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129 Cards in this Set
- Front
- Back
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What is the V in the V/Q match?
What is its normal rate? What are the 5 causes of a V interruption? |
- Ventilation
- 4L/min 1. Pneumonia 2. Asthma 3. Atelectasis 4. COPD: Emphysema and Chronic Bronchitis 5. Surfactant (or lack of) |
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What is Q in the V/Q match?
What is the normal Q rate? What are the two causes of a Q interruption? |
P= Perfusion, normal rate is 4L/min
1. Pulmonary Embolism: (shunt) 2. Pulmonary HTN --> causing Cor Polmonae |
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What are the 8 products carried to the cell by Blood?
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1. Fluid (plasma)
2. Glucose 3. Amino Acids 4. Lipids 5. O2: carried by the RBC 6. Immune System Products 7. Inflammatory System Products 8. The Formed Elements (RBC, WBC, Platelets) |
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What are the 3 types of waste products removed from the cell?
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1. Excess fluid
2. CO2 and H2O: byproducts of glucose metabolism 3. Ceatinine, Nitrates, Nucleic Acids: byproducts of AA |
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What is the ratio of Hematocrit to Hemoglobin?
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3:1
Example: if there are 30% Hct. than there are 10 g/dl Hgb |
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What is Erythropoiesis?
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The generation/ production of RBC
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What is the consequence of Protein (amino acid) deficiency?
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- Deceased strength and flexibility of membrane, resulting in hemolytic anemia.
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What is the consequence of Cabalamin (Vitamin B12) deficiency?
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- Megaloblastic dysplasia leading to Macrocytic Anemia
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What is the consequence of Folate (Folic Acid) deficiency?
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- Macrocytic Anemia
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What is the consequence of an Iron deficiency?
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- Iron Deficiency anemia
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What is Folate? What is it a building block of?
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Folic Acid
- Needed for Development - A building block for DNA |
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What are the 5 stages of a RBC life cycle?
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1. Kidneys detect low O2 in blood and respond by releasing erythropoietin
2. Erythropoeitin travels to bone marrow and stimulates RBC production 3. Red bone marrow manufactures RBC's from stem cells 4. Reticulocytes enter circulation. Heart and lungs work continuously to provide movement and oxygenation of RBC's 5. RBC has a lifespan of 90-120 days. Damaged or old RBC's are destroyed by the spleen |
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What are the 6 things needed to be present for a healthy RBC to form?
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1. Healthy bone marrow
2. Erythropoietin 3. Iron for hemoglobin synthesis 4. Vitamin B12 5. Intrinsic factor 6. Folic Acid |
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What are the 4 ways there can be a reduction in the total number erythrocytes in the circulating blood?
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1. Acute or chronic blood loss
2. Decreased production of RBC 3. Increased destruction of RBC 4. Combination of the above |
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What are the 4 causes of blood loss from GI disease?
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1. PUD
2. Crones Disease/ Ulcerative colitis 3. Tumor of the Rt or left side of the colon 4. Ruptured Diverticula |
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What are the 3 severity levels of anemia?
What is the first thing to worry about when anemia is found? |
1.Mild 7-8g/dl
2. Moderate 3. Severe - Worry about hypoxia and how the perfusion of O2 is affected due to the lack of RBC's |
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What are the manifestations of mild anemia?
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- No clinical symptoms
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What are the 5 moderate clinical manifestations of Anemia?
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1. Fatigue
2. General weakness 3. Loss of stamina 4. Followed by Tachycardia 5. Followed by Excertional dyspnea |
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What type of anemia is relate to a decrease in RBC production?
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Aplastic Anemia
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What are the 10 clinical manifestations of severe anemia?
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VS:
1. Temp: cool hands 2. Tachycardia 3. Orthostatic and nonorthostatic hypotension 4. Transient murmurs 5. Pectoris angina 6. Heart failure 7. Intermittent claudication (bounding of the foot after 3 extensions) 8. Tinnitus 9. Pallor 10. Vasoconstriction |
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Where does Erythropoietin come from?
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Kidneys
A kidney disease = anemia |
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What is the manifestation of Aplastic Anemia?
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- A reduction in bone marrow --> a reduction in production of WBC, RBC, Platelts
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What are the 4 etiologies of Acquired Apastic Anemia?
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1. Injury related to toxin
2. radiation 3. immunologic event (HIV, EBV, or Dengue Fever) 4. possible later stages of lupus |
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What are the 3 etiology of Familial Aplastic Anemia?
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1. Fanconi (a type of anemia that affects the bone marrow)
2. Pancreatic deficincies in children 3. Uptake of folate |
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What tests are done to determine if Apastic Anemia is apparent and if so, what will they detect?
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-Labs: CBC
1. Pancytopenia (compete or pandemic) 2. Low RBC, WBC, and Platles |
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What is the etiology of Anemia from Chronic Renal Failure?
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- Failure of renal endocrine function with uremia (inability to get rid of urea)
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What is the etiology of Hemolytic Anemia?
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- Due to the destruction of RBC's caused by the variety of things
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What are the treatments used to anemia from Chronic Renal Failure?
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1. Dialysis to remove urea/ammonia: we dont want urea to turn into ammonia
2. Erythropoietin Therapy- Procrit |
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What is Erythropoietin Therapy- Procrit?
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- Mimics erythropoietin to bring healthy RBC number up
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What is the other term for Vitamin B12 Deficiency Anemia?
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- Megaloblastic dysplasia (function dictates what it does)
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What is the etiology of Vitamin B12 Deficiency Anemia?
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- Due to the deficiencies in Vitamin B12 or Folate
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How is Vitamin B12 Deficiency Anemia characterized?
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-Characterized by defective DNA synthesis
- Results in the unequal growth of the nucleus and cytoplasm making the cell membrane weak, resulting in cell rupture - Nucleus is present in the bone marrow |
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What is the amount of RBC in Vitamin B12 Deficiency Anemia?
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- 500,000-750,000 cells/mm3
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What is the amount of WBC in Vitamin B12 Deficiency Anemia?
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4,000-5,000 cells/mm3
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What is the amount of Platelets in Vitamin B12 Deficiency Anemia?
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- 50,000 cells/mm3
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How has the bone marrow change in Vitamin B12 Deficiency Anemia?
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- Megaloblastic dysplasia
- Hypersegmented neutophils increased Mean Corpuscular volume (MCV) |
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How has gastric acid analysis changed in Vitamin B12 Deficiency Anemia?
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Achlorhydria: lack of free HCL
- The intrinsic factor needed to absorb Vitamin B12 |
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What are the 5 manifestation of megablastic madness in Vitamin B12 Deficiency Anemia?
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1. Paranoid ideation
2. Dementia 3. Cognitive dysfunction 4. Delusions 5. Hallucinations |
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What are the Neurological (1) and Cerebral (4) manifestations in Vitamin B12 Deficiency Anemia?
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1. Symmetrical paresythasias (lock or tingling in feet and hands w/ vibrations)
2. Cerebral: 2a. Irritability 2b. Somnolence (inability to sleep) 2c. Memory Impairment 2d. The taste buds are all messed up |
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What is the difference between Vitamin B12 Deficiency Anemia and Folate anemia?
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- The neuro component
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What is Pure Folate Deficiency Anemia and its 4 signs and symptoms?
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- Blunted affect w/
1. Depression 2. Sleep deprivation 3. History reveals: bad diet and alcoholism 4. Irritability |
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What are the 3 clinical manifestations of Folate Deficiency Anemia?
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1. Absorption of folate occurs in the upper small intestines
2. Not dependent on any other facilitating factor 3. Similar symptoms to pernicious anemia except neurologic manifestations are generally not seen |
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What is the treatment for Folate Deficiency Anemia?
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- Requires daily oral administration of folate
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What is the etiology of Pernicious Anemia?
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- Caused by a lack of intrinsic factor (found in the stomach) from the gastric parietal cells
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What is the purpose of the intrinsic factor?
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1. Vitamin B12 absorption -->Lack of results in Vitamin B12 deficiency
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What are the 12 symptoms of Pernicious Anemia?
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1. Hypoxia
2. General weakness 3. Loss of stamina 4. Excertional dyspnea 5. Pallor 6. Tachychardia 7. Nerve demylination 8. Loss of Appetite 9. Abdominal Pain 10. Atrophic glossitis: Beefy Red Tongue (clue) 11. Icterus (Jaundice) 12. Splenic (left side) enlargement |
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What is the myelin sheath formed by?
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- Cholesterol
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What is the treatment for Pernicious Anemia?
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- Parenteral (inj) vitamin B12
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What is the treatment of Folic Acid Anemia, what does it do and what labs are important to look at?
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- Treatment: Folic acid replacement
- Essential factor for DNA synthesis . DNA Replication . Cell division cannot proceed . Maintenance of normal erythropoiesis - Usual dosage is: 1 mg qd po - **Stimulates production of RBC, WBC and platelets - Dietary sources: all foods - ** Important to look at hct, hgb, and CBC labs |
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How is Iron Deficiency Anemia characterized?
What are the 3 ways Iron Deficiency Anemia can occur? |
- Abnormally small RBC that contain reduced amounts of hemoglobin
Related to: 1. Disorders of Iron Metabolism 2. Disorders of Prophyrin and heme (iron) synthesis 3. Disorders of globin (protein) synthesis 3a. Pregnancy |
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What are the 4 characteristics of Iron Deficiency Anemia?
Progression in Iron Deficiency Anemia causes what (2)? |
1. Most common type of anemia worldwide
2. Nutritional iron deficiency 3. Metabolic or functional deficiency 4. Microcytic-Hypochromic Anemia: RBC are small and pale Progression causes: 1. Brittle, thin, coarsly ridged, and spoon shaped nails 2. A red, sore, and painful tongue (rule out folic acid or B12 deficiency) |
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What are the 2 ways groups of disorders are characterized by anemia?
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1. Altered mitochondrial metabolism causing ineffective iron uptake and resulting in dysfunctional hemoglobin synthesis
2. Ringed sideroblasts w/in the bone marrow are diagnostic - Sideroblasts: Erythroblasts that contain iron granules that have not been synthesized into hemoglobin --> there should be nothing in the RBC |
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What 3 ways can of Sickle Cell Anemia be inherited?
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1. Autosomal recessive inheritance
2. Hemoglobulin S chains are effected and produced instead of Hgb A 3. Both parents must pass it on to child |
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How does chronic inflammation cause anemia
Who has sickle cell anemia? |
- Can cause an obstruction b/c the RBC's can get stuck due to their shape
- Can cause irritation because the vascular wall is not used to being touched Seen in: 1. HIV and AIDS |
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What are the 3 Pathologic Mechanisms of Sickle Cell Anemia?
What is the normal lifespan of a RBC? |
1. Decreased erythrocyte lifespan, small or large distortions
- Erythropoietin must be created quicker than normal or a problem can occur 2. Ineffective bone marrow response to erythropoietin 3. Altered Iron Metabolism - Normal: 90-100 days |
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What is the drug reaction of drug induced Hemolytic Anemia?
What causes a drug induced hemolytic anemia? |
Reaction:
- Caused by a person having a very active immune system, levels of anticoagulants, and Meth Occurs by (318-319) 1. Autoantibody reaction 2. Hapten reaction 3. Immune complex formation |
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What is Polycythemia and what are its 4 manifestations?
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- The over production of RBC
1. Environment will get crowded and very thick 2. Polycythemia Vera-neoplasm 3. Secondary polycythemia 4. Relative polycythemia |
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What is secondary polycythemia?
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- An increase in erythropoietin as a normal response to chronic hypoxia (chronic bronchitis) or an inappropriate response to erythropoietin- secreting tumors (tumors expected in the kidneys)
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What causes relative polycythemia and who does it tend to affect?
What is the manifestation of polycythemia? |
- Result from dehydration
- Seen in athletes and people who have chronic high fevers - Pushing stem cells from the umbilical cord back into infant |
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What is the cancer associated the bone marrow and how does it migrate?
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- Leukemia: Circulating tumors originating in the bone marrow or blood
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What is the cancer associated with the lymphoid tissue and where is it localized?
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- Lymphoma: localized in the lymph tissues
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What is the cancer associated with the plasma?
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- Plasma cell myeloma: Malignant transformation of B-cell plasma
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In the classification of neoplasms what are the 4 types of cells in the Myeloid line?
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1. RBC
2. Platelets 3. Monocytes 4. Granulocytes |
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In the classification of neoplasms what are the 3 types of cells in the Lymphoma line?
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1. B-cells
2. T-cells 3. NK- cells |
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How is the classification of neoplasms (myeloid or lymphoma line) diagnosed?
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- Diagnosed by the bone marrow aspiration and biopsy from the marrow itself
- Assessment indicates the intervention |
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What are the 4 presenting symptoms of malignancies?
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1. Marrow is stimulated to produce large amounts of WBC
2. Large amounts of WBC cause the cells to be non-differentiated (not functional)- b/c they do not stay in the marrow long enough 3. Blasts: WBC that leave before the non-differentiated 4. Packing of the WBC can be so great that it can cause pain |
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What are the 6 ways to determine if packing of WBC is occurring?
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1. CBC with diff --> blasts are seen on smear --> superdiagnostic that leukemia is on board
2. Indicative when pain in joints does not correlated with the growth spurts 3. Pain 4. Fatigue 5. Non-pink hand 6. Bruising |
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What are the 7 symptoms of a malignancy and which one brings the patient into the hospital?
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1. Malaise
2. Weakness 3. Unexplained Fever 4. Night Sweats 5. Enlarged, non tender lymph nodes 6. CBC elevated WBC 7. Recurrent infections: brings pts. into the hospital |
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What are the 4 categories of Myeloid neoplasms?
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1. Myeloproliferative disease
2. Myelodysplastic/Proliferative disease 3. Myelodysplastic syndromes 4. Acute Myeloid Leukemia (AML) |
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What is a neoplasm?
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Tumor
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What are the 4 categories of Lymphoid Neoplasms?
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1. B-Cell Neoplasm
2. T-Cell neoplasm 3. NK-cell neoplasm 4. Hodgkin Disease |
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What are the 6 mutagenic agents that cause neoplasms?
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1. HIV: B-cell lymphomas
2. Epstein-Barr Virus: Hodgkin and Burkitt lymphoma 3. Radiation: Leukemia and lymphomas 4. Benzene 5. Cigarette smoking 6. Bone marrow and immune suppressant drugs |
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What are the 4 general stages of combating cancer?
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1. Diagnosis
2. Treatment 3. Management 4. Prevention |
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How are the following diseases diagnosed?
1. Anemia 2. Thrombocytopenia 3. Neutropenia 4. Infiltration |
1. Hct 25-30% Hgb 8-10g/dl (worry about the reduced O2 capacity)
2. Platelet count below 20,000 cells --> spontaneous bleeding 3. Neutrophil count <500 cells 4. Lymphadenopathy, hepatomegaly, splenomegaly, CNS |
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What are the 2 general treatments how do they work?
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1. Chemotherapy: Eradicate malignant cells
- Disrupt DNA synthesis, cell replication, or induce apoptosis 2. Stem cell transplant: Restores bone marrow function - Graft vs. host disease: starts out subtle and becomes very oppressive |
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What is the prevention and management of the following manifestations?
1. Infection 2. Anemia 3. Pain 4. Nutrition |
1. Neutropenia is shortened by using growth factors
2. Erythropoietin growth factors and give PRBC and platelets 3. Narcotic, non-narcotic drugs, distraction, biofeedback 4. New drugs for N/V, anorexia |
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What are the following blood components used for?
1. PRBC (Packed RBC's) 2. Platelts (prepared from whole blood) 3. FFP: Fresh frozen plasma 4. Albumin (prepared from plasma) 5. Cryoprecipitate (prepared from FFP) |
1. Increase Hct. (not WBC or platelets)
2. Given for bleeding caused by thrombocytopenia 3. Used for bleeding caused by deficiency (stabilizes part of the cell membrane) 4. Used as volume expander 5. Replacement of clotting factors |
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What is Myloma?
What do the malignant plasma cells produce and how can they affect the renal tubular cells? |
- Proliferation of plasma cells where the tumor can be single or multiple
- Produce abnormally large amounts of one class of immunoglobulin or incomplete immunoglobulin - The unattached light chains of the immunoglobulins (Bence Jones proteins) can pass through the glomerulus and damage the renal tubular cells |
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What are the 3 clinical manifestations of Myloma?
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1. Cortical and medullary bone loss
2. Skeletal pain 3. Recurring infections due to the loss of the humoral immune response |
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What is lymphadenopathy?
What is local lymphadenopathy? What is general lymphadenopathy? |
- Enlarged lymph nodes that become palpable and tender b/c occupying a huge space and can cause CCP which can lead to tissue necrosis
2. Drainage of an inflammatory lesion located near the enlarged node 3. Occurs in the presence of malignant or nonmalignant diseases and the whole lymph system will be affected by the disease |
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What are the 4 differences b/w Hodgkin and non Hodgkin lymphoma?
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Hodgkin is/has:
1. Predictable 2. Orderly 3. Continuous process of lymphadenopathy 4. Reed-Sternberg cells |
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What are the 4 physical findings of Hodgkin Lymphoma?
What are the 4 symptoms of Hodgkin Lymphoma? What are the 5 lab findings in Hodgkin Lymphoma? |
1. Adenopathy, Mediastinal mass, splenomegaly, and abdominal mass
2. Fever, weight loss, night sweats, pruritus (itchy skin) 3. Thrombocytosis, leukocytosis, eosinophilia, elevated ESR (RBC sink), and elevated alkaline phosphatase |
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What is the most common type of lymphoma?
What is Burkitt lymphoma? |
Burkitt lymphoma or non-Hodgkin Lymphom
- A very fast random growing tumor of the jaw and facial bones |
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How many nerves are in the brain?
In code blue, what are we trying to save? |
- 3 trillion and drop to 2 trillion
- The brain |
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What are the two pairs of arteries and when combined, what do they create?
What is the cerebral blood volume %? How does CO2 control vasodilitation in the brain? |
- Internal carotid and vertebral arteries, carry CO2, together they create the circle of willis
2. 20% of cardiac output (massive) 3. During a code blue the CO2 levels will rise, increasing vasodilitation in the brain but the skull will not allow for the expansion |
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Which two arteries do we worry about when there is trauma to the head and neck?
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1. Vertibral and Carotid arteries
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What controls cerebral blood flow?
What are the changes that cerebral blood flow responds to,what is the volume of Cerebral blood flow? |
- Autoregulation which responds to the needs of the brain
- PaO2 and PaCO2 changes and volume is 20% |
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What is the optimal Cerebral perfusion pressure, at what point do we worry and what do we worry about?
What is the optimal blood pressure for the arteries, how low can the diastolic pressure go w/o the arteriole collapsing on itself? |
- 60-100 mgHg in normal brain tissue
- Anything lower, we worry about collapse or rupture - At 50 mgHg we worry about ischemia - 120/80, 80 is as low as we want the diastolic pressure - Higher pressure may injure the brain |
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What are the 3 bodily functions that the parasympathetic system controls?
How do toxicities affect the parasympathetic system? |
- Elimination, Excretion, and digestion
- Work by mimicking or blocking effects and will cause the system to slow down - Slowing down of the system will then retain wastes and therefore more toxicities |
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What are the 3 major functions of the sympathetic nervous system?
What are the 4 types of drugs that alter the sympathetic nervous system? |
- Exerts multiple influences on the heart and blood vessels for homeostasis
1. Regulate cardiovascular system 2. Regulate body temperature 3. Implements fight or flight reaction - Drugs for high B/P, Heart failure, angina, and asthma |
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What are the 5 effects of a sympathetic response?
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1. Increased heart rate
2. Pupil dilation 3. Dilation of pulmonary bronchi 4. Mobilizing stored energy 5. Shunting of blood to skeletal muscle |
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What is the Baroreceptor reflex and what controls it?
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- A feedback regulation for BP control utilizing sensors to monitor a physiologic state and effectors to make appropriate adjustments
- Controlled by the ANS |
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At what age is the brain fully developed and how much does a brain weigh?
What are the 4 cellular components of the brain? What 4 senses change as we age? |
- Developed at age 21 and weighs 2-3 lbs
- Neurons (3 trillion), dendrite structures, senile plagues, lewy bodies - Vision, hearing, taste, and smell |
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What are the 6 things that have to be in perfect balance for the brain to thrive?
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1. Regulation of BP/ adequate blood flow/ blood volume
2. Myelin sheath having enough fat/cholesterol 3. Proper pH of the environment 4. Intact BBB 5. Proper balance of NT’s in the area 6. Balance of brain tissue, CSF, and vasculature |
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What are the 8 things that could happen to the skull that would not be good for the brain?
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1. Fracture of the skill
2. Concussion 3. Osteo tumor 4. Osteo disease 5. Dural Tear or separation 6. Bacterial meningitis 7. Swelling of the brain skull not allowing for expansion 8. Adequate nutrients to the skull |
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What is the primary brain injury?
What is the secondary brain injury? |
- Brain injury occurs as a direct result of the initial insult
- Injury that refers to the progressive damage resulting from the body's physiologic response to the initial insult - Worry about what the concussion wave will do to the brain |
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What is the critical factor in determining the neuronal cell fate after injury?
How long can the brain go without ATP? |
- The degree of (ATP) depletion
- 6 minutes w/o ATP, but suffers a lot with any depletion of ATP |
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What is Ischemia?
What is the relationship between hypoxia and ischemia? |
1. A contributing factor either as the primary insult or as part of the secondary response to injury
2. Ischemia = Hypoxia |
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What are the 6 stages in which Ischemia leads to cell death?
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1. Ischemia leads to hypoxia
2. Cell becomes hypoxic and the mitochondria can not create ATP 3. No ATP = Inability to run the Ca+ pumps 4. Decrease in Ca+ pumping leads to Ca+ overload 5. Ca+ overload causes free radical production 6. Free radicals lead to cell death |
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What yields the O2 free radicals and mediators of inflammation?
How do free radicals cause cell death? |
1. Arachidonic acid
2. Free radicals travel to the mitochondria and rip apart the cell membrane of the mitochondria causing mitochondrial dysfunction |
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1. What is cerebral hypotention and what does it cause?
2. What is cerebral hypotention and what does it cause? |
1. <50mmHg and causes Ischemia
2. >150 mmHg and causes edema |
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What 5 manifestations lead to ischemia in the brain and how?
What causes edema in the brain and how? |
1. Thrombi, 2. Emboli, 3.Vasospasm, 4.Neutrophil aggregation, 5.tissue edema which may inhibit vasodilation due to capillary permeability
- Vascular injury may impair vasoconstricting because the inflammatory mediators will cause vasodilitation but the skull will not allow for the brain to dilate |
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What 3 elements compose the volume of the cranium?
If there is a change in one of the elements how will the brain react? |
1. Brain tissue, 2. Cerebrospinal fluid (CSF), and 3. blood
- The brain will compensate for the change to make the amount of all 3 elements similar |
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What 5 complications in the brain can cause ICP?
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1. Space occupying lesions (tumors, bleeding, infections), 2. Vasogenic, or 3. Cytotoxic edema, or 4. Excessive production of CSF
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What are the 6 causes of increased brain tissue volume?
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1. Tumor
2. Hemorrhage 3. Infection 4. Cytotoxic edema 5. Vasogenic edema 6. Ischemia and necrosis |
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What are the 3 causes of increased CSF volume?
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1. Obstructive hydrocephalus
2. Non-obstructive hydrocephalus 3. Pseudotumor cerebri |
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What are the 4 causes of increased blood volume?
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1. Increased right atrial pressure
2. Dural sinus thrombosis 3. High arterial PaCO2 4. Acidosis |
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What are the 3 manifestations of ICP?
How are ICP and LOC related? |
1. HEADACHE, 2. Projectile vomiting, 3. Altered LOC
- An increase in ICP will cause a decrease in LOC |
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What is Mentation?
What is sensorium? |
- Patient can mentally respond to commands and questions
-Response to pain or stimulation |
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How can ICP be monitored and what is it used for?
What three levels do ICP tracing show? What is an obvious sign that the brain pressure is too high? |
- Monitored by penetrating the skill, and past the dura to relieve the pressure, or by separating the brain from the dura; used to continuously measure ICP
- Normal, elevated, and plateau waves - Brain pressure should always be much lower than the body's blood pressure |
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What instrument is used to drain CSF and how does it work?
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1. Ventriculostomy, works by pulling fluid out of the ventricles when the pressure changes
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What are the 5 ways used to manage ICP and why?
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1. ICP monitoring device
2. Hypothermia: b/c all the regulation systems are gone causing hyperthermia 3. Hypertonic Saline Infusion 4. Drug induced coma 5. Standardized tools for assessment |
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What hypertonic fluid goes into the brain and how does it work?
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- Osmotic dieresis draws fluid int the brain and out of the CSF
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How does the Glasgow coma scale work?
What are the numbers that indicate mild, moderate, and severe comas? |
- The higher the number, the better the score (more conscious) and the lower the number the worse the score (an increase in LOC)
Mild= >12 Moderate= 9-12 Severe= <8 |
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What is the #1 concern in ICP?
What will cause a herniation in the brain? What are the two types of hernias? |
- Capillary closing pressure due to a swollen brain
- Capillaries closing off will cause ischemia which will lead to a hernia 1. Supratentorial: brain tissue moves through the tentorial notch 2. Infratentorial: Tissue moves through the foramen maagnum - Tentorium divides the cerebrum from the cerebellum |
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What are the 4 signs and symptoms of supratentorial herniation?
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1. Decrease in LOC: Mentation then sensation
2. Pupils sluggish to fixed and dilated 3. Cheyne Stokes: quick shallow breathing with apnea between and during the apnea a code is called 4. Extension or flexion posturing to pain |
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What are the 6 signs and symptoms of infratentorial herniation?
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1. Arched stiff neck
2. Knuckle rigidity 3. Shoulder paresthesias (lack of feeling) 4. Decreased consciousness 5. Respiratory abnormalities 6. Pulse rate variations |
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What are the two types of abnormal motor responses in a coma?
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1. Decorticate posturing
2. Decerebrate posturing |
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What is decorticate posturing?
What is decerebrate posturing? |
- indicated by flexed wrist and arm, extended legs and feet- arm and leg extension (1047) with an adduction in the upper extremities (arms toward the core)
- Indicated by arm and leg (all 4 extremities) |
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What are the 3 reflexes that are looked for when a patient is coming out of a coma?
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What is the brand name of Epoetin?
What is the usual route of administration for Epoetin? |
-Procrit
-SubQ |
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What is the mechanism of action of Epoetin?
What is the use of Epoetin? |
- Erythropoietin is one factor controlling rate of red blood cell production.
-Anemia cause by reduced endogenous erythropoietin production |
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What is the black box warning for Epoetin and why is it so serious?
What are the nursing interventions/considerations for Epoetin? |
Warning: Hgb> 12 g/dl, surgery; we worry b/c this is normal Hgb levels and a stimulation of RBC's by Epoetin will cause Polycythemia which can lead to a stroke
-Assess UA, blood studies, BUN, Creat, I&O |
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What is the mechanism of action for ferrous sulfate?
What is ferrous sulfate used to treat? |
- Replaces iron stores for development of RBC
-Iron deficiency anemia |
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What are the 3 serious side effects of ferrous sulfate?
What are the nursing interventions/ considerations of ferrous sulfate? |
1. Ulcerative colitis, 2. PUD, 3. Hemolytic anemia
1. Assess blood monthly while pt. is on med 2. Swallow tabs whole, do not crush 3. Do not administer medication with antacids 4. Teach pt. about iron poison and toxicity levels |
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What are the routes of administration for Hydroxocobalamin?
What is the mechanism of action for Hydroxocobalamin? What is Hydroxocobalamin used to treat? |
Routes: PO, SubQ/IM
MOA: Normal growth and cell reproduction - Used to treat pernicious anemia |
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What is the usual side effect of Hydroxocobalamin?
What are the 3 serious side effects of Hydroxocobalamin? What are the 4 nursing interventions/ considerations for Hydroxocobalamin? |
Usual: optic nerve atrophy
Serious: 1. CHF, 2. Pulmonary edema, 3. Anaphylactic shock 1. Red, beefy tongue 2. Psychosis 3. Teach pt about good sources of Vit B12: egg yolks, fish, organ meats, dairy products, clams, oysters 4. Teach patient that treatment must continue for life |
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What is the therapeutic class of hydroxyurea?
What is the usual route of administration for hydroxyurea? |
Antimetabolite
Route: PO |
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What is hydroxyurea used to treat?
What are the nursing interventions/considerations for hydroxyurea? |
Use: Sickle cell anemia
1. Assess CBC, BUN 2. Do not crush or chew capsules |
