Pathophysiology in NCLEX® - Physiological Integrity for Nursing RN

Aortic Stenosis

Age-related Calcifications

Bicuspid Aortic Valve

Crescendo-decrescendo Murmur

Systolic Murmur

Ejection Murmur

Ejection Click

Radiates to Carotids and Apex

Pulsus Parvus et Tardus

Syncope

Helmet Cells

2 mins

Aortic Regurgitation

Diastolic Murmur

Immediate High-pitched

Blowing Murmur

Wide Pulse Pressure

Water Hammer Pulse

Head Bobbing

Pulsating Nail Bed

Can Cause Austin Flint Murmur

1 min

Tricuspid Regurgitation

Holosystolic

Blowing Murmur

Radiates to Right Sternal Border

Enhanced by Inspiration

1 min

Mitral Stenosis

Murmur Follows Opening Snap

Late Diastolic Murmur

Enhanced by Expiration

Low-Pitched Rumbling

Dilation of Left Atrium (LA)

Recurrent Attacks of Rheumatic Fever

2 mins

Mitral Regurgitation

Holosystolic

Blowing Murmur

Loudest at Apex

Radiates toward Axilla

Louder by Squatting

Hand Grip

Expiration

1 min

Patent Ductus Arteriosus

Continuous

Machine like murmur

Often Due to Congenital Rubella

Prematurity

1 min

Tetralogy of Fallot

Blue Baby Syndrome (Cyanosis)

Crying or Feeding

Pulmonary Stenosis

Right Ventricular Hypertrophy

Overriding Aorta

Ventricular Septal Defect (VSD)

Boot-Shaped Heart

Squatting for Tet Spells

Surgery

2 mins

Hypertrophic Cardiomyopathy Mechanisms

2/3 Autosomal-Dominant

1/3 Sporadic Type

Mutation in Gene for Sarcomere Protein

Cardiac Myosin Binding Protein C

Asymmetric Septal Hypertrophy

Outflow Tract Obstruction

Diastolic Dysfunction

2 mins

Hypertrophic Cardiomyopathy Signs, Symptoms and Treatment

Sudden Death Of Young Athlete

Heart Failure

Angina

Arrhythmias

Syncope

Harsh Systolic Ejection Murmur

S4 Heart Sound

Beta Blocker

Non-dihydropyridine Calcium Channel Blocker

2 mins

Cardiac Enzyme Evaluation: Troponin

Cardiac Muscle Injury

Detection in Blood: 4 Hours

Peak: 24 - 36 Hours

Return to Normal: 5 - 14 Days

Most Specific for Cardiac Muscle

Treat Aggressively

2 mins

Cardiac Enzyme Evaluation: Myoglobin

Skeletal or Cardiac Muscle Injury

Onset: 1 - 4 Hours

Peak: 12 Hours

Return to Normal: 24 Hours

Elevation After 24 Hours: Reinfarction

2 mins

Cardiac Enzyme Evaluation: Creatine Kinase CK-MB

Skeletal or Cardiac Muscle Injury

Onset: 4-8 Hours

Peak: 12-24 Hours

Return to Normal: 2-3 Days

1 min

Parts of an ECG

P Wave

Atrial Depolarization

QRS Complex

Ventricular Depolarization

T Wave

Ventricular Repolarization

2 mins

ECG Interpretation

Rate

Rhythm

P Waves

Upright, Rounded, Before Every QRS

PR Interval (< 0.20 seconds)

Normal QRS (< 0.12 seconds)

2 mins

ECG: Sinus Bradycardia

< 60 bpm

Regular

Present, Upright, Every QRS

< 0.20 seconds

< 0.12 seconds

Atropine

1 min

ECG: Sinus Tachycardia

> 100 bpm

Regular

Present, Upright, Every QRS

< 0.20 seconds

< 0.12 seconds

Treat Underlying Cause

2 mins

ECG: Atrial Flutter

Variable

Regular or Irregular

Saw Tooth, Multiple Before Every QRS

Non-measurable

< 0.12 seconds

2 mins

ECG: Atrial Fibrillation

Variable Rate

Irregular Rhythm

No P Wave

No PR Interval

QRS < 0.12 Seconds

1 min

Torsades de Pointes

Polymorphic Ventricular Tachycardia

Prolonged QT Interval

QRS Twist Around Isoelectric Line

Congenital

Antibiotics

Antiarrhythmics

Antipsychotics

Antidepressants

Electrolyte Deficiencies

Ventricular Fibrillation

Stable: Magnesium Sulfate

Unstable: Defibrillation

3 mins

MET Levels

Metabolic Equivalent

MET Levels 1.0-1.4

Bedrest

MET Levels 1.4-2.0

Sitting Up in Chair

MET Levels 2.0-3.0

Seated Warm Shower

MET Levels 3.0-3.5

Standing Warm Shower

MET Levels 3.5-4.0

Golfing

MET Levels 4.0-10

High-Impact Aerobics

Cardiac Rehabilitation

3 mins

Phases of Cardiac Rehabilitation

MET Levels

Acute Phase

Assessment

Education

Discharge

Goals

Outpatient Phase

Reinforcing Phase 1

Ergonomic Approach

Community Based

Acute Care

Long-Term Acute Care

Skilled Nursing Facilities (SNF)

Independent Living

5 mins

Primary Hypertension Risk Factors

Excessive Alcohol Consumption

High Sodium Diet

Dyslipidemia

Obesity

People of African Descent

Advanced Age

Vitamin D Deficiency

Reduced Nephron Number

Diabetes

Lack of Physical Activity

2 mins

Blood Pressure Classification (JNC 7)

Normal

Systolic (<120)

Diastolic (< 80)

Prehypertension

Systolic +20 (120-139)

Diastolic +10 (80-89)

Stage 1 Hypertension

Systolic +20 (140-159)

Diastolic +10 (90-99)

Stage 2 Hypertension

Systolic + > 20 (160)

Diastolic + > 10 (100)

Hypertensive Crisis

Systolic > 180

Diastolic > 110

4 mins

Blood Pressure Classification (ACC/AHA 2017)

Normal

Systolic Less than 120

Diastolic Less than 80

Elevated

Systolic +10 (120-129)

Diastolic Less than 80

Stage 1 Hypertension

Systolic +10 (130-139)

Diastolic +10 (80-89)

Stage 2 Hypertension

Systolic +40 (140-179)

Diastolic +30 (90-119)

Hypertensive Crisis

Systolic greater than or equal to 180

Diastolic greater than or equal to 120

5 mins

Hypertension Assessment

Essential Hypertension

Secondary Hypertension

Headache

Vision Changes

Nosebleed (Epistaxis)

Chest Pain

Syncope (Fainting)

Average 2 Sets, 2 Minutes Apart

After 2 or More Visits (within 1-4 weeks)

Take BP Both Arms

Common in African Americans

2 mins

Hypertension Intervention

Weight Reduction and Exercise

Diet Changes

Relaxation Techniques

Smoking Cessation

Medications

Encourage Self Monitoring

1 min

Hypertension Medications

Diuretics

ACE Inhibitors

Angiotensin Receptor Blockers (ARBs)

Beta Blockers

Dihydropyridine Calcium Channel Blockers

2 mins

Supine Hypotension (Vena Cava Syndrome)

Compression of the Vena Cava and Descending Aorta

Hypotension

Dizziness

Tachycardia

Decreased Renal Perfusion

Decreased Uteroplacental Perfusion

Side-lying Position

2 mins

Peripheral Artery Disease (PAD)

Atherosclerosis

Intermittent Claudication

Pain with Exercise

Paresthesias

Arterial Ulcers

Critical Limb Ischemia

Amputation

Ankle-Brachial Index (ABI)

2 mins

Arterial Ulcer Assessment

Absent or Decreased Pulses

Intermittent Claudication

Sharp Pain

Dependent Rubor

Well Defined Edges

Over Bony Areas

Smooth, Shiny Skin

Toes, Heels, Lateral Lower Legs

Cool

2 mins

Arterial Ulcer Interventions

Saline Dressing

Structured Exercise Programs

Fibrinolytics

Antiplatelet Medication

No Caffeine, Nicotine

Surgery

1 min

Chronic Venous Insufficiency (Venous Stasis Ulcer) Assessment

Venous Stasis Ulcer

Uneven Edges

Dull Persistent Pain

Medial Malleolus

Necrotic

Normal Pulses

Lower Leg Edema

Bronze-Brown Pigmentation

Warm

Pruritus

2 mins

Chronic Venous Insufficiency (Venous Stasis Ulcer) Interventions

Frequently Elevate Legs

Avoid Standing/Sitting for Long Periods of Time

Elastic Compression Stockings

Bilayer Artificial Skin

Daflon

Wound Dressings

Proper Foot and Leg Care

2 mins

Superficial Thrombophlebitis

IV Catheter Irritation

Erythema

Cord-like Vein

Edema

Remove IV Catheter

Elevate

Warm Compress

Rotate Sites Q3 Days

Aseptic Technique

2 mins

Abdominal Aortic Aneurysm (AAA) Assessment

Atherosclerosis

Bruit

Pulsation in Abdomen

Abdominal or Lower Back Pain

Tearing Pain

Ultrasound

Rupture

Shock

Surgical Repair

1 min

Thoracic Aortic Aneurysm

Elderly Men

Above the Diaphragm

Usually Asymptomatic

Hypertension

Smoking

Connective Tissue Disorders

Vasculitis

Chest X-Ray

Chest CT Angiography

Manage Risk Factors

Surgery if Rupture or Dissection

Observation if Asymptomatic

4 mins

Arterial vs. Venous Insufficiency Interventions

Arterial Insufficiency

Venous Insufficiency

Aerobic Exercise

Strength Training

Soft Tissue Mobilization

Lifestyle Modifications

Vascular Surgery

Compression Therapy

Lower Extremity/Calf Exercises

Manual Therapy

Skin Care

Lifestyle Modifications

3 mins

Angiodysplasia

Tortuous Dilation of Vessels

Fragile Blood Vessels

Right-Sided Colon

Hematochezia

Painless

Endoscopy

Angiography

Von Willebrand Disease

Aortic Stenosis

Elderly

Chronic Renal Failure

Supportive

Surgery

2 mins

Cognitive Abilities Assessment

Collecting/Organizing Objective Information

Mini-Mental State Examination (MMSE)

Montreal Cognitive Assessment Test (MoCA)

Mini-Cog

2 mins

Cerebellar Assessment

Observe Rapid Alternating Movements (RAM)

Touch Thumb to Each Finger

Finger-Nose-Finger Test

Heel-to-Shin Test

Observe Gait

2 mins

Skull, Scalp and Hair Assessment

Inspect Size, Shape and Contour

Inspect and Palpate Areas for Tenderness or Lesions

Inspect for Tenderness, Lesions or Rashes

Inspect for Dandruff

Inspect for Lice or Nits

Inspect Quality and General Appearance of Hair

Observe Hair Distribution

2 mins

Head, Face and Neck Assessment

Inspect Size and Shape of Skull

Palpate Temporal Artery

Observe Facial Expression

Inspect Facial Structures and Symmetry

Look for Symmetry

Check Range of Motion

Inspect Lymph Nodes and Thyroid Gland

Confirm Trachea is Midline

2 mins

Eye Assessment

Eye and Eyebrow Symmetry

Eyeball Alignment

Examine Cornea and Lens for Cloudiness

Iris and Pupil Shape and Size

Pupillary Light Reflex and Accommodation

P.E.R.R.L.A

2 mins

Visual Perceptual Hierarchy

Oculomotor Control

Visual Fields

Visual Acuity

Visual Attention

Visual Scanning

Pattern Recognition

Visual Memory

Visual Cognition

Adaptation Through Vision

A Child Makes Parents See Appropriately

3 mins

Nose Assessment

Inspect for Deformity or Asymmetry

Inspect for Inflammation and Skin Lesions

Check for Nasal Obstruction

Inspect Nasal Mucosa

Note Discharge, Bleeding or Foreign Body

Palpate the Sinus Areas

2 mins

Ear Assessment

Inspect Position and Symmetry

Inspect for Lesions, Drainage, Nodules or Redness

Inspect Opening of Ear Canal

Insert Speculum

Position Scope

View Structures

Light Reflect

Whisper Test

Weber’s Test

Rinne Test

4 mins

Throat and Mouth Assessment

Inspect for Color, Asymmetry and Swelling

Inspect Lips, Teeth, Gums and Oral Mucosa

Assess Tongue

Examine Pharynx with Tongue Depressor

2 mins

Skin Assessment

Observe for Abnormal Skin Pigmentation

Inspect for Cyanosis

Observe Skin for Pallor

Observe for Jaundice

Inspect for Erythema

Check the Temperature

Inspect for Diaphoresis or Dehydration

Imprint Thumb Firmly for 3 to 4 Seconds

Note the Characteristics

Palpate Lesion

4 mins

Nail Assessment

View Index Finger at its Profile

Look at Consistency

Observe Color

Check Capillary Refill

2 mins

Gastrointestinal System Assessment

Inspect Mouth, Jaw, Teeth, Gums and Oral Mucosa

Inspect Tongue

Palpate Areas for Tenderness/Lesions

Inspect Abdominal Quadrants

Auscultate

Percuss

Palpate

Light Palpation

Deep Palpation

Check for Rebound Tenderness and Ascites

Inspect Perianal Area

Palpate Rectum with Gloved Index Finger

6 mins

Abdomen Assessment

4 Quadrants

Contour, Shape, Symmetry

Umbilicus

Bowel Stethoscope

Vascular Sounds

Percuss 4 Quadrants

Tympany or Dullness

Light Palpation

Deep Palpation

Rebound Tenderness

5 mins

Reflexes Assessment

Hyperactive

Hypoactive

Biceps

Triceps

Brachioradialis

Patellar (Quadriceps)

Achilles Tendon

Plantar Reflex (Babinski Sign)

3 mins

ROM Assessment

Active ROM (AROM)

Active Assisted ROM (AAROM)

Passive ROM (PROM)

Neck Flexion, Extension and Rotation

Shoulder Flexion, Extension and Rotation

Elbow Flexion and Extension

Fingers and Wrist Flexion and Extension

Hip and Knee Flexion

Hip Abduction and Rotation

Ankle Rotation

Toe Flexion and Extension

Lumbar Rotation and Spine Inspection

4 mins

Cardiac and Circulation Assessment

Inspect General Appearance

Inspect Chest

Note Location of Apical Impulse

Percuss Chest Wall

Auscultate Heart Sounds: S1, S2, S3, S4

Auscultate for Pericardial Friction Rub and Murmurs

Assess Skin, Fingernails and Toenails

Check Carotid Artery and Jugular Vein

Palpate Skin for Temperature, Texture, Turgor

Check Capillary Refill Time

Palpate Arterial Pulses Bilaterally

5 mins

Male Urinary System Assessment

Past Medical History

Medications

Urination Pattern

Inspection

Palpation

Auscultation

Percussion

Intake and Output

Characteristic of Urine

2 mins

Male Reproductive System Assessment

Inspect the Penis and Urethral Meatus

Inspect the Scrotum, Testicles and Pubic Hair

Inspect the Inguinal and Femur

Palpate the Entire Penile Shaft

Palpate Both Testicles

Palpate Epididymides and Both Spermatic Cords

Palpate for Direct or Indirect Inguinal Hernia and Femoral Hernia

Palpate Prostate Gland

3 mins

Female Reproductive System Assessment

Past Genitourinary and Gynecological History

Current and Past Medication Use

Urine Collection and Characteristics

Inspect External Genitalia

Palpate External Genitalia

Inspect Internal Genitalia Using Lubricated Speculum

Examine Vaginal Wall for Color, Texture, and Integrity

Examine Cervix for Color, Position, Size, Shape, Mucosal Integrity and Discharge

Palpate Internal Genitalia

Note Abnormal Findings

4 mins

Airway and Lungs Assessment

Examine Back of Chest

Determine Respiratory Rate for 1 Minute

Assess for Abnormalities with Uneven Movement or Use of Accessory Muscles

Inspect Skin, Nails and Mucous Membrane

Palpate for Crepitus, Tenderness, Alignment, Masses or Retraction

Palpate for Tactile Fremitus

Check Chest-Wall Symmetry and Expansion

Note Resonance, Hyperresonance, Dullness and Tympany

Use Diaphragm of Stethoscope to Listen to Full Inspiration and Full Expiration

Ask Patient to Breathe Through Mouth

Normal Breath Sounds

Abnormal Breath Sounds

5 mins

Strength Assessment

Assess Patient Appearance for Abnormalities

Observe ROM of Upper and Lower Extremities

Hand Grips

Dorsiflexion and Plantarflexion

Hip and Knee Flexion Against Resistance

Manual Muscle Test (MMT) Grading System

2 mins

Female Urinary System Assessment

Past Medical History

Urination Pattern

Medications

Urine Collection

Inspect Areas Over Kidney and Bladder

Percuss Kidneys

Palpate Kidneys and Bladder

Note Abnormal Findings

Intake and Output

Characteristic of Urine

2 mins

Cranial Nerves I and II Assessments

Cranial Nerve I - Olfactory Nerve

Use Familiar Attainable Smells

Note Any Sense of Smell Asymmetry

Cranial Nerve II - Optic Nerve

Test Visual Fields

2 mins

Cranial Nerves III, IV and VI Assessments

Cranial Nerve III - Oculomotor Nerve

Cranial Nerve IV - Trochlear Nerve

Cranial Nerve VI - Abducens Nerve

Assess Extraocular Movements, P.E.R.R.L.A

Note Any Nystagmus

2 mins

Cranial Nerves V and VII Assessments

Cranial Nerve V - Trigeminal Nerve

Assess Temporal and Masseter Muscles

Assess Light Touch Sensation

Cranial Nerve VII - Facial Nerve

Note Mobility and Facial Symmetry

2 mins

Cranial Nerves VIII, IX and X Assessments

Cranial Nerve VIII - Acoustic (Vestibulocochlear) Nerve

Test Hearing to Normal Conversation

Whisper Test

Cranial Nerve IX - Glossopharyngeal Nerve

Cranial Nerve X - Vegus Nerve

Depress the Tongue and Say “Ahh”

Touch the Posterior Pharyngeal

2 mins

Cranial Nerves XI and XII Assessments

Cranial Nerves XI - Spinal Accessory Nerve

Examine Sternocleidomastoid Muscles

Examine Trapezius Muscles

Cranial Nerve XII - Hypoglossal Nerve

Inspect the Tongue

Note Lingual Speech

2 mins

Shoulder Exam

Skin

Shape

Humeral Head

Acromioclavicular Joint

Rotator Cuff

Clavicle

Spine of Scapula

Flexion

Extension

Abduction

Adduction

Internal Rotation

External Rotation

3 mins

Low Back Assessment

Inspection

Movement

Palpation

Flexion and Extension

Rotation

Lateral Bend

Hyperextension

Straight Leg Raise Test

4 mins

Knee Assessment

Inspection

Palpation

Check Range of Motion

Assess Strength

Neurovascular Assessment

Ballottement and Effusion

Ligament Integrity

Meniscal Integrity

4 mins

Stable Angina

Chest Pain with Exertion

Relieved within 15 Minutes

ST Depression

Nitroglycerin

Up to 3 Doses q 5 Minutes

Rest

Antiplatelet Medication

CABG

Angioplasty

2 mins

Unstable Angina

Chest Pain with Rest or Exertion

Limits ADLs

> 15 Minutes

Less Likely Relieved by Nitroglycerin

ST Depression

Fatigue

Acute Coronary Syndrome (ACS) Treatment

Emergency Treatment

2 mins

Myocardial Infarction Assessment

Substernal Chest Pain

Crushing or Dull Sensation

Arm, Jaw, and Neck

> 20 Minutes

Unrelieved by Nitro

Palpitations

Diaphoresis

Fear of Impending Doom

Nausea and Vomiting

Shortness of Breath

Monitor for Arrhythmias

2 mins

Myocardial Infarction Diagnosis

12 Lead ECG

ST Elevation

Q Wave

T Wave Inversion

Troponin T and I

CK-MB

Early ECG

Cardiac Stress Test

2 mins

Myocardial Infarction Interventions

Morphine

Oxygen

Nitrates

Aspirin

Thrombolytics (tPA)

Cardiac Catheterization

Stent Placement

Angioplasty

Coronary Artery Bypass Grafting (CABG)

Decrease Modifiable Risk Factors

Resuming Activity (Physical, Sexual)

2 mins

Coronary Artery Bypass Grafting (CABG)

ST-Segment Elevation Myocardial Infarction (STEMI)

Cardiovascular Disease (CAD)

Uncontrolled Angina

Internal Mammary Artery

Saphenous (Leg) Vein

Transient Limb Edema

Closely Monitor Patients

Venous Thromboembolism (VTE) Prophylaxis

Incentive Spirometer

2 mins

Cardiac Catheterization

Fluttering Sensation

Contrast Media

NPO 6-12 Hours

Bed Rest

Assess Circulation

Assess for Bleeding

Monitor Vital Signs

2 mins

Evolution of Myocardial Infarction and Complications

Arrhythmia

Fibrinous Pericarditis

Papillary Muscle Rupture

Interventricular Septum Rupture

Ventricular Pseudoaneurysm

Ventricular Free Wall Rupture

True Ventricular Aneurysm

Dressler Syndrome

Left Ventricular Failure

2 mins

Infarction Types

Red Infarct

Venous Occlusion

Organ with Multiple Blood Supplies

Liver

Intestine

Testes

Reperfusion Injury

White Infarct

Arterial Occlusion

Organ with Single Blood Supplies

Heart

Kidney

Spleen

2 mins

Types of Heart Failure

Left Sided

Pulmonary Congestion

Right Sided

Peripheral Edema

High Output

Unable to Meet Metabolic Needs

1 min

Right Heart Failure Assessment

Jugular Venous Distention (JVD)

Peripheral Edema

Hepatosplenomegaly

Nocturia

Weight Gain

Ascites

Fatigue

1 min

Left Heart Failure Assessment

Pulmonary Congestion

Pink Frothy Sputum

Wheezing or Crackles

Dyspnea with Exertion

Cough

Fatigue

Tachycardia

Weak Peripheral Pulse

S3, S4 Heart Sounds

1 min

Heart Failure Interventions

Echocardiogram

Invasive Hemodynamic Monitoring

High Fowler's Position

Oxygen

Advanced Airway

Diuretics

Beta Blockers

Angiotensin II Receptor Blockers (ARBs)

ACE Inhibitors

Digoxin (Lanoxin)

Pacemaker

2 mins

Acute Pericarditis Assessment

Pericardial Sac Inflammation

Sharp Chest Pain

Increased with Inspiration

Pain Decreased by Leaning Forward

Pericardial Friction Rub

Diffuse ST-Elevation

T Wave Inversion

Fever

May Be Asymptomatic

Cardiac Tamponade

2 mins

Acute Pericarditis Causes

Idiopathic

Infection

Trauma

Cardiac

Myocardial Infarction

Autoimmune Diseases

Uremia

Tumor

Radiation

2 mins

Acute Pericarditis Interventions

Treat Underlying Disorder

Antibiotics

Colchicine + NSAIDs

Corticosteroids

Place Patient Upright with Head of Bed at 45°

Pericardiocentesis

Pericardial Window

2 mins

Endocarditis Assessment

Infection of Inner Layer and Valves

Fever

Fatigue

New or Changed Murmurs

Roth's Spots

Splinter Hemorrhages

Janeway Lesions

Osler's Nodes

Heart Failure

Embolization

2 mins

Endocarditis Interventions

IV Antibiotics

4-6 Weeks

Anticoagulants

Good Hygiene

Closely Monitor

Antibiotic Prophylaxis

Dental Procedures

Invasive Procedures

1 min

Cardiac Tamponade

Fluid in the Pericardial Sac

Pericarditis

Decreased Cardiac Output

Beck's Triad

Hypotension

Jugular Venous Distention (JVD)

Distant Heart Sounds

Pulsus Paradoxus

Electrical Alternans

Pericardiocentesis

1 min

Types of Shock

Hypovolemic

Depleted Volume

Cardiogenic

Pump Failure

Obstructive

Indirect Pump Failure

Distributive

Lost Vascular Tone

Neurogenic

Anaphylactic

Septic

2 mins

Sepsis Assessment

Systemic Infectious Process

Fever

Hypotension

Change in LOC

Increased WBC

Shift to the Left

Tachycardia

Tachypnea

Hyperglycemia

Edema

2 mins

Severe Sepsis and Septic Shock Assessment

Microthrombi

DIC

Decreased Oxygen Saturation

Decreased WBC

Oliguria

High Output Heart Failure

Multiple Organ Failure

2 mins

Respiratory Anatomy

Nasal Cavity

Hair Filters

Mucus Filters and Moistens

Capillaries Warm

Pharynx (Throat)

Larynx (Voice Box)

Cilia Expel Mucus and Dust

Trachea

Bronchi

Alveoli

2 mins

Alveolar Gas Exchange

Pulmonary Artery Blood is O2-Poor, CO2-Rich

Two-Cell Thick Air-Blood Barrier

CO2 Diffuses Into Air

O2 Diffuses Into Blood

Gases Equilibrate

Pulmonary Vein is O2-Rich, CO2-Poor

Thermoregulation

2 mins

Hypoxia (Early Symptoms)

Diaphoresis

Restlessness

Tachypnea

Dyspnea on Exertion

Tachycardia

Hypertension

Arrhythmias

Decreased Urine Output

Unexplained Fatigue

1 min

Hypoxia (Late Symptoms)

Cyanosis

Cool, Clammy Skin

Use of Accessory Muscles

Retractions

Hypotension

Arrhythmias

2 mins

Tracheostomy Care

Inner Cannula Removed and Cleaned

Clean Q8 Hours Around Stoma

One Finger Under Ties

Speak with Deflated Cuff

Can Eat with Tube in Place

Keep Replacement Tube Nearby

Immediately Replace if Dislodged

Physician Does First Tube Change

2 mins

Lung Sounds - Wheezes

Throughout Lung

High Pitched

Musical

Air Moving through Narrowed Airways

38 secs

Lung Sounds - Crackles

Lower Lobes

Fine/Coarse

Fine: Twisting Hair through Fingers

Coarse: Velcro

Collapsed Small Airways and Alveoli "Popping Open"

1 min

Lung Sounds - Rhonchi

Trachea and Bronchi

Low Pitched Rumbling

Gurgling

Narrowed Airway

Secretions or Bronchospasm

49 secs

Lung Sounds - Pleural Friction Rub

Anterior Lateral Lung

Dry, Rubbing, or Squeaking

Rubbing a Balloon with Finger

Inflamed Pleura

50 secs

Oxygen Delivery Methods

Nasal Cannula

Simple Face Mask

Non-Rebreather Mask

Venturi-Mask

Oxygen In Use Sign

No Electrical Sparks

Six Feet Away from Open Flames

Dry Nasal and Upper Airway Mucosa

Skin Irritation

Home Education

1 min

Restrictive vs. Obstructive Lung Diseases

Restrictive Lung Disease

Decreased Lung Volume

FEV1/FVC Ratio Normal to Increased

Obstructive Lung Disease

Increased Lung Volume

Decreased FEV1/FVC Ratio

2 mins

COPD Overview (Chronic Obstructive Pulmonary Disease Overview)

Inhaled Toxins

Smoking

AAT Deficiency

Emphysema

Chronic Bronchitis

Asthma

Spirometry

Slow Progression

2 mins

Asthma Assessment

Triggers (Cold air, Dander, Dust, Infection, Mold, Pollen, Smoke)

Shortness of Breath (SOB)

Tachypnea and Tachycardia

Wheezing

Diaphoresis

Accessory Muscles

Decreased Pulmonary Function Tests

2 mins

Asthma Implementation and Education

Oxygen

Corticosteroids

Ipratropium (Anticholinergic)

Albuterol

Inhaler/nebulizer

Pulse Oximetry

Pursed Lip Breathing

Carry Inhaler

Rinse Mouth after Inhaler

Identify Trigger (Cold Air, Dander, Dust, Infection, Mold, Pollen, Smoke)

2 mins

Chronic Bronchitis Assessment

Chronic Productive Cough

> 3 Months for 2 Years

Increased Mucus Production

Dyspnea

Cyanosis

Wheezes

Right Side Heart Failure

Jugular Venous Distention (JVD)

Peripheral Edema

2 mins

Chronic Bronchitis Interventions

Tripod Position

Humidified Oxygen

Pursed Lip Breathing

Increase Fluid Intake

ABGs

Early Detection of Exacerbation

Lowest O₂ Therapy

Assisted Ventilation

Increased Infection Risk

2 mins

Emphysema

Hyperinflation and Loss of Elasticity

Pursed Lip Breathing

Barrel Chest

Dyspnea on Exertion

Clubbing

Depression and Anxiety

Thin Appearance

CO2 Retention

Low Concentration of O2

High Fowler's Position

High Calorie, High Protein Diet

2 mins

Pneumonia Assessment

Older Adult

Immunocompromised

Long Term Care

Shortness of Breath (SOB)

Hypoxemia

Cough and Sputum Production

Wheezing or Crackles

Fever

Pleuritic Pain

Chest X-ray

2 mins

Pneumonia Intervention

Humidified Oxygen

Deep Breathing Exercises

Position of Comfort

Increase Fluid Intake

Manage Fever

Antibiotics

Mucolytics

Expectorants

Pneumococcal Vaccine

Sepsis

Acute Respiratory Failure (ARF)

Prevention Education

2 mins

Pulmonary Embolism Causes

FAT BAT Mnemonic

Fat

Air

Deep Vein Thrombosis (DVT)

Bacteria

Amniotic Fluid

Tumor

Hypercoagulable

Central Venous Lines

Immobilized

1 min

Tuberculosis Assessment

Airborne Droplet

3 Week Productive Cough

Night Sweats

Chest Pain

Fever

Weight Loss

Fatigue

Chest X-Ray

Blood Tests

Mantoux Skin Test

3 Positive Sputum Tests

1 min

Pulmonary Embolism Assessment

Shortness of Breath (SOB)

Pleuritic Chest Pain

Tachypnea

Hemoptysis

Hypoxemia

Sudden Death

52 secs

Tuberculosis Intervention

Airborne Isolation

Combination Drug Therapy (RIPE)

6-12 Months

DOT

BCG Vaccination

Medication Education

3 Negative Sputum Specimens

Infection Control

2 mins

Respiratory Acidosis Assessment

Decreased pH < 7.35

Increased PaCO2 > 45

Reduced Respirations

Anxiety

Change in LOC

Tachycardia

Cyanosis

Increased Electrolytes

ECG Changes

Muscle Weakness

Hyporeflexia

2 mins

Cystic Fibrosis Assessment

Thickened Mucus

Recurrent Pulmonary Infections

Pulmonary Congestion

Pancreatic Insufficiency

Steatorrhea

Fat-Soluble Vitamin Deficiencies

Salty Taste to Skin

Meconium Ileus

Delayed Growth and Poor Weight Gain

2 mins

Respiratory Acidosis Interventions

Improve Respiration

Bronchodilators

Respiratory Stimulants

Drug Antagonists

Oxygen

Assisted Ventilation

Prevent Complications

1 min

Cystic Fibrosis Interventions

Bronchodilators

N-Acetylcysteine (Mucolytics)

Inhaled Hypertonic Saline

Early Antibiotics

Dornase Alfa (Mucolytic Agent)

Postural Drainage with Percussion

Fat Soluble Vitamin Supplements

Pancreatic Enzymes with Every Meal

High Protein, High Calorie Diet

Added Dietary Salt

Glucose Monitoring

2 mins

Respiratory Alkalosis Assessment

Increased pH > 7.45

Decreased PaCO2 < 35 mmHg

Hyperventilation

Brainstem Stimulation

Head Injury

Shock

Lightheadedness

Tingling Lips or Fingers

Trousseau's

Chvostek's Sign

Anxiety

2 mins

Pneumothorax

Air Enters Pleural Space

Sudden Dyspnea

Absent or Restricted Movement on Affected Side

Decreased or Absent Breath Sounds on Affected Side

Chest Pain

Tracheal Deviation

Vital Sign Changes

Crepitus

High Fowler's Position With Oxygen

Prepare For Chest Tube Placement

Educate High Risk Patients

2 mins

Respiratory Alkalosis Interventions

Treat Underlying Cause

Decrease Tidal Volume and/or Respiratory Rate

Give Adequate Pain Control and Sedation

Rebreathing into Paper Bag

Sedatives

Antidepressants

Compensatory Drop in Serum Bicarbonate

Correct CO2 Slowly

2 mins

Croup (Laryngotracheobronchitis)

Parainfluenza Virus

3 Months to 3 Years

Nighttime

Barking Seal Cough

Inspiratory Stridor

Cool Humidified Air

Dexamethasone

Racemic Epinephrine

2 mins

Obstructive Sleep Apnea (OSA)

Narrowed or Obstructed Air Passage

Apnea

Loud Snoring

Startle Response

Daytime Drowsiness

Positional Therapy

Oral Appliance

Continuous Positive Airway Pressure (CPAP)

Surgery

Weight Loss

3 mins

Lung Cancer Assessment

2nd Most Common Cancer

Chronic Cough

Hoarseness

Abnormal Breath Sounds

Hemoptysis

Chest Pain

Anorexia or Weight Loss

Symptoms Appear Late in Disease

2 mins

Adenocarcinoma of the Lung

Most Common Lung Cancer

Most Common in Nonsmokers

Peripheral Location

KRAS, EGFR, and ALK Mutations

Glandular Pattern

Often Stains with Mucin

Presents with Hemoptysis

Clubbing

Surgical Resection

Chemotherapy and Radiation

2 mins

Small Cell (Oat Cell) Carcinoma

Aggressively Malignant

Strong Correlation with Smoking

Central Location

Amplification of Myc Oncogenes

Narrowing of Bronchial Airways

Cushing's Syndrome

Ectopic ACTH

Syndrome Of Inappropriate Antidiuretic Hormone (SIADH)

Lambert-Eaton Syndrome

Kulchitsky Cells

Neuron-Specific Enolase Positive

Chromogranin A Positive

Chemotherapy and Radiation

3 mins

Squamous Cell Carcinoma of the Lung

Strong Correlation with Smoking

More Common in Men

Central Location

Cavitating Lesion Extending to Hilum

PTHrP Causes Hypercalcemia

Keratin Pearls

Intercellular Bridges

Surgical Resection (if Early Stage)

Chemotherapy and Radiation (if Later Stage)

2 mins

Atypical Pneumonia

Diffuse Patchy Inflammation

Interstitial Pattern

"Walking Pneumonia"

Mycoplasma pneumoniae

Chlamydia pneumoniae

Legionella pneumophila

Adenovirus

Respiratory Syncytial Virus (RSV)

Cytomegalovirus (CMV)

Influenza

Dry Cough

Macrolides

2 mins

Acute Respiratory Distress Syndrome (ARDS) Assessment

Damaged Alveolar-Capillary Membrane

Restlessness

Dyspnea

Refractory Hypoxemia

Decreased PaO2

Diffuse Pulmonary Infiltrates

Atelectasis

Pulmonary Hypertension

2 mins

Acute Respiratory Distress Syndrome (ARDS) Interventions

Closely Monitor Patient

ABG's (Arterial Blood Gases)

Oxygen

Assess for O2 Toxicity

Mechanical Ventilation

PEEP

Assess for Pneumothorax

Permissive Hypercapnia

High Mortality Rate

2 mins

Neonatal Respiratory Distress Syndrome

Fetal Lung Immaturity

Lack of Surfactant

Respiratory Distress

Nasal Flaring

Retractions

Grunting

Surfactant

Oxygen

Mechanical Ventilation

Total Parenteral Nutrition (TPN)

2 mins

Alpha 1 Antitrypsin Deficiency

Decreased Alpha Anti Trypsin

Increased Elastase Activity

Decreased Elastic Tissue

Misfolded Protein Aggregates

PAS+ Globules

Panacinar Emphysema

Dyspnea

Cirrhosis

Hepatocellular Carcinoma

2 mins

Idiopathic Pulmonary Fibrosis

Interstitial Restrictive Lung Disease

Age over 50 years, Males, Tobacco

Dyspnea and Cough

Fatigue

Crackles

Digital Clubbing

Bronchiectasis

Honeycomb Pattern

Restrictive Pattern

Respiratory Failure

Right Heart Failure

Oxygen

Antifibrotic Medications

Lung Transplant

5 mins

Beta-2 Agonists

Short-term Treatment

Terbutaline

Asthma

Tocolysis

Albuterol

Asthma

Long-term Treatment

Salmeterol

Asthma

Chronic Obstructive Pulmonary Disease (COPD)

3 mins

Albuterol (Proventil)

Short-Acting Beta-2 Agonist

Bronchospasm

Asthma

Angina

Tachycardia

Tremor

1 min

Cromolyn (Mast Cell Stabilizers)

Mast Cell Stabilizer

Asthma Prophylaxis

Bronchial Inflammation

Allergic Rhinitis

Cough

Bronchospasm

Fixed Schedule Administration

2 mins

Theophylline (Theo-24)

Bronchial Smooth Muscle Relaxation

Asthma

Insomnia

Restlessness

Arrhythmias

Seizures

Narrow Therapeutic Range

Monitor Plasma Levels

1 min

Montelukast (Singulair)

Leukotriene Receptor Blocker

Allergic Rhinitis

Asthma Prophylaxis

Exercise Induced Bronchospasm

Fatigue

Headache

Mood Changes

Suicidal Thoughts

Increased Risk of Churg Strauss

2 mins

Terbutaline (Brethine)

Beta-2 Agonists

Asthma

Tocolytic

Hypotension

Tremor

Tachycardia

Pulmonary Edema

Hyperglycemia

2 mins

Second Generation Antihistamines

Allergies

Lipophobic

Histamine H1 Receptor Antagonist

Azelastine + Fluticasone (Dymista)

Intranasal Spray

Cetirizine (Zyrtec)

Loratadine (Claritin)

Fexofenadine (Allegra)

Fewer Anticholinergic Effects

Fewer CNS Effects

2 mins

First Generation Antihistamines

Histamine H1 Receptor Antagonist

Allergies

Nausea and Vomiting

Motion Sickness

Anaphylaxis

Diphenhydramine (Benadryl)

Promethazine (Phenergan)

Chlorpheniramine

Sedation

Anticholinergic Effects

2 mins

Stages of Asthma Treatments

Short-acting Inhaled Beta-Agonist

Low-Dose Inhaled Corticosteroid

Montelukast (Leukotriene Receptor Antagonist)

Low to Medium-dose Inhaled Corticosteroid

Zileuton

High-Dose Inhaled Corticosteroid

Systemic Corticosteroids

Omalizumab (Allergies)

2 mins

Hypothalamus

Anterior Pituitary Stimulated Through the Hypophyseal Portal

GHRH

GnRH

TRH

PIF

CRF Released During Stress

Posterior Pituitary Stimulated Through Neural Control

3 mins

Anterior Pituitary

Hypothalamic Control

FLAT PeG Mnemonic

Follicle-Stimulating Hormone (FSH)

Lutenizing Hormone (LH)

Adrenocorticotropic Hormone (ACTH)

Thyroid-Stimulating Hormone (TSH)

Prolactin (PRL)

Growth Hormone (GH)

2 mins

Posterior Pituitary

Neuroendocrine Reflex Stimulation (By Hypothalamus)

Vasopressin

Increased Water Retention (In Kidneys)

Oxytocin

Increased Uterine Contraction

Mammary Glands Contraction

2 mins

Thyroid Gland

TSH Stimulates T3 and T4 Release

Metabolism Regulation

Blood Calcium Sensor

Calcitonin Release

Blood Calcium Decreases

Bone Building

2 mins

Parathyroid Gland

Blood Calcium Sensor

Parathyroid Hormone

Bone Resorption

Blood Calcium Increases

Vitamin D Activation

Calcium Absorption From The Small Intestine

1 min

Adrenal Gland (Basic)

Adrenal Cortex

RAAS Stimulates Aldosterone

CRF (CRH) acts on Anterior Pituitary Gland to Release ACTH

Cortisol Released

Androgens Released

Adrenal Medulla

Epinephrine & Norepinephrine

2 mins

Adrenal Gland (Advanced)

Adrenal Cortex

Zona Glomerulosa

Aldosterone

Zona Fasciculata

Cortisol

Zona Reticularis

Androgens

Adrenal Medulla

Chromaffin Cells

Epinephrine & Norepinephrine

2 mins

Peptide Hormones

Fast-Acting and Short-Lived

Bind To Cell Membrane Receptors

Stimulate Secondary Messengers

Amino Acid-Derived

Insulin

Parathyroid Hormone (PTH)

Vasopressin

Oxytocin

2 mins

Steroid Hormones

Nuclear Membrane

Long-Lived and Slow-Acting

Cholesterol-Derived

Intracellular Receptors

DNA Transcription

Testosterone

Aldosterone

Estrogen

Cortisol

2 mins

Pancreas

Acinar Cells Release Digestive Enzymes

Ductal Epithelial Cells Release Bicarbonate

Islets of Langerhans

Beta Cells Release Insulin

Alpha Cells Release Glucagon

Delta Cells Release Somatostatin

Somatostatin Inhibits Alpha and Beta Cells

3 mins

Addison's Disease Assessment

Deficiency of Cortisol and Aldosterone

Irritability

Hyperkalemia

Muscle Weakness

Skin Hyperpigmentation

Hyponatremia

Hypotension

Hypoglycemia

Addisonian Crisis

2 mins

Testes

FSH Stimulates Sertoli Cells

Inhibin B Release

LH Stimulates Leydig Cells

Leydig Cells Secrete Testosterone

Testosterone Causes Male Development

2 mins

Addison's Disease Intervention

Hydrocortisone

2/3 Dose in Morning

1/3 Dose in Late Afternoon

Fludrocortisone

Androgen Replacement Therapy

Salt Additives

Increase Dosage During Stress and Infection

Medic Alert Bracelet

Lifelong Hormone Therapy

2 mins

Syndrome Of Inappropriate Antidiuretic Hormone (SIADH)

Hypersecretion of ADH

Increased Sensitivity to ADH

Serum Hypoosmolality

Coma and Seizure

Dilutional Hyponatremia

Cramps and Tremors

Euvolemia

Change in LOC

2 mins

Addisonian Crisis

Severe Symptoms

Shock

High-Dose Hydrocortisone

Large Volumes of IV Fluid

Insulin with Dextrose

Kayexalate

Loop or Thiazide Diuretics

2 mins

Syndrome of Inappropriate Antidiuretic Hormone (SIADH) Pharmacologic Interventions

Diuretics

Hypertonic IV Fluids

Demeclocycline

Tolvaptan and Conivaptan

1 min

Pheochromocytoma

Adrenal Medulla Tumor

Increased Catecholamines

Episodic Hypertension

Diaphoresis

Abdominal or Chest Pain

Surgery

Antihypertensives

Phenoxybenzamine

Metyrosine (Demser)

Do Not Palpate Abdomen

3 mins

Syndrome of Inappropriate Antidiuretic Hormone (SIADH) Nonpharmacologic Interventions

Monitor Serum and Urine Osmolality

IandOs with Daily Weights

Restrict Fluid Intake

Monitor Cardiovascular and Neurological Status

Seizure Precautions

2 mins

Primary Hyperaldosteronism

Increased Aldosterone Secretion

Adrenal Adenoma

Bilateral Adrenal Hyperplasia

Hypertension

Hypokalemic Metabolic Alkalosis

No Significant Edema

Increased Aldosterone

Decreased Renin

Abdominal CT Scan

Aldosterone Antagonists

Surgery

3 mins

Sheehan's Syndrome

Postpartum Pituitary Gland Necrosis

Agalactorrhea

Amenorrhea

Secondary Hypothyroidism with Cold Intolerance

1 min

Peripheral Precocious Puberty

Secondary Sex Characteristics before 8 Years (Girls) or 9 Years (Boys)

Breast Development (Girls) or Testicular Enlargement (Boys)

GnRH Independent

Congenital Adrenal Hyperplasia

Exogenous Sex Steroids

Granulosa Cell Tumor

Non-Germ Cell Tumor

GnRH Stimulation Test

No Increase in LH

Bone Age

Hormone Levels

Treating Underlying Disorders

3 mins

Central Diabetes Insipidus

ADH Deficiency

Increased Serum and Urine Osmolality

Mental Illness

Brain Injuries

Desmopressin

1 min

Dawn Phenomenon

Increased Hormone Production

Hyperglycemia Upon Awakening

Long-Acting Evening Insulin

Change Administration Times

Insulin Pump

Closely Monitor Glucose Levels

Between 2-6AM

Limit Carbohydrates Before Bedtime

2 mins

Hypothyroidism Assessment

Weight Gain - Edema

Lethargy

Cold Intolerance

Bradycardia

Hypertension

Brittle Nails and Dry Skin

Constipation

Goiter

Prolonged Menses

Slowed Thinking

Decreased Free T4

Increased TSH

2 mins

Diabetes Assessment

Juvenile Onset

Absent Insulin Production

Ketosis Prone

Adult Onset

Insulin Resistance

Obesity

Onset During Pregnancy

Glucose Intolerance

Retinopathy

Peripheral Vascular Disease

Nephropathy

Neuropathy

2 mins

Hypothyroidism Intervention

Levothyroxine (Synthroid)

Liothyronine (Cytomel)

Myxedema Coma

Lifelong Replacement Hormone

Monitor Vital Signs

Fluids and Fiber

Low Calorie, Low Fat Diet

Medication Education

No Switching Brands

2 mins

Diabetes Interventions

Early Diagnosis

Insulin

Oral Hypoglycemics

Glucose Monitoring

Routine Exercise

Diabetic Diet

Monitor for Complications

Insulin Therapy

Diabetic Ketoacidosis (DKA)

2 mins

Hyperthyroidism Assessment

Heat Intolerance

Exophthalmos

Warm, Moist Skin and Silky Hair

Tremors

Goiter

Diarrhea

Weight Loss

Tachycardia

Hypertension

Amenorrhea

Decreased TSH with Elevated Free T4

Radioactive Iodine Uptake (RAIU)

2 mins

Diabetes Education

Self-Monitoring (Blood Glucose)

SubQ Injection Technique

Lifestyle Changes

Symptoms of Hyperglycemia and Hypoglycemia

Sick Day Care

Foot Care

Exercise Therapy

Medication

1 min

Hyperthyroidism Interventions

Propylthiouracil (PTU)

Methimazole (Tapazole)

Iodine

Beta Blockers

Radioiodine Ablation

Thyroidectomy

Thyrotoxicosis

Post-Surgery Hypocalcemia

2 mins

Diabetes Insipidus Assessment

Polyuria

Nocturia

Low Specific Gravity (USG)

Polydipsia

Dehydration

Hypotension

Tachycardia

Confusion

2 mins

Graves' Disease Characteristics

Women 20-40 years old

Anti-TSH Receptor Antibodies

Ophthalmopathy

Exophthalmos

Hyperthyroidism

Goiter

Pretibial Myxedema

1 min

Metabolic Syndrome

Dyslipidemia

Central Obesity

Insulin Resistance

Hypertension

Increased C-Reactive Protein (CRP)

Increased Fibrinogen

Increased Risk Cardiovascular Disease

1 min

Graves' Disease Labs and Treatment

Decreased TSH

Increased T3

Increased T4

Radioactive Iodine Uptake (RAIU)

Beta blocker

Methimazole

Radioiodine Ablation

1 min

Acromegaly Assessment

Excess Growth Hormone (GH)

Protruding Jaw

Large Lips and Nose

Hearing Loss

Enlargement of Hands and Feet

Vision Changes and Headache

Joint Pain

Peripheral Neuropathy

Hyperglycemia

2 mins

Hashimoto's Thyroiditis

Hypothyroidism with Bouts of Hyperthyroidism

Enlarged, Nontender Thyroid

Autoimmune

Anti-Thyroid Peroxidase (TPO)

Anti-Thyroglobulin

Hurthle Cells

Lymphoid Follicles

HLA-DR5 and HLA-DR3

Increased Risk Of Non-Hodgkin Lymphoma

2 mins

Hypocalcemia Causes

Hypoalbuminemia

Hypomagnesemia (Less Common Hypermagnesemia)

Hypovitaminosis D

Hypoparathyroidism

Medications

Hyperphosphatemia

Malnutrition

Acute Pancreatitis

Alkalosis

Sepsis

Chronic Kidney Disease

2 mins

Riedel Thyroiditis

Autoimmune

IgG4

Fibrous Invasion of Thyroid

Very Firm on Palpation

Nontender

Slowly Enlarging Mass

Invades Local Structures

Hypothyroidism

Fibrous Tissue

Eosinophilic Infiltrate

Prednisone

Tamoxifen

Surgery

2 mins

Hypocalcemia

Muscle Spasms

< 8.5 mg/dL Ca2+

Decreased Bone Density

Tetany

Chvostek's Sign

Trousseau's Sign

Increased DTR

ECG Changes

QT Prolongation

Oral and IV Replacement of Ca2+

Seizure Precautions

2 mins

Hypoparathyroidism

Hypocalcemia

Lethargy

Tetany

Arrhythmias

Decreased Calcium and Increased Phosphorus

IV Calcium Chloride

Rebreather Mask

Lifelong Medications

Oral Calcium Supplements with Vitamin D

2 mins

Hypocalcemia Treatments

Treat Underlying Disorder

IV Calcium Gluconate

Cardioprotective

Calcium Carbonate

Calcium Citrate

Vitamin D Supplements

Treat Hypomagnesemia

2 mins

Primary Hyperparathyroidism

Hypercalcemia

Kidney Stones

Osteoporosis

Arrhythmias

Increased Calcium and Decreased Phosphorus

Prevent Injury

Medication Education

Surgery

1 min

Hypercalcemia Causes

Two CHIMPANZEES Acronym

Thyroid Disorders

Calcium Supplements

Hyperparathyroidism

Iatrogenic (Drugs, immobility)

Milk-Alkali Syndrome

Paget's Disease of Bone

Acromegaly or Addison's Disease

Neoplasms

Zollinger-Ellison Syndrome

Excessive Vitamin A

Excessive Vitamin D

Sarcoidosis

2 mins

Cushing's Syndrome Assessment

Increased Cortisol Levels

Truncal Obesity

Purple Abdominal Striae

Buffalo Hump

Decreased Bone Density

Moon Face

Thinning Skin

Hyperglycemia

Hypertension

Long Term Glucocorticoid Use

Immunosuppression

2 mins

Hypercalcemia

> 10.5 mg/dL Ca²⁺

Pathologic Fractures

Lethargy

Hypercoagulation

Constipation

ECG Changes

QT Shortening

No Calcium Intake

Chelating Drugs

Calcitonin

Bisphosphonates

Loop Diuretics instead of Thiazide Diuretics

Increased Risk for Renal Calculi

Increase Fluids

3 mins

Hypercalcemia Treatments

Treat Underlying Disorder

Hydration

Dialysis

Calcium Restriction

Bisphosphonates

Calcitonin

Cinacalcet

Glucocorticosteroids

Denosumab

2 mins

Parkinson's Disease Assessment

Decreased Dopamine

Older Adult

Cogwheel Rigidity

Bradykinesia

Shuffling Gait

Resting Tremor

Pill-Rolling

Mask-Like Face

Cognitive Decline

2 mins

Parkinson's Disease Interventions

Levodopa/Carbidopa (Sinemet)

Entacapone (Comtan)

Selegiline (Eldepryl)

Amantadine (Symmetrel)

Bromocriptine (Parlodel)

Benztropine (Cogentin)

Allow Extra Time

Ensure Patient Safety

Surgery As Last Resort

2 mins

5 A's of Alzheimer's Disease

Agnosia

Anomia

Aphasia

Apraxia

Amnesia

1 min

Alzheimer's Disease Assessment (Early Symptoms)

Advanced Age

Poor Judgment and Decision-Making

Difficulty Having a Conversation

Inability to Manage a Budget

Losing Track of the Date or Season

Misplacing Things

1 min

Alzheimer's Disease Assessment (Late Symptoms)

Memory Impairment

Wandering Behavior

Confabulation

Perseveration

Lack of Abstract Thinking

Severe Cognitive Decline

1 min

Alzheimer's Disease Interventions

PET Scan and CT

Mini-Mental State Examination

Drug Therapy

Safe Environment

Moderate Exercise

Behavioral Modification

Assistance with Functional Independence

Assistance and Support for Caregiver

2 mins

Huntington's Disease Assessment and Interventions

Decreased GABA

Appears around Age 40

Slow Cognitive Decline

Choreiform Movements

Non Repetitive Jerks

Neuroleptics

Tetrabenazine

Genetic Counseling

Stages of Disease

High Calorie Diet

2 mins

Multiple Sclerosis Assessment

Nerve Fiber Demyelination

Motor Issues

Cerebellar Signs

Fatigue

Paresthesias

Spasticity

Urinary Incontinence

Optic Neuritis

Women Between 20-50 Years Old

Relapse and Remission of Symptoms

2 mins

Multiple Sclerosis Interventions

Corticosteroids

Interferon Beta

Dimethyl Fumarate (Tecfidera)

Fingolimod (Gilenya)

Mitoxantrone (Novantrone)

Natalizumab (Tysabri)

Increase Exercise

Identify Triggers

2 mins

Down Syndrome

Trisomy 21

Meiotic Nondisjunction

Intellectual Disability (Mental Retardation)

Single palmar crease

Flat Facies

Duodenal Atresia

Hirschsprung's Disease

Septum Primum Type ASD

Endocardial Cushion Defects

Prominent Epicanthal Folds

Increased Risk of Acute Lymphoblastic Leukemia

Alzheimer's Disease

3 mins

Guillain-Barre Syndrome Assessment

Ascending Paralysis

Muscle Weakness

Paresthesias (Pins and Needles)

Diplopia

Difficulty Speaking

Dysphagia

Labile Blood Pressure

Loss of Bowel and Bladder Control

Aggressive Airway Management

2 mins

Myasthenia Gravis Assessment

Weakness with Muscle Use

Diplopia

Ptosis

Dysphagia

Difficulty Speaking

Fatigue

Cholinergic Crisis

Overmedicated

Myasthenic Crisis

Not Enough Medication

Respiratory Muscle Paralysis

2 mins

Amyotrophic Lateral Sclerosis (ALS)

Progressive Muscle Weakness

Systemic Muscle Wasting

Fasciculations

Spasticity

Fatigue

Riluzole (Rilutek)

Stretching

Little to No Cognitive Decline

Respiratory Support

Palliative Care

2 mins

Sciatica

Compression or Damage to Sciatic Nerve

Herniated Disc

Shooting Pain

Lower Back Down to Thigh

Anti-Inflammatories

Steroid Injections

IDET (Intradiscal Electrothermoplasty)

Straight-leg Raising Test

2 mins

Autonomic Dysreflexia

Injury Above T6

Paroxysmal Hypertension

Bradycardia

Diaphoresis

Flushing Above Lesion

Piloerection

Nasal Congestion

Headache

Elevate Head of Bed

Remove Noxious Stimuli

2 mins

Essential Tremor

Most Common Tremor in Adults

Positive Family History

Bilateral Upper Extremities

Worse with Physical and Psychological Stress

Better with Rest and Alcohol

Beta Blockers

Primidone

1 min

Cranial Nerve Pathologies

Horner Syndrome

Trigeminal Neuralgia

Bell's Palsy

Brain or Brainstem Lesion

Microvascular Cranial Nerve Palsy

Glossopharyngeal Neuralgia

Multiple Sclerosis

Arnold Chiari Malformation

Amyotrophic Lateral Sclerosis (ALS)

Guillain Barre’ Syndrome

Parkinson's Disease

3 mins

Types of Seizures

Tonic-clonic

Tonic

Clonic

Absence (Petit Mal)

Myoclonic

Atonic

Partial (Focal) Seizure

Simple Partial

Complex Partial

2 mins

Seizure Interventions

Maintain Airway

Side-lying Position

Support Head

Move to Floor

Benzodiazepines

Never Restrain

No Objects in Mouth

Document Details

2 mins

Seizure Precautions

Reduce Environmental Stimuli

Identify Triggers

Aura

Pad Side Rails

Bed Lowest Position

Oxygen and Suction Available

Monitor Therapeutic Drug Levels

2 mins

Types of Head Injuries

Open Head Injury

Linear Fracture

Comminuted Fracture

Depressed Fracture

Open Fracture

Basilar Skull Fracture

Closed Head Injury

Coup and Contrecoup

Brain Contusion

Concussion

2 mins

Traumatic Brain Injury Assessment

Change in LOC

Personality Changes

Amnesia

Increased Intracranial Pressure

Diplopia

Posturing

Basilar Skull Fracture

Halo or Ring Sign

Intracranial Bleeding

2 mins

Increased Intracranial Pressure (ICP) Assessment

Change in LOC

Headache

Cushings Triad

Irregular Respirations

Widening Pulse Pressure

Bradycardia

Projectile Vomiting

Abnormal Pupils

Papilledema

Posturing

2 mins

Increased Intracranial Pressure (ICP) Interventions

Elevate Head Of Bed

Foley Catheter

Mannitol (Osmitrol)

High Dose Barbiturates

Passive Hyperventilation

Dexamethasone (Neoplasm or Infection)

Neuro Assessment

Maintain Normal Temperature

Avoid Activities That Increase ICP

Intracranial Monitoring System

2 mins

Types of Strokes

Transient Ischemic Attack (TIA)

Reversible Ischemic Neurologic Deficit (RIND)

Ischemic

Thrombotic

Atherosclerosis

Embolic

Atrial Fibrillation

Hemorrhagic

Severe Hypertension

3 mins

Right Hemisphere Stroke Assessment

Opposite Side Weakness (Hemiplegia)

Poor Proprioception

Disoriented to Person, Place, Time

Can't Recognize Faces (Prosopagnosia)

Loss of Judgement and Awareness

Impulsiveness

Personality Changes

Tonal Hearing Loss

2 mins

Left Hemisphere Stroke Assessment

Opposite Side Weakness (Hemiplegia)

Side to Side Discrimination

Aphasia

Agraphia

Slow Performance

Aware of Deficits

Anxiety

Depression

2 mins

Hydrocephalus

Increased CSF in Ventricles of Brain

Signs of Increased ICP

High Pitched Cry

Irritability

Opisthotonus

Increased Head Circumference

Bulging Fontanel

Setting Sun Sign

Seizure Precautions

Elevate HOB

CSF Shunt

2 mins

Lesions of the Brain and Presentations

Frontal Lobe

Parietal Lobe

Temporal Lobe

Occipital Lobe

Brainstem

Cerebellum

Epidural Hematoma

Subdural Hematoma

Contusion/ Parenchymal Hemorrhage

Intraventricular Hematoma

Subarachnoid Hemorrhage

Diffuse Axonal Injury

3 mins

Concussion

Brain Trauma

Neurometabolic Cascade

Visual Disturbances

Cognitive Dysfunction

Sleep Disturbances

Emotional Instability

Sport Concussion Assessment Tool 5th Edition (SCAT5)

Diagnostic Imaging

Physical and Cognitive Rest

Monitored Exercise

Vestibular Rehabilitation

Second Impact Syndrome

4 mins

Aphasia Post Stroke

Cerebrovascular Accident

Broca’s Aphasia

Wernicke’s Aphasia

Global Aphasia

Conduction Aphasia

Verbal Apraxia

Dysarthria

Cerebral Angiography

Computed Tomography

Magnetic Resonance Imaging (MRI)

Simple Short Sentences

Visual and Tactile Cues

Speech Therapy

4 mins

Rancho Los Amigos Levels of Cognitive Functioning Scale

Level I - No Response

Level II - Generalized Response

Level III - Localized Response

Level IV - Confused/Agitated

Level V - Confused, Inappropriate Non-Agitated

Level VI - Confused, Appropriate

Level VII - Automatic, Appropriate

Level VIII - Purposeful, Appropriate with Stand-by Assistance

Level IX - Purposeful, Appropriate with Stand-by Assistance on Request

Level X - Modified Purposeful, Appropriate

No General Localizes Aggresively Inappropriate Apples Automatically on Purpose

4 mins

Meningitis Assessment

Nausea and Vomiting

Fever

Nuchal Rigidity

Severe Headache

Purpura

Seizures

Photophobia

Opisthotonus Position

High-Pitched Cry

Bulging Fontanel

2 mins

Meningitis Interventions

IV Antibiotics

Dexamethasone

Analgesics

Antipyretics

Closely Monitor for Increased ICP

Bed Rest

Preventative Vaccinations

Droplet-Airborne Precautions

2 mins

Herpes Zoster (Shingles)

Varicella-Zoster Virus

Linear, Unilateral Rash Along a Dermatome

Pruritus

Postherpetic Neuralgia

Acyclovir

Analgesics

Gabapentin

Contagious Vesicles

Shingrix

3 mins

Primary Angle-Closure Glaucoma (PACG - Acute)

Rapid Increase in IOP

Rapid Onset

Pain

Blurred Vision

Halos Around Lights

Nausea and Vomiting

IOP over 30 mm Hg

Drug Therapy

Surgery

1 min

Primary Open-Angle Glaucoma (POAG - Chronic)

Flow of Aqueous Humor Slowed

Slow Onset

No Pain

Tunnel Vision

IOP 22-32mm Hg

Drug Therapy

1 min

Age-Related Macular Degeneration (AMD)

Dry (nonexudative)

Wet (exudative)

Scotomas

Blurred, Darkened Vision

Loss of Central Vision

Distortion of Vision

Drug Therapy

Surgery

Low-vision Assistive Devices

2 mins

Detached Retina

Flashes of Light

Floaters

Curtain Like Shadow

Eye Patch

Bed Rest

Surgical Emergency

No Vigorous Activity

2 mins

Cataract

Age-related

No Pain

Cloudy Opaque Lens

Decreased Visual Acuity

Occurs Gradually

Surgery

1 min

Nystagmus

Vestibulo-Ocular Reflex (VOR) Dysfunction

Vestibular Injury

Concussion

Upbeating or Horizontal Beating Eyes

Oscillopsia

HINTS (Head Impulse-Nystagmus-Test of Skew)

History Examination

INFARCT (Impulse Normal Fast-phase Alternating Refixation on Cover Test)

Visual Acuity Test

Brandt-Daroff Maneuver

Epley Maneuver

Baclofen

Congenital vs Acquired

4 mins

Internal Eye Abnormalities

Nuclear Cataract

Cortical Cataract

Papilledema

Optic Atrophy

Excessive Cup-Disc Ratio

Macular Degeneration

Scotomas

Increased Ocular Pressure

Retinal Detachment

Optic Tract Lesions

Arteriovenous Crossing

Attenuated Arteries

Diabetic Retinopathy

4 mins

External Eye Abnormalities

Strabismus

Exophthalmos

Ptosis

Ectropion

Entropion

Blepharitis

Dacryocystitis

Hordeolum (Stye)

Chalazion

Anisocoria

Mydriasis

Miosis

Pterygium

Hyphema

Hypopyon

4 mins

Age-Related Dizziness

Presbystasis

Visual Decline

Somatosensory Dysfunction

Vestibular Dysfunction

Muscular Atrophy

Increased Loss of Balance

Vertigo

Vestibular Rehabilitation

Strength Training

3 mins

Common Eye Disorders

Conjunctivitis

Refractive Errors

Presbyopia

Cataract

Glaucoma

Uveitis

Age-Related Macular Degeneration

Diabetic Retinopathy

Retinal Detachment

Leukocoria

Cranial Nerve Palsies

4 mins

Retinoblastoma

Loss of Heterozygosity

Chromosome 13

Children

Leukocoria

Strabismus

Vision Loss

Osteosarcoma

Genetic Testing

Cryotherapy

Photocoagulation

Chemotherapy or Radiation

Surgery

3 mins

Otitis Media Assessment

Red or Bulging Tympanic Membrane

Ear Pain

Pulling at Ear

Fever

Upper Respiratory Infection

More Common in Young Children

Eustachian Tube Narrower

Conductive Hearing Loss

Smoking Increases Risk

2 mins

Otitis Media Interventions

Antipyretics

Analgesics

Antibiotics

Irrigation

Position on Affected Side

Myringotomy

Tympanostomy Tube

2 mins

Meniere's Disease

Excess Endolymph

Tinnitus

One-sided Sensorineural Hearing Loss

Vertigo

Nausea and Vomiting

Meclizine (Antivert)

Low Salt Diet

Surgery

2 mins

Labyrinthitis/Vestibular Neuritis

Inner Ear Infection

Postural & Gait Instability

Vertigo

Nystagmus

Increased Fall Risk

Dizziness

Nausea and Vomiting

Medication

Vestibulo-Ocular Reflex (VOR)

Postural Control & Balance Training

Gait Training

Habituation Exercise

3 mins

Vestibular Disorders

Unilateral Vestibular Hypofunction

Vestibular Neuritis

Labyrinthitis

Vestibular Schwannoma (Acoustic Neuroma)

Bilateral Vestibular Hypofunction

Benign Paroxysmal Positional Vertigo

Meniere's Disease

Perilymphatic Fistula

Vertebrobasilar Insufficiency

Traumatic Head Injury

Vestibular Migraine

Brainstem & Cerebellar Conditions

3 mins

Brachial Plexus Roots

C5 through T1

Long Thoracic Nerve

Dorsal Scapular Nerve

43 secs

Brachial Plexus Trunks

Superior Trunk

Suprascapular Nerve

Middle Trunk

Inferior Trunk

1 min

Brachial Plexus Divisions

Anterior (Division)

Posterior (Division)

27 secs

Brachial Plexus Cords

Lateral Cord

Lateral Pectoral Nerve

Posterior Cord

Upper Subscapular Nerve

Thoracodorsal Nerve

Lower Subscapular Nerve

Medial Cord

Medial Pectoral Nerve

Medial Cutaneous Nerve of Arm and Forearm

1 min

Brachial Plexus Branches

Musculocutaneous Nerve

Axillary Nerve

Radial Nerve

Median Nerve

Ulnar Nerve

56 secs

Gastroesophageal Reflux Disease (GERD) Assessment

Relaxed Lower Esophageal Sphincter

Dyspepsia (Indigestion)

Belching

Nighttime Coughing

Dysphagia

Epigastric Pain

Regurgitation

Heartburn (Pyrosis)

Globus

2 mins

Barrett's Esophagus

Metaplasia in Lower Esophagus

Columnar Epithelium

Gastroesophageal Reflux Disease (GERD)

Esophagitis

Esophageal Ulcers

Increased Risk of Esophageal Adenocarcinoma

1 min

Mallory-Weiss

Bleeding From Tears in Mucosa

Forceful Vomiting

Alcoholism

Eating Disorders (Bulimia)

Painful Hematemesis

Endoscopy

Observation

2 mins

Boerhaave Syndrome

Esophageal Rupture

Increased Esophageal Pressure while Vomiting

Lower 1/3 of Esophagus

Chest Pain

Odynophagia

Subcutaneous Emphysema

Shock

Surgical Emergency

2 mins

Tracheoesophageal Fistula (TEF)

Esophageal Atresia

Ends in Blind Pouch

Coughing

Choking

Cyanosis

Drooling

NPO

Surgical Emergency

Aspiration Pneumonia

2 mins

Esophageal Adenocarcinoma Characteristics and Presentation

Most Common Esophageal Cancer in USA

Lower 1/3 of Esophagus

Gastroesophageal Reflux Disease (GERD)

Barrett's Esophagus

Achalasia

Obesity

Smoking

Weight Loss

Progressive Dysphagia

Anemia

2 mins

Dysphagia

Neurological Disorders

Muscular Disorders

Structural Abnormalities

Gastroesophageal Reflux Disease (GERD)

Inflammatory Conditions

Difficulty Swallowing

Choking or Coughing

Regurgitation

Clinical History and Physical Examination

Fiberoptic Endoscopic Evaluation of Swallowing (FEES)

Videofluoroscopy (Modified Barium Swallow Study - MBSS)

Treat Underlying Cause

Therapy

Dietary Modifications

Medications

Surgery

3 mins

Sialolithiasis

Stone Formation

Ducts of Major Salivary Glands

Recurrent Periprandial Pain

Swelling

Trouble Swallowing

Dehydration

Smoking Tobacco

Trauma

NSAIDs

Stimulation of Salivary Flow

Antibiotics

Surgery

2 mins

Peptic Ulcer Disease Interventions

Combination Drug Therapy

Two Antibiotics

Proton Pump Inhibitor (PPI)

Decrease Acid Secretion

Avoid NSAIDs

Diet and Lifestyle Changes

1 min

Peptic Ulcer Disease Assessment

Helicobacter Pylori

Increased Stomach Acid

Abdominal Pain

Heartburn (Pyrosis)

Melena

Weight Changes

GI Distress

Most Commonly in Duodenum

Duodenal: Pain Relieved by Eating

Gastric: Pain Caused by Eating

2 mins

Gastroenteritis

Viruses

Bacteria

Food Intolerances

Flu-Like Symptoms

GI Distress

Bloody Stool

Oral Rehydration

Self-Limiting

Prevention

2 mins

Hypertrophic Pyloric Stenosis (HPS) Assessment

Hypertrophied Pylorus

Macrolide Use

3-6 Weeks of Age

Projectile Vomiting After Feeding

No Pain or Discomfort

Weight Loss

Dehydration

Hungry Baby

Olive Mass

2 mins

Hypertrophic Pyloric Stenosis (HPS) Interventions

Pyloromyotomy

Stabilize Fluid and Electrolyte Balance

Nasogastric Tube

Monitor Feeding

Start Formula or Breastfeeding Within 24 Hours

Feedings Every 4-6 hours

Full Feeding Within 2 days

2 mins

Acute Gastritis

Erosive

Disruption of Mucosal Barrier

Caused by Stress

NSAIDs (Non-Steroidal Anti-Inflammatory Drugs)

Alcohol

Uremia

Burns

Curling's Ulcer

Brain Injury

Cushing Ulcer

Increase H+ Production

1 min

Chronic Gastritis

Type A

Fundus and Body

Autoimmune

Autoantibodies to Parietal Cells

Pernicious Anemia

Achlorhydria

Type B

Most Common Type

Helicobacter pylori

Antrum

Increased Risk of MALT Lymphoma

HIV/AIDS

Crohn's Disease

3 mins

Helicobacter Pylori

Gram-Negative

Bacilli

Curved

Polar Flagellum

Catalase-Positive

Oxidase-Positive

Gastric and Duodenal Ulcers

Ammonia

Neutral Environment

Gastric Adenocarcinoma

MALT lymphoma

Serology IgG antibody

Stool Antigen

Urease Positive Breath Test

Biopsy

2 ABX and PPI

2 mins

Helicobacter pylori Associations

Gastritis

Peptic Ulcer Disease

Stomach Cancer

50 secs

Colorectal Cancer Assessment

3rd Most Common Cancer

Change in Bowel Habits

Bowel Obstruction

Rectal Bleeding

Anemia

Weight Loss

Ascites

Colonoscopy

FOBT and FIT

2 mins

Irritable Bowel Syndrome (IBS) Assessment

Abdominal Pain

Relieved by Defecation

Alternating Diarrhea and Constipation

Fatigue

Excessive Flatulence

Sensation of Incomplete Evacuation

Stressors

Food Intolerances

More Common in Women

Rule Out Other Disorders

2 mins

Irritable Bowel Syndrome (IBS) Interventions

Identify Triggers

Increase Fiber Intake

Probiotics

Anticholinergics

Tricyclic Antidepressants (TCAs)

Loperamide

Linaclotide

Tegaserod (Zelnorm)

Lubiprostone (Amitiza)

Alosetron (Lotronex)

2 mins

Types of Hernias

Hiatal

Gastroesophageal Reflux Disease (GERD)

Inguinal

Men

Femoral

Women

Incisional

Umbilical

Strangulation

1 min

Hernia Interventions

Reduce Intra Abdominal Pressure

Avoid Straining and Lifting

Open Mouth Sneezing

Excision

Herniorrhaphy

Hernioplasty

Scrotal Support

1 min

Types of Intestinal Obstruction

Adhesions

Hernia

Volvulus

Intussusception

Tumor

Mesenteric Artery Occlusion

Spinal Injury

Paralytic Ileus

2 mins

Intestinal Obstruction

Severe Abdominal Pain

Vomiting

High Pitched Bowel Sounds

Abdominal Distention

Increased Peristalsis

Absent Bowel Sounds

Paralytic Ileus

1 min

Hirschsprung's Disease

Congenital Aganglionic Megacolon

No Peristalsis

No Meconium Within 24 Hours

Refusal to Feed

Abdominal Distention

No Stool on Rectal Exam

Forceful Expulsion of Fecal Material After Exam

Surgical Resection

Colostomy

2 mins

Celiac Disease

Intestinal Mucosa Damage

Ingestion Wheat, Barley, Rye

GI Distress

Steatorrhea

Weight Loss

Dermatitis Herpetiformis

Gluten-free Diet

Screening

2 mins

Chronic Mesenteric Ischemia

Intestinal Angina

Atherosclerosis

Celiac Artery

Superior Mesenteric Artery

Inferior Mesenteric Artery

Postprandial Epigastric Pain

Weight Loss

Angiography

Anticoagulation

Surgery

2 mins

Crohn's Disease Assessment

Diarrhea

5-6 per day

Cramping Abdominal Pain

Fever

Weight Loss

Malabsorption

Anemia

Obstruction

Fistulas

2 mins

Ulcerative Colitis Assessment

Cramping Abdominal Pain

Tenesmus

Bloody Diarrhea

Up to 10-20 / Day

Fever

Hemorrhage

1 min

Appendicitis Assessment

Obstruction of Appendix

Periumbilical Pain

RLQ Pain

Nausea/Vomiting/Anorexia

Increased White Blood Cells

Rebound Tenderness

Fever

Peritonitis

Sepsis

2 mins

Appendicitis Interventions

Appendectomy

Antibiotics

IV Fluids

No Enema or Laxative

Semi-Fowler's Position

Nasogastric Tube

Diet as Tolerated

Pain Management

Early Ambulation

2 mins

Diverticulosis and Diverticulitis Assessment

Outpouching

Inflamed Diverticula

Abdominal Pain

Abdominal Distention

Flatulence

Fever

Rectal Bleeding

Alternating Constipation and Diarrhea

Peritonitis

2 mins

Diverticulosis and Diverticulitis Interventions

High Fiber Diet

Reduce Intra-abdominal Pressure

Stool Softeners

Exercise

Anticholinergics

Antibiotics

Bowel Resection

2 mins

Cirrhosis Assessment

Degeneration and Destruction of Liver Cells

Jaundice

Fatigue

Palmar Erythema

Spider Angiomas

Hepatosplenomegaly

Edema

Gynecomastia

Change in LOC

2 mins

Cirrhosis Interventions

Maintain Nutrition

Paracentesis

Drug Therapy

Endoscopic Band Ligation or Sclerotherapy

Balloon Tamponade

Transjugular Intrahepatic Portosystemic Shunt (TIPS)

Lactulose

Antibiotics

2 mins

Complications of Cirrhosis

Portal Hypertension

Ascites

Esophageal Varices

Coagulation Defects

Portal-Systemic Encephalopathy

Hepatorenal Syndrome

1 min

Hepatitis A (HAV) Assessment

Fecal-Oral

Ingestion of Contaminated Food or Water

4 Weeks

Fever

General Malaise

Hepatomegaly

Self-Limiting

Proper Hand Washing

2 mins

Hepatitis B (HBV) Assessment

Bodily Fluids

Blood Transmission

People Who Use IV Drugs

Variable 1-6 Months

Fever

Nausea and Vomiting

Hepatomegaly

Cirrhosis

Hepatocellular Carcinoma

Vaccination

2 mins

Hepatitis C (HCV) Assessment

Blood Transmission

High Risk Sex (rare)

IV Drug Users

7 Weeks

Cirrhosis

Barrier Protection

2 mins

Nonalcoholic Fatty Liver Disease

Fat Infiltration of Hepatocytes in Absence of Alcohol Consumption

Obesity

Hyperlipidemia

Type II Diabetes

Often Found Incidentally

Elevated Liver Enzymes

Ultrasound

Weight Loss

Abstinence From Alcohol

3 mins

Autoimmune Hepatitis

Chronic Inflammatory Disease

Most Common in Females

Asymptomatic

Fatigue

Nausea

Pruritus

Antinuclear antibody (ANA)

Anti-smooth Muscle

Anti-Liver/Kidney Microsomal-1 Antibodies

Increased AST/ALT

Portal and Periportal Lymphoplasmacytic Infiltrate

Prednisone

Azathioprine

2 mins

Cholecystitis Causes

Gallbladder Inflammation

Female

Fair (Caucasian)

Fat (Obese)

Fertile (Pregnant)

Forty (Advanced Age Over 40)

Flatulence

2 mins

Cholecystitis Assessment

RUQ Pain

Referred Shoulder Pain

Clay Colored Stools

Jaundice

Nausea and Vomiting

Dyspepsia (Indigestion)

Fever

Increased WBCs

Fatty or Spicy Foods

Ultrasound

2 mins

Cholecystitis Interventions

Supportive Therapy

Antibiotics

Low Fat Diet

NG Tube

Analgesics

Lithotripsy

Cholecystectomy

T Tube

2 mins

Biliary Atresia

Cholestasis

Unknown Etiology

Persistent Jaundice

Acholic Stools

Hepatomegaly

Dark Urine

Lab Values

Ultrasound

Kasai Procedure

Liver Transplantation

Cirrhosis

Portal Hypertension

3 mins

Urinary Tract Infection Prevention and Treatment

Shower after Sex

Urinate after Sex

Wipe front to Back

I and Os with Daily Weights

Increase Water Intake

Antibiotics

Avoid Caffeine

Dr Appointment in 2 Weeks

Void every 2 - 4 hours

2 mins

Urinary Tract Infection Symptoms

More Common in Elderly

Most Common in Females and Babies

Change in LOC

Dehydration

Fever

Urgency

Urethral Infection

Burning

Smelly Urine

Dark Cloudy Urine

Frequency of Urination

2 mins

Marasmus

Deficiency of all Nutrients

Body Weight < 60% of Normal

Tissue and Muscle Wasting

Loss of Subcutaneous Fat (Buttocks and Thighs)

Variable Edema

2 mins

Renal Calculi Assessment

Hypercalcemia (Most Commonly)

Flank Pain

Radiates Toward Bladder

Renal Colic

Urinary Tract Infection

Urinary Retention

Hematuria

Stone Recurrence

2 mins

Kwashiorkor

Protein Deficiency

Swollen Belly

MEALS

Malnutrition

Edema

Anemia

Liver Malfunction

Skin Lesions

2 mins

Renal Calculi Interventions

Increase Fluid Intake

Opioids

NSAIDs

Antibiotics

Lithotripsy

Surgical Stone Removal

Identify Type CT-KUB

Low Sodium Diet

2 mins

Food Allergies and Restrictions

Gluten-Free

Lactose-Free

Plant-Based

Diabetic and Sugar-Free

Nut Allergy

Soy Allergy

4 mins

Urge Incontinence

Strong Urge To Void

Unable To Void Quickly Enough

Nocturia

Increased Frequency

Small Volume Voids

Increased Detrusor Muscle Activity

Avoid Caffeine & Alcohol

Anticholinergics

Mirabegron

Botox

Sacral Neuromodulation

2 mins

Functional Incontinence

Increased Urinary Volume

Unable to Timely Urinate

Dementia

Excessive Alcohol Consumption

Immobility

Scheduled Voiding

1 min

Overflow Incontinence

Increased Residual Urine Volume

Involuntary Urine Dribble

Urinary Frequency

Nerve Lesions Cause Bladder Atony

Bladder Outlet Obstruction

Weak Detrusor Muscles

Bethanechol

Catheterization

Sacral Neuromodulation

2 mins

Stress Incontinence

Urine Leak with Movement

Cough or Sneeze

Increased Intra-abdominal pressure

Laxity of Pelvic Floor Muscles

Urethral Sphincter Insufficiency

Kegel Exercises

Pessaries

Alpha-adrenergic Agonists

Surgery

History of Vaginal Birth

Cystocele

2 mins

Glomerulonephritis Assessment

Group A Beta-Hemolytic Streptococcal Infection

Hypertension

Hematuria

Proteinuria

Oliguria

Generalized Edema

Increased BUN and CR

Flank Pain

2 mins

Acute Glomerulonephritis Interventions

Rest

Restrict Salt and Fluid Intake

Restrict Protein

Antihypertensives

Diuretics

Antibiotics

2 mins

Chronic Glomerulonephritis Interventions

Corticosteroids

Antihypertensives

Erythropoietin

Cytotoxic Agents

Dialysis

Plasmapheresis

Transplant

2 mins

Pyelonephritis Assessment

Ascending Urethral Bacteria

Dysuria

Fever

Fatigue

Flank Pain

Costovertebral Tenderness

Nausea and Vomiting

1 min

Pyelonephritis Interventions

Urinalysis

NSAIDs

Antibiotics

Increase Fluid Intake

Avoid Catheterization

Urosepsis

1 min

Nephrotic Syndrome

Massive Proteinuria > 3.5g per Day

Edema

Increased risk of infection

Thromboembolism

Hyperlipidemia

Fatty casts

1 min

Nephritic Syndrome

Inflammatory

Hematuria

RBC casts

Increased Nitrogen in blood

Oliguria

Hypertension

Proteinuria < 3.5 grams per day

2 mins

Kidney Transplant

End Stage Renal Disease (ESRD)

Selective Candidacy

Close Compatibility

Immunosuppressants

Monitor for Rejection

Monitor for Infection

Monitor Urine Output

2 mins

Wilms' Tumor (Nephroblastoma)

Malignant Renal Tumor

Abdominal Mass

Hematuria

Fever

Hypertension

Nephrectomy

Chemotherapy

Radiation

Do Not Palpate Abdomen

Children Under 5 Years Old

2 mins

Chronic Kidney Disease Early Symptoms Assessment

GFR < 60mL/min

Accumulation of Waste Products

General Malaise

Hypertension

Proteinuria

Hyperkalemia

Mineral and Bone Disorders

Neuropathy

2 mins

Chronic Kidney Disease Late Symptoms Assessment

Metabolic Acidosis

Severe Uremia

Arrhythmias

Edema

CNS Depression

Anemia

Oliguria

Pruritus

End Stage Renal Disease (ESRD)

GFR < 15mL/min

2 mins

Chronic Kidney Disease Interventions

Daily Weights

Strict I/O

Renal Diet

Strict Medication Regimen

Erythropoietin

Manage Hyperkalemia

Manage CKD-MBD

Dialysis

Kidney Transplant

2 mins

Dialysis

Hemodialysis

Rapid Shifts of Fluid and Electrolytes

Disequilibrium Syndrome

Hypotension

NO BP IN ARM with Shunt or Fistula

Assess for Thrill and Bruit

Peritoneal Dialysis

Slow Process

Peritonitis

Loss of Protein

Hyperglycemia

3 mins

Rheumatic Fever Assessment

Aschoff Bodies

Carditis

Subcutaneous Nodules

Polyarthritis

Chorea

Erythema Marginatum

Fever

Arthralgia

Elevated ESR and C-reactive Protein

Rheumatic Heart Disease

2 mins

Rheumatic Fever Interventions

Antibiotics

Prophylactic Treatment

Relieve Joint Pain

Prevent Cardiac Complications

Educate Chorea is Temporary

1 min

Rheumatoid Arthritis Assessment

Destruction of Connective Tissue and Synovial Membrane

Inflammation of Joints

Morning Stiffness

Nodules

Joint Deformities

1 min

Rheumatoid Arthritis Interventions

Heat and Cold Applications

Therapeutic Exercise

Balance Rest and Activity

NSAIDs

DMARDs

Glucocorticoids

PT/OT

Reconstructive Joint Surgery

2 mins

Systemic Lupus Erythematosus (SLE) Interventions

Avoid Sunlight

Glucocorticoids

Methotrexate

NSAIDs

Hydroxychloroquine

Azathioprine

Monitor for Renal Failure (ARF)

Manage Pain

2 mins

Systemic Lupus Erythematosus (SLE) Assessment

Multisystem Inflammatory Disorder

Malar Rash

Discoid Rash

Arrhythmias

Arthritis

Hemolytic Anemia

Seizures

Glomerulonephritis

Periods of Exacerbation and Remission

Diagnosed by ANA (Anti-nuclear antibody assay)

2 mins

Rhinosinusitis Assessment

Sinus Obstruction

Nasal Drainage

Facial Pain

Lower Forehead

Cheeks

Nose

Retro-orbital

Fever

Persistent Symptoms

2 mins

Hemoglobin

Hemoglobin Has Four Iron Hemes

Lots Of Hemoglobin In Red Blood Cells

High O2 Levels Increase O2 Binding

High Temperature Reduces O2 Binding

High CO2 Levels Reduce O2 Binding

Low pH Reduces O2 Binding

Myoglobin Binds Oxygen in Muscle

2 mins

Whole Blood Composition

Plasma

Electrolytes And Other Solutes

Proteins

Albumin

Fibrinogen

Globulins

Water

Formed Elements

Buffy Coat

White Blood Cells (WBC)

Platelets

Red Blood Cells (RBC)

2 mins

Blood Types and Compatibilities

No Antigens (Type O Blood)

Universal Donor

A Antigen (Type A Blood)

B Antigen (Type B Blood)

AB Antigen (Type AB Blood)

Universal Recipient

Rh (Rhesus) Antigen

Never Rh+ to Rh-

Blood Transfusion

Obstetric Patient

2 mins

Coagulation Cascade

Secondary Hemostasis

Intrinsic Pathway

Partial Thromboplastin Time (PTT)

Heparin

Extrinsic Pathway

Prothrombin Time (PT)

Warfarin

Common Pathway

Thrombin

Convert Fibrinogen to Fibrin

Stabilizes the Platelet Plug

2 mins

Clotting Overview

Endothelial Cells are Damaged

Platelets Respond to Exposed Collagen and Stick

Platelets Release Recruiting Factors

More Platelets are Attracted

Soluble Fibrinogen Turns to Insoluble Fibrin

Fibrin Seals the Clot

Clot Dissolves

Liver Produces Clotting Factors

2 mins

Sickle Cell Anemia Assessment

Hemoglobin S (Genetic Defect)

Sickle Shaped RBCs

Jaundice

Vaso Occlusive Crisis

Fever

Priapism

Severe Pain

Prominent in African Americans

May be Asymptomatic

Increased Risk of Infection

2 mins

Sickle Cell Anemia Interventions

Increase Hydration

Analgesics

Oxygen

Warm Compress

Bone Marrow Transplant

Hydroxyurea

Avoid High Altitudes

Prophylactic Antibiotics

Avoid Strenuous Exercise

Vaccines

3 mins

Iron Deficiency Anemia

Malnutrition/Malabsorption

Hemorrhage

Microcytic, Hypochromic Anemia

Decreased Heme Synthesis

Decreased Reticulocytes

Decreased Ferritin

Increased Red Cell Distribution Width (RDW)

Poikilocytosis

Anisocytosis

Increased Central Pallor

2 mins

Types of Blood Products

Whole Blood

Packed Red Blood Cells

Fresh Frozen Plasma

Immunoglobulins

Clotting Factors

Albumin

Platelets

Use within 24 Hours

Washing Removes Antibodies

Irradiation Destroys WBCs

2 mins

Blood Transfusion Administration

Proper Patient Identification

Large Bore Needle

Y Tubing

Baseline Vital Signs

Slow IV Infusion

Monitor During First 15 Minutes or 50 mL of Blood

Monitor for Reactions

Do Not Add Anything To Same IV Line

No Dextrose or Lactated Ringers

Jehovah's Witnesses, No Transfusions

3 mins

Transfusion Reactions

Acute Hemolytic

Febrile, Non-Hemolytic

Mild Allergic

Anaphylactic

Circulatory Overload

Sepsis Reaction

Transfusion-Related Acute Lung Injury (TRALI)

Massive Blood Transfusion

2 mins

Leukemia Assessment

Immature WBCs

Recurrent Infections

Easy Bruising

Bleeding

Anemia

Fatigue

Weight Loss

Bone Pain

May Have Normal or High WBC Count

2 mins

Leukemia Interventions

Bone Marrow Aspiration

X-Rays

Chemotherapy

Bleeding Precautions

Neutropenic Precautions

Strict Asepsis

Bone Marrow Transplant

Blood Transfusions

Monitor Temperature Elevations

Adequate Nutrition

Imatinib (Gleevec) for Chronic Myelogenous Leukemia (CML)

3 mins

Hodgkin's Lymphoma Assessment

Lymph Node Cancer

Contiguous Spread

Painless Lymphadenopathy

Constitutional B Signs

Night Sweats

Fever

Weight Loss

Bimodal Age Distribution

Reed-Sternberg Cells

2 mins

Hodgkin's Lymphoma Interventions

Biopsy

Staging

Radiation

Chemotherapy

Treat Side Effects of Therapy

Secondary Cancer Screening

2 mins

Non-Hodgkin's Lymphoma Assessment

Lymphatic Cancer

Non-Contiguous Spread

B or T Cells

Painless Lymphadenopathy

Constitutional B Signs

Night Sweats

Fever

Weight Loss

Mediastinal or Abdominal Mass

Older Adults

> 60 Subtypes

2 mins

Primary Central Nervous System Lymphoma

EBV (Epstein Barr Virus)

HIV/AIDS

Elderly

Immunocompromised

Confusion

Memory Loss

Seizures

Blurry Vision

MRI

Single, Ring-Enhancing Lesion

CSF Analysis

Methotrexate

Radiotherapy

2 mins

Disseminated Intravascular Coagulation (DIC) Interventions

Risk for Shock

Renal Failure

Treat Underlying Cause

Manage Bleeding

Maintain Fluid and Hemodynamic Balance

Transfusion

Oxygenation

Heparin Drip

2 mins

Disseminated Intravascular Coagulation (DIC) Assessment

Improper Initiation of Clotting Cascade

Systemic Bleeding

Petechiae, Purpura, Ecchymosis

Change in LOC

Increased PT and PTT

Cyanosis

Increased Fibrin Degradation Products (FDP)

Decreased Platelets and Fibrinogen

2 mins

Polycythemia Vera Disease

JAK2 Mutation leading to increased red blood cells

Tyrosine Kinase

Erythromelalgia

Pruritus

Often After Hot Shower

Headache

Phlebotomy

Aspirin

1 min

Heparin Induced Thrombocytopenia (HIT)

5-10 Days After Heparin Exposure

Heparin-Platelet Factor 4 Complex

Autoantibodies Form Against Complex

Heparin-Platelet Factor 4-Antibody Complex Binds Platelets

Platelet Aggregation

Procoagulant Release

Thrombocytopenia

Serotonin Release Assay (SRA)

Stop Heparin, Start Direct Thrombin Inhibitor

2 mins

Venous Thromboembolism (DVT) Assessment

Venous Wall Inflammation caused by Thrombus

Tenderness

Edema

Warmth

Asymmetry

Could be Asymptomatic

Monitor for Pulmonary Embolism

58 secs

Venous Thromboembolism (DVT) Interventions

Anticoagulants

Prevention Education

Frequent Ambulation

Leg Exercises

Compression Stockings or SCD's

Avoid Nicotine and Oral Contraceptives

Surgery

1 min

Hemophilia

Genetic Mutation

Prolonged Bleeding

Pain

Hemarthrosis

Clotting Factor Replacement Therapy

DDAVP (Desmopressin Acetate)

Antifibrinolytic Therapy

Analgesics

Genetic Counseling

Prevent Injury

3 mins

ABCDEs of Melanoma

Asymmetry

Border

Color

Diameter

Evolving

1 min

Cancer Warning Signs (CAUTION)

Change in Bowel or Bladder Habits

A Sore That Does Not Heal

Unusual Bleeding or Discharge

Thickening or Lump in the Breast or Elsewhere

Dyspepsia (Indigestion)

Obvious Change to Warts or Moles

Nagging Cough

1 min

Rule of 9's for Burns

Total Body Surface Area (TBSA)

Head

Chest

Abdomen

Upper Back

Lower Back

Posterior Leg (each)

Anterior Leg (each)

Each Arm

Genitalia 1%

2 mins

Parkland Formula

Burn victims

24 hours

TBSA %

x Weight (kg)

x 4

= Fluid Requirement (in first 24 hrs)

1/2 of fluid given in first 8 hours

1 min

Types of Burns

Superficial Thickness

Sunburn

Superficial Partial Thickness

Blisters

Blanching

Deep Partial Thickness

Little or Non-blanching

Full Thickness

Waxy White, Yellow or Black

Decreased Pain

2 mins

Stages of Burn Care

Resuscitative/Emergent Phase

Injury to Return of Capillary Permeability

48-72 hours

IV Fluid Replacement

Acute Phase

Diuresis to Near Wound Closure

Wound Closure to Return of Optimal Level

2 mins

Burns Assessment

Stage and Extent of Burn

Dyspnea

Singed Nasal Hairs

Pain

Initial Decrease Urinary Output

Paralytic Ileus

Signs of Inadequate Hydration

Shock

Hypothermia

Hyperkalemia

2 mins

Burns Interventions

Ensure Airway Patency

O2

IV Fluid Replacement

Dry Sterile Dressing

Debridement

Elevate Burned Limbs

Analgesics

Silver Sulfadiazine

Escharotomy

2 mins

Burns Considerations

Maintain Body Temperature

Increased Risk of Infection

Venous Thromboembolism (VTE) Prophylaxis

Curling's Ulcer

Excision and Grafting

Adequate Nutrition

Contractures

2 mins

R.I.C.E. (Treating Soft Tissue Injury)

Rest

Ice

Compression

Elevation

1 min

Wound Drainage Types and Devices

Serous

Serosanguineous

Sanguineous

Purulent

T-tube

Penrose

Jackson-Pratt (JP)

Hemovac

Record Drainage Amounts

Check Device Function

2 mins

Types of Wound Healing

Acute

Chronic

Primary Intention

Approximated Edges

Secondary Intention

Edges Not Approximated

Tertiary Intention

Delayed Closure due to Infection and Necrosis

2 mins

Braden Scale

Sensory Perception

Moisture

Activity

Mobility

Nutrition

Friction and Shear

2 mins

Interventions for Impaired Skin Integrity

Signs of Skin Breakdown

Pain

Redness

Decreased Skin Turgor

Bleeding

Bony Prominences

Reposition Q2H

Pressure Relief

Maintain Clean and Dry Skin

Adequate Nutrition and Hydration

2 mins

Pressure Ulcers

Prolonged Immobilization

Neurologic Disease

Decreased Level of Consciousness

Stage 1: Intact Skin with Non-blanchable Erythema

Stage 2: Partial Thickness Skin Loss

Stage 3: Full-thickness Skin Loss without Fascial Involvement

Stage 4: Full-thickness Skin Loss with Fascial Involvement

Wound Care

Surgery

Septicemia

Osteomyelitis

Prevention

3 mins

Scabies

Sarcoptes Scabiei Mite

Pruritus

Papules with Burrows

Webs of Fingers and Toes

Axilla and Nipples

Skin Scraping

Dermoscopy

Mites and Eggs on Magnification

Permethrin Cream

Oral Ivermectin

Lindane Cream

Wash All Linens In Hot Water

3 mins

Psoriasis

Epidermal Hyperproliferation Keratinocytes

Defined Red Salmon Plaques

Silvery Scales

Extensor Surfaces

Bleeding when Removed

Auspitz Sign

Pruritus

Nail Changes

Munro Microabscesses

Nucleated Cells in Stratum Corneum

Retinoids

Topical Corticosteroids

Tar

Immunosuppressants

2 mins

Atopic Dermatitis / Eczema

Pruritic Vesicles

Inflammatory Skin Rash

Cheeks in Children

Skin Flexural Areas

Associated with Asthma and Allergic Rhinitis

Tacrolimus

Moisturizers

Corticosteroids

Phototherapy

Avoid Triggers

Antihistamines

2 mins

Rosacea

Episodes Provoked by Alcohol, Heat, or Emotions

Facial Flushing and Telangiectasias

Sun Protection

Topical Brimonidine

Papules and Pustules

Topical Metronidazole

Rhinophyma

Laser Ablation

Avoid Triggers

2 mins

Acne Vulgaris Presentation and Pathophysiology

Papules/Comedones in Mild Cases

Blackheads Open, Whiteheads Closed

Pustules in Mild-Moderate Cases

Nodules/Cysts in Severe Cases

Inflammation at Hair Follicle/Sebaceous Gland

Increased Androgens

Colonization by Cutibacterium Acnes

3 mins

Impetigo

Transmission

Incubation

Non-Bullous

Bullous

Clinical Presentation

Antibiotics

Hygiene

Return to Work or School

Post-streptococcal Glomerulonephritis

Rheumatic Fever

Staphylococcal Scalded Skin Syndrome

2 mins

Allergic Contact Dermatitis

Type IV Hypersensitivity

Physical Contact with Allergen

Nickel

Neomycin

Poison Ivy

Urticaria

Pruritus

Erythematous, Vesicular

Patch Testing

Avoid Cause

Topical Hydrocortisone

Antihistamines

Cool Water Soaks

2 mins

Albinism

Normal Melanocyte Number

Decreased or Absent Melanin Production

Decreased or Absent Tyrosinase Activity

Defective Tyrosine Transport

Genetic Mutation

Hypopigmentation

Ocular Disturbances

Sunburn

Avoid UV Light

Nitisinone

Increased Risk of Skin Cancer

2 mins

Types of Fractures

Nondisplaced

Displaced

Incomplete

Complete

Closed

Open

Direction of Fracture Line

2 mins

Hip Fracture

External Rotation

Muscle Spasms

Shortened Leg

Pain

Buck's Traction

Analgesics

Surgery

Avascular Necrosis

1 min

Hip Surgery

Neurovascular Assessment

No 90 Degree Hip Flexion

No Adduction

No Internal Rotation

Avoid Turning on Affected Side

Thromboembolism Prevention

2 mins

Neurovascular Assessment 6 P's

Pain

Paresthesia

Pulse

Pallor

Pressure

Paralysis

1 min

Weight-Bearing Restrictions

Orthopedic

Help Limb or Joint Surgeries Heal Properly

Non-Weight Bearing (NWB)

Toe-Touch Weight Bearing (TTWB)

Partial Weight Bearing (PWB)

Weight Bearing as Tolerated (WBAT)

Full Weight Bearing (FWB)

2 mins

Sizing Crutches

3 Finger Widths

6 Inches Lateral From Heel

30 Degree Flexion

Tripod Position

1 min

Spinal Cord Injuries

Spinal Shock

Respiratory Complications

Autonomic Dysreflexia (Hyperreflexia)

Orthostatic Hypotension

Deep Vein Thrombosis

Thermal Regulation

Circulatory Problems

Spasticity

Dermal Complications

Genitourinary Complications

Anterior Cord Syndrome

Central Cord Syndrome

Brown-Sequard’s Syndrome

Conus Medullaris Syndrome

Cauda Equina Syndrome

4 mins

Total Knee Replacement (TKR)

Joint Pain (Uncontrolled)

Impaired Mobility

Compression Dressing

Frequent Neurovascular Assessments

Continuous Passive Motion (CPM) Devices

Early Ambulation

Venous Thromboembolism (VTE) Prophylaxis

Limit Flexion Positions

Monitor for Infection

2 mins

Herniated Disc (Nucleus Pulposus)

Spine Trauma

Natural Degeneration

Spinal Stenosis

Pain

Weakness

Urinary and Fecal Incontinence

Brace

Medications

Outpatient Procedures

Surgery

2 mins

Amputation

Trauma

Peripheral Vascular Disease

Diabetes Complications

Gentle Handling

Surgical Tourniquet at Bedside

Prevent Contractures

Frequent Inspection

Compression Bandages

Phantom Pain

Mirror Therapy

2 mins

Compartment Syndrome Assessment

Trauma

Increased Pressure

Compressed Nerves and Blood Vessels

1 or more of 6 P's

Ankle-Brachial Index (ABI)

May take Days to develop

Early Detection

Ischemia

Damage often Irreversible

2 mins

Compartment Syndrome Interventions

Frequent Neurovascular Assessments

Evaluate Pain

Do Not Elevate Extremity

Remove or Loosen Restrictive Items

Fasciotomy

Amputation

Infection

Monitor Urine Output

2 mins

Reactive Arthritis

Type III Hypersensitivity Reaction

HLA-B27

Campylobacter jejuni

Chlamydia trachomatis

Salmonella

Yersinia enterocolitica

E. coli

Shigella

Arthritis

Urethritis

Conjunctivitis

2 mins

Osteoarthritis

Articular Cartilage Destruction

Biomechanical Stress

Aging

Asymmetric

Pain Decreases with Rest

Morning Stiffness Under 30 Minutes

Crepitus

DIP and PIP Joints

Lifestyle Changes

Acetaminophen or NSAIDs

2 mins

Osteoarthritis Assessment

Aging

Articular Cartilage Destruction

Biomechanical Stress

Asymmetric

Pain Decreases with Rest

Morning Stiffness under 30 Minutes

Crepitus

DIP and PIP Joints

1 min

Osteoarthritis Interventions

Balance Rest and Activity

Therapeutic Exercise

Heat and Cold Applications

Intra-articular Injection

NSAIDs

Reconstructive Joint Surgery

1 min

Osteoporosis Assessment

Postmenopausal Women

Long Term Corticosteroids

Kyphosis

Dowager's Hump

Loss of Height

Back Pain

Pathologic Fractures

Spinal Compression Fracture

1 min

Osteoporosis Interventions

Increased Calcium Intake

Vitamin D Supplements

Bisphosphonates

Raloxifene

Denosumab

Calcitonin

Teriparatide

Bone Densitometry (DEXA) Scan

Weight Bearing Exercises

2 mins

Osteomyelitis

Bone Infection

Warmth

Edema

Constant Bone Pain

Fever

IV Antibiotics

Implanted Beads

Hyperbaric Oxygen

Surgical Removal of Ischemic Tissue

Elevated ESR

3 mins

Scoliosis

S Shaped Lateral Spinal Rotation

Unequal Shoulder and Scapula Height

Uneven Gait

Impaired Oxygenation

Hump when Bending Forward

Body Braces

Worn 23 Hours/Day

Surgery

Adolescent Screening

3 mins

Muscular Dystrophy

X-linked Recessive

Muscle Weakness

Motor Problems

Gower Sign

Large Calves

Waddling Gait

Loss of Ambulation

Cardiac and Respiratory Failure

2 mins

Gout Disease

Acute Inflammatory Monoarthritis

Primarily in Males

Precipitation of Monosodium Urate Crystals

Underexcretion of Uric Acid

Overproduction of Uric Acid

Negatively Birefringent, Needle-Shaped

Swollen, Red, Painful Joint

Asymmetric Joint Distribution

Podagra

Tophus

After Large Meal or Alcohol

2 mins

Gout Treatment

NSAIDs

Glucocorticoids

Colchicine

Impairs Leukocyte Chemotaxis

Inhibit Xanthine Oxidase

Allopurinol

Febuxostat

Inhibit Reabsorption of Uric Acid

Probenecid

1 min

Pseudogout

> 50 Years Old

Arthritis of Large Joints (Classically the Knee)

Calcium Pyrophosphate Crystals

Positively Birefringent

Chondrocalcinosis (On X-ray)

NSAIDs

Colchicine

Steroids

1 min

Osgood-Schlatter Disease (Tibial Tubercle Apophysitis)

Apophysitis of Tibial Tubercle

Active, Young Boys

Running and Jumping

Overuse Injury

Recent Growth Spurt

Diagnosis Made on History

Anterior Knee Pain

Enlarged Tibial Tubercle

Edema

Rest

NSAIDs

Activity Restriction

Self-limiting

2 mins

Ganglion Cyst

Benign

Fluid-filled Swelling

Water Balloon on a Straw

Herniation of Dense Connective Tissue

Dorsal Side of Wrist

Observation

Surgery

Resolves Spontaneously

1 min

Erectile Dysfunction

Age-Related Changes

Psychological

Medical Conditions

Drug-Induced

Sexual Dysfunction (Unable to Maintain Erection)

Phosphodiesterase Type 5 (PDE5) Inhibitors

Vacuum Constriction Devices

Intraurethral Devices

Penile Implants

Sexual Counseling

2 mins

Benign Prostatic Hyperplasia (BPH) Assessment

Men Over 50

Enlarged Prostate Gland

Urinary Retention

Weak Urine Stream

Frequency

Urgency

Nocturia

1 min

Benign Prostatic Hyperplasia (BPH) Interventions

Timed Voiding

Decreased Caffeine Intake

Catheterization

Finasteride (Proscar)

Tamsulosin (Flomax)

TURP Procedure

Open Prostatectomy

Continuous Bladder Irrigation (CBI)

2 mins

Prostate Cancer Assessment

Most Common Cancer in Men

Mimics BPH

Metastasis to Back

Low Back Pain

Fatigue

Prostate Specific Antigen (PSA)

Digital Rectal Examination (DRE)

Transrectal Ultrasound (TRUS)

Biopsy

2 mins

Hydrocele

Impaired Lymphatic Drainage

Large Scrotum

Painless

Needle Aspiration or Surgery

Scrotal Support

Monitor for Bleeding and Infection

1 min

Prostatitis

Chronic Bacterial Prostatitis

Acute Bacterial Prostatitis

Sexually Transmitted Organisms

E. Coli Infection

Flu-Like Symptoms

Perineal Pain

Dysuria

Sexual Dysfunction

Recurrent UTIs

Urinalysis

Tender Boggy Prostate

Antibiotics

Chronic Prostatitis

3 mins

Infertility

No Conception After 1 Year

Artificial Insemination

In Vitro Fertilization (IVF)

Clomiphene Citrate (Clomid)

Menotropins

GnRH Agonists

Treat Underlying Disorders

Emotional Support

Multiple Gestations

3 mins

Benign Prostatic Hyperplasia (BPH) Diagnosis and Treatment

Digital Rectal Exam

Urinalysis to Detect Infection or Blood

Alpha-1 Antagonists

Tamsulosin

5 Alpha Reductase Inhibitors

Finasteride

TURP (Transurethral Resection of Prostate)

1 min

Prostate Adenocarcinoma Characteristics and Presentation

Most Common Cancer in Men

Screening Test if Suspicious

Prostate Specific Antigen (PSA)

Peripheral Zone

African American

Advanced Age

Usually Asymptomatic

Terminal Hematuria

Urinary Retention or Incontinence

Lower Back Pain

2 mins

Breast Cancer Diagnosis

Mammography

Ultrasound

MRI for High Risk Patients

Confirmed with Biopsy

Lymph Node Involvement

Receptor Positivity

Estrogen and Progesterone Receptors

HER-2

2 mins

Breast Cancer Interventions

Radiation or Chemotherapy

Hormonal Therapy

Tamoxifen

Lumpectomy

Mastectomy

Avoid BP and Injections Affected Arm

Hand Exercises

Grief Related to Body Image

Prosthetics

Reconstruction

Lymphedema

3 mins

Endometriosis

Endometrial Tissue Outside Uterus

Retrograde Menstrual Flow

Dysmenorrhea

Cyclic Pelvic Pain

Irregular Vaginal Bleeding

Pain with Defecation

Dyspareunia

Medications to Decrease Ovulation

NSAIDs

Surgery

2 mins

Pelvic Inflammatory Disease (PID) Assessment

Untreated Cervicitis

May Be Asymptomatic

Dysuria

Vaginal Discharge with Odor

Fever

Dyspareunia

Lower Abdominal Pain

Spotting

Cervical Motion Tenderness

2 mins

Pelvic Inflammatory Disease (PID) Interventions

Antibiotics

No Intercourse for 3 Weeks

Semi-Fowler's Position

Analgesics

Monitor Temperature

Treat Partners

2 mins

Contraception

Preventing Unplanned Pregnancy

Spermicides

Diaphragm

Cervical Cap

Contraceptive Sponge

Male Condom

Oral Contraceptive

Intrauterine Device (IUD)

Injectable Progestins

2 mins

Dysfunctional Uterine Bleeding

Bimodal Age Distribution

Painless Vaginal Bleeding

Amenorrhea

Menorrhagia (Heavy Menstrual Bleeding)

Metrorrhagia (Bleeding Between Menses)

Balloon Thermotherapy

Hormone Medications

Dilation and Curettage (DandC)

Monitor for Anemia

3 mins

Vaginitis

Infection

Postmenopausal Atrophy

Vaginal Discharge

Pruritus

Antifungals (Miconazole, Clotrimazole)

Antibiotics

Estrogen Hormones

Abstinence

Good Hygiene

Recurrent Vaginitis

2 mins

Menopause Symptoms

HAVOCS Mnemonic

Hot Flashes

Atrophy of Vagina

Osteoporosis

Coronary Artery Disease (CAD)

Sleep disturbances

50 secs

Postpartum Blues

Depressed Affect

Tearfulness

Fatigue

Resolves in 2 Weeks

Supportive Care

2 mins

Gonorrhea

Neisseria gonorrhoeae

Dysuria

Yellowish-Green Discharge

Increased Urinary Frequency

Women Often Asymptomatic

Ceftriaxone (IM)

Doxycycline

Azithromycin

Treat Partners

2 mins

Chlamydia

Chlamydia trachomatis

May Be Asymptomatic

Dysuria

Epididymitis

Discharge

Dyspareunia

Doxycycline

Azithromycin

No Intercourse for 1 Week

Treat Partners

2 mins

Genital Herpes

Herpes Simplex Virus 1 and 2 (HSV)

May Be Asymptomatic

Oral or Genital Lesions

Vesicles in Clusters

Pain

Flu-like Symptoms

Acyclovir

Valacyclovir

Famciclovir

Infectious During Recurrences

2 mins

Syphilis

Treponema pallidum

Painless Chancre

Rash on Palms and Soles

(Generalized) Lymphadenopathy

Condylomata Lata

Asymptomatic

Aortitis

Neurosyphilis

Gummas

Penicillin

Jarisch-Herxheimer Rash

3 mins

Genital Warts - Condylomata Acuminata

Human Papillomavirus (HPV)

Papillary Cauliflower Like Growths

Bleeding

Vaginal Discharge

Wart Removal

Trichloroacetic acid (TCA)

Podophyllin resin

Cryotherapy

HPV Vaccine

Cervical Cancer

2 mins

Ovulatory Hormones I - Follicular Phase

0-14 Days

GnRH Stimulates FSH and LH

Follicle Secretes Estrogen

Negative Feedback from Estrogen

Increased Estrogen Leads to Positive Feedback

FSH and LH Surge

LH Spike Leads to Ovulation

2 mins

Ovulatory Hormones II - Luteal Phase

Days 15-28

Corpus Luteum

Secretes Progesterone

Negative Feedback inhibits FSH and LH

No pregnancy forms Corpus Albicans

Stops Estrogen Secretion

Endometrial Sloughing - Menses

GnRH secretion produces new follicular phase

2 mins

Fetal Circulation

Placenta

Umbilical Vein

Ductus Venosus

Right Atrium

Foramen Ovale

Left Atrium

Aorta

Right Ventricle

Ductus Arteriosus

Umbilical Arteries

2 mins

Postnatal Circulation

Infant Breathes

Decreased Pressure in Pulmonary Vasculature

Decreased Right Heart Pressure

Increased Left Atrial Pressure

Closes Foramen Ovale

Increased O2

Decreased Prostaglandins

Closed Ductus Arteriosus

Open with Prostaglandins

Closed with Indomethacin

3 mins

Imperforate Anus

Congenital Anorectal Malformation

No Anal Opening

Absence of Meconium

Gradual Increase in Abdominal Distention

Surgical Repair

Bowel Management

2 mins

Developmental Dysplasia of the Hip

Abnormal Femoral Head in Acetabulum

Positive Barlow Sign

Clicking with Adduction

Positive Ortolani Sign

Clicking with Abduction

Asymmetrical Limb Lengths and Folds (Gluteal and Thigh)

Trendelenburg Sign

Abduction Device

Pavlik Harness

Closed Reduction

3 mins

Hyperbilirubinemia

Increased Unconjugated Bilirubin

Jaundice

Kernicterus

Early Feedings

Heme Oxygenase Inhibitors

Phototherapy

Protect Eyes

Monitor for Dehydration

Monitor Bilirubin Levels

3 mins

Preeclampsia Assessment

After 20 Weeks of Pregnancy

Hypertension > 140/90

Proteinuria or End-Organ Dysfunction

Hypertension > 160/110

Progressive Renal Insufficiency

Vision Changes

HELLP Syndrome

Pulmonary Edema

2 mins

Preeclampsia Interventions

Side Lying Position and Bedrest

Antihypertensives

Magnesium Sulfate

Labor Induction

1 min

Eclampsia

Increased Central Nervous System Irritability

Hyperreflexia

Positive Ankle Clonus

Headaches

Visual Disturbances

Epigastric or RUQ Pain

Seizures

Coma

Don't Leave Bedside

Magnesium Sulfate

2 mins

Severe Preeclampsia

Vasospasm and Decreased Organ Perfusion

Intravascular Coagulation

Increased Permeability and Capillary Leakage

Hypertension

Proteinuria or End-Organ Dysfunction

Hepatic Dysfunction and Hemolysis

Elevated Liver Enzymes

Low Platelet Counts

3 mins

Incompetent Cervix

Premature Cervical Dilation

Recurring Miscarriage

Short Cervix

Cervical Cerclage

Rest

Labor

1 min

Prolapsed Umbilical Cord

Cord Prolapses

Visualization of Cord

Prolonged or Variable Decelerations

Hips Elevated

Insert 2 fingers in Vagina

Saline Towel on Cord

Oxygen

2 mins

Chorioamnionitis

Fever

Maternal or fetal tachycardia

Leukocytosis

Foul Odor to Amniotic Fluid

Treatment: Antibiotics

Monitor uterine tenderness, contractions and fetal activity

Monitor maternal vital signs & FHR

2 mins

RhoGam [Rho(D) Immune Globulin]

Antepartum Prevention at 28 weeks

Suppress Antibody Production

Lysis of Fetal RBC in Maternal Bloodstream

Myalgia and Lethargy

Negative Coombs Test

Standard Dose 300 mcg

Microdose 50 mcg

Blood Product

2 mins

Spontaneous Abortion Overview

Bleeding < 20 weeks Gestation

Identify Type

Bed Rest

Monitor for Hemorrhage

Save Pads and Linens

RhoGAM

Dilation and Curettage (DandC)

Cerclage

Emotional Support

2 mins

Hydatidiform Mole (Molar Pregnancy)

Abnormal Fertilization

Symptoms of Pregnancy

Elevated hCG

Vaginal Bleeding

Inappropriate Uterine Growth

No Fetal Heart Rate (FHR)

Dilation and Curettage (D&C)

Emotional Support

No Pregnancy 1 Year

Hysterectomy

3 mins

Pregnant Cardiac Patient Assessment

Cardiac Decompensation

Frequent Cough

Dyspnea

Palpitations

Excessive Fatigue

Pulse > 100 bpm

Crackles

2 mins

Pregnant Cardiac Patient Interventions

Monitor for Cardiac Decompensation

Stool Softener

Calcium Channel Blockers

ECG Monitor

Open Glottis Pushing

Pulmonary Artery Catheter

No Beta-Adrenergic Medications

Penicillin Prophylaxis

Stress on Heart

2 mins

Pregnant Diabetic Patient Interventions

Increase Insulin then Decrease

Metformin

Nutrition

Exercise

Increase Insulin

More Likely to Develop Hypoglycemia than Hyperglycemia

Double or Quadruple Insulin

Early Delivery

Drastically Decrease Insulin

Monitor Neonate for Hypoglycemia

3 mins

Placental Implantation Abnormalities

Placenta Adheres Directly to Myometrium

Placenta Accreta

Placenta Increta

Placenta Percreta

Caused by Scar Tissue

Hemorrhage

Ultrasound is First-line, then MRI

C-section Delivery

Artery Ligation or Embolization

2 mins

Placenta Previa

Placenta Covers Cervical Os

Painless

Bright Red Vaginal Bleeding

Stable Fetus

Bed Rest

Observation

Unstable Fetus

C-section Delivery

Risk for Shock

Magnesium Sulfate

Tocolysis

3 mins

Abruptio Placentae

Premature Separation of Placenta

Tearing Pain

Bleeding (Often Concealed)

Rigid Uterus

Contractions

Corticosteroids as Needed

Emergent Delivery

Increased Risks for Neonate

Rh (Rhesus) Incompatibilities

Increased Risk for Shock

Monitor Fetal Heart Rate

3 mins

Ectopic Pregnancy

Lower Abdominal Pain

Delayed Menses

Abnormal Vaginal Bleeding

Shock

Referred Shoulder Pain

Cullen Sign

Methotrexate

Surgery

RhoGAM

2 mins

TORCHeS Screening

Toxoplasmosis

Other

Rubella

Cytomegalovirus (CMV)

Herpes Simplex Virus (HSV)

Syphilis

Diagnostic Testing

3 mins

Cytomegalovirus (CMV) TORCH

Nonspecific TORCH symptoms

Intrauterine Growth Restriction (Retardation)

Deafness

Microcephaly

Seizures

Periventricular Calcifications

Petechial Rash

Blueberry Muffin Rash

Chorioretinitis

Urine Viral Culture or PCR

2 mins

Syphilis TORCH

Nonspecific TORCH Symptoms

Often Results in Stillbirth

Hydrops Fetalis

Saber Shins

Notched Teeth

Saddle Nose

Blindness

Deafness

Hepatitis

3 mins

Rubella TORCH

Nonspecific TORCH Symptoms

Patent Ductus Arteriosus

Pulmonary Artery Hypoplasia

Cataracts

Deafness

Blueberry Muffin Rash

Glaucoma

1 min

Toxoplasma gondii TORCH

Congenital TORCH Infection

Mom Usually Asymptomatic

Rarely Lymphadenopathy

Nonspecific TORCH Signs

Intrauterine Growth Retardation

Hepatosplenomegaly

Deafness

Chorioretinitis

Hydrocephalus

Calcifications

1 min

Postpartum Infection

Fever > 100.4F After 24 Hours (38 C)

Multiple Vaginal Examinations

Vaginal Trauma

Prolonged Rupture of Membranes

Cesarean Birth

Anemia of Pregnancy

Retained Placental Fragments

Poor Health Status

3 mins

Postpartum Hemorrhage

Uterine Atony

Lacerations

Retained Placenta

Bleeding

Hypotension

Boggy Uterus

Oxytocin

Bimanual Compression of Uterus

Surgery

Blood Transfusion

2 mins

Cleft Lip or Palate Interventions

Encourage Bonding

Prosthodontic Device

Modified Nipple

Burping

Surgical Repair

Normal Saline Rinse

Elbow Restraints

Avoid Rigid Eating Utensils

2 mins

Cerebral Palsy (CP)

Maternal Infections

Fetal Hypoxia

Developmental Delay

Neurological Dysfunction

Spasticity

Dysphagia

Muscle Relaxants

Muscle Exercises

Assistive Devices

Braces

2 mins

Muscle Types

Skeletal Muscle

Somatic Nervous System

Striated

Multinucleate

Cardiac Muscle

Autonomic Nervous System

Myogenic

Gap Junctions

Uninucleate

Smooth Muscle

2 mins

Clubfoot

Multifactorial Congenital Anomalies

Fetal Position

Deformed Foot and Ankle Position

Talipes Equinovarus

Serial Casting

Ponseti Method

Early Surgery

2 mins

Skeletal Muscle Contraction Initiation

Somatic Motor Neuron Releases Acetylcholine

Acetylcholine Causes Sodium Influx

Cell Reaches All-or-Nothing Threshold

Voltage-Gated Calcium Channels Undergo Conformational Change

Sarcoplasmic Reticulum Causes Calcium Flood

Calcium Flood Enters Myofibrils

1 min

Tetralogy of Fallot (TOF)

Blue Baby Syndrome

PROVe Acronym

Pulmonary Infundibular Stenosis

Right Ventricular Hypertrophy

Overriding Aorta

Ventricular Septal Defect (VSD)

Boot-Shaped Heart

Squatting for Tet Spells

Surgery

2 mins

Skeletal Muscle Contraction Action

Calcium Binds Troponin

Active Site Exposed

Many Mitochondria Produce ATP

Myosin Head Binds

Power Stroke

Myosin Head Releases Active Site

ATP Consumed

1 min

Neuron Resting Potential

More Na+ Outside

Sodium-Potassium Pump

K+ Leaks Out

More K+ Inside

About -70mV

Voltage-Gated Sodium Channels are Closed

2 mins

Neuron Action Potential Initiation

Summation of Signals

-50 mV Threshold Value Reached

Voltage-Gated Sodium Channels Open

Local Depolarization

Na+ Influx

Potassium Channels open

Repolarization

2 mins

Neuron Action Potential Propagation

Unidirectional Depolarization

Absolute Refractory Period In Preceding Na+ Channels

Neighboring Voltage Gate Channels Open

Nodes of Ranvier

Myelination Increases Propagation Speed

Saltatory Conduction

3 mins

Chemical Synapse

Voltage-Gated Calcium Channels Open

Ca2+ Influx

Vesicle-Membrane Fusion

Exocytosis of Neurotransmitter

Neurotransmitter Binds Post-Synaptic Receptors

Neurotransmitter Breakdown

Neurotransmitter Reuptake

1 min

Somatic Reflex Arc

Spinal Cord

Sensory (Afferent) Neuron

Interneurons Transmit

Motor (Efferent) Neuron

Effector Targets

1 min

Stomach Digestion

Chief Cells Secrete Pepsinogen

Pepsinogen Turned to Pepsin By H+

Protein Breakdown Begins

Mucous Cells Secrete Mucus and Bicarbonate

G Cells Secrete Gastrin

Gastrin Stimulates Parietal Cell HCl Release

Parietal Cells Secrete Intrinsic Factor

2 mins

Small Intestine Digestion

Brush border enzymes

Pancreatic Enzymes are secreted via a Duct

Pancreas secretes bicarbonate

Brush Border activates Pancreatic Trypsin

Trypsin activates Chymotrypsin

Trypsin and Chymotrypsin digest Proteins

Gallbladder Releases Bile

Pancreatic Lipase breaks down Lipids

Goblet cells secrete mucus

Pancreatic Amylase breaks down Carbohydrates

Pancreatic Nucleases breakdown DNA/RNA

Digestion occurs in the Duodenum

2 mins

Small Intestine Absorption

Carbohydrates Undergo Active Transport

Amino Acids Undergo Active Transport

Small Lipids Undergo Passive Diffusion

Epithelial Cells

Intestinal Capillaries

Hepatic Portal Transports Nutrients

Liver

Large Lipids Transported as Chylomicrons

Lacteals Transport Chylomicrons

2 mins

Large Intestine

Colon

Electrolyte Reabsorption

Water Reabsorption

Microflora Produce Vitamins

Rectum Stores Feces

1 min

Intussusception

Telescoping of Bowel Segments

Lead Point

Episodic Abdominal Pain

Diarrhea

Sausage-Shaped Mass

Red Currant Jelly Stools

Ultrasound/CT

Target Sign

More Common in Children

Rotavirus Vaccine Contraindicated

Air or Hydrostatic Enema

Surgical Reduction

3 mins

Cardiac Cycle - Diastole

Aortic Valve Closes

Pulmonary Valve Closes

Ventricles Relax

Mitral Valve Opens

Tricuspid Valve Opens

Ventricles Fill

Sinoatrial (SA) Node Fires

Atrial Contraction

3 mins

Cardiac Cycle - Systole

AV Node

AV Node Conducts Signal to Bundle of His

Bundle of His Signals Purkinje Fibers to Contract Ventricles

Tricuspid Valve Closes

Pulmonary Valve Opens

Mitral Valve Closes

Aortic Valve Opens

2 mins

Spina Bifida Assessment

Congenital Malformation of Vertebrae

Dimple With or Without Hair Tuft

Lumbar Sac

Hydrocephalus

Paralysis

Identify Type

2 mins

Electrical Synapse

Cardiac and Smooth Muscle Location

Fast Transmission

Bidirectional

Presynaptic Na+ Floods Through Gap Junction

Na+ Influx Initiates Postsynaptic Action Potential

2 mins

Spina Bifida Interventions

Surgery

Prone Position

Cover Sac with Moist (Sterile) Dressing

Measure Head Circumference

Bulging Fontanel

Other Congenital Malformations Common

Bowel Control

Neurogenic Bladder

2 mins

Lymphatics

Recycles 10% of Interstitial Fluid

Transport Large Lipids from Lacteals

Unidirectional Valves

Lymph Nodes Filter Lymph

WBCs Monitor Lymph for Pathogens

Merge with Veins

2 mins

Phenylketonuria (PKU)

Autosomal Recessive Genetic Disorder

Enzyme Deficiency

Failure to Thrive

Irritability

Musty or Mousy Odor

Cognitive Impairment

Low Phenylalanine Diet

Low Protein Foods (Diet)

Avoid Aspartame

Sapropterin (Kuvan)

Guthrie Blood Test

2 mins

Innate Immunity Cellular Response

Natural Killer Lymphocytes Attack Abnormal Cells

Neutrophils in Blood

Infected Cells Release Interferon

Complement Proteins Lyse Pathogens/Infected Cells

Dendritic Cells in Tissue

Macrophages in Tissue

2 mins

Innate Immunity Barriers

Skin Protects Against Pathogens

Normal Flora Outcompete Pathogens

Lysozyme in Saliva, Tears, and Mucus

Mucous Traps Pathogens

Cilia Remove Mucus

Acid and Digestive Enzymes in the Stomach Kill Pathogens

2 mins

Tonsillectomy

Recurrent Tonsillitis

Saline Gargles

Ice Chips

Monitor for Bleeding

Within 24 Hours

After 5-7 days

Soft Foods

Do Not Cough, Clear Throat, or Blow Nose

Do Not Use Straws

2 mins

Inflammatory Response

Pathogens Infect Tissue

Mast Cells Release Histamine

Histamine Dilates and Increases Capillary Permeability

Macrophages Engulf Pathogens

Macrophage Signals Cells With Cytokines

Responding Neutrophils Cross Capillary Wall

B And T Lymphocytes Arrive At Injury Site

2 mins

Tourette Syndrome

Motor and Vocal Tics

Onset Before Age 18

> 1 year

Obsessive-Compulsive Disorder (OCD)

Attention Deficit Hyperactivity Disorder (ADHD)

Cognitive Behavioral Therapy

High-Potency Antipsychotics

Atypical Antipsychotics

Alpha-2 Agonists

Tetrabenazine

4 mins

Humoral Adaptive Immunity

B Cell Binds Free Floating Antigen

B Cell Presents Antigen to Helper T Cell

Helper T Cells Help B Cells Develop Antigen Specificity

Plasma B Cells Secrete Antibodies

Memory B Cells Cause Faster Secondary Response

2 mins

Rubeola (Measles)

Virus

Fever

Red Maculopapular Rash

3 C's

Photophobia

Koplik Spots

MMR Vaccination

Antipyretics

Vitamin A Supplementation

2 mins

Cell-mediated Adaptive Immune Response

Macrophages and Dendritic Cells Present Antigens

T Cell Develops Antigen Specificity

Regulatory T Cells Suppress Response

Memory T Cells Cause Faster Secondary Response

Cytotoxic T Cells Lyse Infected Cells

Infected Cells Present Antigen On Surface

2 mins

Rubella

Rubella Virus

Swollen Glands

Cold-like Symptoms

Pinkish-red Maculopapular Rash

Low Grade Fever

Rubella Titer

Avoid Contact with Pregnant Women

MMR Vaccination

2 mins

Immune System Tissues

Bone Marrow

B Cells and T Cells Formed

B Cells Mature

Thymus

T Cells Tested For Self-Response

T Cells Mature

Lymph Nodes

Mature B Cells and T Cells Monitor Lymph For Pathogens

Spleen

Mature B Cells and T Cells Monitor Blood For Pathogens

1 min

Low Blood Pressure Response

Posterior Pituitary Releases Vasopressin

Vasoconstriction

Adrenal Cortex Releases Aldosterone

Increased Na+ and H2O Reabsorption

1 min

Erythema Infectiosum (Fifths Disease)

Human Parvovirus B19

Cold-like Symptoms

Three Stage Rash

Slapped Face

Maculopapular Red Spots on Trunk

Rash Reappears

Aplastic Crisis

Joint Pain and Swelling

2 mins

High Blood Pressure Response

Atria Release Atrial Natriuretic Peptide

Vasodilation

Antagonizes Aldosterone

Na+ and Water Excreted

1 min

Exanthema Subitum (Roseola Infantum)

Human Herpesvirus Type 6

Sudden High Fever

Maculopapular, Nonpruritic Rash

Febrile Seizures

Tepid Baths

Ibuprofen

Acetaminophen

2 mins

Blood Acid-Base Control

In a State of Acidemia

Medullary Chemoreceptors Control Ventilation Rate

Expulsion of CO2 through Lungs Increases pH

Bicarbonate Reabsorption from the Kidney Increases pH

Kidney Excretion of H+ Increases pH

2 mins

Varicella (Chickenpox)

Varicella Zoster Virus (VZV)

Red Maculopapular Rash

Vesicles Ooze and Crust

Pruritus

Centripetal

Varicella Immunization

Skin Care to Minimize Itching

Isolate until Vesicles Crust

2 mins

Urinary Excretory Anatomy

Renal Medulla

Renal Cortex

Nephron

Bowman's Capsule

Glomerulus

Proximal Tubule

Loop of Henle

Distal Tubule

Collecting Duct

Ureter

Urinary Bladder

Urethra

2 mins

Mumps (Parotitis)

Paramyxovirus

Fever

Headache

Earache

Orchitis

Pain and Swelling of Parotid Glands

MMR Vaccination

1 min

Skin Functions

Thermoregulation

Protection

Innate Immune Protection

Synthesize Vitamin D

Water and Salt Excretion

Dilated Capillaries are a Blood Reservoir

2 mins

Infectious Mononucleosis

Herpes-like Viral Infection

Fatigue

Fever

Sore Throat

Head and Body Aches

Hepatomegaly and Splenomegaly

Swollen Lymph Nodes in Neck and Armpits

Rash

Suppressed Immune Response

Positive Monospot

2 mins

Skin Anatomy

Epidermis

Keratinocytes

Melanocytes

Dendritic Cells

Merkel Cells

Dermis

Sweat Glands

Hair Follicles

Sebaceous Glands

Hypodermis

3 mins

Proximal Tubule

Na+ Reabsorbed Via Active Transport

Water Follows Na+

Most Of Glucose Reabsorbed

Most Of Amino Acids Reabsorbed

Bicarbonate Exchanged For H+

Drugs and Toxins Excreted

Filtrate Osmolarity Same As Plasma

Leads To Loop Of Henle

2 mins

Respiratory Syncytial Virus (RSV) Assessment

Viral Infection Affecting Epithelial Cells

Begins After a Upper Respiratory Infection

Copious Secretions

Coughing and Sneezing

Wheezing

Otitis Media or Conjunctivitis (Possible Ear or Eye Drainage)

Poor Feeding

Tachypnea

2 mins

Loop of Henle

Descending Limb

Water Follows Na+

Medullary Hypertonicity

Increased Water Reabsorption

Vasa Recta

Na+ Reabsorbed Via Active Transport

Ascending Limb

Reabsorbs Na+, K+, Cl-

Decreased Concentration of Filtrate

Impermeable to Water

Distal Tubule

2 mins

Respiratory Syncytial Virus (RSV) Interventions

Palivizumab (Synagis)

Hospitalization

Contact Precautions

Oxygen

Separate Room

Maintain Fluid Intake

Short-acting Beta-Agonist Bronchodilator

2 mins

Distal Tubule

Hormonally Regulated

Aldosterone Causes Na+ Reabsorption

Na+ Reabsorbed Via Active Transport

Water follows Na+

Parathyroid Hormone Causes Ca2+ Reabsorption

Leads to Collecting Duct

1 min

Epiglottitis Assessment

Haemophilus Influenzae

Drooling

Fever

Stridor

Restlessness

Dyspnea

Cough

Tripod Position

Emergency Treatment

Do Not Examine Throat

2 mins

Physiologic Dead Space (VD)

Tidal Volume (VT)

Partial pressure of arterial CO2 (PaCO2)

Partial pressure of CO2 in expired air (PECO2)

VD = TV x (PaCO2-PECO2) / PaCO2

2 mins

Epiglottitis Interventions

Maintain Airway

Upright/Sitting Position

Humidified Oxygen

Intubation/Tracheostomy Supplies At Bedside

IV Antibiotics

Decrease Anxiety

NPO

Vaccine

Restrain to Prevent Extubation

2 mins

Alveolar Gas Equation

Partial Pressure of Alveolar Oxygen (PAO2)

Partial Pressure of Oxygen in the Inspired Air (PIO2)

PIO2 Normally Approximated = 150 mmHg

Arterial Partial Pressure of CO2 (PaCO2)

Respiratory Quotient (R)

R Normally Approximated = 0.8

PAO2 = PIO2 - (PaCO2/R)

1 min

Kawasaki Disease

Acute Vasculitis

High Fever

Conjunctivitis

Strawberry-Red Tongue and Mucosa

Erythema and Edema of Hands and Feet

Desquamative Skin Rash

Aspirin

Intravenous Immunoglobulin (IVIG)

Antipyretics

Coronary Aneurysm

Children < 5 Years old

2 mins

A-a Gradient

Partial pressure of alveolar oxygen (PAO2)

Partial Pressure of Arterial O2 (PaO2)

Normal 10 to 15 mmHg

Hypoxemia with an Abnormal A-a Gradient

Diffusion problem

Shunting (Low V/Q)

Dead space (high V/Q)

1 min

Circle of Willis

Anterior Cerebral Artery (ACA) Supplies Motor/Sensory Parts of the Cortex for Lower Extremities

Anterior Communicating Artery (Acomm) Connects ACA to ACA

Internal Carotid Arteries (ICA)

Middle Cerebral Arteries (MCA) Supply Cortex for Upper Limbs and Face

Posterior Communicating Artery (Pcomm) Connects ICA to PCA

Posterior Cerebral Arteries (PCA) Supply Occipital Cortex

Basilar Artery Supplies Medulla, Pons, and PCA

3 mins

CN I

Olfactory Nerve

Sensory

Smell

36 secs

Tonsillitis

Bacterial or Viral Inflammation

Sore Throat

Dysphagia

Throat Culture

Antibiotics

Tonsillectomy

Often Streptococcus

Monitor for Acute Glomerulonephritis

Monitor for Rheumatic Heart Disease

3 mins

CN II

Optic Nerve

Sensory

Vision

35 secs

CN III

Oculomotor Nerve

Motor

Eye Movement

Accommodation

Eyelid Opening

Pupillary Constriction

1 min

CN IV

Trochlear Nerve

Motor

Abducts, Depresses, Internally Rotates

48 secs

CN V

Trigeminal Nerve

Sensory

Facial Sensation

Motor Function (Via Mandibular Nerve)

Mastication Muscles

1 min

CN VI

Abducens Nerve

Motor

Abducts Eye

48 secs

CN VII

Facial Nerve

Lacrimation

Salivation

Sensory

Taste from Anterior 2/3 of Tongue

Motor

Facial Movement

Stapedius Muscle

Eyelid Closing

1 min

CN VIII

Vestibulocochlear Nerve

Sensory

Hearing

Balance

55 secs

CN IX

Glossopharyngeal Nerve

Sensory

Taste from Posterior 1/3 of Tongue

Monitoring Carotid Body and Sinus

Motor

Stylopharyngeus

Swallowing

Salivation

1 min

CN X

Vagus Nerve

Sensory

Aortic Arch Chemoreceptors and Baroreceptors

Taste from Epiglottic Region

Motor

Swallowing

Palate Elevation

Talking

Coughing

Midline Uvula

1 min

CN XI

Accessory Nerve

Motor

Head Turning

Shoulder Shrugging

36 secs

CN XII

Hypoglossal Nerve

Motor

Tongue Movement

34 secs

Cranial Nerve Function

CN I

CN II

CN VIII

CN III

CN IV

CN VI

CN XI

CN XII

CN V

CN VII

CN IX

CN X

1 min

Hypersensitivity Type II

Cytotoxic

IgM or IgG antibody-mediated

Membrane Attack Complex (MAC)

Opsonization

Complement Activation

NK Cells

Direct Coombs test

Indirect Coombs Test

1 min

Hypersensitivity Type III

Immune Complex

Antigen-antibody (IgG) complex activates complement

Neutrophils release lysozomal enzymes

Arthus Reaction

Serum Sickness

Systemic Lupus Erythematosus (SLE)

1 min

Hypersensitivity Type IV

Delayed-Type Hypersensitivity

T Cell Mediated

Antibody Independant

Macrophages Activated

Transplant Rejection

PPD Skin Test

Contact Dermatitis

1 min

Spinothalamic Tracts

Ascending Pathway (Sensory)

Lateral

Temperature

Pain

Pressure

Decussates at Anterior White Commisure

Contralateral Anesthesia

2 mins

GI Absorption

Stomach

Alcohol

Duodenum

Iron

Jejunum

Folate

Terminal Ileum

Vitamin B12

Bile Resorption

1 min

Collecting Duct

Na+ Reabsorption

Vasopressin Causes Water reabsorption

Concentrates Filtrate

2 mins

Postural Reflexes

Optical Head Righting

Labyrinthine Righting

Downward Parachute

Forward Parachute

Sideward Parachute

Backward Parachute

Prone Tilting

Supine Tilting

Quadruped Tilting

Standing Tilting

5 mins

Primitive Reflexes

Integrated Reflexes

Rooting Reflex

Sucking/Swallowing Reflex

Traction

Moro Reflex

Palmar Reflex

Spinal Galant Reflex

Plantar Grasp

Asymmetrical Tonic Neck Reflex (ATNR)

Tonic Labyrinthine Reflex (TLR)

Symmetric Tonic Neck (STNR)

Landau

Neck Righting

Body Righting

Babinski Reflex

3 mins

Cardiac Pacemaker Action Potential

Phase 0

Depolarization

Rapid Influx of Calcium

Phase 3

Repolarization

Potassium Efflux

Phase 4

Depolarization

Slow Influx of Sodium

2 mins

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