningeal irritation include
|
Positive kerning
Positive Brudzinski |
|
|
How long does symptoms of bacterialr meningitis take to occur
|
Symptoms acute occur rapidly rapid deterioration
|
|
|
Some diagnostic tests for bacterial meningitis
|
CBC
chem 7 PT PTT INR Brain CT plain Lumbar puncture |
|
|
what a sensitivity |
A true positive 100% of individuals who have the disease will test for it
|
|
|
When you want to rule out the disease you excluded by checking
|
Sensitivity
|
|
|
When you want to rule in a disease you check it by using
|
Specificity
|
|
|
Possibilistic approach
|
Consider all causes equally likely
|
|
|
What is the probabilistic approach
|
Considers the most likely cause first... Most likely will be...
|
|
|
Prognostic approach
|
Considers the most dangerous or serious c diagnosis first
|
|
|
Pragmatic approach
|
Considers the diagnosis most responsive to treatment first
|
|
|
When prioritizing care what approach is used
|
Prognostic followed by probabilistic
|
|
|
Describe the test threshold model
|
Patient in between the test and treatment threshold will actually be further evaluated until their position falls pass the test or treatment threshold.
Is the test threshold is too low example complaining of sharp chest pain after lifting we do not need to test for a heart attack patients will fall after the treatment threshold is so obvious that you cheat right away while still doing testing |
|
|
A test that is highly specific
|
Has a low percentage of false positive meaning that if a positive results come back it's likely that the patient has the disease
|
|
|
A test that is highly sensitive
|
Has a low percentage of false-negative results meaning that a negative result likely means that the patient does not have the disease
|
|
|
adc vandalism |
Admitting service location and physician
Diagnosis Condition of the patient Vital signs frequency Activity limitations Nursing interventions-Fully catheter wound care daily weights Diet-NPO except for meds Allergies sensitivities and previous drug reactions Laboratory test and radiographic studies IV fluids\ Sedatives analgesics and other PRN medications Medications including dose frequency route an indication |
|
|
First-line for G.I. prophylaxis
|
H2 blockers
|
|
|
what will indicate immediate dialysis |
Acidosis hyperkalemia fluid overload
|
|
|
Presence of hematuria without protein urea
|
Does not indicate A serious pathology
|
|
|
Presents of this is more diagnostic and prognostic of glomerular disease
|
Protein urea
|
|
|
Renal ultrasound can help look for
|
Stenosis hydronephrosis Stones does not assess pyelonephritis
|
|
|
Can you use a renal ultrasound for pyelonephritis
|
No
|
|
|
If you want to check Fir stone's how would you order imaging
|
Without any contrast/ plane
|
|
|
How do you assess for pyelonephritis
|
CT with contrast but first you have to get a urinalysis
|
|
|
How can you differentiate a stone versus pyelonephritis
|
Get a urinalysis patient with the kidney stone will have hematuria but no pyuria
|
|
|
Is abnormal to have increased red blood cells in urine after exercising
|
No it is not abnormal
|
|
|
Difference between T colored urine and Frank red urine
|
Bronzy color may indicate glomerular involvement
Red is often the distal source |
|
|
He materia and protein urea
|
Needs further evaluation
|
|
|
Positive red blood cells positive protein in urine
|
Glomerular prompt evaluation
|
|
|
Positive red blood cells negative protein in urine
|
Extra glomerular reason
|
|
|
Negative red blood cells positive heme in urine
|
Hemoglobin or myoglobin
|
|
|
Negative red blood cell negative heme in urine
|
Drugs dyes
|
|
|
These medications give you a prerenal failure
|
nsaids, ace |
|
|
What questions would you ask for a history to work up kidney disorders
|
Abdominal or flank pain-kidney stones
Trauma Strenuous exercise - increased cpk/ rhabdo Menstruation-Red urine Recent upper respiratory infection or sore throat-Glomerulonephritis Joint pain swelling-Rheumatic fever Medications or toxins Sickle cell disease or trait |
|
|
Describe afferent and efferent arterioles
|
afferent-controlled by prostaglandin, mediates vasodilation efferent-Control by angiotensin IICauses constriction |
|
|
How does ibuprofen and nsaids effect gfr
|
It blocks cox1 and inhibits prostaglandin preventing vasodilation but efferent is still constricting and not being affected so what is coming in is a lot less since the vasodilation is being prevented
|
|
|
If you're patient is on nsaids and has now developed acute renal failure what do you do
|
Remove the nsaud
|
|
|
How ace1 affect renal filtration rate
|
ace prevents vasoconstriction while prostaglandins are still dilating there is no pressure everything that comes in is going to come out |
|
|
These medications and foods affect urine color
|
Beats
Berries Hydroxychloroquine Nitrofurantoin pyridium Rifampin |
|
|
drugs Causes hematuria by interstitial mephitis
|
nsaid Cipro Lasix Antibiotics |
|
|
Drugs that cause hematuria by papillary necrosis
|
nsaids Aspirin |
|
|
nsaids causes hematuria by which way |
Interstitial nephritis
Papillary necrosis |
|
|
Causes hematuria by urolithiasis
|
Carbonic anhydrase inhibitors
Triamterene |
|
|
Any renal problems what class of medications should be removed
|
nsaids |
|
|
Periorbital edema in the kidneys
|
Can suggest nephrotic syndrome from loss of protein
|
|
|
thIn glomerular basement membrane disease
|
This is a genetic disorder that is benign and causes chronic hematuria there's nothing to do
|
|
|
Hemolytic uremic syndrome
|
Often preceded by a G.I. Disorder where you will see you at decreasing glomerular filtration rate
|
|
|
So multisystem reasons for having glomerular hematuria
|
Lupus
Goodpasture's syndrome Hemolytic uremic syndrome Sickle cell |
|
|
Extraglomerular reasons for hematuria
|
Tumor
Polycystic kidney disease Pyelonephritis Acute tubular inecrosisHeavy exercise Cystitis urethritis Coagulopathy trauma |
|
|
Defined acute renal failure
|
Abrupt decrease in glomerular filtration rate with increase in creatinine resulting in the inability to maintain fluid and electrolyte balance
|
|
|
How is acute renal failure diagnosed
|
Creatinine increase in 0.3-0.5
Decreased GFR of at least 50% Can be oliguric versus non-oliguricDepending on if theUrine output isLess then 500 mlper day or 25 ml.hr for four hours |
|
|
phase of acute renal failure
|
Oliguric
Diuretic Recovery/Convalescence |
|
|
Oliguric phase of the cute Reno failure
|
can last 1 to 2 weeks
GFR decrease Dropping urine output less than 400 a day Hypertension Hyperkalemia Sodium normal or decrease depending on fluid status Fluid overload Elevated bun creatinine |
|
|
can last 1 to 2 weeksGFR decreaseDropping urine output less than 400 a dayHypertensionHyperkalemiaSodium normal or decrease depending on fluid statusFluid overloadElevated bun creatinine |
oliguric phas of arf |
|
|
diuretic phase of acute renal Fellure |
GSR begins to rise
Urine output begins to ride and then diuresis occurs 4-5 L per day Excessive urine output indicates recoveryOf damaged nephrons Hypotension tachycardia Improvement in level of consciousness Hypokalemia hyponatremia hypovolemia Declining BUn creatinine |
|
|
GSR begins to riseUrine output begins to ride and then diuresis occurs 4-5 L per dayExcessive urine output indicates recoveryOf damaged nephronsHypotension tachycardiaImprovement in level of consciousnessHypokalemia hyponatremia hypovolemiaDeclining BUn creatinine |
diuretic phase of acute renal failure |
|
|
Recovery phase of acute renal failure
|
This is a slow process that can take up to 1 to 2 years fully complete
Urine volume is normal Increases strength Increasing level of consciousness bun stable and normal However the client Can develop chronic renal failure |
|
|
Prerenal intervention
|
Hydrate vasopressors if hydration is not working
|
|
|
Causes of intrarenal failure
|
Dyes medications like vancomycin aminoglycosides chemotherapy
|
|
|
What is the main form of intrarenal failure
|
Acute tubular necrosis
|
|
|
Common reasons foratn is
|
A prerenal cause usually hypovolemia
|
|
|
Prerenal failure is caused by
|
Hypovolemia
Volume shift Decreased cardiac output Myocardial infarction Septic shock |
|
|
Septic shock and myocardial infarction can cause what type of renal failure
|
Prerenal failure
|
|
|
Examples of houses for intrarenal failure
|
Acute tubular necrosis
Trauma Antibiotics Nephrotoxic medications Infectious diseases |
|
|
When trying to assess if it's a prerenal versus intrarenal cause what parameters to look at
|
Bun creatinine ratio
Urine sodium FenA |
|
|
This indicates Prerenal
|
Bun creatinine ratio greater than 20 to 1
fena less than 1% Urine sodium less than 20% |
|
|
This indicates intrarenal
|
Bun creatinine ratio <20:1
Urine sodium greater than 20 percent fena Greater than 1% Castes in urineIndicates nephrons are sloughing off |
|
|
Mild hyperkalemia treatment
|
Less than six
Potassium restriction Kayexalate |
|
|
Severe or moderate hyperkalemia treatment
|
Calcium gluconate if there are EKG changes
Insulin Glucose Sodium bicarb |
|
|
Metabolic acidosis mild treatment
|
Greater than 7.2
Sodium bicarb |
|
|
Severe metabolic acidosis treatment
|
Less than 7.2
Sodium bicarb Monitor fluid overloadAnd rebound alkalosis and hypocalcemia |
|
|
Adverse effects of IV sodium bicarb
|
Flash pulmonary edema to sodium retention
|
|
|
Contraindications of Kayexalate
|
It dialysis in 24h
|
|
|
In hospital cause of arf is most likely due to
|
Acute tubular nec from multiple insults like hypotension sepsis and nephrotoxic drugs
|
|
|
To distinguish acute tubular in the process from prerenal states what three things do we look at
|
urine electrolytes
Urinalysis Button and creatinine |
|
|
To distinguish acute tubular nec from obstruction
|
Ultrasound
|
|
|
Treatment of intrarenal failure from contrast dye
|
Give acetylcysteine or sodium bicarb and IV fluids
|
|
|
What is renal insufficiency
|
Decreasing renal function resulting in a decrease in GFR
|
|
|
Diminished renal reserve
|
50% nephron loss creatinine doubles
|
|
|
Renal insufficiency quality
|
75% of nephron loss mild azotemia
|
|
|
End-stage renal disease quality
|
90% nephron damage azotemia metabolic alterations
|
|
|
Stages and GFR
|
Stage one GFR greater than 90 protein urea and he materia
States to 60 to 89Protein and hematuria Stage 3 30 to 59 Stage for 15 to 29 States five less than 15 |
|
|
Stage one renal failure has a normal GFR how do we know that they are still in Reno Fellion
|
Protein and hematuria
|
|
|
What their flank pain with the urinary tract obstruction
|
Because there is increased pressure
|
|
|
When do we see anuria
|
Less than 100 ML's of urine per day
Seeing if there is a complete obstruction In severe shock severe AtN and severe glomerulonephritis |
|
|
How do we assess urinary tract obstruction
|
Using an alter sound they will see dilation of the collecting system i and sites of obstruction
|
|
|
When treating a urinary obstruction what A very important intervention
|
After post obstruction there will be a lot of diuresis so make sure you are replenishing what the patient is putting out to prevent hypovolemic shock
|
|
|
Difference between urolithiasis and nephrolithiasis
|
Urolithiasis is the formation of urinary stones formed in the ureters
Nephrolithiasis is the formation of kidney stonesFormed renal parenchyma |
|
|
What happens at the renal obstruction is not removed
|
Urinary stasis results in infection impairment of renal function on the side of the blockage and hydronephrosis and can cause irreversible kidney damage
|
|
|
Causes of urolithiasis and nephrolithiasis
|
Family history
Diet high in calcium vitamin D milk protein purine Alkali Dehydration Urinary stasis Use of diuretics which can causeVolume depletion UTI Prolong urinary catheterization Hypercalcemia hyperparathyroidism Elevated uric acid |
|
|
Meeting etiology of kidney stones
|
Hyperparathyroidism
|
|
|
Prevention ofCalcium phosphate stones
|
Caused by saturation of urine with calcium and phosphate
DietaryChanges to decrease intakeHigh calcium and high phosphate foodsTo avoid excessive vitamin D intake |
|
|
Calcium oxalate stones
|
Of what oxalate food source like tea almonds cashews chocolate Cocoa beans spinach rhubarb
|
|
|
Struvite stones
|
Triple phosphate stone composed of magnesium and ammonium phosphate
Limit high phosphate foodLike redAnd working meats whole-grain |
|
|
Limit high phosphate foods to prevent this type of stone
|
Struvite
|
|
|
Uric acid stones
|
From a diet high in purine
Organ meats red wine sardines Allopurinol may be prescribed Common in men |
|
|
When is the patient ready to go home after a diagnosis of kidney stone
|
If there pain-free
If the hydronephrosis is not getting worse PO challenge if they can tolerate PO |
|
|
Treatment of the stone less than 6 mm and no signs of sepsis
|
Opioids
nsaids Flomax Antibiotics Anti-medics Strain all urine Fluids Urologist |
|
|
Achievement of kidney stone greater than 6 mm war sights of sepsis
|
Morphine dilaudid
Lomax Toradol Antibiotics Antiemetic Strain Fluids Urology Lithotripsy |
|
|
Antibiotic of choice for a large stone and size of sepsis
|
Fluoroquinolone
|
|
|
When will you admit the patient with A stone
|
Greater than 6 mm
Any size stone with signs of sepsis 5 mm stoneWith moderate to severe hydronephrosis UTI and stone But you should look at the whole pictureWill be patient follow-up to have comorbidities if they cannot follow up even if they have a small stone they should be emitted |
|
|
What is extracorporeal shock wave lithotripsy
|
Noninvasive procedure for breaking up stones in the kidneys or ureters ultrasonic waves are delivered through a bath of warm water to the areas of the stone stone surpassing the human within a few days
|
|
|
Percutaneous lithotripsy
|
Stones in the bladder ureters or kidneys
Invasive Ultrasonic wave Indwelling catheter is needed |
|
|
After Lithotripsy what should you monitor for
|
Grossi materia is that a good sign
Monitor for infection and hemorrhage and extra visitation of fluid Retroperitoneal cavity Encourage fluids |
|
|
Treatment of simple UTI
|
bactrim Nitrofurantoin for 3 to 7 days |
|
|
Treatment of complicated UTI
|
Levaquin mild to moderate
Moderate to severe-Cefepim, rocephin zosyn |
|
|
Treats pyelonephritis
|
Fluoroquinolone
Aminoglycosides Unison |
|
|
Most common organism in urosepsis
|
E. coli
|
|
|
Most common cause of urosepsis
|
indwelling Catheter or untreated UTI
|
|
|
What is pyelonephritis
|
Information of the renal pelvisand parenchyma occurs after contamination of the uReatha or following an invasive procedure can also occur after chronic obstruction
|
|
|
Most common bacteria of pyelonephritis
|
E. coli
|
|
|
Can you have to pyelonephritis in a normal CT
|
Yes this is called clinical pyelonephritis examples fever chills flank pain patient is diagnosed with a UTI and giving Macrobid they come back with worsening symptoms you do another urinalysis initials nothing you repeat the CT and it shows nothing this patient has clinical pyelonephritis seen in patients were immunocompromise as well
|
|
|
Signs of pyelonephritis
|
Fever chills nausea flank pain CVA tenderness dysuria frequency urgency
|
|
|
When you admit someone with pyelonephritis
|
Severely ill pregnant Alderly comorbidities
|
|
|
Outpatient treatment of pyelonephritis
|
Fluoroquinolones cephalosporins penicillin aminoglycosides
|
|
|
Outpatient treatment of pyelonephritis for patients were hospitalized and institutionalized
|
Ampicillin or vancomycin to cover enterococci
|
|
|
First-line Inpatient treatment of the cute pyelonephritis
|
Cipro levaquin for 10 to 14 days
|
|
|
A young male comes in with UTI symptoms
|
Assume it is STD before you get a urinalysis culture the patient if you culture after you'll miss the gram-negative cocci
|
|
|
Causes urethritis and men and cervicitis and women
|
Gonorrhea
|
|
|
Leading cause of infertility in women
|
Gonorrhea
|
|
|
Gram stain shows gram-negative diplicocci
|
Gonorrhea
|
|
|
Chaitman of gonorrhea
|
Rocephin 250 Im
cefexime 400 po Plus Azithromycin 1 g Or doxycycline 100 for seven daysTo cheek chlamydia |
|
|
Most common STDs in the US
|
Chlamydia
|
|
|
Is allergic to rocephin how do we treat gonorrhea
|
Spectinomycin 2 g im x1
|
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Caused by Ctreponema Pallidium
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Syphilis
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Primary syphilis
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Painless canker indurated ulcer
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Secondary syphilis
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Flulike symptoms rash on Palmer and plantar surfaces malaise
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Latent syphilis
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seropositive but asymptomatic
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Tertiary syphilis
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Multi system involvement meningitis cardiac insufficiency neurosyphilis
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Diagnostic test for syphilis
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vdrl/rpr fta/abs (Fluorescent antibody of sorption) Confirms cases |
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Cause of epididymitis in the young
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Chlamydia
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How do you treat syphilis
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Primary or secondary early less than a year-penicillin G2 .4 Times one dose
Latent greater than a year-Penicillin 2.4×3 doses Neurosyphilis aqueous Crystaline penicillin 18 to 24,000,000 unitsPer dayFor 10 to 14 days or Procaine penicillin 2.4 im plus probenecid 500 PO four times a day for 10 to 14 days |
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Dysuria in Man difference of diagnosis
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Urethritis prostatitis epididymitis UTI
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Urethritis diagnosis
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Mucopurulent or Parula discharge
Urethral swab shows greater than 5 Pmn Positive Leukocyte esteraseOn first void urineIn the presence of greater than 10 wbc |
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Tenzer rectal exam and dysuria
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Prostatitis
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How do you diagnose prostate tightest
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Digital rectal exam will show edematous and tender prostate
LeukocytosisPyuria bacteriuriaElevated serum prostate antigenAnd support diagnosis |
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Differential diagnosis for acute testicular pain
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Testicular torsion
Varicocele Hydrocele Epididymitis Kidney stone |
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Causes of vaginitis
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Bacterial vaginosis trich candidiasis
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How do you diagnose vaginitis
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vag discharge file smell itching without the presence of urinary frequency or urgency history and physical vaginal culture NPH
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Signs of trichom9nas
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frothy discharge
File order dyspururia Painful intercourse |
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Signs of bacteria vaginosis
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Gray white discharge in patches in the vagina Clue cells whiff test
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Treatment of bacterial vaginosis
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Flagyl for seven days
Clindamycin cream |
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How do you treat vaginosis in pregnant women
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Flagyl
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Treatment of Trichomonas
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Flagyl 2 g Times one pills
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Chaitman uncomplicated candidiasis
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-azole |
