NSER 7210 Final Exam – Questions With Complete
Solutions
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Terms in this set (96)
Describe the role of universal
screening of ED patients for
interpersonal violence (IPV) and
other social issues
Outline common complications of (1) Blunt abdo traumas
early pregnancy for which women - Used a FAST (Focused Abdominal Sonogram for
present to EDs Trauma) --> only identifies presence of free
intraperitoneal or pericardial fluid, faster than CT,
free fluid can be attributed to hemorrhage and can
lead to clues about severity of injury, US is not good
at identifying & grading solid organ injury/bowel
injury/retroperitoneal trauma
(2) Ectopic Pregnancy
(3) Hyperemesis Gravidarum (HG)
,Ectopic Pregnancy - non-ruptured Clinical features:
- 1st trimester bleeding
- Abdo pain
- Missed period
Physical Findings:
- HypoT
- TachyC
- Abdo/pelvic tenderness
- Peritoneal signs --> rebound tenderness and
guarding
Risk Factors:
- Hx of chlamydia or gonorrhea
- Exposure to diethylstilbestrol
- IUD use
- Assisted reproductive technology
- Previous ectopic preg
- PID
Hyperemesis Gravidarum (HG) Can lead to hypovolemia
Pregnant women can present to ED with:
- Vomit → weight loss
- Ketonuria
- Electrolyte imbalance
- acid/base imbalance
- Severe volume depletion
These women need aggressive fluid administration
Outline the basic patho of shock and Patho of Shock:
related compensatory mechanisms The CVS is made up of (1) pump; (2) pipes; (3) fluid.
In shock states, either the pump is not working
properly or the pipes are malfunctioning. Life-
threatening pathophysiologic state referring to
inadequate end organ perfusion, which can
progress to end organ dysfunction and eventually,
multiple organ failure and death
O2 delivery to cells << O2 required by cells
Regardless of type of shock - pts will progress
through similar stages: Compensated -->
uncompensated --> irreversible
,Shock Patho - Impaired Cellular - Cells primarily use O2 to produce ATP → affects
Metabolism all cellular respiration
Aerobic metabolism:
- Metabolism of glucose to ATP/energy in the
presence of O2
- Most efficient cells can produce ATP without O2
but not effectively AND not for long
Anaerobic metabolism
- Lactic acid → byproduct
- Lactate is a Non specific clue in BW that O2 isnt
meeting the demand
- Lactate is cleared by the liver
- If body isnt getting enough O2 → lactate isnt
cleared properly → compounds the problem
When end organ perfusion needs are not met:
- Compensatory methods will eventually fail
HR/RR drop
- Vessels dilate → leading to full blown circulation
failure
- CO decreases, Cells die → release their waste
(waste products increase in body)
- Shunting of flow to vital organs
- Endothelial damage caused by inflammatory
mediator release
- Tissue perfusion worsens
- Cellular hypoxia, acidosis, organ failure, death
Compensated Shock Refers to state in which body has activated
hormonal and chemical compensatory mechanisms
to help with homeostasis
- Normal/normal high VS
- Little evidence of shock
, Apply a systematic approach to the Type of problem:
recognition and treatment - Inadequate amount of circulating intravascular
hypovolemic shock fluid volume to deliver O2 and nutrients, leading to
tissue hypoperfusion
Causes:
- Hemorrhagic
- Hypovolemia
- DKA
Tx:
- Replace lost fluids (fluid or blood)
Outline the significant differences in - Changes in absorption in meds (older adults have
ED presentations between younger slower absorption)
and older adults - Distribution changes (loss of lean body mass and
gaining adipose tissue)
- Less fluid available (water soluble meds can reach
toxic levels more quickly)
- Clearance changes, decreased kidney and liver
functioning means drug excretion takes longer
- Changes in mental status
Apply a systemic approach to Do not assume that older people are just confused
assessing and managing geriatric - Disease
giants - Delirium - Drug tox
- Psychological trauma
- Delirium
Confusion Assessment Method:
(1) Did the confusion happen rather quickly (e.g.,
since admission or onset of illness) and are there
times when the person is more confused than other
(2) Is this person easily distracted and inattentive to
tasks or conversations
(3) Does the person have an altered level of
consciousness? Are they overly alert, groggy or
stuporous
Solutions
Add to calendar
Play your way to mastery with fun games
Match Blocks Charms NEW
Terms in this set (96)
Describe the role of universal
screening of ED patients for
interpersonal violence (IPV) and
other social issues
Outline common complications of (1) Blunt abdo traumas
early pregnancy for which women - Used a FAST (Focused Abdominal Sonogram for
present to EDs Trauma) --> only identifies presence of free
intraperitoneal or pericardial fluid, faster than CT,
free fluid can be attributed to hemorrhage and can
lead to clues about severity of injury, US is not good
at identifying & grading solid organ injury/bowel
injury/retroperitoneal trauma
(2) Ectopic Pregnancy
(3) Hyperemesis Gravidarum (HG)
,Ectopic Pregnancy - non-ruptured Clinical features:
- 1st trimester bleeding
- Abdo pain
- Missed period
Physical Findings:
- HypoT
- TachyC
- Abdo/pelvic tenderness
- Peritoneal signs --> rebound tenderness and
guarding
Risk Factors:
- Hx of chlamydia or gonorrhea
- Exposure to diethylstilbestrol
- IUD use
- Assisted reproductive technology
- Previous ectopic preg
- PID
Hyperemesis Gravidarum (HG) Can lead to hypovolemia
Pregnant women can present to ED with:
- Vomit → weight loss
- Ketonuria
- Electrolyte imbalance
- acid/base imbalance
- Severe volume depletion
These women need aggressive fluid administration
Outline the basic patho of shock and Patho of Shock:
related compensatory mechanisms The CVS is made up of (1) pump; (2) pipes; (3) fluid.
In shock states, either the pump is not working
properly or the pipes are malfunctioning. Life-
threatening pathophysiologic state referring to
inadequate end organ perfusion, which can
progress to end organ dysfunction and eventually,
multiple organ failure and death
O2 delivery to cells << O2 required by cells
Regardless of type of shock - pts will progress
through similar stages: Compensated -->
uncompensated --> irreversible
,Shock Patho - Impaired Cellular - Cells primarily use O2 to produce ATP → affects
Metabolism all cellular respiration
Aerobic metabolism:
- Metabolism of glucose to ATP/energy in the
presence of O2
- Most efficient cells can produce ATP without O2
but not effectively AND not for long
Anaerobic metabolism
- Lactic acid → byproduct
- Lactate is a Non specific clue in BW that O2 isnt
meeting the demand
- Lactate is cleared by the liver
- If body isnt getting enough O2 → lactate isnt
cleared properly → compounds the problem
When end organ perfusion needs are not met:
- Compensatory methods will eventually fail
HR/RR drop
- Vessels dilate → leading to full blown circulation
failure
- CO decreases, Cells die → release their waste
(waste products increase in body)
- Shunting of flow to vital organs
- Endothelial damage caused by inflammatory
mediator release
- Tissue perfusion worsens
- Cellular hypoxia, acidosis, organ failure, death
Compensated Shock Refers to state in which body has activated
hormonal and chemical compensatory mechanisms
to help with homeostasis
- Normal/normal high VS
- Little evidence of shock
, Apply a systematic approach to the Type of problem:
recognition and treatment - Inadequate amount of circulating intravascular
hypovolemic shock fluid volume to deliver O2 and nutrients, leading to
tissue hypoperfusion
Causes:
- Hemorrhagic
- Hypovolemia
- DKA
Tx:
- Replace lost fluids (fluid or blood)
Outline the significant differences in - Changes in absorption in meds (older adults have
ED presentations between younger slower absorption)
and older adults - Distribution changes (loss of lean body mass and
gaining adipose tissue)
- Less fluid available (water soluble meds can reach
toxic levels more quickly)
- Clearance changes, decreased kidney and liver
functioning means drug excretion takes longer
- Changes in mental status
Apply a systemic approach to Do not assume that older people are just confused
assessing and managing geriatric - Disease
giants - Delirium - Drug tox
- Psychological trauma
- Delirium
Confusion Assessment Method:
(1) Did the confusion happen rather quickly (e.g.,
since admission or onset of illness) and are there
times when the person is more confused than other
(2) Is this person easily distracted and inattentive to
tasks or conversations
(3) Does the person have an altered level of
consciousness? Are they overly alert, groggy or
stuporous
