Question: Pressure Ulcer Stage 1

Answer: Non- blanchable reddness (erythema)
Superficial (intact skin)
Epidermis tissue showing

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Question: Pressure Ulcer Stage 2

Answer: Red or pink (erythema) ulcer
Dermis tissue showing
Partial thickness (damage of epidermis and dermis)
Risk for infection
-Hydrocolloid dressing needed for autolytic debridement; should be left on for several days at a time to be effective

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Question: Pressure Ulcer Stage 3

Answer: Yellowish ulcer
Adipose tissue showing
Full thickness (damage of epidermis, dermis, and deeper tissues)
Wet-to-dry dressing until debrided to establish granular tissue
Consult wound care; debridement needed

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Question: Pressure Ulcer Stage 4

Answer: Bone or muscle showing
Wet-to-dry dressing until debrided to establish granular tissue
Consult wound care; debridement needed

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Question: Unstageable Pressure Ulcer

Answer: Black
Unable to assess underlying tissues; wound base is obscured by slough or eschar

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Question: Morse Fall Scale

Answer: History of falls
Secondary diagnosis
Ambulatory Aids
IV therapy/heparin lock
Gait
Mental status

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Question: Horizontal infection

Answer: person to person

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Question: vertical infection

Answer: mother to child

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Question: C. Diff

Answer: *Contact Precautions
Hand washing with soap and water
Often caused by overuse of antibiotics
Severe and foul-smelling odors
BLEACH

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Question: Gastroenteritis

Answer: *Contact Precautions
inflammation of the stomach and intestines
may be caused by rotavirus, norovirus
vomiting/diarrhea

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Question: Croup (Laryngotracheal bronchitis)

Answer: *Contact Precautions
Caused by diptheria virus
Barking cough and stridor
minor: treat with anti-inflammatories
major: treat with epinephrine

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Question: Rabies

Answer: *Contact Precautions
leads to meningitis

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Question: Hepatitis A

Answer: *Contact Precautions
Enteric precautions
Fecal/oral route of transmission
Incubates 3 to 5 weeks
Vaccine available (Can give immune globulin after exposure)
HAsAg (this is what the blood test show) Hepatitis A surface Antigen

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Question: Impetigo

Answer: *Contact Precautions
Common in pediatric population
Honey-crusted lesions on mucous membranes (sometimes on back)

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Question: Respiratory Syncytial Virus (RSV)

Answer: *Contact Precautions
-unless productive cough exists, then droplet precautions

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Question: Contact Precautions

Answer: Wear gloves & gown
-VRE/MRSA
-Lice/scabies
-Conjunctivitis (pink eye)

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Question: Standards Precautions

Answer: Wear gloves to reduce risk of bodily fluid exposure
-Blood-borne infectious diseases: Ebola, Hep B/C, HIV
Anthrax: Inhaled as a white powder, not communicable

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Question: Droplet Precautions

Answer: Wear gloves, gown, mask & goggles
-Influenza type b (Hib) *vaccine
-Meningococcal meningitis
-Rubella (German measles) *MMR vaccine
-Sepsis
-Pertussis (whooping cough)

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Question: Mumps

Answer: *Droplet Precautions
-MMR vaccine
Swollen salivary glands
Fever and headache

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Question: Streptococcus

Answer: *Droplet Precautions
Most commonly respiratory
Pharyngitis
Pneumonia
Pertussis

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Question: Parvovirus

Answer: *Droplet Precautions
Causes fifth disease (common in children)
Appears as rash on face (looks like a redness from a slap on the face)

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Question: Airborne Precautions

Answer: Wear an N95 or a surgical mask and use a negative airflow room
-Sudden acute respiratory syndrome (SARS)
-Tuberculosis

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Question: Herpes Zoster (Shingles)

Answer: *Airborne Precautions
Only possible if chickenpox infection occurred in past
Begins with pain; rash form after

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Question: Measles (rubeola)

Answer: *Airborne Precautions
Vaccinate to prevent (MMR)
Fever, irritability

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Question: Varicella zoster (chickenpox)

Answer: *Airborne Precautions
7-day incubation period
Oatmeal baths
Tzanck test
Pain when chewing

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Question: Yersinia pestis

Answer: Transmitted by rats and fleas
Cause of bubonic plague

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Question: Shigella

Answer: Similar to salmonella
Contracted by consuming undercooked food
Causes diarrhea

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Question: Yellow fever

Answer: Transmitted by mosquitoes
Causes headaches and vomiting

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Question: West Nile virus

Answer: transmitted by mosquitos
may lead to meningitis

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Question: Lyme disease

Answer: transmitted by ticks
bullseye rash
causes flu-like symptoms

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Question: Brucellosis

Answer: Contracted by consuming uncooked meats and unpasteurized milk

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Question: Typhoid fever

Answer: Contracted by consuming contaminated food or water
Causes diarrhea

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Question: Pinworm

Answer: Transmitted via ingestion
Fecal-oral route
More common children
Place tape on anus during sleep to diagnose

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Question: Legionnaire's disease

Answer: Contracted by inhaling droplets of contaminated water
Found in fountains and ponds with stagnant water

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Question: IV infiltration

Answer: Catheter falls out of the vein (third spacing of fluid)
Coolness, redness, swelling, discomfort
Stop the IV infusion, discontinue the IV, apply a warm compress, elevate the extremity

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Question: IV Thrombophlebitis

Answer: Formation of a clot/inflammation at the catheter site
Warmth, redness, swelling, pain, discoloration of vein
Stop the IV infusion, discontinue the IV, apply a warm compress, elevate the extremity

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Question: IV Extravasation

Answer: Infiltration of third space with a vesicant medication
Destruction of cells and pain at the site
Stop the IV infusion, discontinue the IV, apply a warm compress, elevate the extremity
A medication may be ordered to soak up vesicant

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Question: Christianity Religious Beliefs

Answer: Anointing of the oil upon death

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Question: Judaism Religious Beliefs

Answer: 2-3 hour gap between eating dairy and meat

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Question: Islam Religious Beliefs

Answer: Face east toward Mecca to pray
Genuflect (kneel) upon praying; assist a patient to floor if able
Do not touch deceased Muslim if not Muslim yourself
Direct eye contact is considered sexually advancing

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Question: Buddhism Religious Beliefs

Answer: Commonly practiced in China
Karma

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Question: Hinduism Religious Beliefs

Answer: Reincarnation

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Question: Jehovah's Witness

Answer: No blood products should be used

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Question: Anglo Saxon Culture

Answer: Caucasian
Eye contact is considered respectful
May sit closer

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Question: Mexican culture

Answer: Hot milk concept????

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Question: Asian Culture

Answer: Stoic in relation to pain
Hot-cold concept (cold food given for a sickness of heat and viceversa?)

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Question: Native American Culture

Answer: Higher prevalence of diabetes mellitus

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Question: Muslim Culture

Answer: Do not sit closer together, considered rude
No caring of opposite sex
Men often decision makers

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Question: Myocardial Infarction (Heart Attack)- Pathophysiology

Answer: Ischemia of heart muscle

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Question: Myocardial Infarction (Heart Attack)- Causes

Answer: Clotting (embolism)
Atherosclerotic (narrowed coronary)
Vasospastic (Prinzmetal's angina)
-Caused by stimulants (cocaine)

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Question: Myocardial Infarction (Heart Attack)- Signs & Symptoms

Answer: Men:
Chest pain radiating down left arm
Shortness of breath
Chest pressure
Tachycardia
Jaw Pain

Women/Elderly:
Nausea/Vomiting
Malaise
Cold Sweats
Jaw Pain

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Question: Myocardial Infarction (Heart Attack)- Interventions

Answer: M- Morphine: treats pain, also aids in vasodilation
O- Oxygen: delivery to point of infarct
N- Nitroglycerin: vasodilator
A- Aspirin/clopidogrel: prevents growth or further exacerbation

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Question: Heart Failure/Cardiomyopathy- Pathophysiology

Answer: Preload: pressure of blood filling into relaxed ventricles
Afterload: pressure ventricles overcome to push blood out of the heart
Cardiac Output=HRxSV: decrease in HF
-diagnosed via echocardiogram
-transesophageal echocardiogram requires sedation and oxygen
-men & pregnant women have higher cardiac outputs
-ejection fraction: precentage showing function of heart

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Question: Heart Failure/Cardiomyopathy- Causes

Answer: R-sided: Pulmonary hypertension (vasculature), myocardial infarction
L-sided: Systemic hypertension, myocardial infarction

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Question: Heart Failure/Cardiomyopathy- Signs & Symptoms

Answer: R-sided: Edema- peripheral, dependent (gravity), generalized, legs, ankles, abdominal ascites, JVD, hypertrophy
L-sided: Fatigue, SOB, decreased cardiac output and ejection fraction leading to hypotension, pulmonary edema- fine crackles and an increase in pulmonary pressure, hypertrophy

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Question: Heart Failure/Cardiomyopathy- Interventions

Answer: Low-salt diet (>2,000mg per day)
Fluid Restriction
Pharmacology: Diuretics, ACE inhibitors, digoxin
Intra-aortic balloon pump
AICD Defibrillator placement
Surgery/transplant

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Question: Endocarditis

Answer: inflammation of the inner lining of the heart

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Question: Pericarditis

Answer: inflammation of the membrane surrounding the heart, the pericardium

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Question: Valvulitis

Answer: inflammation of a heart valve

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Question: Endocarditis/Pericarditis/Valvulitis- Pathophysiology

Answer: Inflammation of the layers of the heart
Common in those with a history of grafts, IV drugs users, and previous heart surgery patients

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Question: Endocarditis/Pericarditis/Valvulitis- Signs & Symptoms

Answer: Elevated WBC, fever, pain
May decrease cardiac output, causing hypotension
Pericardial friction rub

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Question: Endocarditis/Pericarditis/Valvulitis- Interventions

Answer: IV antibiotics

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Question: Cardiac Tamponade- pathophysiology

Answer: Medical emergency
Pericardial effusion (fluid build-up)
-May be blood (trauma)

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Question: Cardiac Tamponade- Signs & Symptoms

Answer: SOB
Tachycardia
Narrowing pulse pressure (Systolic - Diastolic)
Muffled heart sounds
Pulsus paradoxus (BP drops more than 10 mmHg during inhalation)

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Question: Cardiac Tamponade- Interventions

Answer: Pericardiocentesis
-Patient supine, may cause pneumothorax

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Question: Aortic Aneurysm/Aortic Dissection- Pathophysiology

Answer: Bulging of the aorta (aneurysm)
Tearing away of the aortic lining (dissection)

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Question: Aortic Aneurysm/Aortic Dissection- Signs & Symptoms

Answer: Thoracic: Back pain indicates emergent rupture (PRIORITY)
Abdominal (AAA): Palpable pulsating mass; NEVER palpate it again.

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Question: Aortic Aneurysm/Aortic Dissection- Interventions

Answer: BP management (beta blockers)
Interventions radiology
Surgical graft repair
-Assess for post-op pre-renal acute kidney injury (oliguria)

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Question: Marfan Syndrome- Pathophysiology

Answer: Genetic
Abnormal weakening of the vessel lining, affects the connective tissue

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Question: Marfan Syndrome- Signs & Symptoms

Answer: Frequents aneurysms
Tall body with thin and long fingers

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Question: Marfan Syndrome- Interventions

Answer: Screening and preventions to treat the various complications

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Question: Heart Sounds

Answer: S1/S2: normal "lub dub'
S3: extra heart sound after s2
S4: fluid overload (normal in pregnant women)

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Question: Arterial

Answer: -Has a pulse
-Dangle the artery
***Intermittent claudication

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Question: Intermittent claudication

Answer: Pain in the calves
Light ambulation helps with increased blood flow
Pentoxifylline may help

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Question: Peripheral arterial disease/arterial insufficiency

Answer: -diabeties mellitus
-decreased peripheral sensation
inspect feet daily
lotion prevent cracking
wear cotton socks
cotton between toes prevents friction
snug-fitting shoes
take care cutting toenails

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Question: Venous

Answer: elevate the veins
ambulate (venous valves prevent blood from pooling)
-varicose veins if valves fail
DVT prophylaxis
-antiembolism stockings
-sequential compression devices
-subq heparin
Venous stasis ulcer/stasis dermatitis
-painful ulcer on lower extremities

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Question: Shock- Pathophysiology

Answer: Decreased perfusion to vital organs and tissues

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Question: Shock- Signs & Symptoms

Answer: Acute kidney injury (first organ to fail)
-Decreased urine output
Elevated lactate

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Question: Shock- Interventions

Answer: Fluids
Vasopressors
Treat the underlying condition

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Question: Cardiogenic Shock- Causes) Acute MI

Answer: Decreased cardiac output
Ischemia, Dysrhythmias, Myocarditis, Endocarditis, Cardiomyopathy, HF, MI

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Question: Cardiogenic Shock- Signs & Symptoms) Heart is Weak

Answer: Low BP, Low Cardiac Output, High HR, Weak/Thready Pulse, Chest Pain, Cool-Pale Skin (Cyanosis), Confusion/Agitation, Crackles, Tachypnea, Oliguria

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Question: Cardiogenic Shock- Treatment

Answer: 1. Immediate EKG
2. Supplemental Oxygen
3. Pain Control
4. Immediate Re-perfusion - BP Support Meds: Dopamine, Norepinephrine, Dobutamine, Pressors
5. Monitor for tissue perfusion
6. Watch for signs of fluid overload in lungs

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Question: Hypovolemic Shock- Causes

Answer: -dehydration/fluid volume deficit
-hemorrhage (blunt trauma, pregnancy)
-severe vomiting, diarrhea

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Question: Hypovolemic Shock- Signs & Symptoms

Answer: Loss of Fluid
Low BP, High HR, Low CO, High SVR, Weak-Thready Pulse, Cool-Pale Skin, Oliguria, Orthostatic Hypotension, Confusion

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Question: Hypovolemic Shock- Treatment

Answer: 1. Trendlenburg
2. Fluids: NS or LR until blod can be matched
3. Monitor fluid overload (JVD, pulm. edema, RR)
4. Monitor VSq15
5. Supplemental Oxygen
6. Monitor Oxygen
7. Meds: Vasoactive drugs, Desmopressin-DI, Insulin- hyperglycemia, antiemetics/diarrheals

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Question: Septic Shock- Cause

Answer: Response to untreated infection

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Question: Septic Shock- Signs & Symptoms

Answer: Vasodilation (blood volume is not diminished)
Persistant low BP, that doesn't respond to IV fluids; warm flushed skin, hyperthermia - may become hypothermic later on, high CO, HIGH HR, high RR, low SVR

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Question: Septic Shock- Treatment

Answer: Antibiotics within first hour, vasopressors, fluids, and oxygen

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Question: Neurogenic Shock- Pathophysiology

Answer: Inability of SNS to stimulate nerve impulses

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Question: Neurogenic Shock- Causes

Answer: Spinal cord injury (T6 or higher), drugs, spinal anesthesia

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Question: Neurogenic Shock- Signs & Symptoms

Answer: Vasodilation (blood volume is not diminished)
Low BP, Low SVR, Low HR, Low CO, Warm/Dry extremities but cold body, hypothermia

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Question: Neurogenic Shock- Treatment

Answer: Keep spine immobilized, IV fluids to increased CO; watch fluid overload , vasopressors, atropine to increase HR , assess urine output

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Question: Anaphylactic Shock- Cause

Answer: allergen via injection, inhalation, oral, contact

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Question: Anaphylactic Shock- Sign & Symptoms

Answer: Vasodilation (blood volume is not diminished)
Bronchoconstrcition, dyspnea, wheezing, high HR, low BP, sweeling, itchy

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Question: Anaphylactic Shock- Treatment

Answer: Airway! Trendelenberg, Epinephrine, Albuterol, Remove Allergen

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Question: Hemodynamic Monitoring: Arterial Line (red)

Answer: Catheter typically radial or femoral artery
Continuous blood pressure
ABG blood draws

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Question: Hemodynamic Monitoring: Central Venous Pressure (blue)

Answer: Sensor via central line catheter
-sits in a venae cavae
Good indicator of preload and pressure from the right side of the heart
Often used in HF
Normal CVP is 2-6
-Elevated: worsening HF
-Decreased: hypovolemia

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Question: Hemodynamic Monitoring: Pulmonary Pressure/Pulmonary Wedge Pressure (yellow)

Answer: Sensor via Swan-Ganz catheter
-sits in the pulmonary artery
Good indicator of pulmonary hypertension
Can inflate balloon for pulmonary wedge pressure
-Never inflate for prolonged periods of time
-Never remove specialized syringe to inflate

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Question: Sinus Tachycardia

Answer: Assess for underlying causes:
-Substances (caffeine, stimulants)
-Medical (infection, anemia)

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Question: Sinus Bradycardia

Answer: May affect blood pressure
May be expected due to medications ( beta blockers, digoxin)
Symptomatic bradycardia (hypotension leading to dizziness)
-Atropine

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Question: Supraventricular Tachycardia (SVT)

Answer: Assess for underlying causes.
-Electrolyte imbalances
Vagal/Valsalva maneuver (bear down)
-Baroreceptors cause lowering of the heart rate
-Do not perform in patients with underlying heart conditions.
Adenosine
-Push rapid: half-life <10 seconds
-Central line push preferred
-Chemical cardioversion
-Expect ventricular asystole for a few seconds
Cardioverison (synchronized shock)
-Do not confuse with defibrillation
-Sedate the patient
Cardiac ablation
-Destroys tissue causing electrical activity

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Question: Atrial Fibrillation

Answer: No discernable/multiple P waves
Risk for clotting/clotting events
-Prevention (aspirin, warfarin, clopidogrel)
-Risk for pulmonary embolism, stroke, heart attack

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Question: Atrial Flutter

Answer: Sawtooth pattern
Same risks as with atrial fibrillation: clots/clotting events

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Question: Preventricular Contractions (PVCs)

Answer: Wide QRS complex
May be caused by stimulants
Six or more per minute requires a call to the HCP
Prevent or treat with amiodarone
Assess for hyperkalemia

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Question: Ventricular Tachycardia

Answer: Code Blue
Pulse or Pulseless
-Assess carotid
Torsades
-Type of V. Tach
Assess for hypomagnesemia
Assess for long QT syndrome
No pulse
-CPR first
-Defibrillation (shock) second

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Question: Ventricular Fibrillation

Answer: Code Blue
Always pulseless
CPR first
Defibrillation second

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Question: Asystole

Answer: Code Blue
Flatline
CPR first

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Question: Code Blue

Answer: V. Tach, V. Fib, Asystole
CPR
-2 inches for an adult
- 1 inch with the palm of hand for children
-1 inch with two fingers for infants
Avoid any pauses in compressions
Defibrillations
-Biphasic: 200 joules
-Monophasic: 360 joules
Medications: epinephrine, amiodarone

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Question: ST elevation

Answer: Injury to myocardial tissue

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Question: T wave inversion

Answer: Ischemia to myocardial tissue

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Question: URTIs - Rhinitis

Answer: Common cold
Viral
Rhinorrhea (runny nose)

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Question: URTIs - Sinusitis

Answer: Frontal sinus: forehead
Maxillary sinus: zygomatic bone (cheek)

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Question: URTIs - Pharyngitis

Answer: Sore throat, cough
Bacterial

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Question: URTIs- Influenza

Answer: Fever, muscle aches, malaise
Viral

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Question: Strep Throat - Pathophysiology

Answer: Caused by the streptococcus bacterium through droplet transmission
Diagnosed via throat culture

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Question: Strep Throat - Signs & Symptoms

Answer: Fever, sore throat, enlarged lymph nodes
Tonsillar exudate (whitish tonsils)

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Question: Strep Throat - Interventions

Answer: Early treatment with antibiotics; prevent progression to rheumatic fever or post-strep glomerulonephritis
Antibiotics may be given even with a negative culture (protect the patient).

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Question: Rheumatic Fever - Pathophysiology

Answer: Complication secondary to streptococcus infection
May progress to rheumatic heart disease (permanent condition)
Heart damage increases risk for subsequent infections (endocarditis)
Prophylactic antibiotics common for procedures (dental)

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Question: Rheumatic Fever - Signs & Symptoms

Answer: Systemic inflammation
Muscles, joints, & the brain

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Question: Rheumatic Fever - Interventions

Answer: Treat strep throat early
Monitor and treat inflammation

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Question: Epiglottitis - Pathophysiology

Answer: Most common in pediatric clients
Inflammation of the epiglottis
Potential airway loss (medical emergency: prioritization)

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Question: Epiglottitis - Signs & Symptoms

Answer: Difficulty swallowing and stridor (early signs)
Drooling, loss of consciousness (late signs)
Quieting stridor (late sign) *red flag

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Question: Epiglottitis - Interventions

Answer: Assess and treat inflammation early
Emergency intubation may be needed if it progresses to an airway obstruction
Keep tracheostomy kit bedside

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Question: Cystic Fibrosis - Pathophysiology

Answer: Genetic disorder with no cure
Diagnosed via sweat test (measures chloride in the sweat)
Abnormally thick mucus secretions lead to lung disease
May affect multiple organs ( lungs, liver, kidneys, pancreas, intestines)

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Question: Cystic Fibrosis - Signs & Symptoms

Answer: Cough with or without blood/phlegm
Frequent lung infections
Pancreatitis
Difficulty gaining weight (GI/endocrine related)
Steatorrhea (fatty stools)

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Question: Cystic Fibrosis - Interventions

Answer: Vaccinations (pneumococcal, flu)
Chest physiotherapy (helps break up mucus); often performed by the respiratory therapist
-Postural drainage (vibrations on the back)
-Flutter valve (blow out; expiratory effort)
Lung transplant (last resort)

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Question: Asthma- Pathophysiology

Answer: Commonly diagnosed in childhood
Often triggered by environmental factors (pollution, pollen, etc.)
Chronic inflammation and/or constriction of the airway obstruction

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Question: Asthma- Signs & Symptoms

Answer: Coughing and shortness of breath (dyspnea)
Three or more ED visits in past year
Wheezing (auscultate)
-If diminishing, signs of worsening condition
Loss of airway (status asthmatics): medical emergency

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Question: Asthma- Interventions

Answer: Reduce triggers (environmental, lifestyle, etc.)
Pharmacological (bronchodilators, anti-inflammatory agents)
Emergency intubation (status asthmatics)

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Question: Chronic Obstructive Pulmonary Disease (COPD)- Pathophysiology

Answer: Chronic inflammatory disease (bronchitis)
Emphysema (ballooning out of the alveoli, dysfunctional)
Risk with smoking

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Question: Chronic Obstructive Pulmonary Disease (COPD)- Signs & Symptoms

Answer: Dyspnea, especially exhalation (pursed lip)
Barrel chest (larger diameter anterior-posterior)
Chronic respiratory acidosis
Chronic hypoxia (88-92%)

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Question: Chronic Obstructive Pulmonary Disease (COPD)- Interventions

Answer: Low oxygen supplementation
Bronchodilators/inhaled glucocorticoids

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Question: Atelectasis - Pathophysiology

Answer: Partial collapse of the lung (alveoli)
Risk with post-op patients
May lead to pneumonia if not treated or prevented

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Question: Atelectasis - Signs & Symptoms

Answer: Soft or absent lung sounds at base
Desaturations via pulse ox and/or serum oxygen

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Question: Atelectasis - Interventions

Answer: Deep breathing and incentive spirometry
Splint chest with a pillow during coughing or painful breathing

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Question: Pneumonia - Pathophysiology

Answer: caused by the pneumococcal bacterium
Droplet transmission
May lead to fluid accumulation (lung consolidation)

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Question: Pneumonia - Signs & Symptoms

Answer: Fever, chills, dyspnea, cough, increased WBC
Chest pain (pleuritic); pain upon breathing
Hemoptysis (blood in cough, green

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Question: Pneumonia - Interventions

Answer: Pleurocentesis/thoracentesis
Chest tube placement to suction out the air

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Question: Chest tube - Purpose

Answer: Removal of air or fluid from the pleural cavity
Suction out blood (chest cavity/mediastinum) post-cardiac surgery
Oscillating water-seal chamber: normal

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Question: Chest tube - Complications

Answer: Continuous bubbling in water-seal chamber: not normal (air leak)
No output may be a sign of a clogged tube: a risk for blood build-up
Tube accidentally removed from patient: Apply petrolatum (Vaseline) gauze.
Tube accidentally removed from the chest tube: Place tube in sterile water.
Do not strip a chest tube; you may cause a clot to break.
Do not clamp the chest tube; you may cause a tension pneumothorax.

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Question: Mechanical Ventilation - Purpose

Answer: Assisted ventilation of oxygen and carbon dioxide
Endotracheal or tracheostomy
Commonly used in acute respiratory distress syndrome (ARDS)

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Question: Mechanical Ventilation - Settings

Answer: Respiratory Rate
Tidal Volume: Volume in a normal breath
FiO2
PEEP - Keeps alveoli open

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Question: Mechanical Ventilation

Answer: Can ventilate on 3 modes:
Assist control- Complete control of all four settings, used for critically ill patients and those in the operating room
Synchronized Intermittent Mechanical Ventilation (SIMV)- A demand/backup setting (Example: The ventilator is set at 14 breaths per minute; if patient breaths are below that, the machine will kick in.)
Pressure Support- Also called CPAP setting, provides inward pressure to aid breathing but does not trigger a rate or tidal volume; used before extubation to test for readiness to wean

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Question: Mechanical Ventilation Complications

Answer: High-Pressure alarm: obstruction, biting tube, mucous plug, kinking tube
Low-Pressure alarm: air leak, disconnection
Ventilator-associated pneumonia (VAP)

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Question: Ventilator-associated pneumonia (VAP)

Answer: Elevate head of bed
Administer proton-pump inhibitors
Oral care q4 hours
Monitor residuals/distention, and do not overfeed.
Maintain endotracheal cuff pressure

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Question: BiPAP

Answer: Pressure support during inhalation and exhalation
Commonly the last resort before intubation is necessary
May deliver added oxygen if needed
Improvement of oxygenation is the goal (even if the patient is in restraints, do not think safety; physiology is the priority).

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Question: CPAP

Answer: Continuous pressure support
Used for sleep apnea

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Question: Rebreather Mask

Answer: Reservoir bag holds patient's carbon dioxide
Patient breathes back come Co2
Use in respiratory alkalosis (similar to using a brown paper bag).

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Question: Non-Rebreather Mask

Answer: Carbon dioxide escapes the mask during exhalation
Patient breathes higher concentration of oxygen

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Question: Simple Mask/Venturi

Answer: Venturi masks utilize color-coded jets that deliver set amounts of oxygen.
Regulate oxygen liter flow via the wall oxygen piping
RN may start without an order; LPN may initiate if order exists.

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Question: Nasal Cannula

Answer: Use humidification to reduce irritation
RN may start without an order; LPN may initiate if order exists.

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Question: Early Hypoxia

Answer: Anxiety
Pallor (whitish skin)
Discoloration of mucous membranes (dark-skinned patients)

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Question: Late Hypoxia

Answer: Delirium
Mottled skin appearance
Clubbing of fingers (chronic hypoxia)

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Question: Anoxia

Answer: Complete lack of oxygen supply to cellular tissue
After 5 minutes, permanent damage is likely (myocardial infarction, anoxic brain injury)

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Question: Carbon Monoxide (CO) Poisoning

Answer: CO competes with oxygen in hemoglobin (carboxyhemoglobin)
Leads to oxygen deprivation of tissues
Early sign: a dull headache
Treat with oxygen supplementation

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Question: Tracheal

Answer: *Normal Lung Sound
High Pitch
Heard over the Trachea

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Question: Bronchovesicular

Answer: *Normal Lung Sound
Medium to low pitch
Heard over the middle lobes/center of the lungs

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Question: Bronchial

Answer: *Normal Lung Sound
Medium pitch
Heard over the upper lobes

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Question: Vesicular

Answer: *Normal Lung Sounds
Low pitch
Heard over the lower lobes

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Question: Crackles (rales)

Answer: Popping sound (bubble wrap)
Consolidation in the lungs
Fine crackles: pulmonary edema
Coarse crackles: pneumonia

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Question: Wheezing (Rhonchi)

Answer: Musical in quality
Continuous
Typically louder during expiration
Common in asthma and COPD patients

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Question: Stridor

Answer: High-pitched sound during inspiration
A sign of obstruction (airway compromise)
Common symptom in laryngotracheobronchitis (croup)

==================================================

Question: Pleural Friction Rub

Answer: Crunching sound
Common symptom in inflammatory diseases of the lungs, especially the pleural lining

==================================================

Question: Allen test

Answer: Test for collateral blood flow (radial and ulnar arteries)
Occlude both arteries, pump first causing pallor, then open one of the arteries
The hand should pink up when one of the arteries is opened
Failed Allen test denotes no radial arterial line in that hand

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Question: Respiratory Acidosis Pathophysiology

Answer: Retention of Co2
Patient is not breathing enough
Obstruction (COPD, emphysema)
Respiratory distress/ARDS
Brainstem trauma

==================================================

Question: Respiratory Acidosis - Signs & Symptoms

Answer: Hypercapnia
Respiratory distress/bradypnea
High Co2 , Low pH

==================================================

Question: Respiratory Acidosis - Interventions

Answer: Treat the underlying problem
CPAP, BiPAP
Intubation (last resort)

==================================================

Question: Respiratory Alkalosis - Pathophysiology

Answer: Loss of Co2
Patient is breathing too often
Anxiety, fear, pain

==================================================

Question: Respiratory Alkalosis - Signs & Symptoms

Answer: Hypocapnia
Hyperventilation
Paresthesias, dizziness

==================================================

Question: Respiratory Alkalosis - Interventions

Answer: Rebreather mask/brown bag
Treat the underlying condition (pain meds, anxiolytics)

==================================================

Question: Metabolic Acidosis - Pathophysiology

Answer: Decrease in bicarb
Production of too much acid (lactic acidosis, ketoacidosis)
Kidneys not producing enough bicarb ( chronic renal failure)
Long-term diarrhea may cause

==================================================

Question: Metabolic Acidosis - Signs & Symptoms

Answer: Kussmaul breathing (ketoacidosis)
Arrhythmias
Coma, death (if left untreated)

==================================================

Question: Metabolic Acidosis - Interventions

Answer: Correct the underlying problem (provide oxygen if needed)
Intravenous bicarbonate

==================================================

Question: Metabolic Alkalosis - Pathophysiology

Answer: Increase in bicarb
Long-term vomiting may cause (also chronic NG tube suctioning)

==================================================

Question: Metabolic Alkalosis - Signs & Symptoms

Answer: Confusion
Muscle twitching
Paresthesias

==================================================

Question: Metabolic Alkalosis - Interventions

Answer: Treat the underlying problem
Condition is secondary to a broader problem

==================================================

Question: Hypoxemia

Answer: Low oxygenation in the blood
Early signs: pallor, mucous membrane discoloration, anxiety, irritability
Late signs: delirium, begins to affect organs

==================================================

Question: Hypoxia

Answer: Low oxygenation to the tissues
Pulse Ox: Infrared technology reads hemoglobin concentration. Falsely elevated in carbon monoxide poisoning; carboxyhemoglobin
Early signs: shortness of breath, tachypnea, anxiety
Late signs: delirium, clubbing of fingers (chronic)

==================================================

Question: Osmosis:

Answer: Water moves into higher solute concentrations (water follows salt)

==================================================

Question: Diffusion

Answer: Movement of molecules from an area of higher concentration to an area of lower concentration.

==================================================

Question: Hyperosmolar

Answer: Higher concentration than blood

==================================================

Question: Iso-osmolar

Answer: Same concentration as blood

==================================================

Question: Hypo-osmolar

Answer: Lower concentration than blood (diluted)

==================================================

Question: 3% and 7% NaCl (Crystalloid)

Answer: Hypertonic solution (higher concentration than blood)
Used in severe hyponatremia and increased intracranial pressure
Causes water to shift into the vasculature
Risks to dehydrate the surrounding cells
Do not use in hypertension (remember, low salt).

==================================================

Question: 0.9% NaCl (Normal Saline) *Crystalloid

Answer: Isotonic solution (same concentration as blood)
Used in dehydration and hypovolemia (fill up the tank)

==================================================

Question: 0.45% NaCl (Half-Normal Saline) *Crystalloid

Answer: Hypotonic solution (lower concentration than blood)
Often combined with dextrose to maintain iso-osmolality

==================================================

Question: Lactated Ringer's (LR) *Crystalloid

Answer: Isotonic solution
Contains potassium, chloride, sodium, and calcium
Used in trauma, volume loss, and especially burns
Alkalizing agent used to counteract acidosis (contains bicarb)

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Question: Dextrose 5% and 10% *Crystalloid

Answer: Glucose-containing solution
Becomes hypotonic once the dextrose is metabolized out
Typically combined with other salines
Used in hypoglycemia (often severe infection)
Contained in vitals such as D5 (50%), pushed IV for hypoglycemia protocol

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Question: Albumin (Colloid)

Answer: Responsible for 60% of blood osmolality (maintaining blood concnetration)
Serum protein created by the liver
Also given via IV like crystalloids
Commonly in liver failure, burn victims, and general hypoalbuminemia

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Question: Platelets

Answer: Given for thrombocytopenia (cancer, infection, sepsis, liver failure, heparin-induced thrombocytopenia, disseminated intravascular coagulation)AQ

==================================================

Question: Fresh Frozen Plasma

Answer: Contains everything, but red blood cells
Patient has normal hemoglobin, does not require RBCs

==================================================

Question: Packed Red Blood Cells (PRBCs)

Answer: Given for anemia (low hemoglobin)
Hemorrhage

==================================================

Question: Whole Blood

Answer: Entire composition of blood (plasma and RBCs)

==================================================

Question: Transfusion Reaction- Allergic: Minor

Answer: Localized rash (individualized rash), pruritus
-Slow the drip rate and notify the HCP for an antihistamine (diphenhydramine)

==================================================

Question: Transfusion Reaction- Allergic: Major

Answer: Diffuse or generalized rash (all over), difficulty breathing, sweating, complaints of feeling hot
-Stop the drip, flush normal saline through alternate tubing, and call the HCP
-Epinephrine may be needed
-Send remaining blood to blood bank for analysis

==================================================

Question: Hemolytic/Cytotoxic Reaction

Answer: Incompatible blood (ABO mismatch)
Flank/back pain
Fever
Dark-colored urine (cola-colored)
-Stop the drip, flush normal saline through alternate tubing, and call the HCP
-Epinephrine may be needed
-Send remaining blood to blood bank for analysis

==================================================

Question: White Blood Cells (WBCs)

Answer: 5,000-10,000
If high: leukocytosis
-Active infection
If low: neutropenia/leukopenia
-Risk for infection

==================================================

Question: Red Blood Cells (RBCs)

Answer: 4.2-5.5
Reticulocytes (baby RBCs)
If high: polycythermia vera
-Risk for clotting events (MI, PE, CVA)/poor circulation
If low: anemia

==================================================

Question: Hemoglobin (HgB)

Answer: 12-16
Oxygen-carrying component of blood
Transfusion likely under 8 (especially 7)

==================================================

Question: Hematocrit (HcT)

Answer: 37-50
Percentage of RBCs to total blood volume
If high: dehydration, polycythemia, hypovolemia
If low: fluid overload, anemia, hypervolemia

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Question: Platelets (Plts)

Answer: 150,00-300,000
If low: thrombocytopenia
May be caused by numerous factors (heparin-induced, chemotherapy, bone marrow suppression)
Bleeding risk (no razors, no hard edges, no rectal temps, no enemas, no suppositories, no hard-bristle toothbrushes)

==================================================

Question: Sodium

Answer: 135-145
Water follows salt (osmosis)
If high: hypernatremia
Dehydration
Follow a low-sodium diet
If low: hyponatremia
Fluid retention
Very low sodium (water intoxication) is a potential medical emergency leading to a seizures
Replete with sodium chloride

==================================================

Question: Potassium

Answer: 3.5-5
If high: hyperkalemia
Cardiac dysrhythmias (PVCs)
If low: hypokalemia
May be caused by vomiting, diarrhea, and GI suctioning
Muscle weakness, malaise, dysrhythmias
May lead to digoxin toxicity
Replete with potassium chloride

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Question: Calcium

Answer: 8-10
If high: hypercalcemia
CNS-related issues (irritability, paresthesias)
May lead to hypercalcemic crisis and death (typically secondary to bone cancer)
If low: hypocalecemia
Chvostek's sign/Trousseau's sign
Muscle tetany
Replete calcium chloride/gluconate (reversal agent for hypermagnesemia as well)

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Question: Magnesium

Answer: If high: hypermagnesmia
Decrease in deep tendon reflexes
Potential adverse effect of magnesium sulfate for preeclampsia
If low: hypomagnesemia
Muscle weakness or tetany

==================================================

Question: Phosphorus

Answer: Inverted relationship to calcium; one goes up, the other goes down
If high: hyperphosphatemia
May lead to osteopenia/osteoporosis
Carbonated beverages are high in phosphorus (colas)
If low: hypophosphatemia
May be due to alcoholism
Replete with IV phosphorus

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Question: Glucose

Answer: 70-100
If high: hyperglycemia
-The 3 P's (polydipsia, polyuria, polyphagia)
If low: hypoglycemia
Diaphoresis, tachycardia, clammy skin, confusion, death

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Question: Albumin

Answer: 3.5-5
If high: hyperalbuminemia
Dehydration
If low: hypoalbuminemia
Malnutrition, liver failure
Replete with IV albumin

==================================================

Question: Creatinine

Answer: 0.1-1.5
If high: azotemia
Acute kidney injury (formerly called acute renal failure)
Chronic renal failure (CKD)

==================================================

Question: BUN (Blood, Urea, Nitrogen)

Answer: 8-20
If high: azotemia
Acute kidney injury/chronic renal failure
Heart failure/dehydration

==================================================

Question: Liver Enzymes (ALT, AST)

Answer: If high: liver injury

==================================================

Question: Troponin

Answer: By-product of dead heart muscle
If high: myocardial injury/infarction

==================================================

Question: Brain Natriuretic Peptide (BNP)

Answer: Hormone released by ventricles when stretched
If high: heart failure

==================================================

Question: Creatine Kinease

Answer: Inflammation of muscles (MI, rhabdomyolysis, autoimmunity)

==================================================

Question: Total Cholesterol: Less than 200

Answer: If high: hypercholesterolemia
Risk for cardiovascular disease (CVD)

==================================================

Question: HDL: More than 40-60

Answer: Good cholesterol (carries away LDL)
Diet and exercises encourage high HDL.

==================================================

Question: LDL: Less than 150

Answer: Bad cholesterol
If high: hyperlipidemia
Risk for CVD

==================================================

Question: D-Dimer

Answer: Indicates abnormal clotting (thrombus, coagulation, active clotting)
Elevation may indicate DVT/PE/DIC

==================================================

Question: C-Reactive Protein

Answer: Indicates inflammation in the body (acute)

==================================================

Question: Erythrocyte Sedimentation Rate (ESR)

Answer: Indicates inflammation in the body (chronic)

==================================================

Question: aPTT

Answer: normal: 20-40 seconds (heparin)
therapeutic: 40-80 seconds

==================================================

Question: PT/INR

Answer: normal: 0.5-1.5 seconds
therapeutic: 2-3 seconds

==================================================

Question: digoxin

Answer: sub-therapeutic/normal: 0
therapeutic: 0.5-1.5

==================================================

Question: lithium

Answer: sub-therapeutic/normal: 0
therapeutic:0.6/1.4

==================================================

Question: theophylline

Answer: sub-therapeutic/normal: 0
therapeutic: 10-20

==================================================

Question: phenytoin

Answer: sub-therapeutic/normal: 0
therapeutic: 10-20

==================================================

Question: metoprolol

Answer: Beta blocker - suffix "lol"
Lowers heart rate and decrease force of contraction
Treats hypertension, dysrhythmias
-May mask signs of hypoglycemia
-Careful with asthma clients
-Contraindicated in bradycardia & heart block

==================================================

Question: losartan

Answer: Angiotensin Receptor Blocker - suffix "sartan"
Decreases retention of water and sodium
Treats hypertension and diabetic neuropathy
-Used if ACE inhibitor cannot be tolerated
-Hyperkalemia risk

==================================================

Question: pentoxifylline

Answer: Vasodilator
Smooth muscle relaxation (blood vessels)
Pain due to PAD (intermittent claudication)

==================================================

Question: verapamil, diltiazem, nicardipine

Answer: Calcium channel blocker - suffix "dipine"
Decreases force of contraction
Treats hypertension, angina, cardiac dysrhythmias
-No grapefruit juice

==================================================

Question: clonidine

Answer: Alpha agonist
Lowers heart rate, vasodilators
Treats hypertension
-Side effects: dry mouth

==================================================

Question: nitroglycerin, isosorbide dinitrate

Answer: Nitrate
Vasodilator, decreases preload
Treats hypertension and angina
-Sublingual: 3 times, 5 minutes apart
-If second dose fails, head to ER
-Risk for orthostatic hypotension
-Risk for headache; treat with acetaminophen
-Do not take with erectile dysfunction meds (sildenafil)
-Given via IV for severe HTN

==================================================

Question: captopril

Answer: Angiotensin Converting Enzyme (ACE) Inhibitor ; suffix "pril"
Decreases retention of water and sodium
Treats hypertension
-Side effect: cough
-Hyperkalemia risk

==================================================

Question: hydralazine

Answer: Vasodilator
Strong vasodilator, decreases preload
Hypertensive crisis
-Oral or IV

==================================================

Question: nitroprusside

Answer: Nitrate
Strong vasodilator, decreases preload
Hypertensive crisis
-Slowly lower BP or MAP (too quickly may cause body to go into shock)
-May cause cyanide poisoning (caution)

==================================================

Question: dopamine

Answer: Catecholamine/Vasopressor
Increases force of contraction and heart rate
Treats shock
-Close hemodynamic monitoring necessary (ICU)
-Renal dose: low dose to increase GFR

==================================================

Question: dobutamine

Answer: Adrenergic agonist/vasopressor/positive inotrope
Increases force of contraction and heart rate
Shock, heart failure

==================================================

Question: epinephrine

Answer: Catecholamine/vasopressor/adrenergic agonist
Cardiovascular and CNS stimulant, increases force of contraction
Shock, cardiac emergency
-EpiPen for anaphylaxis; head to EF after administration
-Injection can go through clothes
-Close hemodynamic monitoring
-Risk for hyperglycemia

==================================================

Question: norepinephrine

Answer: Catecholamine/vasopressor/adrenergic agonist
Strong vasoconstrictor
Shock
-May cause limb ischemia (purple toes, necrosis)

==================================================

Question: Inotropic

Answer: contractility (dopamine)

==================================================

Question: Chronotropic

Answer: time (digoxin, atropine)

==================================================

Question: Dromotropic

Answer: conduction (nervous system of heart)

==================================================

Question: hydrochlorothiazide

Answer: Thiazide diuretic
Increases urine production
Treats hypertension, fluid overload
-Check I/O, Weight Changes, and Electrolyte Imbalances

==================================================

Question: furosemide, bumetanide

Answer: Loop diuretic
Increases urine output including sodium and potassium
Treats fluid volume excess, edema, pulmonary edema, hypertension
-Contraindicated in chronic kidney disease (CKD)
-Risk for hypokalemia
-Push slowly; risk for ototoxicity

==================================================

Question: triamterene, eplerenone, spironolactone

Answer: Potassium-sparing diuretic
Increases urine output with retention of potassium
Treats fluid volume excess, edema, hypertension
-Risk for hyperkalemia (avoid salt substitutes, avoid bananas)

==================================================

Question: mannitol

Answer: Osmotic diuretic
Increases urine output
Treats increased intracranial pressure and intraocular pressure
-Contraindicated in CKD

==================================================

Question: acetazolamide

Answer: Carbonic anhydrase inhibitor
Increases urine output with sodium, potassium, and bicarb
Used for glaucoma, pulmonary edema
-Risk for orthostasis

==================================================

Question: digoxin for HF

Answer: cardiac glycoside
lowers heart rate, increases force of contraction
used for symptomatic heart failure, atrial fibrillation
-do not administer if HR is below 60
-risk for digitalis toxicity (anorexia, N/V/D, headache); hypokalemia may trigger toxicity

==================================================

Question: lovastatin

Answer: Statin; suffix "statin"
Increases HDL, lowers LDL, lowers cholesterol
Used for hypercholesterolemia and hyperlipidemia
-Contraindicated in liver disease
-Risk for rhabdomyolysis (medical emergency)

==================================================

Question: fenofibrate

Answer: Fibrate
Increases HDL, lowers LDL, lowers cholesterol
Used for hypercholesterolemia and hyperlipidemia

==================================================

Question: niacin

Answer: Nicotinic acid (vitamin B3)
Increases HDL, lowers LDL, lowers cholesterol
Used for hypercholesterolemia and hyperlipidemia
-Over the counter supplement
-Added to other therapies

==================================================

Question: Hypocoagulation

Answer: thin blood

==================================================

Question: Hypercoagulation

Answer: thick blood

==================================================

Question: Heparin, enoxaparin

Answer: Anticoagulant; suffix "parin"
Blocks mechanism in clotting cascade
Prevention of blood clots (DVT)
-Lab values: aPTT
-Antidote: protamine sulfate
-SQ injection: Rotate injection sites; never massage
-For inpatient use
-Risk for heparin-induced thrombocytopenia (HIT)

==================================================

Question: warfarin

Answer: Anticoagulant
Blocks mechanism in clotting cascade
Prevention of blood clots (atrial fibrillation)
-Lab values: PT/INR
-Antidote: vitamin K
-For outpatient or inpatient use
-Take warfarin while going off of heparin (use will overlap)

==================================================

Question: clopidogrel, aspirin

Answer: Antiplatelet
Block platelet aggregation
Prophylaxis for clotting events (MI, PE, CVA)
-Risk for salicylate poisoning (aspirin)
-Risk for bleeding (assess)

==================================================

Question: alteplase, tissue plasminogen activator (tPA)

Answer: Thrombolytic/fibrinolytic
Enzyme that breaks down clots
Diagnosed acute ischemic stroke, myocardial infarction, pulmonary embolism
-Given within the golden window (3 hours)
-Hemorrhagic stroke must be ruled out (obtain CT of head)
-Caution in the elderly

==================================================

Question: aminocaproic acid

Answer: Hemostat
Aids in clotting cascade, prevents breakdown of formed clots
Used for hemorrhage, DIC, controlling bleeding, overdose of fibrinolysis
-Commonly used post-op to prevent hemorrhage

==================================================

Question: quinidine, procainamide

Answer: Antiarrhythmic
Decreases conduction
Used for atrial dysrhythmias

==================================================

Question: lidocaine

Answer: Antiarrhythmic
Decreases threshold or membrane response
Used in ventricular dysrhythmias (V.fib)
-Lidocaine toxicity: CV/CNS

==================================================

Question: amiodarone

Answer: Antiarrhythmic
Prolongs action potential duration
Used in life-threatening dysrhythmias
-Prophylaxis for fatal rhythms
-Risk for pulmonary toxicity

==================================================

Question: adenosine

Answer: Antiarrhythmic
Decreases conduction through AV node
Used in supraventricular tachycardia (SVT) and ventricular tachycardia
-Hemodynamic monitoring required (keep crash cart close)
-Central preferred, peripheral allowed
-Push fast followed by 10 mL NS flush (FAST)

==================================================

Question: sodium-polystyrene sulfonate

Answer: Potassium removing resin
Causes excretion of potassium in stool
Used for hyperkalemia
-Slow onset
-Assess for constipation
-Hypokalemia risk
-Oral or by enema

==================================================

Question: Addison's disease - Pathophysiology

Answer: Adrenal insufficiency
Hypocortisolism/hypoadrenalism

==================================================

Question: Addison's disease - Signs & Symptoms

Answer: Fatigue, weakness
Weight loss, anorexia
Increased pigmentation of skin
Painful muscles/joints
Inability to cope with stress, intolerance to cold
Hyponatremia (salt cravings), hyperkalemia

==================================================

Question: Addison's disease - Interventions

Answer: Lifelong cortisol replacement

==================================================

Question: Addisonian Crisis - Pathophysiology

Answer: Medical emergency
Cortisol levels dangerously low
Often triggered by infection or stress

==================================================

Question: Addisonian Crisis - Signs & Symptoms

Answer: Hypotension
Nausea/Vomiting
Fever, chills
Skin rash

==================================================

Question: Addisonian Crisis - Interventions

Answer: Immediate cortisol administration

==================================================

Question: Cushing's Syndrome - Pathophysiology

Answer: Elevated cortisol levels
Hypercortisolism/hyperadrenalism

==================================================

Question: Cushing's Syndrome - Signs & Symptoms

Answer: Weight gain, central obesity (abdominal)
Moon face
Thinning skin, easily bruised
Fatigue, muscle weakness
Depression, anxiety
Hypertension
Hypernatremia (polydipsia), hypokalemia

==================================================

Question: Cushing's Syndrome - Interventions

Answer: Stop steroid medications
Removal of the adrenal glands (adrenalectomy)

==================================================

Question: Hyperparathyroidism - Pathophysiology

Answer: Excessive release of parathyroid hormone
Hypercalcemia caused by the body pulling calcium from the bones

==================================================

Question: Hyperparathyroidism - Signs & Symptoms

Answer: CNS issues (irritability, fatigue, confusion)
Kidney stones
Osteopenia/osteoporosis: may lead to fractures

==================================================

Question: Hyperparathyroidism - Interventions

Answer: Pharmacological (calcitonin, bisphosphonates)
Resection of the parathyroid

==================================================

Question: Hypoparathyroidism - Pathophysiology

Answer: Decreased production of parathyroid hormone
Leads to hypocalcemia
Common complication post-thyroidectomy

==================================================

Question: Hypoparathyroidism - Signs & Symptoms

Answer: Muscle tetany, cramping
Paresthesias
Chvostek's sign/Trousseau's sign

==================================================

Question: Hypoparathyroidism - Interventions

Answer: Pharmacological (calcitriol, vitamin D, calcium gluconate)
Decrease intake of phosphorus

==================================================

Question: Hyperthyroidism - Pathophysiology

Answer: Decreased thyroid-stimulating hormone (TSH) from the brain
Excessive release of thyroid hormones
Radioactive iodine uptake test (diagnostic)

==================================================

Question: Hyperthyroidism - Signs & Symptoms

Answer: Body function sped up (metabolism)
Weight loss
Heat intolerance
Thyroid storm (thyrotoxicosis): medical emergency

==================================================

Question: Hyperthyroidism - Interventions

Answer: Pharmacological (methimazole, propythiouracil, iodine)
Radioactive iodine: results in ablation of thyroid function
Thyroidectomy

==================================================

Question: Hypothyroidism - Pathophysiology

Answer: Increased TSH
Decreased production of thyroid hormones

==================================================

Question: Hypothyroidism - Signs & Symptoms

Answer: Fatigue
Cold intolerance
Weight gain
Muscle weakness
Myxedema coma (throat tightness): medical emergency

==================================================

Question: Hypothyroidism - Interventions

Answer: Lifelong hormone replacement

==================================================

Question: Graves' Disease - Pathophysiology

Answer: Autoimmune disorder leading to overactivity of the thyroid gland
Mimics hyperthyroidism
More common in women over 20

==================================================

Question: Graves' Disease - Signs & Symptoms

Answer: Similar to hyperthyroidism
Exothalmos (bulging eyeballs)

==================================================

Question: Graves' Disease - Interventions

Answer: Similar to hyperthyroidism
Immunomodulators

==================================================

Question: Hashimoto's Thyroiditis - Pathophysiology

Answer: Autoimmune disorder leading to underactivity of the thyroid gland
Mimics hypothyroid
More common in women
May be caused by high intake of selenium or iodine

==================================================

Question: Hashimoto's Thyroiditis - Signs & Symptoms

Answer: Similar to hypothyroidism

==================================================

Question: Hashimoto's Thyroiditis - Interventions

Answer: Similar to hypothyroidism

==================================================

Question: Goiter - Pathophysiology

Answer: Enlarged thyroid
Lack of iodine in the diet
Tumor or nodules on thyroid

==================================================

Question: Goiter - Signs & Symptoms

Answer: Visible enlargement of the neck
May be benign
Dizziness when raising arms above heads
Dysphagia
Respiratory distress: medical emergency

==================================================

Question: Goiter: Interventions

Answer: Monitoring
Surgical

==================================================

Question: Hypoglycemia - Pathophysiology

Answer: Not enough glucose
Using ginseng while on insulin
Beta blockers with insulin
Diabetes mellitus (DM) patient exercising more than normal
Too much insulin

==================================================

Question: Hypoglycemia - Signs & Symptoms

Answer: Hypotension, tachycardia
Anxiety, diaphoresis
Cold, clammy
CNS issues (irritability, fatigue)

==================================================

Question: Hypoglycemia - Interventions

Answer: 15/15 rule
-Intervention for slight hypoglycemia
-15g of carbs followed by a 15-minute assessment
Simple carbs (juice)
D5/dextrose (IV infusion or push)
Glucagon (severe hypoglycemia)

==================================================

Question: Hyperglycemia - Pathophysiology

Answer: Diabetes mellitus (DM)
Total parenteral nutrition (TPN)
Long-term steroid use

==================================================

Question: Hyperglycemia - Signs & Symptoms

Answer: 3 P's - (polydipsia, polyuria, polyphagia)

==================================================

Question: Hyperglycemia - Interventions

Answer: Diet and exercise
Oral antidiabetic agents
Insulin

==================================================

Question: Diabetes Type 1

Answer: insulin dependent
possibly caused by coxsackievirus
typically presents in children (juvenile)
no production of insulin from pancreas

==================================================

Question: Diabetes Type 2

Answer: Insulin resistant
Obesity (poor cellular response to insulin)
Lack of exercise (sedentary)
Poor diet

==================================================

Question: Dawn Phenomenon

Answer: Higher glucose level in morning

==================================================

Question: Somogyi effect

Answer: Rebound hyperglycemia due to hypoglycemic event overnight
Encourage checking glucose at night and bedtime snack

==================================================

Question: Comorbidity with Cardiovascular Disease (CVD)

Answer: May lead to CVD, increasing risk of myocardial infarction

==================================================

Question: Diabetic nephropathy

Answer: May lead to chronic kidney disease

==================================================

Question: Diabetic retinopathy

Answer: Begins with blurred vision
Patient may lost vision

==================================================

Question: Foot ulcers/infection

Answer: Decreased sensation due to arterial insufficiency
Wet-to-dry dressings for open wounds
Prevention is key

==================================================

Question: Diabetic Ketoacidosis (DKA) - Pathophysiology

Answer: Glucose cannot get into cells for energy
Body switches to fat energy (breakdown of ketones)
Uncontrolled type 1 DM

==================================================

Question: Diabetic Ketoacidosis (DKA) - Signs & Symptoms

Answer: 3 P's
Fruit-scented breath
Nausea/Vomiting, Weakness
Kussmaul breathing (fast and deep)
-Compensatory for metabolic acidosis)

==================================================

Question: Diabetic Ketoacidosis (DKA) - Diagnostic Testing

Answer: Glucose level >600
Ketones in urine

==================================================

Question: Diabetic Ketoacidosis (DKA) - Interventions

Answer: Fluid (priority) and electrolyte replacement
Insulin

==================================================

Question: Hyperosmolar Hyperglycemic Nonketotic Syndrome (HHNS) - Pathophysiology

Answer: Kidneys excrete too much water in attempt to rid glucose
Dehydration
Prevalent in type 2 DM
Prevalent in elderly (decreased thirst mechanism)

==================================================

Question: Hyperosmolar Hyperglycemic Nonketotic Syndrome (HHNS) - Signs & Symptoms

Answer: Glucose > 600
3 P's
Hot and dry (may see fever)
Sleepy and confused
May lead to seizures, coma, and death

==================================================

Question: Hyperosmolar Hyperglycemic Nonketotic Syndrome (HHNS) - Interventions

Answer: Fluids (priority)
Insulin
Potassium may be needed

==================================================

Question: Glycosylated Hemoglobin (A1C)

Answer: Gives a 3-month outlook on glucose management
Displays adherence of meds, diet, and exercise
Higher A1C indicates unregulated diabetes

==================================================

Question: Basal Dose/Scheduled Dose

Answer: Outside the scope of the nurse to change scheduled medications
Doses meant to stabilize the patient long term

==================================================

Question: Prandinal Dose

Answer: Extra dose of insulin at mealtime
15g of carbs equal 1 carbohydrate exchange
Typically 1 unit per exchange

==================================================

Question: SICK Day Rules

Answer: S - Sugar: Check more often (q4hr)
I - Insulin: May need more
C - Carbs: Pay attention to diet.
K - Ketones: Watch for signs of DKA.

==================================================

Question: Insulin Infusion Pump

Answer: Do not confuse with subQ
Needle change every 3 days
Sterile technique
Cleanse insertion site with alcohol

==================================================

Question: Diabetes Insipidus - Pathophysiology

Answer: Lack of antidiuretic hormone (ADH)

==================================================

Question: Diabetes Insipidus - Signs & Symptoms

Answer: Frequent urination
Dehydration leading to hypovolemia
May lead to hypotension (dizziness)
Rebound tachycardia
Hyperosmolar blood: concentrated lab values

==================================================

Question: Diabetes Insipidus - Interventions

Answer: Pharmacological (vasopressin, desmopressin)

==================================================

Question: Syndrome of Inappropriate Antidiuretic Hormone (SIADH) - Pathophysiology

Answer: Excessive release of ADH

==================================================

Question: Syndrome of Inappropriate Antidiuretic Hormone (SIADH) - Signs & Symptoms

Answer: Decreased urine output (oliguria)
Fluid retention leading to hypervolemia
May lead to hypertension
Hypo-osmolar blood: diluted lab values

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Question: Syndrome of Inappropriate Antidiuretic Hormone (SIADH) - Interventions

Answer: Water restriction (ice chips)
Diuretics
Vasopressin Antagonist

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Question: prednisone, hydrocortisone

Answer: Glucorticosteroid, mineralocorticosteriod, hormone agonist
Replacement hormone, anti-inflammatory agent, suppresses immune system
Used for Adrenal insufficiency (Addison's disease), inflammation, and organ transplants
-Short-term side effects: CNS stimulation
-Long-term side effects: Immunosuppression, Weight gain(water), Hyperglycemia, Osteoporosis

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Question: Aminoglutethimide

Answer: steroid hormone antagonist
slows down the production of adrenal steroids
used for hypercortisolism (Cushing's syndrome)
-Short-term therapy until surgery
-May cause orthostatic hypotension

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Question: aspart

Answer: rapid acting insulin
causes glucose to move into the cells
used for type 1 and 2 diabetes
-may cause hypokalemia
-may be pushed with D5 for hyperkalemia
-risk for hypoglycemia

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Question: lispro
glulisine
regular insulin

Answer: short acting insulin
causes glucose to move into the cells
used for type 1 and 2 diabetes
-may cause hypokalemia
-may be pushed with D5 for hyperkalemia
-risk for hypoglycemia

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Question: NPH/isophane

Answer: intermediate acting insulin
causes glucose to move into the cells
used for type 1 and 2 diabetes
-may cause hypokalemia
-may be pushed with D5 for hyperkalemia
-risk for hypoglycemia

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Question: Detemir, glargine

Answer: long acting insulin
causes glucose to move into the cells
used for type 1 and 2 diabetes
-may cause hypokalemia
-may be pushed with D5 for hyperkalemia
-risk for hypoglycemia

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Question: glyburide, glipizide

Answer: Sulfonylureas
Stimulates pancreatic cells to release insulin, decreases sugar release insulin, decreases sugar release by liver
Used for Type 2 Diabetes
-Cross hypersensitivity (allergy) with sulfa antibiotics (SMZ TMP)
-Contraindicated in severe liver and renal disease

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Question: metformin

Answer: Oral antidiabetic agent
Decreases sugar release by liver, increases cell sensitivity to insulin
Used for Type 2 Diabetes
-Nephrotoxic, hold dose for diagnostics with contrast (CT, cardiac cath, etc.)
-Contraindicated in severe liver and renal disease

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Question: exenatide

Answer: Antidiabetic agent
Increases release of insulin from pancreas, decreases release of glucagon by pancreas
Used for Type 2 Diabetes
-SubQ injection

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Question: glucagon

Answer: Glucose elevator
Stimulates the release of glucose by the liver
Severe hypoglycemia
-May be given IM for outpatient emergencies (similar to EpiPen, stick through clothes into thigh)

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Question: somatropin

Answer: Growth hormone
Stimulates growth when epiphyses of bones not closed
Low intrinsic GH in children, Turner's syndrome

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Question: vasopressin

Answer: Antiduretic hormone
Retention of fluid, vasocontricts
Diabetes insipidus, code situations

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Question: levothyroxine (T4)

Answer: Thyroid hormone
Stimulates metabolism
Hypothyroidism
-Take in AM on empty stomach
-Lifelong therapy
-Watch for thyroid storm

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Question: propylthiouracil (PTU), iodine, methimazole

Answer: Antithyroid compound
Inhibits thyroid hormons (T4 and T3)
Used for hyperthyroidism, thyrotoxic crisis, Grave's disease
-Iodine may be radioactive (destroys tissue), but not a cure
-If radioactive, caution to surrounding people for 72 hours
*Caution in bodily fluids (bathroom use)
-Risk for neutropenia with PTU

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Question: Calcitonin / Alendronate / Risedronate

Answer: Antihypercalcemic, bisphosphonates
Inhibits body's ability to pull calcium from the kidneys
Used for hyperparathyroidism, hypercalcemia, Paget;s disease, osteopenia, osteoporosis
-Do not lie down after taking (GERD risk).
-Take bisphosphonates on empty stomach
-Bisphosphonates commonly taken in postmenopausal women

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Question: calcitritol, vitamin D

Answer: Antihypocalcemic
Stimulates bone growth
Used for hypoparathyroidism, hypocalcemia, bone disease
-UV light (sunlight) needed to work

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Question: Hepatology/Liver Anatomy

Answer: Blood through portal liver vein rich in nutrients from GI tract
Portal vein and hepatic artery deliver blood to Kupffer cells for filtration

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Question: Hepatology/Liver Physiology

Answer: Glucose metabolism
Ammonia conversion
Protein metabolism
Fat metabolism
Vitamin and iron storage
Bile formation
Medication metabolism

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Question: Hepatology/Liver Interventions

Answer: Lifelong cortisol replacement

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Question: Hepatitis - Pathophysiology

Answer: Caused by a virus (HAV, HBV, HCV)
Hep A (HAV): transmitted by food (contact, uncooked food, fecal-oral)
Hep B (HBV): transmitted via bodily fluids (blood)
Hep C (HCV): transmitted via bodily fluids (blood)
Subsequent hepatitis infections (Hep D and Hep E) are secondary to HBV or HCV

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Question: Hepatitis - Signs & Symptoms

Answer: Fatigue
Nausea/vomiting
Hep C may lead to liver damage and liver cancer

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Question: Hepatitis - Interventions

Answer: Vaccination (Hep A and Hep B)
Treat the symptoms and ride it out

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Question: Liver Failure/Cirrhosis - Pathophysiology

Answer: Late stages of scarring (fibrosis) of the liver
Hardening and thickening
Chronic alcohol (ETOH) use
Hepatitis
Fatty liver disease

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Question: Liver Failure/Cirrhosis - Signs & Symptoms

Answer: Easy bruising and bleeding
Jaundice (icterus) of skin and sclera
Ascites and swelling of the legs
Muscle wasting
Decrease in chest/axillary hair
Late stage cirrhosis; fetor hepaticus (musty breath smell) identifies increased blood ammonia

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Question: Liver Failure/Cirrhosis - Diagnositics

Answer: Liver panel (ALT, AST)
Bilirubin levels (elevated)
Clotting factors (elevated)

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Question: Liver Failure/Cirrhosis - Interventions

Answer: Avoid alcohol
Weight loss
Liver transplant

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Question: Hepatic Encephalopathy

Answer: *Liver Complications
Build-up of toxins normally cleaned by the liver (ammonia)
Leads to confusion, drowsiness, slurred speech, and delirium

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Question: Portal Hypertension

Answer: *Liver Complications
Cirrhosis slows flow of blood through portal vein
Leads to splenomegaly, esophageal varices, gastric varices
May require a transjugular intrahepatic portosystemic shunt (TIPS) surgery

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Question: Pancreatitis - Pathophysiology

Answer: Pancreatic enzymes become activated while inside the organ, causing damage
Alcoholism, smoking
Cholelithiasis (gallstones) most common cause of acute pancreatitis in adults
Cystic fibrosis

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Question: Pancreatitis - Signs & Symptoms

Answer: Upper abdominal pain radiating to the back, worse after eating
Nausea and vomiting
Fever
Cullen's sign (superficial edema and bruising at the umbilicus)
Grey-Turner's sign (bruising on the flank, sign of bleeding)

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Question: Pancreatitis - Diagnostic Testing

Answer: Elevated amylase and lipase
CT/MRI
Endoscopic retograde cholangiopancreatography (ERCP)
-May include fluoroscopy

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Question: Pancreatitis - Interventions

Answer: Bowel rest for the pancreas (NPO)
High-carb diet with no fatty acids when diet is restored
Pain meds
IV fluids
Antibiotics
Whipple procedure (pancreaticoduodenectomy)

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Question: Cholangitis - Pathophysiology

Answer: Infection of the common bile duct
Medical emergency
Secondary to cholelithiasis/cholecystitis

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Question: Cholangitis - Signs & Symptoms

Answer: Charcot's triad:
Jaundice (rapid onset)
Abdominal pain
Fever

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Question: Cholangitis - Interventions

Answer: ERCP with lithotripsy

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Question: Chloelithiasis (Gallstones)

Answer: Stones are usually made of bile
Risk factors: female, fertile, 40, overweight
Diagnosed by ultrasound
Lithotripsy may be effective in breaking up stones
Ursodiol used to break up stones
May lead to infection

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Question: Cholecystitis

Answer: Right upper quadrant (RUQ) rebound tenderness (Murphy's sign)

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Question: Chloecystectomy

Answer: Typically laproscopically
Low-fat diet post-surically

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Question: Stomatitis

Answer: Inflamed sore in the mouth
Avoid spicy food
Avoid hot and cold

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Question: gastroesophageal reflux disease (GERD)

Answer: do not lie supine after meals; sit up 3-4 hours after eating
small frequent meals
no spicy food, no caffeine, no alcohol, no smoking

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Question: fundoplication

Answer: surgical wrap of the fundus of the stomach around the esophagus
treats advanced GERD or hiatal hernia

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Question: gastrectomy (subtotal or total)

Answer: loss of intrinsic factor (needed for B12 absorption)
patients require B12 (cobalamin) injections for life; can lead to pernicious anemia if B12 not administered

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Question: dumping syndrome

Answer: ingest fluids between meals, not with
risk after gastric bypass (gastrectomy)

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Question: pyloric stenosis

Answer: narrowing of pylorus (bottom of the stomach)
infants: projectile vomiting after feeding
corrected surgically

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Question: achalasia

Answer: abnormal narrowing of the lower part of the esophagus
dysphagia is common
dilation of the esophagus on the top
barium swallow to diagnose

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Question: Nasogastric (NG) tube

Answer: Measure from the nose to the back of the throat to the xiphoid process
Placed by RNs or LPNs with specialized certification
OG tube passed through mouth instead of nose
Cannot use without x-ray confirmation

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Question: Sengstaken-Blakemore tube

Answer: Used in ruptured esophageal or gastric varcies

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Question: PEG tube

Answer: Typically placed when patients cannot feed orally
Common in post-stroke or comatose patients

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Question: Stomach Decompression

Answer: Suction to the wall for decompression
Initiated for GI bleeding, pancreatitis, etc. (stop bowel movements)
Document color and amount as output (UAP may perform)
Chronic suctioning may lead to hypokalemia

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Question: Tube Feedings

Answer: Feedings have 24-hour shelf life
Monitor for signs of intolerance (nausea, bloating, fullness)
Keep head of bed (HOB) elevated at all times during feedings
Assessing residual and effectiveness of feedings:
-50% or more residual being aspirated: discard, halve the rate on pump
-50% or less residual being aspirated: push back in, keep the rate on pump
Confirmation
-Aspiration of contents of pH
-Gold standard is x-ray
Feedings cannot begin until x-ray confirmation

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Question: total parenteral nutrition (TPN)

Answer: Used when oral and NG tube intake are not possible
Intravenous nutrition
Risk for hyperglycemia, infection, and fluid overload

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Question: Appendicitis - Pathophysiology

Answer: Inflammation and infection
May lead to rupture

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Question: Appendicitis - Signs & Symptoms

Answer: Right lower quadrant (RLQ) pain - McBurney's point
Nausea/vomiting
Fever

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Question: Appendicitis - Interventions

Answer: Appendectomy
Easy delegation to LPN or new RN

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Question: Peritonitis - Pathophysiology

Answer: Risk of peritoneal dialysis
Sign of rupture of organs (medical emergency)
Sign of internal bleeding (medical emergency)

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Question: Peritonitis - Signs & Symptoms

Answer: Abdominal pain and distention
Rigid/board-like abdomen
Cloudy output (peritoneal dialysis)
May lead to sepsis/septic shock

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Question: Peritonitis - Interventions

Answer: Surgical abdominal washout
Antibiotics

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Question: Inflammatory Bowel Disease - Pathophysiology

Answer: Colitis, ulcerative colitis, gastroenteritis, diverticulitis, Crohn's disease
Bacterial, viral, fungal, autoimmune

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Question: Inflammatory Bowel Disease - Signs & Symptoms

Answer: Abdominal cramping, diarrhea
Blood in stool (fecal occult)
Change in bowel habits

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Question: Inflammatory Bowel Disease - Interventions

Answer: Avoid tobacco, caffeine, alcohol, and tea (GI stimulants)
Avoid popcorn, nuts, and gas-producing foods
Low-residue diet while in hospital (no need at discharge)
-Less frequent and looser stool
No gluten (celiac disease)

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Question: GI Bleeding - Pathophysiology

Answer: Common cause is helicobacter pylori
Peptic ulcers, duodenal ulcers

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Question: GI Bleeding - Signs & Symptoms

Answer: Upper GI: black, tarry stools (melena)
Lower GI: bright red stool
Esophagogastroduodenoscopy (EGD) to diagnose upper GI
Colonscopy to diagnose lower GI

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Question: GI Bleeding - Interventions

Answer: NPO until bleeding is controlled

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Question: Bowel Obstruction - Pathophysiology

Answer: Fecal obstruction
Intussusception (common in pediatric patients)
Volvulus (twisting of the bowels)

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Question: Bowel Obstruction - Signs & Symptoms

Answer: Sudden onset of abdominal cramps and vomiting
Drawing of legs up to chest (intussusception)
Watery discharge with no stool
Can lead to infection or perforation if left untreated

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Question: Bowel Obstruction - Interventions

Answer: Push fluids (2-3 L per day is recommened for any human being)
Increase fiber for constipation
Laxatives and enemas
Air enemas (intussusception)

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Question: Dehiscence

Answer: Montgomery strap used to prevent
Opening of a surgical wound
Intestines may protrude from opening
Apply gentle pressure and call HCP

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Question: Hemochromatosis

Answer: Abnormal collection of iron in organs

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Question: Wilson's Disease

Answer: Abnormal collection of copper in organs

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Question: Colostomy/Ileostomy - Indications

Answer: Inflammatory bowel diseases (providing bowel rest)
Colorectal cancer (bypass resected bowel)

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Question: Colostomy/Ileostomy - Stoma Care

Answer: Swelling and slight bleeding are normal after placement
Prevent excoriation post-op
Red or pink is normal color for stoma
Purple, maroon, or black is sign of cyanosis
Refer to stoma nurse for body image issues

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Question: Colostomy/Ileostomy - Diet

Answer: Formed stool: colostomy
Loose stool: ileostomy
Roughage may obstruct the stoma (caution)
Ileostomies require increased water intake

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Question: Colonscopy - Indications

Answer: Age 50 or older
Every 5 years (more frequently if problems present)
Secondary prevention (screening)
Early identification of colorectal cancer (polyps)

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Question: Colonscopy - Procedure Care

Answer: Bowel prep (polyethylene glycol)
NPO (8-12 hours prior)
Strong benzodiazepine (midazolam) with fentanyl (moderate sedation)
-Anterograde amnesia is the goal (forget the procedure)
RN monitors vital signs, especially the respiratory rate and O2 saturation

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Question: Colonscopy - Post-procedure Care

Answer: Same-day procedure (patient must urinate before discharge)
Slowly advance diet after procedure

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Question: aluminum, hydroxide, sucralfate (*Upper GI Tract)

Answer: antacid
increases pH within stomach
used for GERD, esophagitis, hiatal hernia, and peptic ulcers
-take separate from other drugs, food, etc. (30 minutes before or after )
-coats the stomach

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Question: ondansetron (*Upper GI Tract)

Answer: Antiemetic
decreases the stimulation causing nausea and vomiting
for post-operative and chemo-related nausea and vomiting

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Question: omeprazole (*Upper GI Tract)

Answer: proton pump inhibitor; suffix "prazole"
suppresses acid production in the stomach
used for GERD, and peptic ulcers
-common for prophylactic prevention of aspiration pneumonia
*NG tube, tracheostomy, intubated patient
-May lead to osteoporosis

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Question: ranitidine (*Upper GI Tract)

Answer: H2-receptor antagonist; suffix "tidine"
suppresses acid production in the stomach
used for GI ulcers, GERD, and esophagitis

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Question: metoclopramide (*Upper GI Tract)

Answer: prokinetic agent
increases GI peristalsis
used for gastroparesis, nausea/vomiting, post surgery or chemotherapy
-commonly used post-op or prevent constipation (opioids)

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Question: pancrelipase, amylase (*Upper GI Tract)

Answer: digestive enzymes
breaks down food into nutrient components for absorption
used for enzyme replacement for cystic fibrosis or pancreatic insufficiency
-do not crush or chew tablets
-take with meals (no need if not eating)

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Question: ursoidol (*Upper GI Tract)

Answer: breaks down cholesterol-formed gallstones
used for cholesterol gallstones

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Question: simethicone (*Lower GI Tract)

Answer: Antiflatulent
Decreases gas production
Used for pain and discomfort from GI upset
-Take after meals

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Question: loperamide (*Lower GI Tract)

Answer: Antidiarrheal
Suppresses GI peristalsis
Used for diarrhea
-Risk for abuse

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Question: magnesium hydroxide, lactulose (*Lower GI Tract)

Answer: Laxatives
Softens stool, induces bowel movements
Used for constipation, and hepatic encephalopathy
-Lactulose used to discard ammonia through stool
*Assess for constipation first (it may not work)
-Castor oil contraindicated in pregnancy
*May lead to preterm labor

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Question: sulfasalazine (*Lower GI Tract)

Answer: Aminosalicylate
Decreases acid and inflammation in colon
Used for inflammatory bowel disease (IBD)
-Contains salicylate (aspirin)
*avoid in children (reye's syndrome)
*bleeding risk

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