Med Surg 2

Front 1

Normal ICP Levels

Back 1

0-15 mmHg

Front 2

Calculate CPP

Back 2

CPP = MAP - ICP

MAP = [(2 x DBP) + SBP] /3

Front 3

Normal CBF

Back 3

50 mL per minute per 100 gm brain tissue

Front 4

Normal CPP

Back 4

70-100 mmHg

need 50-60, <30 is inadequate

Front 5

Increased ICP

Back 5

sustained pressure greater than 20 mmHg

M: change in LOC, headache that doesn't respond to meds; decerebrate

MM: prevent injuries secondary to increased ICP

NI: maintain neutral alignment of neck and body; GCS Q2 hrs; bed rest, no coughing

Front 6

Brain Injury

Back 6

Epidural bleeding is emergency.

Right side: left side neglect, vis/spacial impair., awareness deficits, creativity perception altered

Left side: depression, language, decreased control over right side

must dx promptly to avoid ICP increase, GCS

Front 7

Brain Tumors

Back 7

Astrocytomas (3-5; 50%), Glioblastomas (malig. astro.; 1), Oligodendrogliomas (calci.; 7), Meningiomas (>50%; slow; remove), Schwannomas (benign; CNVIII; remove), Ependymomas (spread from brain to cord)

Tx: Chemo- VINCRISTINE

Front 8

Meningitis

Back 8

Viral: self-limiting, tx symptoms
Bacterial: isolation

M: high fever, stiff neck

Tx: AMPICILLIN, ROCEPHIN, or VANCOMYCIN

Front 9

Trigeminal Neuralgia

Back 9

Face pain

Tx: TEGRETAL, DILANTIN (block pain);
TOPOMAX, NEURONTIN (prevent attacks)

NI: Trigger mngt.

Front 10

Bell's Palsy

Back 10

nerve branch disrupt when stroke is not cause

Dx: rule out everything else

Tx: PREDNISONE, ACYCLOVIR (if +HSV)

Front 11

Guillan-Barre

Back 11

ascending paralysis is hallmark

Front 12

Spinal Cord Injury

Back 12

NI: monitor for Autonomic Dysreflexia (vasoconstriction below level of injury = lot of blood above injury level until noxious stimulus is removed. Tx: Procardia)

Front 13

Stroke

Back 13

Ischemic = thrombotic and embolitic

Hemorrhagic = Intracerebral and subarachnoid ("worst headache ever")

M: Right side - left side paralysis and neglect, vis/spac diffic., deny problems, impulsive, impaired judgement

Left side: paralized on right, impaired speech, more cautious, depressed, imp. math and language comprehension

Dx: CT Scan

Front 14

TIA

Back 14

"mini-stroke" important warning sign of a stroke

prevention is key - HTN

Front 15

Headaches

Back 15

Tension - vice, bilateral;
Migraine - throbbing (tx: TOPOMAX, prevention);
Cluster - seasonal, sharp around eye

Front 16

Seizures

Back 16

Tx: anti-epileptics - DILANTIN, TEGRETOL, DEPAKOTE

Front 17

Multiple Sclerosis

Back 17

Fatigue is hallmark sign

NI: treat symptoms
Fatigue- PROVIGIL, AMANTIDINE
Spasms- BACLOFEN
Bowel/bladder - DITROPAN
Contrl flares - PREDNISONE

Complications usually form infection

Front 18

Parkinson's

Back 18

Triad:
1. Tremors
2. Rigidity
3. Bradykinesia (shuffle)

Dx: 2 of the 3 symptoms in triad

Tx: LEVADOPA-CARBIDOPA; MIRAPEX and REQUIP (mimic dopamine); ARTANE and COGENTIN (anticholinergics, cause dry mouth); AMANTADINE (treats dyskinesias)

Front 19

Myasthenia Gravis

Back 19

fluctuating weakness and fatigue of voluntary muscles is hallmark.

Tx: NEOSTIGMINE and MESTINON (cholinesterase inhibitors); PREDNISONE or DECADRON (immunotherapy);
IMURAN or CYTOXAN (immunosupression)

Myasthenic Crisis - respiratory ststus will be compromised

Front 20

Amyotrophic Lateral Sclerosis (ALS)

Back 20

degeneration of upper and lower motor neurons in spinal cord, brainstem, and cerebral cortex

M: cognition remains intact

Dx: no definitive test, rule everything else out

Tx: RILUTEK

Front 21

Huntington's

Back 21

Chronis progressive chorea and eventually dementia; genetic, fatal after about 10-15 yrs from s/s onset; suicide big COD

Tx: supportive, HALDOL, THORAZINE (antipsychotics); TOFRANIL (antidepressant)

Front 22

Cancer Classification by:

Site

Back 22

Carcinomas: skin, glands, mucous of GIT, GUT, RT

Sarcomas: connective tissue, muscle, bone, fat

Lymphomas & Leukemias: blood and lymph

Front 23

Cancer Classification by:

Histology

Back 23

Grades 1-4 based on level of dysplasia and differentiation; 1 is mild dysplasia and well differentiated

Front 24

Cancer Classification by:

Staging

Back 24

Stages 0-4 based on how far the cells have traveled; 0 = in situ, 4 = metastasis

Front 25

Cancer Classification by:

T/N/M

Back 25

T = Tumor (T0, T, T1-4, Tx)

N = Nodes (N0, N1-4, Nx)

M = Metastases (M0, M1-4, Mx)

Front 26

7 Warning Signs of Cancer

Back 26

1. bowel/bladder
2. booboo
3. bleeding
4. breast lump
5. blech
6. bump change
7. bad cough

Front 27

Leukemia

Back 27

MM: neutropenia; ADRIAMYCIN (antibiotic), VINCRISTINE, VINBLASTINE (antineoplastics), NEUPOGEN (granulocyte colony stimulating factor)

NI: encourage expression o feelings

Front 28

Lymphoma

Back 28

Hodgkin's: Reed-Sternberg cells

Non-Hodgkin's: enlarged, non- tender, firm, movable lymph nodes in lower cervical regions

Front 29

Colorectal Cancer

Back 29

3rd most common in men>women

M: rectal bleeding, chx in bowel habits, abdominal cramping

Dx: H&P

Screen: After 50- colonoscopy q10yrs, FOBT yearly, DRE yearly

MM: surgical, colostomy, hemicolostomy; DOXORUBICIN 5-FU (chemo); LOVENOX b/c of surgery

Front 30

Breast Cancer

Back 30

2nd most common cancer in women

M: cervical, supraclavicular, or axillary lymph node lump or enlargement on palpation; painless lump of mass in the breast or thickening of the breast tissue; skin chx

Tx: CYTOXIN, METHOTREXATE (chemo); TAMOXIFEN (hormone therapy)
Complications: Lymphadema due to blockage of draining channels

Front 31

Prostate Cancer

Back 31

No relation to BPH

M: r/t obstruction of the flow of urine; urine retention, decreased size and force of urine stream, hematuria

Tx: LUPRON (LH releasing agonists), TAXOL (chemo)

Front 32

Lung Cancer

Back 32

four types, two classes in order of growth rate:
1. squamous cell (non-small)
2. adenocarcinoma (non-small)
3. large-cell anaplastic (non-small)
4. small cell (oat cell)

M: chronic cough, hemoptysis,
hoarseness, weight loss

Front 33

Radiation

Back 33

uses waves of energy to try to break up the DNA of abnormal cancer cells; skin care important

Front 34

Chemo

Back 34

chemicals that eliminiate or reduce the number of malignant cells is tumor and mets

Front 35

Osteomyelitis

Back 35

bone infection; microorganisms cause ischemia where they grow; if in the bone cortex, chances of necrosis increase a lot

MM: antibiotics, rest, pain mngt

NI: teach about sepsis, yeast, and length of tx

Front 36

Bone Tumors

Back 36

Osteochondroma: benign, no tx, but can become malignant

Osteogenic Sarcoma: most common bone cancer; very aggressive, often fatal

Front 37

Back Pain

Back 37

Acute: Dx: straight leg raise

Tx: ALEVE (nsaid), FLEXORIL, ROBAXIN (muscle relaxers)

Chronic: Tx: NSAIDS and muscle relaxers, ELAVIL or ZOLOFT (antidepressants for pain)

Front 38

Lumbar Disc Damage

Back 38

ask about pain radiating down sciatic nerve

surgery sometimes exacerbates problem, does not cure

Front 39

Osteomalacia

Back 39

softening and decalc. of bone secondary to Vitamin D deficiency

M: bone pain

Dx: ribbons of calcification where pain exists called Looser's Transformation Zones

Tx: Vitamin D

Front 40

Osteoporosis

Back 40

SILENT KILLER

Dx: DEXA- noted as T scores, testing age 50 for women, 70 for men

MM: OS0CAL, CALCITONIN (Ca supplement), FOSAMAX (biphosphate, taken with water in upright position for 1/2 hour on empty stomach)

Front 41

Paget's

Back 41

irregular bone breakdown and formation; bone is more fragile bc it is made of fibrous, vascular tissue; pathological fractures are most common complication

Front 42

Carpel Tunnel Syndrome

Back 42

Dx: Tinel's sign - lightly percuss inner wrist, + is discomfort or numbness

Phalen's sign: flexing wrist for about 30 seconds causes pain or numbness in hands or fingers; more rapid, more severe