Chapter 45

Front 1

When determining the optimal method to communicate with, assess, treat, and transport a patient with a special health care challenge, the paramedic should demonstrate ______ and ______ the expertise of the patient or care-giver.

Back 1

Confidence, enlist

Front 2

________ of vulnerable people is four times more common than physical abuse.

Back 2

Neglect

Front 3

List 4 care-giver behaviors that may be suggestive of abuse or neglect.

Back 3

Demeanor, behaviors, history provided by the caregiver, refusing to allow a physical examination, preventing medics from removing clothing during exam, or offering unsolicited explanations for abnormal physical findings

Front 4

_____ _____ are present at birth in many infants of Asian or African American origin may be mistaken for bruising.

Back 4

Mongolian Spots

Front 5

When caring for a patient with suspected abuse or neglect, your FIRST priority should be to:

Back 5

The safety of the emergency responders

Front 6

A terminal illness is accurately defined as a(n):

Back 6

A sickness that a patient cannot be cured of; death is imminent

Front 7

List 5 treatments that would be considered palliative care for terminally ill patient.

Back 7

Analgesic medications, oxygen, iv fluids, treatment of fevers, possibly antibiotic medications

Front 8

List 3 primary & 7 secondary causes of obesity.

Back 8

Primary- poor dietary choices, excessive food intake, lack of exercise. Secondary- hormonal changes, inadequate sleep, low basal metabolic rate, environmental toxins, genetic predisposition, declining smoking, widespread dependence on air conditioning

Front 9

Assumptions by the paramedic based on stereotypes of a particular communicable disease are _____ to accomplish anything except _____ patient care efforts.

Back 9

Unlikely, undermine

Front 10

A fenestrated tracheostomy tube will allow the patient to:

Back 10

Speak, breathe, or clear secretions from the upper airway

Front 11

A patient with a long-term vascular access device is in cardiac arrest and requires epinephrine. In order to remove any heparin from the device, the paramedic should:

Back 11

The catheter requires up to 10 mL of blood to be removed and discarded before any flush, medication push, or infusion is given

Front 12

Which vascular access devices is "tunneled" under the skin and placed into the superior vena cava?

Back 12

Hickman, Broviac, and Groshong Catheters

Front 13

Following removal of an ostomy device and cleansing the stoma, what should be done to prevent contamination of the clean skin with stool or urine?

Back 13

Place a clean gauze pad over the stoma to prevent contamination of the clean skin with stool or urine.

Front 14

When urine becomes evident in the tubing during insertion of an indwelling urinary catheter in a male, you should:

Back 14

Insert the catheter until the “Y” between the drainage port and the balloon port is at the tip of the penis

Front 15

When urine becomes evident in the tubing during insertion of an indwelling urinary catheter in a female, you should:

Back 15

Insert the catheter another 1 to 3 inches

Front 16

During peritoneal dialysis, fluid is put into the patient's __________.

Back 16

Involves instilling a special solution through a catheter into the patient’s abdomen. (through the peritoneal membrane)

Front 17

List the signs and symptoms that are consistent with a malfunctioning cerebrospinal fluid shunt?

Back 17

You should suspect shunt malfunction in any patient with a CSF Shunt who presents with a headache, visual disturbances, seizures, or altered mental status

Front 18

An intra-aortic balloon pump functions by inflating a balloon during ____, which pushes into _____ _____.

Back 18

Diastole, Systemic Circulation

Front 19

List the characteristic physical features of a patient with down syndrome.

Back 19

Flattened face, and nose, short neck, upward slanting eyes, and often a protruding tongue. Additionally, only a single crease is noted on the palms of the patient’s hands.

Front 20

Cognitive ability can ___ ____ among people with autism. What are some complex skills patients with autism can have?

Back 20

Vary Significantly.

Front 21

What is the difference between central auditory processing disorder and auditory neuropathy?

Back 21

CAPD= an auditory process deficit that can be characterized by difficulty interpreting speech when other background noises are present. Auditory Neuropathy is a condition characterized by normal function of the structures of the ear with a corresponding stimulation of auditory centers of the brain. (Linked to prematurity, congenital anomalies, and several neurologic conditions

Front 22

What is the difference between amblyopia and cortical visual impairment?

Back 22

Amblyopia= partial or complete vision loss in one eye. Cortical Visual Impairment= visual impairment caused by a brain abnormality

Front 23

What is the definition of paralysis? What is the difference between paraplegia & quadriplegia?

Back 23

Paralysis= the inability to move.
Paraplegia= paralysis of the lower extremities. Quadriplegia= paralysis of the upper and lower extremities.

Front 24

Why are patient's receiving chemotherapy at risk for developing deadly infections?

Back 24

Patients have a compromised immune system following chemotherapy

Front 25

What is the pathophysiology of cystic fibrosis?

Back 25

A genetic disorder that is characterized by increased production of mucus in the lungs and digestive tract. CF is caused by a defective recessive gene, inherited from each parent, that makes it difficult for chloride to move through cells. This causes unusually high sodium loss (resulting in salty skin.) The increased mucus impairs respirations, disrupts digestion of food, and may become a life-threatening condition.

Front 26

What is spina bifida? What other conditions is it associated with?

Back 26

It is a birth defect caused by improper development of the fetal neural tube consisting of the brain and spinal cord. It is associated with hydrocephalus, scoliosis, and other Orthopaedic disorders

Front 27

Approximately 70% of all child abuse or neglect cases involve:

Back 27

Approximately 70% of all child abuse or neglect cases involve substance abuse by the perpetrator

Front 28

What type of maltreatment involves isolating the victim from others, resulting in a substantial change in the victim's behavior or cognitive function?

Back 28

Emotional Abuse

Front 29

List 5 injury patterns that would be highly suggestive of child abuse?

Back 29

bruises on the torso, ears, proximal arms, abdomen and buttocks are suggestive of abuse. Also… symmetric burns or those without splash marks, ligature marks, bruises that resemble finger marks, shoes, or other common items

Front 30

What is cupping? what populations practice this?

Back 30

Cupping is performed by heating the inside of a small glass vessel (cup), then applying it to a patient’s skin. A Vacuum is created as the vessel cools, creating round red marks or bruising, usually on the patient’s torso. Marks from these techniques appear highly suggestive of physical abuse; however, they are actually healing techniques practiced for many centuries and are not associated with any malice or maltreatment.

Front 31

What is curative care? how does it differ from palliative care?

Back 31

Patients with a terminal illness often receive continued medical care. Some continue aggressive medical treatment, hoping for a statistically improbable recovery or attempting to prolong life as much as possible. This approach is known as Curative Care

Front 32

What is the purpose of hospice care?

Back 32

It is a program and philosophy that attempts to help the patient maximize the quality of remaining life. Hospice programs provide social and emotional support, treat discomfort with pharmacologic and nonpharmacologic approaches, and help patients and families cope with the prospect of impending death

Front 33

List 3 factors that complicate airway management in an obese patient?

Back 33

Bariatric patients have a larger tongue, larger patient head size, limited neck mobility

Front 34

What does a tracheostomy tube bypass? what will these patients need due to these structures being bypassed?

Back 34

Bypasses the nasal passages that filter, warm, and humidiry inspired air. Patients with a tracheostomy tube will need humidification and heating of inspired air whenever possible

Front 35

You would likely encounter the presence of a ventricular assist device in what patient populations?

Back 35

Ventricular Assist Devices are used by people with heart failure in the community. Also…Patients that are awaiting a heart transplant or a long-term treatment for patients who are not candidates for heart transplants.

Front 36

What are the differences between a PICC line and a midline catheter?

Back 36

PICC Lines: a long intra-venous catheter that is usually placed in either arm and follows peripheral veins into the superior vena cava. It may be in place up to a year. The smaller diameter and longer catheter length may increase resistance during rapid infusion. These may or may not be flushed with heparin after use.
Midline Catheter: a catheter placed into an upper extremity that is not as long as the PICC Catheter. It does not reach central circulation. Midline Catheters are longer than traditional peripheral IV Catheters and are better suited for many irritating medications. These catheters typically contain heparin

Front 37

When accessing an implantable venous access device, how much blood should be aspirated? What type of needle should be used?

Back 37

Use a special access needle, called an unbeveled or noncutting needle, to avoid slicing the silicone reservoir wall. You should also aspirate 5mL of blood

Front 38

What are the first 3 steps in replacing an ostomy device? why is proper PPE an important step?

Back 38

1.Empty/Remove the current appliance and dispose of it appropriately.
2. Wash the area around the stoma with water. Cleanse the stoma with water only, being careful not to rub or irritate the area.
3. Place a clean gauze pad over the stoma to prevent contamination of the clean skin with stool or urine.

Front 39

Patients with a colostomy have had a ____ ____ that directs the _____ intestine out through a _______ in the anterior abdominal wall.

Back 39

Surgical Procedure, Large Intestine, Opening

Front 40

What is the difference between straight catheter & foley catheter?

Back 40

Foley Catheters may remain in place and Straight Catheters may just be used intermittently

Front 41

The fistula used for hemodialysis is a surgical connection between:

Back 41

The Fistula used for hemodialysis is a surgical connection between an artery and a vein, usually in one of the patient’s upper extremities

Front 42

When treating a dialysis patient, it is especially important to do what with IV fluids that we administer?

Back 42

Modest volumes of IV Fluids may cause fluid overload, particularly in otherwise susceptible patients. IV fluids need to be monitored carefully and titrated judiciously to patient response. If too much IV Fluid is given, it will be impossible to correct in the pre-hospital setting

Front 43

What part of the brain produces CSF? How do we decrease our volume of CSF? What is the condition when we have too much CSF?

Back 43

Approximately 500 mL of CSF is produced daily by the Choroid Plexus in the brain, and is constantly being reabsorbed by the bloodstream to maintain a balance within the CNS. An excess volume of CSF around the brain is called Hydrocephalus. A Cerebrospinal Fluid Shunt is placed to drain excess CSF from the CNS.

Front 44

The majority of current invasive hemodynamic monitoring involves placement of different types of catheters into what areas?

Back 44

Into areas within the cardiovascular system, such as arteries, central veins, and various chambers of the heart

Front 45

The transducer or drainage system of an intracranial pressure monitor typically aligned at the same height as the patient's:

Back 45

The transducer is typically aligned at the same height as the patient’s ear canal, which may take some creativity to accommodate in the back of an ambulance.

Front 46

A persons _____ status can influence his or her ____ well being, and vice-versa.

Back 46

mental, physical

Front 47

The majority of acquired hearing loss in children and adults is the result of:

Back 47

from excessive exposure to loud noise and other causes, including infection

Front 48

When troubleshooting a hearing aid that is not working, you should avoid trying to:

Back 48

never try to clean hearing aids, and never get them wet

Front 49

A patients presents with a sudden onset of unilateral eye pain and blurred vision. You should suspect:

Back 49

acute angle-closure glaucoma

Front 50

A paraplegic patient has increased sensitivity and interprets normal touch as severe pain. What is this condition known as?

Back 50

hyperesthesia

Front 51

What is cerebral palsy? What body system is primarily affected?

Back 51

cerebral palsy is non-progressive neurologic disorder that results from injury to brain tissues during brain development. Primarily affects brain tissue and skeletal muscle

Front 52

In a patient with multiple sclerosis, what is happening to the nervous system?

Back 52

immune cells within the body attach the myelin sheath of certain nerve fibers, ultimately destroying nerve fibers and preventing nerve transmission to other body tissues

Front 53

How does a polio infection initially present? What is postpolio syndrome?

Back 53

similar to the common cold viral syndrome with headache, sore throat, fever, malaise, and vomiting. Post-polio syndrome: this disorder is characterized by progressive or sudden worsening of muscle weakness, previously caused by polio virus, muscle atrophy, and respiratory problems.