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102 Cards in this Set
- Front
- Back
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VIP score numbering |
0-5. Resite on stage 2.
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size of blue needle
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22
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size of pink needle
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20
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size of green needle
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18
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Size of gray needle
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16
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size of orange needle
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14
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size of yellow needle
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24 (too small for anything!)
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regular osmolarity of blood
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275-295 mOsm/L
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daily replacement needed of Na
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100 mEq
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Daily replacement needed of K
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40-80 mEq
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fluid loss during surgery by evaporation per hour
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500-1000 mL/ hr
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What is in 1 L of LR
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130 Na, 109 Cl, 4 KCl, 3 Ca, 28 HCO3. 273 total.
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osmotic pressure from 1 g dextrose
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5 mOsm
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Fever within 24 hours of admit
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atelectasis, wound cellulitis, drug fever (NOT likely CAUTI)
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Fever on day 2
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pneumonia or CAUTI
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Fever on day 3 or 4
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Thrombophlebitis, DVT, wound infection, tissue/organ inflammation
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Fever after day 5-7
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"not good!" deep infection, DVT, Cdiff, neoplasm, leaking anastmosis
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when would wound dehiscence occur
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5-12 days after surgery
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Lymphocytes are up with
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viral infection (often mono) or leukemia
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How to diagnose COPD
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Test FEV1 <70% AFTER giving short acting bronchodilator
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3 most common symptoms of COPD
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dyspnea, cough, sputum
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CAT assessment criteria (7)
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Cough, sputum, tightness, stairs/breathless, limits on home activities, confident leaving home, sleep soundly, energy
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MMRC dyspnea scale
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1 - slight hill, 2- slower than everyone else on flat ground, 3 - stop after 100 yards, 4- too breathless to leave house
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Gold scale
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1 (mild) FEV more than 80%, 2 (moderate) 50
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how to combine assessment of COPD (GOLD standard)
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mMRC or CAT (low or high) and then number of exacerbations/year (0-1 vs 2 or more)
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COPD combined assessment categories (4)
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A: less symptoms, less risk. B: more symptoms, less risk. C: Less symptoms, high risk. D: More symptoms, high risk.
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COPD comorbidiities (6)
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CVD, Osteoporosis, RI, Anxiety/depresion, DM, Lung cancer
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5 med categories for COPD
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Beta 2 agonists, Anticholinergics, Methylxanthines, Corticosteroids, Phosphodiesterase 4 inhibitors.
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Inhaled Corticosteroids indicated when
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when FEV1 is less than 60%
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Phosphodiesterase-4 inhibitors indicated when
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GOLD 3 or 4 (less than 50% FEV1), AND Hx of exacerbations and chronic bronchitis.
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roflumilast
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phosphodiesterase-4 inhibitor (for severe COPD)
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When is flu vaccine indicated r/t COPD
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when FEV1 is less than 40%, or pt. is over 65
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Can O2 therapy increase survival rates? With whom?
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pts with severe resting hypoxemia
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when is lung volume reduction surgery indicated
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pts with upper-lobe emphysema and low exercise capacity
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use of corticosteroids with COPD
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recommended short term and/or in combination with others long term. Not LT monotherapy!
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what is an exacerbation of COPD
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worse symptoms beyond normal day-to-day variations AND leads to Cx. In medication
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most common cause of COPD exacerbation
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URI or infective trachea/bronchitis
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normal Rx for exacerbation
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Short acting bronchodilators with or without anthicholinergics, corticosteroids and antibiotics, noninvasive ventilation
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ideal pulse ox reading for COPD patient
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88-92% to keep from getting O2 dependent
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3 cardinal symptoms indicating use of antibiotics in COPD
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increased dyspnea, increased sputum, and increased sputum purulence. AND/or mechanical ventilation.
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why does smoking increase pneumonia risk?
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disrupts ciliary and macrophage activity
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Why does NPO increase pneumonia risk?
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colonization of bacteria in pharynx
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why does ETOH increase pneumonia risk?
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decreases ciliary mvmt and immunosuppression
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classical symptoms of pneumonia
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PaO2 <80%, shaking chills, stabbing chest pain, fever, and increased HR 10 BPM for every degree Celsius, increased WBC (with bacterial) or lymphocyte (Viral)
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normal WBC count
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5-10,000
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why would monocytes be high?
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chronic infection/ end of infection (become macrophages)
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why would eosinophil count be high?
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inflammatory or allegic reaction
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Never let momma eat beans
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order of multiplicity in blood. Neutrophils, lymphocytes, monocytes, eosinophils, basophils
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what does WBC "shift to the left" mean?
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high neutrophil and band (immature neutrophils) count. Indicates acute bacterial infection.
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HAP timing
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48 hours or more after admission
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VAP timing
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24 hours to 4 days after intubation
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HCAP timing
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within 2 days of admission in a pt who is in a LTCF, was hospitalized within past 30 days, or received blood dialysis
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CAP timing
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pneumonia present upon admission
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parenchyma
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function tissue of an organ (ex. Lung or liver), as opposed to support structure (such as pleura)
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does asthma increase mucus production
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Why yes, it does!
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AG->AB response
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antigen to antibody
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viral illnesses often lead to…
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sinusitis (treat with amoxicillin)
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can cold precipate asthma?
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yes, it can! And also sinus infection.
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3 Rx for acute asthma
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O2, SABA, high dose systemic corticosteroid
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Asthma treatment steps (6)
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1) SABA, 2) ICS or LTRA or AntiCh or Methylxanthine. 3) medium ICS or low ICS and LABA. 4) Medium IC and LABA. 5) High ICS and LABA. 6) High ICS, LABA and PO CS.
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ICS
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inhaled corticosteroid
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LTRA
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leukotrine receptor antagonist (for bronchodilation)
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osmotic pressure from 1 g dextrose
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5 mOsm
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Isoetharine (bronkosol)
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SABA
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Albuterol med type
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SABA
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Epinepherine med type r/t asthma
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SABA
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Atrovent
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anticholinergic (block parasympathetic NS)
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Aminophylline
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xanthine group (methylxanthine). Decrease bronchospasm, longer than SABAs.
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Theophylline
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xanthine group (methylxanthine). Decrease bronchospasm, longer than SABAs.
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Xanthine levels
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5-15 mcg/mL
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cromolyn sodium (nasalcrom)
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prophylaxis decreae airway inflammation and edema. Start 2-3 wk beore allergy season
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Nedocromil (Tilade)
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inhibits release of inflammatory mediators
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Intal
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prevent mast cells from opening for allergen
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Zafirlukast (accolate)
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prevent leukotreine synthesis
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montelukast (singulair)
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prevent leukotreine synthesis
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zileuton (zyflow) type and concern
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prevent leukotreine synthesis. Inhibits P450.
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Mg as a med
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vaso and bronchodilator
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how to do peak flow measurement
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fill lungs completely, bite and close lips, blow out hard and fast as possible, record. Repeat 3 times. Take "personal best"
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when should PRN SABA move to scheduled dose
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when used more than 3X week
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when should more powerful dose of bronchodilator be used
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when you need more than 6 puffs/day
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how much K lost per L of urine
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20 mEq
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Ampicillin-sulbactam treatment for what type of Pneumonia
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early onset simple pneumonia
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Ceftriaxone for pneumonia
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early onset simple pneumonia
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levofloxacin or moxifloxacin for pneumonia
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early onset simple pneumonia
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ciprofloxacin for pneumonia
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early onset simple pneumonia
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ertapenem for pneumonia
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early onset simple pneumonia
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cefepime for pneumonia
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late onset or multidrug resistant pneumonia
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ceftazidime for pneumonia
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late onset or multidrug resistant pneumonia
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imipenem or meropenem for pneumonia
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late onset or multidrug resistant pneumonia
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piperacillin-tazobactam and cipro or levofloxacin for pneumonia
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late onset or multidrug resistant pneumonia
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amikacin, gentamycin, or trobramycin AND linezolid or vancomycin for pneumonia
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late onset or multidrug resistant pneumonia
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minimum treatment time for CAP
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5 days
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minimum treatment time for HCAP HAP or VAP
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7 to 10 days
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POX
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pulse oximeter reading
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PaO2
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partial pressure of oxygen in blood Usually over 80
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SPO2
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pulse oximeter reading
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hypoxemia definition
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PaO2 of less than 60 mmHg or POX of less than 90%
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what flow rate of O2 to start humidifying
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when more than 6 L/min
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what are the conditions for oxygen toxicity?
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more than 60% O2 for more than 48 hours
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five drugs for TB
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isonazid, rifampin, pyrazinmide, streptomycin, ethambutal
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virchows triangle for PE
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stasis, vessel wall injury, hypercoagulability
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PERC for PE criteria (8)
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over 50, HR over 100, POX under 95, Hx of DVT, recent trauma, hemoptysis, Estrogen, Unilateral leg swelling |
