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298 Cards in this Set

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Arterial monitoring line (A-line) ***

a catheter inserted into an artery and attached to an electronic monitoring system to directly measure arterial blood pressure
Catheter ***
a rubber, plastic, metal, or glass tube used to remove fluids from or inject fluids into a person.
broken or crushed into small pieces
a bluish discoloration of the skin and mucous membranes caused by excessive concentration of reduced hemoglobin in the blood
diffusion of solute molecules though a semipermeable membrane passing from the side of higher concentration to the side of lower concentration; a method sometimes used in cases of defective renal function to remove elements from the blood that are normally excreted in the urine (hemodialysis)
Electrocardiogram (ECG or EKG)

a graphical record of the heart's electrical action derived by amplification of the minutely small electrical impulses normally generated by the heart

Endotracheal tube (ETT) ***
a hollow tube, approximately 10 inches long, with an inflatable cuff near one end that is inserted and positioned in the trachea

after the tube has been positioned, the cuff is inflated to maintain the tube’s position so the patient can breathe through the tube
any abnormal, tubelike passage within body tissue, usually between two internal organs or leading from an internal organ to the body surface
Fowler's position ***
position in which the head of the patient’s bed is raised 18 –20 inches above level with the knees flexed
abnormally prolonged and deep breathing
deficient oxygenation of the blood
the slow, therapeutic introduction of fluid other than blood into a vein
Infusion pump (IMED, IVAC)
an electronic device designed to automatically control the flow and rate of intravenous fluids into a patient
administration of fluids into a vein through the use of a steel needle or plastic catheter
Intravenous therapy
introduction of a fluid into a person's vein; nutrients or medications may be supplied intravenously
the mass of tissues and organs separating the sternum in front and the vertebral column behind, containing the heart and its large vessels, trachea, esophagus, thymus, lymph nodes, and other structures and tissues
voiding of urine
Myocardial infarction (MI)
necrosis of the cells of an area of the heart muscle resulting from oxygen deprivation caused by obstruction of the blood supply
Nasogastric (NG) tube ***
a plastic tube usually inserted into a nostril and ending in the stomach;

it can be used to remove fluid or gas from the stomach, monitor the digestive function of the stomach, administer medications or nutrients, or obtain specimens of the stomach contents
Oximeter ***
a photoelectrical device that measures oxygen saturation of the blood
open, unobstructed, or not closed
accumulation of air or gas in the pleural cavity resulting in collapse of the lung on the affected side
Shunt ***
a passage or anastomosis between two natural vessels, especially between blood vessels
above the pubis
Swan-Ganz catheter ***
- a long intravenous tube inserted into a vein (usually the basilic or subclavian vein) and terminating in the pulmonary artery

- a monitor attached to the catheter measures the pulmonary artery pressure and the pulmonary capillary wedge pressure; it permits evaluation of cardiac function

- patient may exercise while catheterized, but caution around insertion; if in subclavian vein, shoulder extension should be avoided and other shoulder motions restricted
very rapid respirations
a longitudinal assemblage of tissues or organs--especially a bundle of nerve fibers having a common origin, function, and termination--or several anatomical structures arranged in a series and serving a common function
exertion of a pulling or distracting force to maintain a proper position of bone ends or joints to facilitate the healing process
Trendelenburg's position ***
- a position in which the patient lies supine with the head lower than the rest of the body

- not good for patients post CVA, brain surgery, MI
- good for chest congestion, shock
Turning frame
an apparatus that allows a patient's position to be changed from supine to prone, and vice versa, by one person by maintaining the patient's position between two frames of the apparatus

patient may be turned horizontally or vertically, depending on the apparatus used
Ventilator ***
a mechanical apparatus designed to intermittently or continuously assist or control pulmonary ventilation (breathing)

also referred to as a respirator
Wedge pressure
intravascular pressure measured by a catheter inserted into the pulmonary artery (Swan-Ganz catheter) to permit indirect measurement of mean left atrial pressure
CCU ***
coronary (cardiac) care unit
critical care unit
ER or ED ***
emergency room
emergency department
ICU ***
intensive care unit
intermediate care unit
MICU ***
medical intensive care unit
NICU ***
neurological intensive care unit
neonatal intensive care unit
OHRU ***
open heart recovery unit
PACU ***
postanesthesia care unit
SICU ***
surgical intensive care unit
Caregivers should be oriented specifically to
the equipment and treatment protocols in each employment setting before providing patient care
Things you should do before treating a patient
- speak with nursing regarding patient's condition (vitals, physical activity level, mental capacity, alertness, etc.) as it can fluctuate even hour to hour

- review the medical record even if you are providing multiple sessions daily

- wash hands and apply any needed protective garments

- take a few minutes to observe the unit and patient before initiating any treatment:
-- observe monitoring equipment/devices for current status
-- observe type and location of equipment/devices used by patient (IV, oxygen, urinary catheter, A-line, NG tube, etc.)
-- identify location of all tubes, monitor leads, IV line connections and insertions and keep them free of occlusion and tension

- evaluate patient's present physical and mental status before initiating treatment

- recognize the precautions or contraindications associated with the treatment you are giving

- observe patient and monitors frequently to determine response to treatment and adjust accordingly

- notify nursing personnel of significant change in patient's condition or physiological status

- document and record your activities and observations
When patients are acutely ill, less intense treatment is called for. How is this done?
- shorter treatment sessions
- fewer exercise repetitions
- less demand for active participation by the patient

- careful and continuous monitoring of the patient's response to treatment for cues
How is patient's response to treatment monitored?
- observation of and communication with the patient
- awareness of patient's vital signs on a monitor
- comparison of the current responses with previous responses to treatment
What is the best source for information on a patient's current condition?
the nursing staff

discuss patient's condition with them before treatment because a patient's condition may fluctuate from hour to hour and you may not be able to rely on information from your previous visit or the most recent note in the medical record

Don't forget to speak with the family also, if available!
What are the overall goals of treatment for patients in the ICU?
to minimize or prevent the adverse effects of inactivity and immobility and assist each person to become functionally independent
Aspects of care and intervention to be considered when treating patients in ICU
- prevention of contractures through passive and active exercise, proper positioning, and body alignment
- improvement of general condition of patient through exercise and physical activity
- bed mobility training as a precursor to transfer and ambulation activities required for functional independence
- stimulation of the sensory system to improve awareness and coordination through passive and active exercise
- instruction on breathing more efficiently and coughing effectively for patients with respiratory difficulties
- prevention of pressure ulcers and wound care management
- use of protective garments
- assisting patient to cope with or adjust to painful stimuli through selective exercise techniques, pain-relieving electrotherapy, and being a compassionate caregiver
Precautions to use in ICU ***
- observe and assess patient before, during, and after treatment; determine subjective and objective response to treatment

- modify or cease treatment if the patient exhibits abnormal, unexpected or undesired response to treatment (e.g., changes in vitals, breathing, indication of increased pain, reduced mental awareness or alertness)

- avoid occlusion of or excessive tension on all tubes, monitor leads, suction units, supplemental nutrition items and oxygen lines

- request nursing or respiratory service assistance if you identify changes in function or performance of patient support systems (e.g., intravenous line, monitors, ventilation, supplemental nutrition, or drainage devices)

- note appearance and odor of visible wounds, wound dressings, wound drainage, and urine drainage; observe the general appearance of the patient

- request assistance, as necessary, to adjust or move equipment or reposition the patient

- at conclusion of treatment
--be certain patient is properly positioned
-- elevate or replace side rails on bed, if indicated
-- position bedside table and other personal items so they are accessible to the patient
-- inform the patient of the location of the nurse call button and position it so it is accessible
Types of beds ***
- standard adjustable bed
- turning frame (Stryker Wedge Frame or Foster)

- Air Fluidized Bed (Clinitron)
- Post-trauma mobility beds (Keane, Roto-Rest)

- Low air loss therapy bed
What can be done if patient's position is appropriate for his/her medical condition, but inappropriate for treatment?
- reschedule treatment for a time the patient is positioned more appropriately

- temporarily reposition the patient for treatment

- treat the patient as much as possible without changing position
If patient needs to be repositioned for treatment, what should the caregiver do?
- communicate with nursing
After treatment, how should the patient be positioned?
- normally the caregiver returns the patient to the original position

- however, any turning schedules/time schedules for positioning need to be adhered to
What does Fowler's position do? ***
- elevates the head and creates hip and knee flexion

- more comfortable for the patient, and tends to prevent sliding down in the bed, but also presents possibility of contractures and pressure ulcers if prolonged
When is the bed considered to be "gatched"?
in Fowler's position with the upper portion raised and the lower portion flexed
When using side rails for security, what must you ensure before leaving? ***
- they are locked securely

- you haven't compressed or stretched any IV or tubing
If there is an order to use side rails as a restraint, what should be done at the end of treatment? ***
- the side rails must be secured

- ensure they are locked
When may upper rails be used? ***
at patient request

(to assist rolling over, for location of call button, TV controls, etc.)
How should the bed height be adjusted for treatment? ***
- adjust for your best body mechanics to avoid injury to you or the patient

(e.g., elevate the entire bed so you can kneel on it with one knee to assist with heel slides, etc. rather than bending over a low bed and torquing your back)
Describe a Stryker wedge frame or Foster frame ***
- canvas cover over a frame

- pivot joint to allow turning prone to supine and back

- can elevate head or feet (Trendelenburg's position) in either supine or prone position
Although it is now rarely used, for what types of patients is (was) the Stryker wedge frame or Foster frame used? ***
- for patients requiring skeletal stability and alignment
- for patients requiring continuous skeletal cervical traction
- for patients requiring immobilization after a spinal fracture
Advantages of the Stryker wedge frame or Foster frame ***
- allows access to the patient for treatment
- allows one person to safely and easily turn the patient
- requires little space, even to turn the patient

- allows the patient to be wheeled from one location to another without being removed from the frame
- can be elevated/lowered as a unit and height of head or foot can be changed independently
- allows cervical traction to be applied and maintained when the patient is turned
Disadvantages of the Stryker wedge frame or Foster frame ***
- patient can only be positioned supine or prone
- large patients (>200 lbs or >6 feet tall) will be uncomfortable

- can cause skin problems due to shear and pressure
- contractures may develop unless appropriate exercise and positioning techniques are used
Describe an air-fluidized support bed (Clinitron) ***
- bed that contains 1600 lbs. of silicone-coated glass beads called microspheres

- heated, pressurized air flows through the beads to suspend a polyester cover that supports the patient
For what types of patients is the air-fluidized support bed (Clinitron) indicated? ***
- patients with several infected lesions or extensive pressure ulcers
- patients requiring skin protection but who cannot be moved easily (e.g., patients with burns or SCI)

- patients at risk of developing deterioration of the skin (e.g, obese persons)
- patients with recent, extensive skin grafts.
- patients that require prolonged immobilization.
Advantages of air-fluidized support bed (Clinitron) ***
- decreases need for application of topical medications & dressings because the environment is favorable for the healing process

- temperature can be controlled for the needs of the patient

- reduces (or eliminates) pressure, friction, and shear forces, thus pressure sores less likely to develop

- patient can lie on the lesions or wounds for brief periods

- when off, the polyester cover becomes a firm surface, beneficial for some therapeutic interventions
Disadvantages of air-fluidized support bed (Clinitron) ***
- easily punctured & microspheres will be expelled

- air movement around & across skin surface may make body fluids evaporate more quickly than normal--watch for signs of dehydration

- patient still requires positioning due to tendency for fluid to pool in the lungs

- tall & obese patients may not fit well & may be uncomfortable

- due to height of bed treatments & transfers may be difficult

- very expensive bed!
Description of post-trauma mobility beds (Keane, Roto-rest) ***
- designed to maintain a seriously injured patient in a stable position & to maintain proper postural alignment through the use of bolsters

- oscillates side to side (cradle-like)
Indications for use of of post-trauma mobility beds (Keane, Roto-rest) ***
- patient with restricted respiratory function

- patients with advanced or multiple pressure ulcers

- patient that requires stabilization & skeletal alignment post-trauma
Advantages for use of of post-trauma mobility beds (Keane, Roto-rest) ***
- improves respiratory function

- reduces the need to turn the patient to prevent pressure injury, eliminating friction and shear forces

- increases stimulation for neurological patients

- bowel & bladder function improved due to constant motion.
Disadvantages for use of of post-trauma mobility beds (Keane, Roto-rest) ***
- patient may have signs of motion sickness –vertigo, nausea

- exercises & ROM limited due to bolsters

- bed requires a lot of space due to movement.
Description of low air loss therapy bed ***
- has multiple segmented air bladders that allow the limited escape of air

- each bladder is individually controlled based on patient size, weight, and shape, and it may be adjusted to different positions
Indications for low air loss therapy bed ***
- patient requiring prolonged immobilization

- patient with pressure injury(ies), or high risk of development

- patient whose condition requires frequent elevation of the trunk to promote proper respiratory function

- obese patients
Advantages of low air loss therapy bed ***
- adjustable to hip/knee flexion, sitting, or semi-recumbent

- patient's weight is monitored by the bed

- air bladders are inflated or deflated automatically to adjust for patient weight
Disadvantages of low air loss therapy bed ***
- air bladders can be punctured

- frequent alterations of the patient’s position are required to prevent pressure injury

- transfers can be difficult

(must lock wheels, elevate patient’s trunk 20-30 degrees, deflate the seat position, perform the transfer, and turn off the seat deflation control to reinflate the seat)
Precautions for exercise with low blood counts: ***
Hematocrit (Hct)
<27% - possible anemia - NO exercises

27%-30% - light exercise

> 30% - resistive exercise
Precautions for exercise with low blood counts: ***
Hemoglobin (Hgb)
<8g/dL - anemia, trauma, surgery, or dietary iron deficiency - NO exercises

8-10g/dL - light exercise

>10g/dL - resistive exercise
Precautions for exercise with low blood counts: ***
<50,000 mm³ - NO exercise

50,000-70,000 mm³ - light exercise

>70,000 mm³ - resistive exercise
Precautions for exercise with low blood counts: ***
White cells (WBC)
<500mm³ with fever - NO exercise

>500mm³ - light exercise

>500mm³ - resistive exercise
What are elevated/decreased WBCs indicative of? ***
- elevated = infection, leukemia, neoplasm, allergic
reaction, inflammation, or tissue necrosis

- decreased = bone marrow deficiency or infection with
human immunodeficiency virus or it may be due to
radiation or chemotherapy treatments
What is Hct? ***

packed RBCs
What is Hgb? ***

protein in RBCs
What are the precautions for the use of wound drainage tubes/containers (hemovac, Jackson-Pratt, etc.)? ***
- watch for kinks in tubing and/or compression by bed rails

- watch that the patient isn’t lying on the tubing

- keep tubing off of the floor when ambulating with the patient

- best to keep container lower than wound site, although not necessary if working properly

- ask the nurse to empty when full

- watch that you don't aim it toward your face
What are the precautions for the use of colostomy/illeostomy equipment? ***
- check to see if full before getting patient up, if so ask nurse to empty

- avoid excessive stress to area during treatment; place gait belt above the site only

- if a leak is noticed, stop treatment and get assistance from nursing
What are the precautions for the use of tracheostomy tubes? ***
it is easy for infection to enter so do not touch the trach or the area around it

- use proper hand cleansing; if patient needs suctioning, perform only if you have been thoroughly instructed on how to perform with a sterile technique

- do not let patient’s clothing block airway.
What are the precautions for the use of urinary catheters/Foley catheters? ***
- Foley catheter (indwelling with balloon to keep in place)
- condom catheter (external)

- note color of urine--it should be straw colored; look for signs of blood (color or streaked), check for cloudiness or if sediment is present and report abnormal findings to the nurse

- do not kink the tubing.

- do not dislodge from patient.

- do not put bag on floor or let tubing drag when ambulating or using WC.

- if bag is full, ask nursing to empty it; patient may be on I & O, amount may need to be measured and recorded.

- drainage works by gravity so the bag must be below the patients hips
What are the precautions for the use of nasogastric (NG) tubes? ***
- used for feeding, to remove fluid or gas, or to administer medications

- note fluid color in tubing, it should be clear not yellow or bloody

- do not kink tubing

- do not dislodge

- watch confused patients' hands

- you may need to re-tape and/or safety pin tube to patient’s clothing

- avoid neck flexion.

- no food or drinks by mouth
What are the precautions for the use of gastric tubes? ***
- used for direct feeding; tubing is inserted through incision in abdomen directly into patients stomach

- take care to not dislodge; transfer belt should always be placed above the tube

- you may need to check that the cap or plug is on tight to avoid leakage

- use much caution when having a patient perform prone activies
What are the precautions for the use of oxygen? ***
- oronasal (face) mask (usually short term, higher oxygen concentration)
- tracheostomy mask (temporary or permanent)
- nasal cannula (typically for patients requiring low to moderate concentrations of oxygen; e.g., COPD)

- avoid sparks of any kind
- no electric razors

- take care to not dislodge
- take care to not step on tubing
- no kinks in tubing

- maintain prescribed flow (liters/min - usu. 2-3L/min)
- do not exceed prescribed levels, even during exercise; too much oxygen can kill patient
- be alert for signs/symptoms of respiratory distress, dyspnea, SOB, cyanosis of nail beds/lips, cramping of calf muscles
What is the normal flow rate for oxygen?
2-3 L/min

do not exceed what is prescribed; a patient can be killed with too much oxygen
What does a red armband on a patient indicate?
allergy of some type
What are the most common infusion sites? ***
- hand
- wrist
- elbow
- leg
- foot
What are the complications associated with IV therapy? ***
- infiltration
- phlebitis
- thrombophlebitis
- air embolism
- infection of venipuncture site
- systemic infection
- allergic reaction
What are IV complications of infiltration? ***
cool skin or swelling around the site of IV; swelling of the limb; sluggish flow rate
What are IV complications of phlebitis? ***
pain in limb; erythema; edema with induration; streak formation
What are IV complications of thrombophlebitis? ***
painful IV site; erythema, edema with induration; sluggish flow rate
What are IV complications of an air embolism? ***
decrease or drop in blood pressure; weak, rapid pulse; cyanosis; loss of consciousness; increase or rise in central venous pressure
What are IV complications of infection of venipuncture site? ***
swelling and soreness at the site; foul-smelling discharge
What are IV complications of systemic infection? ***
sudden rise in temperature and pulse rate; chills and shaking; changes in blood pressure
What are IV complications of allergic reaction? ***
fever; swelling or generalized edema; itching or rash; respiratory distress, especially shortness of breath
What precautions should be taken with a patient with an IV? ***
- keep the IV site immobilized
- always use a portable I.V. pole when ambulating your patient; ambulate with the IV pole on same side as IV
- the IV bag must be above the infusion site at all times
- infusion site should be at heart level

- check for kinks in tubing
- don’t pull on tubing
- if you are having the patient change positions, make sure they are not lying on the tubing

- note that the needle has not dislodged; don’t touch it but immediately report it to nursing if you feel it has

- do not apply restraint above an infusion site.
- do not take BP on limb with IV

- note that contents of bag is still dripping.
What is a "drug"? ***
a chemical intended for use in the diagnosis, cure, treatment, or prevention of disease
What does pharmacology mean? ***
from Greek:

pharmakon = “poison” or “drug”

logia = “study of”
From what sources do we obtain drugs? ***
- animals
- plants
- viruses
- bacteria
- synthetic
What types of drugs are obtained from animals? ***
insulin – pig/cow pancreas
exenatide – enzyme from Gila monster venom (lizard spit)
calcitonin – hormone derived from salmon
What types of drugs are obtained from plants? ***
galantamine – extracted from daffodil bulbs
ipecac – chemical from tropical plant Cephaelis ipecacuanha
codeine – poppy seeds
metformin – lilac
What types of drugs are obtained from viruses? ***
vaccines – viral components
What types of drugs are obtained from bacteria? ***
Botox – neurotoxin produced by Clostridium botulinum
Streptomycin – isolated from soil bacteria Streptomyces griseus
What types of drugs are obtained synthetically? ***
Amoxicillin – semi-synthetic penicillin
What the three types of names for drugs? ***
- chemical name: N-acetyl-p-aminophenol (APAP)
- generic name: acetaminophen
- trade/Brand name: Tylenol®
For every drug that achieves FDA approval and reaches the market, how many compounds do not make it through the process? ***
- 5,000-10,000 compounds begin
- about 250 make it to preclinicals
- about 5 make it to clinical trials
- only one is approved
What are the phases of clinical trials? ***
- phase I -- 20-100 participants - healthy volunteers studied to determine drug safety and PKPD*

- phase II -- 100-500 participants - small group of patients studied to determine optimal dosing

- phase III -- 1,000-5,000 participants - large-scale clinical trials to determine safety and efficacy in large populations

- phase IV - (post-marketing surveillance) - continue monitoring drug safety and efficacy

* pharmacokinetics and pharmacodynamics
What are the steps to development and marketing of a drug? ***
- drug discovery
- preclinical trials (animal studies) - to determine feasibility for human use
- investigational new drug (IND) application submitted to FDA for human studies
- clinical trials
- FDA review
- large-scale manufacturing
- post-marketing surveillance
What are
- pharmacokinetics?
- pharmacodynamics?
- what the body does to the drug

- what the drug does to the body
Approximately how many drugs brought to market recoup their average $802M developmental cost? ***
only 3 out of 10
What are the dosage forms for drugs? ***
Inhalation (IH)

Intradermal (ID)
Intramuscular (IM)

Intraosseous (IO)
Intrathecal (IT)
Intravenous (IV)

Oral (PO)


Rectal (PR)
Subcutaneous (SubQ)
Sublingual (SL)

Topical (Top.)
Transdermal (TD)
Vaginal (vag.)
What is the most common method of drug administration? ***
oral (PO)
In what forms are drugs administered orally? ***
- tablets
- capsules
- caplets
- geltab/gelcap
- granules
- syrup (sugar-based)
- suspension (settles)
- emulsions (doesn’t settle)
- elixir (alcohol-based)
In what forms are drugs administered rectally? ***
- suppository
- solution
In what forms are drugs administered vaginally? ***
- suppository
- cream
- solution
In what forms are drugs administered by inhalation? ***
- dry powder inhaler

- HFA (hydrofluoroalkane) inhaler
In what forms are drugs administered topically? ***
- cream (thicker)
- ointment (sticks to hairy areas)
- lotion (watered down cream)
- powder
- solution
What types of drugs are adminstered transdermally? ***
- hormones (birth control, testosterone)
- nicotine replacement
- nitroglycerine
- pain patches (local, fentanyl)
How are drugs administered intravenously? ***
- PICC line

- central catheter
What types of drugs are administered intradermally (under skin, not into vein)? ***
- TB tine test
- allergy testing
How are drugs made available (levels of control)? ***
- over the counter (OTC) - without prescription
- behind the counter (e.g, Sudafed) - no prescription, but must sign for limited amounts
- legend drugs - need prescription
How are drugs with high abuse potential controlled? ***
- they are placed in restricted categories (classes I-V)

DEA registration is required for
- doctors prescribing these drugs
- pharmacies carrying these drugs
- wholesalers distributing these drugs

- they are also inventoried on a regular basis
What are Schedule I (C-I) drugs? ***
- drugs with high abuse potential and no accepted medical use (e.g., heroin, LSD, peyote)
What are Schedule II (C-II) drugs? ***
- drugs with high abuse/dependency potential but also with accepted medical use (e.g., morphine, amphetamine, methylphenidate, methadone)
What are Schedule III (C-III) drugs? ***
- drugs with accepted medical use and less abuse potential than C-I or C-II (e.g., Tylenol® with codeine, anabolic steroids, Lortab®)
What are Schedule IV (C-IV) drugs? ***
- drugs with accepted medical use and less abuse potential than C-I through C-III ( e.g., Valium, phenobarbital, Xanax®, Soma®)
What are Schedule V (C-V) drugs? ***
- drugs with accepted medical use and less abuse potential than C-I through C-IV (e.g., Robitussin AC, Lomotil)
Name 4 types of anti-inflammatory analgesics. ***
- steroids
- non-steroidal anti-inflammatory drugs (NSAIDs)
- cyclo-oxygenase-2 (cox-2) inhibitors
- acetaminophen
What are steroids? ***
- substances that suppress the body’s inflammatory response

common examples
- Medrol ® (prednisolone)
- Decadron ® (dexamethasone)
- Deltasone ® (prednisone)
- Solu-Medrol ® (methylprednisolone)
- Solu-Cortef ® (hydrocortisone)
What are some adverse effects of steroids? ***
- insomnia
- nervousness
- upset stomach
- GI bleeding
- osteoporosis
- hyperglycemia
What are NSAIDs and how do they work? ***
- non-steroidal anti-inflammatory drugs

- block the action of chemicals called prostaglandins

- prostaglandins are responsible for the body’s pain and inflammatory responses but they also exert protective effects in the gut

- also have antipyretic (anti-fever) properties
What are some common NSAIDs? ***
- Bayer®, Bufferin®, Anacin® (aspirin)

- Advil®, Motrin® (ibuprofen)
- Aleve® , Naprosyn® (naproxen)

- Toradol® (ketorolac)
- Relafen® (nabumetone)
- Voltaren® (diclofenac)
- Mobic® (meloxicam)
What are some adverse effects of NSAIDs? ***
- sedation

- upset stomach
- GI bleeding (due binding prostaglandins in gut)

- renal toxicity
- platelet inhibition—may interfere with coagulation
What are cyclo-oxygenase 2 inhibitors? ***
- newer type of NSAID

- fewer GI adverse effects than other NSAIDs (because it binds only cox-2 and leaves gut-protective cox-1)

- usually reserved for arthritis

- examples
Celebrex® (celecoxib)
Vioxx® (rofecoxib) – off market
Bextra® (valdecoxib) – off market
What is acetaminophen? ***
- Tylenol®

- prostaglandin inhibition not as extensive as that of NSAIDs

- no anti-inflammatory activity

- fewer adverse effects than NSAIDs

- better GI tolerance
Adverse effects of acetaminophen? ***
- liver toxicity is the most notable side effect and is potentially fatal

- as of July 2011
OTC labeling changes Fall 2011 – 2012
Maximum daily dose is now 3 grams/day (down from 4)

- Ofirmev® (IV acetaminophen): remains 4 grams/day since it is in-hospital and more easily monitored
What are narcotic analgesics? ***
- superior to all other analgesics

- controlled drugs (C-II – C-III)

- suppress opioid receptors in the brain

- analgesia

- more side effects
Name some common narcotic analgesics. ***
- Morphine (Roxanol®, Oramorph® SR, MS Contin®)

- Codeine (Tylenol® #3)

- Hydrocodone (Vicodin®, Norco®, Lortab®)

- Oxycodone (Percodan®, Percocet®)

- Fentanyl (Duragesic®, Sublimaze®)
What are some adverse effects of narcotic analgesics? ***
- drowsiness
- mental cloudiness
- respiratory depression
- constipation

- sedation additive with alcohol
What is Darvocet® or Darvon®? ***
- generic: propoxyphine + acetaminophen, propoxyphene

- withdrawn from market

- potentially serious or fatal heart rhythm abnormalities

- in this case, the risk > benefit
What is Ultram® or Ultracet®? ***
- generic name: tramadol, tramadol + acetaminophen

- narcotic-like medication

- not placed in a controlled drug schedule (yet)
Adverse effects of Ultram® or Ultracet®? ***
- dry mouth
- dizziness

- sedation (additive with alcohol)
- seizures (overdose)
What do muscle relaxants do? ***
- suppress neurons in the spinal cord to decrease muscle spasticity

- treatment of muscle spasms associated with musculoskeletal injuries
Name some muscle relaxants? ***
- Flexeril® (cyclobenzaprine)
- Robaxin® (methocarbamol)

- Skelaxin® (metaxolone)
- Lioresal® (baclofen)

- Soma® (carisoprodol) – Schedule IV
What are some adverse effects of muscle relaxants? ***
- primarily sedation (which is additive with alcohol)

- avoid driving/operating heavy machinery while starting/increasing dose of drug
How do antipsychotics work? ***
by increasing and/or decreasing certain neurotransmitters in the brain
What are two broad categories of antipsychotics? ***
- typical (older)

- atypical (newer)
List some typical antipsychotics. ***
- Haldol® (haloperidol)
- Prolixin® (fluphenazine)
- Thorazine® (chlorpromazine)
List some atypical antipsychotics. ***
- Zyprexa® (olanzapine)
- Abilify® (aripiprazole)
- Seroquel® (quetiapine)
- Risperdal® (risperidone)
- Geodon® (ziprasidone)
What are some adverse reactions to antipsychotics? ***
- muscle rigidity
- drowsiness/sedation/lethargy/somnolence
- ataxia (clumsiness when walking)
- tardive dyskinesia (involuntary movements,
most often around the mouth)
- pseudoparkinsonism
- cardiac abnormalities (QT prolongation)
- seizures
How does serotonin syndrome present? ***
Cognitive effects:
- mental confusion
- hypomania
- hallucinations
- agitation
- headache
- coma

Autonomic effects:
- shivering
- sweating
- hyperthermia
- hypertension
- tachycardia
- nausea
- diarrhea

Somatic effects:
- myoclonus (muscle twitching)
- hyperreflexia (manifested by clonus)
- tremor
What are some adverse reactions to typical agents? ***
Extrapyramidal symptoms
- muscle rigidity/ataxia (loss of muscle coordination)
- pseudoparkinsonism
- akathisia (restlessness)
- akinesia (slow movement)
- tardive dyskinesia (more permanent, involuntary movements, especially “lip smacking”)
How do antiepileptic drugs work, and how are they used? ***
- act on the CNS to suppress hyperactive neurons

therapeutic uses
- seizure prevention in head trauma patients (up to 1 year)
- also used for neuropathic pain
Name some antiepileptic drugs. ***
- Dilantin® (phenytoin)
- Tegretol® (carbamazepine)
- Depakote® (valproic acid)
- Neurontin® (gabapentin)
- Lamictal® (lamotrigine)
Signs of Dilantin toxicity. ***
- dizziness
- lethargy
- drowsiness
- rapid eye movements
What are some adverse effects of antiepileptic drugs? ***
- sedation
- rash
- weight gain/loss
- hair growth/loss
How do osteoporosis medications work and for what are they used? ***
- they work by inhibiting cells that break down bone (osteoclasts) to decrease the rate of reabsorption and tunover and increasing osteoblasts to increase bone formation (bone mineral density)

- used for:
- treatment and prevention of osteoporosis
- hypercalcemia associated with malignancy (Zometa®)
Name some biphosphonates. ***
- Fosamax® (alendronate)
- Boniva® (ibadronate)
- Actonel® (risedronate)
- Zometa®, Reclast® (zolendronic acid)
What are biphosphonates? ***
osteoporosis medications
What are some adverse effects of biphosphonates? ***
- gastrointestinal issues (need to stay upright, don’t eat after taking)
- abdominal pain
- acid reflux/dyspepsia
- nausea, vomiting, diarrhea (N/V/D)
- gas
- constipation
- headache
- esophageal irritation/ulceration
- bone/muscle/joint pain (rare, atypical femur fractures, jaw necrosis)
Name 7 types of cardiovascular agents. ***
- alpha blockers (antihypertensive)
- beta blockers (antihypertensive)

- ACE inhibitors (antihypertensive)
- antihypertensives

- cardiac glycosides
- nitrates
- statins
How do statins work? ***
- statins work by lowering the production of cholesterol in the body

- they are taken at night so peak statin level matches peak cholesterol level
Name some statins. ***
- Lipitor® (atorvastatin)
- Zocor® (simvastatin)
- Pravachol® (pravastatin)
- Crestor® (rosuvastatin)
- Levalo® (pitavastatin)
- Lescol® (fluvastatin)
What are some adverse reactions to statins? ***
- muscle pain (rhabdomyolysis)
- flushing
- stomach ache
- diarrhea
What are some antihypertensive drugs? ***
- alpha blockers
- beta blockers

- ACE inhibitors
- angiotensin receptor blockers (ARB)

- centrally acting Alpha2 agonist Catapress® (clonidine)
- calcium channel blockers

- diuretics (thiazide, loop)
- direct renin inhibitors - Tekturna® (aliskiren)

- vasodilators – nitrates
What is a side effect of antihypertensive drugs? ***
all have potential to cause significant orthostatic hypotension
What is orthostatic hypotension and with what drugs is it commonly associated? ***
- orthostatic hypotension – a sudden drop in blood pressure due to changing from a seated/supine position to a standing position (risk of falls!)

- signs and symptoms similar to those for shock

- antihypertensive drugs -- the main offenders are alpha blockers, and nitrates, which dilate vessels
What do beta blockers do? ***
decrease heart rate
Name some beta blockers. ***
- Tenormin® (atenolol)*
- Lopressor ®, Toprol XL® (metoprolol)*
- Coreg ®, (carvedilol)
- Inderal ® (propranolol)
- Normodyne®, Trandate®

* Selective beta blockers - better with patients with asthma, doesn’t interfere with lung function
What must be considered when prescribing beta blockers to asthmatic patients? ***
selective beta blockers (e.g., Tenormin®, Lopressor®) are better for patients with asthma because they don't interfere with lung function
What are some adverse effects of beta blockers? ***
What is ACE? ***
- ACE = angiotensin converting enzyme

- ACE is an enzyme in the body (kidneys) that helps maintain blood pressure
For what are ACE inhibitors used? ***
- hypertension
- heart failure
- post MI
Name some ACE inhibitors? ***
- Zestril® (lisinopril)
- Altace® (ramipril)
- Capoten® (captopril)
- Lotensin® (benazepril)
- Vasotec® (enalapril)
- Mavik ® (trandolapril)
What are some adverse effects of ACE inhibitors? ***
- orthostatic hypotension
- cough* (ACE is in bradykinin — makes dry cough)
- electrolyte abnormalities (hyperkalemia)

- may worsen kidney function
- angioedema (won’t try a 2nd ACE if pt has angioedema on one)
For what are alpha blockers used? ***
pimarily used for augmenting antihypertensive treatment and benign prostatic hyperplasia (BPH)
What are some adverse effects of alpha blockers? ***
- orthostatic hypotension
- headache
- palpitations
- nausea
Name some alpha blockers. ***
- Catapres® (clonidine)
- Flomax® (tamsulosin)
- Hytrin® (terazosin)
- Cardura® (doxazosin)
What do nitrates do? ***
- cause blood vessels to dilate
- blood pressure decreases
- cardiac workload decreases
- oxygen demand decreases
What is the therapeutic use of nitrates? ***
angina pectoris
Name some nitrates. ***
- Nitrostat® (nitroglycerin)
- Imdur® (isosorbide mononitrate)
- Isordil® (isosorbide dinitrate)
What are some adverse effects of nitrates? ***
- orthostatic hypotension – can become life-threatening when combined with erectile dysfunction drugs
- headache
- edema
With what drug should nitrates be used with caution? ***
ED meds
What are cardiac glycosides? ***
work by increasing cardiac muscle contractility and efficacy of cardiac output
For what are cardiac glycosides used? ***
heart failure
Name a cardiac glycoside. ***
Lanoxin® (digoxin)
For what are anticoagulants used? ***
- stroke prevention
- heart attack prevention
- orthopedic surgery
- thromboses
- certain cardiac arrhythmias (atrial fibrillation – increased stroke risk)
Name some anticoagulant drugs. ***
- Coumadin ® (warfarin) inhibits vitamin K clotting factors
- Plavix ® (clopidogrel)
- Effient ® (prasugrel)
- Aspirin
- Lovenox ® (enoxaparin) – faster than warfarin; subQ inj
- Heparin
- Pradaxa ® (dabigatran)
How do Coumadin ®, Heparin, and Lovenox ® work? ***
- interfere with blood clotting mechanisms in the body

- blood takes longer to clot
Name a cardiac glycoside. ***
Lanoxin® (digoxin)
What are some adverse effects of cardiac glycosides? ***
- nausea/vomiting
- headache
- muscle weakness
- confusion
- cardiac abnormalities--K+ drug interaction (potassium competes for same binding site and decreases effectiveness)
- visual changes (blind spots, blurring, changes in color perception, halos around objects, seeing bright spots/lights)
How do Plavix ®, Effient ®, and aspirin work? ***
- anti-platelet effect
- prevent platelets from clumping together
- no building blocks for blood clots
What are the side effects of anticoagulants? ***

- easy bruising
- blood in stool/urine
- gums bleed easily
- excessive nosebleeds

Coumadin® has numerous food and drug interactions
(antidote is vitamin K injection)

What is Type I diabetes? ***
- Type I diabetes: insulin dependent (IDDM)

- cannot produce insulin

- treated with insulin shots
What is Type II diabetes? ***
- Type II DM:

- may still produce some insulin, although progress to be insulin dependent

- treated with oral hypoglycemics and insulin
What is insulin? ***
a substance that allows glucose to enter cells in the body
From what is insulin derived? ***
- pig
- cow
- human
What is unique to different varieties of insulin? ***
- time to onset

- duration of action
Name some insulins. ***
- Humilin R®, Humilin N®
- Novolin R®, Novolin N®
- Humalog® (short-acting, take with meals)
- Novalog® (short-acting, take with meals)
- Lantus®
- Lente®
What are the short-acting insulins and how are they administered? ***
- Humalog® (short-acting, take with meals)
- Novalog® (short-acting, take with meals)
What are some adverse effects of insulin? ***
- injection site reaction

- allergic reaction due to animal derivatives (however, now our insulin is human recombinant product)

- hypoglycemia
What are oral hypoglycemics? ***
drugs that work at different sites within the body to help control plasma glucose levels
What are the drug classes of oral hypoglycemics? ***
- Biguanide

- Thiazolinediones – increase risk of MI and HF

- Sulfonylurea
Name some oral hypoglycemics. ***
- Amaryl® (glimepiride)
- Actos® (pioglitazone) – increase MI/HF risk
- Avandia® (rosiglitazone) – increase MI/HF risk

- Glucophage® (metformin)
- Glucotrol® (glipizide)
- Glynase® (glyburide)
What are some adverse effects of oral hypoglycemics? ***
- N/V/D
- hypoglycemia
- fluid retention
- liver toxicity
How do anticholinergics work? ***
by inhibiting the neurotransmitter acetylcholine in smooth muscle cells to cause relaxation
For what are anticholinergics used? ***
- overactive bladder

- urinary incontinence
Name some anticholinergics. ***
- Detrol® (tolterodine)
- Detrol LA® (tolterodine ER)
- Ditropan® (oxybutynin)

- Enablex® (darifenacin)
- Sanctura® (trospium)
- Vesicare® (solinfenacin)
What are some adverse effects of anticholinergics? ***
- dry mouth
- dry eyes

- constipation
- GI upset

- blurred vision
- headache
- dizziness/fatigue
Types of calcium ***
- acetate
- carbonate
- gluconate
- citrate
What should the patient know about taking calcium? ***
- know how much elemental calcium is in each salt (recommended intakes are in elemental calcium)

- do not take > 600mg at a time because of decreased absorption
What is the maximum number of C-II narcotic analgesic refills a doctor may prescribe? ***
trick question

C-II narcotic analgesics may not be refilled; if the pt needs more, they must go back to the doctor for a new prescription
Describe precautions to improve safety and reduce patient and employee injury in the treatment setting. (emergency procedures) ***
- read the clinic or hospital policy and procedure manuals

- know the procedure for calling a code or outside emergency services (code blue, 911)

- check for medic alert bracelet or pendant; ask pt name & check ID band

- emergency care – per established policy & procedure
– get assistance, if possible
– stay with the patient
– post emergency phase: document incident in detail
– notify supervisor & risk manager
– file an incident report!
Describe precautions to improve safety and reduce patient and employee injury in the treatment setting. (patient care) ***
- communicate often with your supervising PT, nursing, and any other support personnel that may help you keep up to date about patient changes; (don’t forget the patient and family!)

- read the patients chart before each treatment; look for changes in orders, treatment plans, test results, etc.

- recognize the precautions or contraindications associated with the treatment you are giving

- a mentally competent patient should be informed by the caregiver about the intent, anticipated or desired outcome, and potential risks associated with the planned treatment

- watch for signs of patient becoming intolerant to the treatment--vital signs should be taken even if the patient just doesn’t look right to you; may need to stop or modify the treatment

- “Expect the unexpected”--always keep your full attention on your patient during mobility activities and use extreme caution with confused patients

- all equipment should be secured before use--apply brakes on wheel chairs and beds before transfers begin!

- always use a gait/transfer belt. Watch for abdominal wounds, GI tubes, colostomy bags, low back surgery, apply belt above!

- use proper body mechanics to the best of your ability
Describe precautions to improve safety and reduce patient and employee injury in the treatment setting. (general precautions) ***
- help to keep the department clean, call housekeeping when appropriate

- keep equipment clean and well maintained

- use sterile technique when required; follow procedure manual for your facility wound care & infection control requirements.

- know and perform only the duties that are covered by your license
List and describe the emergency care objectives for allergic reactions. ***
- identify and reduce/remove the cause of the allergy

- prevent or reduce extent of allergic reaction
List and describe the signs and symptoms for mild/moderate and severe allergic reactions. ***
Mild/moderate reaction
- itchy skin
- skin redness, rash, areas of swelling
- itchy, watery eyes
- sneezing
- hives at several body sites

Severe reaction
- swelling of the face or mouth
- difficulty swallowing, speaking
- wheezing, difficulty breathing
- abdominal pain, nausea, vomiting
- dizziness or syncope
List and describe the emergency care treatment for mild/moderate and severe allergic reactions. ***
Mild/moderate reaction
- calm and reassure the patient
- identify the allergen and avoid further contact, or remove it (e.g., bee stinger)
- apply cool compresses or calamine to itchy areas
- observe the person for signs/symptoms of increased distress
- obtain or refer for medical assistance

Severe reaction
- calm and reassure the person
- check the person's airway; if compromised, seek medical assistance; begin rescue breathing and CPR
- assist the person to ingest or inject emergency allergy medication if they have it; do not use an oral medication if the person has breathing difficulty
- position the person to prevent shock
List and describe the emergency care objectives for lacerations. ***
- prevent contamination of the wound

- control breathing
List and describe the emergency care treatment for lacerations. ***
- wash your hands and apply protective gloves

- in some instances the wound can be cleansed with an antiseptic or by rinsing with water

- apply a clean or sterile, nonabsorbent towel or similar object to the wound

- if blood flow is excessive, elevate the wound above the heart to reduce blood flow to the area

- encourage the patient to remain quiet and avoid using the extremity

- if there is arterial bleeding, it may be necessary to apply intermittent direct pressure to the artery above the level of the wound or directly over the wound
(this is done most frequently to the brachial or femoral arteries to restrict blood flow to the distal wound site; however, prolonged pressure by tourniquet should be avoided and the person should be transported to a site where appropriate medical care can be provided unless assistance is brought to the patient)
List and describe the emergency care objectives for shock. ***
- identify and reduce or remove the cause, if possible

- prevent or reduce the extent of the physiologic state of shock
List and describe the signs and symptoms for shock. ***
- pale, moist, cool skin
- shallow and irregular breathing
- dilated pupils
- weak, rapid pulse
- diaphoresis (profuse sweating)
- dizziness
- nausea
- syncope
List and describe the emergency care treatment for shock. ***
- determine the cause of shock (e.g., excessive bleeding, inability to adjust to moving from supine to sitting/standing position, response to excessive heat, etc.) and remedy it if possible

- monitor pt's blood pressure and pulse rate

- obtain additional assistance and contact emergency support personnel as necessary

- place the person supine with head slightly lower than LE (Trendelenburg) unless there are head/chest injuries or impaired respiration, in which case it may be necessary to place the person supine with body flat or even with head and chest slightly elevated

- if bleeding is the apparent cause and the wound is visible, attempt to control bleeding as described for laceration

- cool compress may be applied to the person's forehead for comfort, and a light blanket may be used to prevent loss of body heat

- have patient remain quiet and avoid exertion

- after the symptoms have been relieved, gradually return the person to an upright position and monitor to ensure regression of the condition

- request transportation so the patient can be taken to a facility where proper care and treatment can be provided
What patients are most at risk for orthostatic (postural) hypotension? ***
- most frequently occurs when a person attempts to stand rapidly from a stooped, kneeling, recumbent, or sitting position

- older adults

- people who use antihypertension medication

- people with a decreased ability to return blood from the periphery to the heart

- people with hypotension.

- people on prolonged bed rest (immobilized)
List and describe the emergency care objectives, S&S, and treatment for orthostatic hypotension. ***
same as for shock

- identify and reduce or remove the cause, if possible.
- prevent or reduce the extent of the physiologic state of shock

signs and symptoms
- pale, moist, cool skin
- shallow and irregular breathing
- dilated pupils
- weak, rapid pulse
- diaphoresis (profuse sweating)
- dizziness
- nausea
- syncope

- initally treat for shock

- monitor pt's blood pressure and pulse rate

- obtain additional assistance and contact emergency support personnel as necessary

- place the person supine with head slightly lower than LE unless there are head/chest injuries or impaired respiration, in which case it may be necessary to place the person supine with body flat or even with head and chest slightly elevated

- cool compress may be applied to the person's forehead for comfort, and a light blanket may be used to prevent loss of body heat

- have patient remain quiet and avoid exertion

- after the symptoms have been relieved, gradually return the person to an upright position and monitor to ensure regression of the condition

- request transportation so the patient can be taken to a facility where proper care and treatment can be provided
List and describe the methods of prevention for orthostatic hypotension? ***
prevention by

- elastic wrap bilateral LEs distal to proximal, from feet to groin. (SCI, burn pt’s)

- use of abdominal binder (SCI)

- elastic (TED) hose bilateral LEs

- instruct patient to perform many ankle pumps and alternate knees to chest (heel slides) while supine or seated (this helps in the long run but won’t prevent it from occurring today)

- move patient to upright position very slowly (tilt table)

- in severe cases, may be necessary to apply a full-body pressurized garment (G suit) to stabilize venous circulation
List some human risk factors related to falls. ***
- age (> 65)
- impaired vision/hearing
- use of assistive devices for ambulation or support
- inattentiveness while walking

- decreased strength, flexibility, proprioception, balance or coordination
- previous history of falling
- episodes of vertigo, seizures, or syncope
- use of medications such as antihypertensives, sedatives, pain modifiers
List some environmental risk factors related to falls. ***
- uneven or irregular walking surfaces
- doorway thresholds
- area/throw/scatter rugs
- obstacles in the area (furniture, electrical cords, toys, other objects)

- insufficient lighting
- wet, icy, snow-covered, or waxed surfaces
- steps, especially those with tread overhanging the riser

- absence of non-skid strips or mat in bathtub
- no handrails in shower or bathtub
- no handrail on either side of stairs
- chair with unstable bases or without armrests
List and describe the emergency care objectives for fractures. ***
- protect the fracture site, avoid further injury

- prevent shock

- reduce pain

- prevent wound contamination if bone ends have penetrated the skin
List and describe the emergency care treatment for fractures. ***
- obtain information about the injury from a conscious pt (e.g., cause, location, extent of discomfort and any restricted ROM); obtain additional assistance and contact emergency services

- observe the site of injury or the position of the extremity; examine and evaluate the patient's general appearance and condition; monitor blood pressure and heart rate

- gently palpate the area and surrounding tissue to evaluate swelling or edema and tenderness; deformity and soft-tissue bruising may indicate fracture

- avoid movement or activity that has the potential to cause additional damage to the site

- apply support to the site to stabilize, but do not attempt to align the bone ends; use a firm object to stabilize the fracture before transporting the patient; a pillow folded around the site, canes or crutches applied on either side of a LE fracture, or a flat piece of wood applied to either side of the fracture site can be used; on small extremities, a large magazine can be wrapped around the site

- cover an open fracture site with a sterile towel or dressing, but do not attempt to reinsert the bone ends beneath the skin

- if a spinal fracture is suspected, use extreme caution when handling the patient; place the patient on a firm, flat board or surface, and maintain the head and neck in a neutral position; to insert the spinal board, logroll the patient while supporting the head, avoiding forward, backward, or side bending of the spine (this will require at least 3 persons); evaluate the level of neurological sensation and function by asking the patient to move an extremity or report any response to a stimulus applied to the skin; evaluate the patient for signs of shock, bleeding, and additional injuries; obtain qualified medical assistance rather than attempting to transport the patient with minimal assistance or without sufficient immobilization; this is a serious injury and the patient must be managed carefully

- request transportation to move the person to a facility where proper care and treatment can be provided
List and describe the emergency care objectives for burns. ***
- prevent wound contamination
- relieve or reduce pain
- prevent shock
List and describe the emergency care treatment for burns. ***
- remove or eliminate the agent causing the burn, or remove the patient from the agent; contact skilled personnel when the burn wounds are extensive or involve the face, hands, perineum, or feet; obtain additional assistance and contact emergency services personnel as necessary

- cut away or remove clothing near the site of the burn, but do not attempt to remove clothing that lies over or is part of the wound; remove jewelry from the patient if edema has not developed and the jewelry can be removed without causing additional trauma

- a clean or sterile dressing or towel can be loosely laid over the wound; in some instances a moist dressing will be more comfortable for the patient; do not apply any cream, salve, ointment or similar substance (e.g., butter or lard) to the wound because this will mask the appearance of the wound and may lead to infection or a delay in healing

- if the wound has been caused by a toxic chemical, use a copious amount of water to wash the wound site to dilute the substance; however, avoid washing the chemical onto an unaffected portion of the skin to prevent causing a burn to that area

- observe the patient for shock, respiratory distress, and other symptoms or injuries; prepare the patient for transportation or transport to a facility that is prepared to manage this type of injury
List and describe the emergency care objectives for seizures. ***
- protect the person from injury, should they fall

- protect the patient’s modesty or privacy
List and describe the emergency care treatment for seizures. ***
- place the person in a safe location and position; do not attempt to restrain or restrict the convulsions; obtain additional assistance and contact emergency services personnel as necessary

- monitor the rate and quality of respiration; there may be a period of tonic contraction of all body muscles which will cause respiration to cease for up to 50-70 seconds; after this, respirations may be slower and deeper than normal for a brief period

- assist in keeping the patient's airway patent, but do not attempt to open the mouth by placing any object between the teeth; never place your finger or a wooden or metal object in the patient's mouth, and do not attempt to grasp or position the tongue

- when the convulsions subside, turn the person's head to one side in case vomiting occurs

- allow the patient to rest after the convulsions cease, and protect modesty and privacy; it may be helpful to cover the person with a blanket or screen from view; sphincter control may be lost during or at the conclusion of the seizure, resulting in the involuntary discharge of bladder or bowel contents

- the patient should be evaluated by a physician to determine the cause of the seizure if the cause is not known
List and describe the emergency care objectives for heat-related illnesses. ***
- remove or reduce the cause of the illness

- return the individual to a state of normal homeostasis
What are the two forms of heat-related illness? ***
- heat exhaustion

- heat stroke - threat of loss of life--this is a medical emergency!
What are the causes of heat exhaustion/heat stroke? ***
- hot/humid environment
- vigorous exercise
- dehydration
- depleted body electrolytes
What are the signs and symptoms of heat exhaustion and heat stroke? ***
heat exhaustion
- profuse diaphoresis
- nausea
- headache
- shallow, rapid breathing
- weak, rapid pulse
- pale skin
- normal or slightly elevated body temperature
- person is exhausted, collapses
- unconscious
- pupils normal

heat stroke
- dry skin, no diaphoresis
- nausea
- headache
- labored breathing
- strong, rapid pulse
- flushed or grayish skin
- very elevated body temperature (106-110 F)
- person is exhausted, collapses, convulses
- unconscious
- pupils contract, then dilate
List and describe the emergency care treatment for heat exhaustion. ***
- place person in comfortable position in a shady or covered area or well-ventilated room; loosen or remove outer clothing and monitor vital signs; obtain additional assistance and contact emergency service personnel as necessary

- sponge the person's forehead and neck with a cold compress or ice bag; cool, wet towels or sheets can be used to cool the person, and water or a solution containing electrolytes may be given by mouth if the person is conscious

- observe the person for shock or other physiological changes and treat the symptoms as appropriate; vomiting, refusal of fluids, or loss of consciousness indicates the condition is worsening

- request transportation so the person can be taken to a facility where proper care and treatment can be provided if no relief of signs and symptoms occurs within a short time or if further progression of the signs or symptoms occurs
List and describe the emergency care treatment for heat stroke. ***
- place the person in a semireclining position in a shady or well-ventilated covered area or room; remove the outer clothing and monitor the pulse and respiration rates; obtain additional assistance and contact emergency services personnel immediately

- cool the person quickly with large amounts of cool or cold water or apply cold, wet compresses, towels, or sheets to the body; ice bags can be applied to the wrists, ankles, each groin area, each axilla, and lateral neck areas to cool the large blood vessels (and thus, the blood supply)

- this is a life-threatening condition and prompt emergency care must be provided; the person should be transported to a medical facility as rapidly as possible
List and describe the emergency care objectives for insulin-related illnesses. ***
- restore the person to a normal insulin-glucose state

- remove, correct, or compensate for the cause of the condition
What should you ensure with diabetic patients before you treat them? ***
- their sugar is stable

- they have checked their sugar, taken their insulin, and eaten
What are the causes of hypoglycemia (hyperinsulinemia or insulin reaction)? ***
- too much systemic insulin

- too little food

- excessive exercise
Warning signs and symptoms of insulin reaction (hypoglycemia or hyperinsulinemia) ***
- sudden onset
- pale, moist skin
- excited, agitated behavior
- normal breath odor
- normal to shallow breathing
- no vomiting
- moist tongue
- hunger
- no thirst
- no or slight glucose in urine
Warning signs and symptoms of acidosis (hyperglycemia) ***
- gradual onset
- flushed, dry skin
- drowsiness
- fruity odor to breath
- deep, labored breathing
- vomiting present
- dry tongue
- no hunger
- thirst
- large amounts of glucose in urine
List and describe the emergency care treatment for hypoglycemia (hyperinsulinemia or insulin reaction). ***
- if conscious, provide sugar (candy, juice)

- stop all activity and rest

- possibly counsel patient on proper balance of food intake, exercise levels, & monitoring glucose levels more carefully.
What are the causes of hyperglycemia? ***
- too little systemic insulin.

- intake of too much food or improper food (i.e. excessive sugar/starch)

- insufficient physical activity in relation to the metabolic state of the person
List and describe the emergency care treatment for hyperglycemia (acidosis). ***
- get medical care stat as this may lead to diabetic coma or death

- do NOT give sugar (insulin is needed)
Which patients are susceptible to autonomic hyperreflexia (dysreflexia)? ***
individuals with a relatively recent complete injury to the cervical and upper thoracic portions of the spinal cord down to the T6 cord level (T6 and above/book seems to say above T6)
List and describe the signs and symptoms of autonomic hyperreflexia (dysreflexia)? ***
- severe hypertension
- bradycardia
- a pounding headache

- profuse diaphoresis above the level of the cord injury
- a general feeling of discomfort
- red skin blotches
- piloerection (“goose bumps”)

- convulsions possible
- respirations may become difficult
- person may become unconscious
List and describe the emergency care objectives for autonomic hyperreflexia (dysreflexia). ***
determine and remove the noxious stimulus causing the condition; could be:
- bladder distension
- fecal impaction
- open pressure sore
- tight straps from an orthosis or urine retention bag
- localized pressure
- exercise

return the patient to their level of normal homeostasis.
List and describe the emergency care initial treatment for autonomic hyperreflexia (dysreflexia). ***
- initially place the person in a sitting or semirecumbent position to reduce the hypertension; do NOT place them supine

- if the noxious stimulus can be identified, it should be removed or relieved

- monitor the person's vital signs frequently, provide reassurance, and obtain qualified medical assistance

- be aware that this condition could occur at any time, and be prepared to assist the patient
Another term for ventilator
Purpose of ventilator
use positive air pressure to maintain adequate and appropriate air exchange when normal respiration is inhibited or cannot be performed by the patient
Ventilators may be used for diseases or conditions that
- affect patients neurological or musculoskeletal control of respiration, or

- that interfere with the exchange of gases in the lungs

- produce apnea or the potential for respiratory distress or failure
What is ARDS?
acute respiratory distress syndrome

- possibly caused by systemic shock, diffuse respiratory infection, systemic response to sepsis or extensive trauma

- signs and symptoms include dyspnea, tachypnea, cyanosis and hypoxemia

- caregiver must watch patient's response to activity and monitor patient's response to activity and watch ABGs

- patient likely to not tolerate active, especially resistive, exercise in early stages of recovery and complete recovery may take several weeks

- life-threatening because it may cause organ failure
Types of ventilators
volume-cycled - long-term support; pre-determined volume of air delivered on inspiration, but expiration is still passive; COPD, SCI, TBI, ALS, polio, Guillain-Barre,

pressure-cycled - short-term support; predetermined, maximum pressure of gas during respiration and the inspiration phase ends when that level is reached, expiration is still passive

negative pressure device - rarely used; "iron lung" and "turtle shell" chest respirator create negative pressure in patient's chest so lungs fill passively for inspiration; were used for polio patients
Airway placement for ventilator
may be
- oral pharyngeal
- nasal pharyngeal
- oral esophageal
- nasal endotracheal
- oral endotracheal
- tracheostomy
- laryngostomy
Modes of ventilation
- assist mode - pt must cause negative pressure to trigger gas delivery
- continuous positive airway pressure (CPAP) - superimposes PEEP on pt's breathing pattern; useful for weaning off ventilator or maximize gas exchange for immobile, inactive patient

- control mode - inspiration at timed intervals based on pt need
- assisted control mode - combination of assist (pt must cause negative pressure) and control (inspiration at timed intervals) modes

- intermittent mandatory ventilation (IMV) mode - pt's ventilation cycle is established at a set minimum per minute; used for weaning off ventilators and developing independent respiration

- synchronized IMV mode - allows ventilation cycle to be coordinated with patient's own breathing cycle

- positive end-expiratory pressure (PEEP) - oxygen induced by maintaining positive pressure at end of expiration, which increases alveolar surface area able to absorb gas induced by ventilator and leads to maximal alveolar ventilation; helps expand, maintain and keep alveoli patent
Signs and symptoms of respiratory or cardiopulmonary distress
- dyspnea
- tachycardia
- arrhythmia
- hyperventilation
- syncope
- cyanosis
Common monitoring parameters
- vital signs (BP, respiration, temperature)
- cardiac vital signs
- ABGs
- intracranial pressure
- pulmonary artery pressure
- central venous pressure
- arterial pressure (A-line)
How does the oximeter work?
measures oxygen saturation (SaO2) of pt's blood by recording different modulations of transmitted beam of light affected by reduced hemoglobin and oxyhemoglobin

- normal is 95-98%
Cautions for patients with intracranial pressure monitors
- pts monitored after closed head injury, cerebral hemorrhage, brain tumor or overproduction of CSF

- avoid rapid increase in ICP, such as with isometrics and Valsava (ensure they are not holding breath on exertion)

- avoid hip and neck flexion greater than 90 degrees and do not lower head more than 15 degrees below horizontal
Common A-line insertion points
- radial
- dorsal pedal
- axillary
- brachial
- femoral
Potential complications of A-line
- sepsis
- hemorrhage
- fistulae
- aneurysm
- ischemia
- arterial necrosis
What factors help determine treatment approaches for a patient?
- diagnosis
- physical/mental condition
- institutional or physician guidelines or protocols
- patient's lab values

thus persons with the same diagnosis may require very different approaches to care because of differences in their physical responses to disease, trauma or condition (or treatment)
What is the minimum O2 saturation level for exercise/physical activity?
90% - if lower, stop activity
If hyperventilation occurs during exercise, what should the caregiver instruct the patient to do?
- relaxation techniques
- abdominal-diaphragmatic breathing
- pursed-lip breathing
If hypoventilation occurs during exercise, what should the caregiver instruct the patient to do?
- deep breathing
- assume upright, trunk-supported position
What is a gastric (G) tube?
- tube inserted directly into stomach through incision in abdomen

- similar functions as NG tube
Common IV infusion sites
superficial veins usually

upper extremities
- metacarpal and dorsal venous plexus of hand
- basilic vein
- cephalic vein
- anticubital vein

lower extremities
- dorsal venous plexus
- medial, lateral, and marginal veins of foot
- saphenous veins
- femoral veins

- superficial scalp veins (usu for infants and the elderly)
What are the components of the IV system
- solution or fluid container
- device to measure drops administered per minute
- plastic tubing
- roller clamp to control rate of flow of fluid
- needle
(some IV systems include an infusion pump, which provides a constant, preselected fluid flow rate
Possible complications associated with IV administration
- infiltration of fluid into subcutaneous tissue
- phlebitis
- cellulitis
- thrombosis
- local hematoma
- sepsis
- pulmonary thromboembolus
- air embolus
- catheter fragment embolus
Where should the caregiver place the IV bag when moving a patient?
above the heart to prevent reflux of IV fluid
What should not be applied above the IV infusion site?
any restraint (e.g., blood pressure cuff)
pathological condition resulting from the accumulation of acid or depletion of the alkaline reserve in the blood and body tissues; characterized by an increase in hydrogen ion concentration
a substance, protein or nonprotein, capable of inducing allergy or specific hypersensitivity
Autonomic hyperreflexia (dysreflexia)
an uninhibited and exaggerated reflex of the autonomic nervous system as a result of a stimulus
Cardiac arrest/death
sudden and often unexpected stoppage of effective heart action
Cardiopulmonary resuscitation (CPR)
the reestablishment of heart and lung action as indicated for cardiac arrest
a series of involuntary contraction of the voluntary muscles
excess of glucose in the blood
abnormally low level of sugar (glucose) in the blood
a double-chain protein hormone formed from proinsulin in the beta cells of the pancreatic islets of Langerhans
a wound produced by the tearing of body tissue, as distinguished from a cut or an incision
Orthostatic (postural) hypotension
a fall in blood pressure associated with dizziness, syncope, and blurred vision that occurs on standing or when standing motionless in a fixed position
a convulsion or attack, as in epilepsy
acute peripheral circulatory failure caused by derangement of circulatory control or loss of circulating fluid
a decrease in the caliber of blood vessels
What may be the initial indication of heat-related illness?
muscle cramps in the legs and abdomen
Are oral salt tablets an effective treatment for heat exhaustion?
no, the excess salt may interfere with the person's ability to readjust the electrolyte balance to a normal state
Why do burn patients need leg wraps? ***
- to care for wounds
- prevent infection
- prevent fluid loss
- prevent hemosiderin staining (or it will become permanent tattoo)
When is the abdominal binder placed on the patient with SCI? ***
before they get up (while still supine)
What is one of the biggest human factor for falls? ***