AG-ACNP - Common Problems in
Acute Care Exam-Graded A
Define pain. - ANSWER-Subjective descriptor of perceived distress.
Acute pain - ANSWER-Pain lasting <6 months
Caused by tissue damage
Chronic pain - ANSWER-Pain lasting >6 months
Combination is usually necessary to effectively treat chronic pain
Cutaneous pain - ANSWER-Localized on the skin or surface of body
Visceral pain - ANSWER-Poorly localized
Internal organs
Somatic pain - ANSWER-Non-localized
Muscle, bones, nerves, blood vessels and supporting tissue
Neuropathic pain - ANSWER-Nerve pathway injury or compression
Frequently neuropathic pain is caused by tumor
What is the single most reliable indicator of existence and intensity of pain? - ANSWER-
Subjective findings - patient report
WHOSE PAIN IS IT
Normal body temperature - ANSWER-37 C
Fever temperature and what to do - ANSWER-38.6 C = 101.5
Culture patient and start Tylenol
When is it appropriate to start Tylenol in presence of 38.6 C fever? - ANSWER-Once
the cultures are drawn, you can administer Tylenol
Neuroleptic Malignant Syndrome - ANSWER-SSRI toxicity
Family history is significant for neuroleptic malignant syndrome
Malignant Hyperthermia is associated with what drug? - ANSWER-Succyncholine
Succs is contraindicated in what situation? - ANSWER-Hyperkalemia - contraindicated
for succs
,What is the most common cause of non-infectious fever? - ANSWER-Post-operative
atelectasis
Elevated esoinophils are present in what reactions? - ANSWER-Allergic reactions
Drug-induced fever
Drug Induced Fever - ANSWER-Slow onset (7-10 days)
PCN derivatives most common inducing fever
In the absence of infection, what is the treatment for non-infectious fever? - ANSWER-
Hydration
Increasing lung expansion
What is the treatment of drug-induced fever related to Thorazine? - ANSWER-Flush out
Thorazine with IVF
Infectious etiology of fever is manifested by: - ANSWER-Elevated WBC with L shift -
bandemia
WBC >30,000 is suggestive of: - ANSWER-Leukemia
Not r/t infection causing fever
Treatment of Infectious Fever - ANSWER-Culture
Tylenol
Supportive IVF
Gram stain and culture all lines and invasive catheters
When patient presents with 101.5 F >3 weeks, what diagnosis is suspected and what is
the plan of care? - ANSWER-FUO - endocarditis, malignancy
NOTHING. You do nothing until source of fever is identified
Most important part of history of headache - ANSWER-Chronology - onset, when it
started
Total calcium is 50% bound to albumin - normal calcium level in hypoalbuminemia =
HYPERCALCEMIA
Acidemia and calcium - ANSWER-Acidemia INCREASES calcium
Alkalemia and calcium - ANSWER-Alkalemia DECREASES calcium
Hypocalcemia causes - ANSWER-Hypomag
Hypoparathyroidism
PANCREATITIS
, Renal failure
Trauma
Hypocalcemia s/s - ANSWER-CATS go numb - NOT ENOUGH SEDATIVE
Convulsions
Arrythmias - >QT prolongation
Tetany - Trousseau, Chvostek (cheek)
Seizures
Numbness, tingling
Hypocalcemia treatment - ANSWER-Acute hypocalcemia
IV calcium gluconate
Chronic
Vitamin D
Calcium supplements
aluminum hydroxide
Hypercalcemia causes - ANSWER-TOO MUCH SEDATIVE
Malignancy
Hyperparathyroidism
SHAMPOO DIRT
sarcoidosis
hyperparathyroidism, hyperthyroidism
alkalosis
mets
pagets dx
osteoporosis
D vitamin intoxication
Immobility
R
Thiazide diuretic
Hypercalcemia s/s - ANSWER-TOO MUCH SEDATIVE
Nausea/vomiting
Constipation
Coma and death
Hypercalcemia medical emergency management - ANSWER-Ca > 12 mg/dL
IV NS and loop diuretics
Acute Care Exam-Graded A
Define pain. - ANSWER-Subjective descriptor of perceived distress.
Acute pain - ANSWER-Pain lasting <6 months
Caused by tissue damage
Chronic pain - ANSWER-Pain lasting >6 months
Combination is usually necessary to effectively treat chronic pain
Cutaneous pain - ANSWER-Localized on the skin or surface of body
Visceral pain - ANSWER-Poorly localized
Internal organs
Somatic pain - ANSWER-Non-localized
Muscle, bones, nerves, blood vessels and supporting tissue
Neuropathic pain - ANSWER-Nerve pathway injury or compression
Frequently neuropathic pain is caused by tumor
What is the single most reliable indicator of existence and intensity of pain? - ANSWER-
Subjective findings - patient report
WHOSE PAIN IS IT
Normal body temperature - ANSWER-37 C
Fever temperature and what to do - ANSWER-38.6 C = 101.5
Culture patient and start Tylenol
When is it appropriate to start Tylenol in presence of 38.6 C fever? - ANSWER-Once
the cultures are drawn, you can administer Tylenol
Neuroleptic Malignant Syndrome - ANSWER-SSRI toxicity
Family history is significant for neuroleptic malignant syndrome
Malignant Hyperthermia is associated with what drug? - ANSWER-Succyncholine
Succs is contraindicated in what situation? - ANSWER-Hyperkalemia - contraindicated
for succs
,What is the most common cause of non-infectious fever? - ANSWER-Post-operative
atelectasis
Elevated esoinophils are present in what reactions? - ANSWER-Allergic reactions
Drug-induced fever
Drug Induced Fever - ANSWER-Slow onset (7-10 days)
PCN derivatives most common inducing fever
In the absence of infection, what is the treatment for non-infectious fever? - ANSWER-
Hydration
Increasing lung expansion
What is the treatment of drug-induced fever related to Thorazine? - ANSWER-Flush out
Thorazine with IVF
Infectious etiology of fever is manifested by: - ANSWER-Elevated WBC with L shift -
bandemia
WBC >30,000 is suggestive of: - ANSWER-Leukemia
Not r/t infection causing fever
Treatment of Infectious Fever - ANSWER-Culture
Tylenol
Supportive IVF
Gram stain and culture all lines and invasive catheters
When patient presents with 101.5 F >3 weeks, what diagnosis is suspected and what is
the plan of care? - ANSWER-FUO - endocarditis, malignancy
NOTHING. You do nothing until source of fever is identified
Most important part of history of headache - ANSWER-Chronology - onset, when it
started
Total calcium is 50% bound to albumin - normal calcium level in hypoalbuminemia =
HYPERCALCEMIA
Acidemia and calcium - ANSWER-Acidemia INCREASES calcium
Alkalemia and calcium - ANSWER-Alkalemia DECREASES calcium
Hypocalcemia causes - ANSWER-Hypomag
Hypoparathyroidism
PANCREATITIS
, Renal failure
Trauma
Hypocalcemia s/s - ANSWER-CATS go numb - NOT ENOUGH SEDATIVE
Convulsions
Arrythmias - >QT prolongation
Tetany - Trousseau, Chvostek (cheek)
Seizures
Numbness, tingling
Hypocalcemia treatment - ANSWER-Acute hypocalcemia
IV calcium gluconate
Chronic
Vitamin D
Calcium supplements
aluminum hydroxide
Hypercalcemia causes - ANSWER-TOO MUCH SEDATIVE
Malignancy
Hyperparathyroidism
SHAMPOO DIRT
sarcoidosis
hyperparathyroidism, hyperthyroidism
alkalosis
mets
pagets dx
osteoporosis
D vitamin intoxication
Immobility
R
Thiazide diuretic
Hypercalcemia s/s - ANSWER-TOO MUCH SEDATIVE
Nausea/vomiting
Constipation
Coma and death
Hypercalcemia medical emergency management - ANSWER-Ca > 12 mg/dL
IV NS and loop diuretics
