CEN Part 1 Exam 100% Verified Graded A

"Tearing chest pain" - Aortic dissection. Unequal upper extremity blood pressure readings (L arm R arm with difference of 20mmHg systolic) ST elevation in V1, 2, 3, and 4 - Anterior myocardial infarction ST elevation leads I, AVL, V5, V6 - Lateral myocardial infarction Reciprocal changes in leads V1 and V2 with ST elevation - Posterior myocardial infarction ST elevation in leads II, III, and AVF - Inferior myocardial infarction Wellen's syndrome - EKG shows a lack of Q wave and significant ST-segment elevation, but no serum marker abnormalities. Critical, proximal LAD artery stenosis. Ludwigs's angina - Results from a secondary dental infection, does not affect EKG, can lead to airway problems. Diffuse swelling of the tissue of the oral cavity and face, extending to the deeper structure of the neck. Hoarseness, stridor, pain on swallowing, and neck pain. Afib - Rate control first and then rhythm conversion Tachydysrhythmia in the pediatric population - Unstability = s/s of poor tissue perfusion (resp distress or failure) Nitrates - Preload reducing effects. Not to be used in right ventricular MI (RVMI), as this might further cause decreased preload and cardiac output. Pericarditis - Diffuse ST-segment elevation, no reciprocal changes, pt's feeling better when sitting forward. Fever, chills, dyspnea, chest pain are typical symptoms. Atrial kick - The enhanced cardiac output that occurs when both of the atria beat simultaneously. Contributing 20-30% more blood volume to cardiac output. Digibind - Digoxin antagonists Pyloric stenosis - Most common cause of intestinal obstruction in infancy. Usually diagnosed in the first 3-12 weeks of life. "Olive-shaped" mobile hard pylorus on palpation. Severe vomiting. Poor weight gain, projective vomiting, and constipation. Narrowing of the opening from the stomach to the intestines, due to enlargement of the muscle surrounding this opening. IBS - High fiber diet to decrease cramping and bloating Esophagitis - Small frequent meals GERD - Small meals and avoidance of alcohol, mint, chocolate, and caffeine Cholecystitis - Low-fat diet to prevent gallbladder attack Epididymitis teaching - Safe sex practice, and limiting the number of sexual partner Ectopic pregnancy - Should be considered in all women of child-bearing age. Life-threatening. Ovarian cyst - Pain to one side of the abd during the menstrual cycle at mid-month, and pain worsens with movement Pregnancy-induced hypertension (PHI) - Visual changes, headache, RUQ abd pain, decreased urination occurred from hypertension and vasospasm. Le Fort I fracture - A horizontal fracture of the maxilla that causes the hard palate and alveolar process to become separated from the rest of the maxilla. The Fracture extends into the lower nasal septum, lateral maxillary sinus and palatine bones. Le Fort II fracture - A pyramid shaped fracture. It extends from the nasal bone to the frontal processes of the maxilla, lacrimal bones and inferior orbital floor, and it may extend into the orbital foramen. Inferiorly, it extends into the anterior maxillary sinus and the pterygoid plates. This type of fracture also is associated with leakage of CSF into the nasal sinuses. Le Fort III - combo of I and II plus orbital zygome - bones pretty much just floating on face (fracture across fronto-zygomatic suture line, entire orbit and nasal bridge - craniofacial disjunction). Complete separation of the cranial attachments from the facial bones. Blow-out orbital fracture - Painful or restricted extraocular muscle movements, esp upward or lateral. Subcutaneous emphysema, infraorbital anesthesia, palpable bony tenderness and deformity, and enophthalmos. Laryngeal injuries - Most are caused by blunt force trauma, often involves other serious injuries. Classic s/s in addition to hoarseness, dysphagia, stridor, and hemoptysis include dyspnea, cough, and difficulty speaking. Pneumomediastinum - Free air in the mediastinal space. Should be suspected if an abnormal crunching sound is heard synchronous with the heartbeat (Hamman's crunch), although this finding is not always present. TMJ dislocation teaching - Soft diet to reduce chewing, no stress on the TMJ (no grinding/clenching), avoid yawning or opening the mouth widely (recurrent dislocations are common) PPD test - Postive = 10mm induration or greater, 5mm for pt with + HIV Adolescence (12-18 years old) fears - loss of control and change in body image Infants (birth to 18 months) and toddlers (18 months to 3 years) fears - Parental separation Toddlers (6 months to 3 years) fears - Stranger anxiety Preschool children (age 3-5) fears - body mutilation, insides leaking out, the dark, pain, the unknown, loss of control amitryptyline (Elavil) - Tricyclic antidepressant, may take up to 3 weeks to achieve pain control, should be taken nightly at bedtime (drowsiness effects), should not exceed 300mg/day Rubeola (red measles) - Highly contagious illness affecting the skin, eyes, and upper respiratory tract. Koplik's spots. Koplik's spots - Classic presentation of rubeola, appears as bluish-white spots to the mouth and throat 1-4 days before the rash fully appears all over the body Rubbella (German measles) - Red rash that starts in the face and spreads to the trunk and extremities. Classic presentation: swollen lymph nodes at the base and sides of the neck. The rash lasts only 2-3 days, but the child is still contagious 1 wk prior to the outbreak of the rash. Roseola infantum - Flat, reddish rash most prominently on the back and trunk. The rash can last as long as 5-15 days to appear after initial exposure incidence of fever mad irritability. The rash usually lasts 1-2 days. Varicella - Red, raised fluid-filled lesion. Most commonly appear on the trunk and face and then become generalized. Severe itching in most children. Spreading with itching and opening of the fluid-filled vesicles. Individuals are infectious 48 hours before the rash appears and remain contagious until all skin lesions have crusted over and no new lesions have formed. donepezil (Aricept) overdose - Potentially life-threatening cholinergic crisis characterized by severe nausea, increased salivation, diaphoresis, bradycardia, flushed skin, and hypotension. Can lead to respiratory depression and cardiopulmonary arrest if the respiratory muscle weakness is severe. Neurogenic shock - Loss of the sympathetic function below the level of spinal cord injury. The unopposed vagal (parasympathetic) stimulus causes vasodilation, bradycardia, and hypotension. phenytion (Dilantin) - Administer slowly over 1-5 min in small increments. Diluted with normal saline 1ml/50mg of Dilantin. Clear IV line first and then give Dilantin with an in-line filter at 50mg/min (10-15mg/kg for status epilepticus). S/E: hypotension, bradycardia. Epidural hematoma - Acute collection of blood between the skull and the dura matter. It is usually due to a laceration in the middle meningeal artery with a rapid collection of blood and increased intracranial pressure. Characterized by a brief period of unconsciousness, followed by a lucid period, and then another loss of consciousness. Diffuse axonal injury - Widespread dysfunction of neurological function without any focal lesions. It is often caused by a sudden acceleration of deceleration injury to the brain resulting in shearing forces to the axons. It is often characterized by an immediate loss of consciousness that can last from days to weeks. Subarachnoid hemorrhage - Collection of blood between the arachnoid and the pia matter. Classically associated with a severe headache. Subdural hematoma - Collection of blood between the dura matter and the subarachnoid layer of the meninges. A loss of consciousness, hemiparesis, and fixed and dilated pupils. The elderly are at greater risk. Chronic subdural hematomas can take as long as 2 weeks to develop.