What is Diabetes?
disease caused by lack or ineffective act of insulin, there are two types;
Type 1: Patient does not produce insulin. Onset is early in life. Needs daily injections of insulin
Type 2: does not produce adequate amounts of insulin. Onset later in life.
what is the action of insulin?
acts as the "key" for glucose into the cells
What are normal blood glucose levels in a healthy individual?
3 Ps causing water loss in uncontrolled diabetes
Polyuria: frequent and plentiful urination
Polydipsia: frequent drinking of liquid to satisfy continuous thirst
Polyphagia: excessive eating as a result of cellular "hunger"; seen only occasionally
what are the Signs and Symptoms of a Hyperglycemic crisis (Diabetic Coma)?
-Dehydration, as indicated by dry, warm, "tenting" skin and sunken eyes
-A sweet or fruity (acetone) odor on the breath
-A rapid, weak "thready" pulse
-A normal or slightly low B/P
-Weakness, Nausea, and vomiting
What are the Signs and Symptoms of a Hypoglycemic crisis (Insulin shock)?
-Normal to shallow or rapid respirations
-Pale, moist (clammy) skin
-Normal to low B/P
-AMS (altered mental status)
-Anxious or combative behavior
-seizure, fainting, or coma
-weakness on one side of body (may mimic stroke)
-Rapid changes in mental status
A strangulated hernia is one that:
loses its blood supply due to compression by local tissues.
A 42-year-old male is found unresponsive on his couch by a neighbor. During your assessment, you find no signs of trauma and the patient's blood glucose level is 75 mg/dL. His blood pressure is 168/98 mm Hg, his heart rate is 45 beats/min and bounding, and his respirations are 8 breaths/min and irregular. The patient is wearing a medical alert bracelet that states he has hemophilia. You should:
suspect that he has intracranial bleeding, assist his ventilations, and transport rapidly to an appropriate hospital.
____________ is what you can see of a person's response to the environment.
The MOST common and significant complication associated with an acute abdomen is:
A young female presents with costovertebral angle tenderness. She is conscious and alert with stable vital signs. Which of the following organs is MOST likely causing her pain?
A raised, swollen, well-defined area on the skin that is the result of an insect bite or sting is called:
The first step in assessing a patient with a behavioral emergency is to:
Ensure your safety
A 78-year-old female presents with an acute change in her behavior. The patient's son tells you that his mother has type 2 diabetes and was diagnosed with Alzheimer's disease 6 months ago. The patient's speech is slurred and she is not alert to her surroundings. You should:
inquire about the possibility of head trauma
Esophageal varices MOST commonly occur in patients who:
drink a lot of alcohol
A man finds his 59-year-old wife unconscious on the couch. He states that she takes medications for type 2 diabetes. He further tells you that his wife has been ill recently and has not eaten for the past 24 hours. Your assessment reveals that the patient is unresponsive. You should:
open and maintain her airway and assess breathing
Solid abdominal organs include the
spleen, kidneys, and pancreas
When obtaining a SAMPLE history from a patient with diabetes, it would be MOST important to determine
if he or she has had any recent illnesses or excessive stress
In contrast to a behavioral crisis, a psychiatric emergency occurs when a person
demonstrates agitation or violence or becomes a threat to himself or herself, or to others
A 3-year-old female ingested several leaves from a plant in the living room. The child's mother is not sure what type of plant it is, stating that she bought it simply because it was pretty. After completing your initial assessment of the child, you should
contact the regional poison control center
A 28-year-old female patient is found to be responsive to verbal stimuli only. Her roommate states that she was recently diagnosed with type 1 diabetes and has had difficulty controlling her blood sugar level. She further tells you that the patient has been urinating excessively and has progressively worsened over the last 24 to 36 hours. On the basis of this patient's clinical presentation, you should suspect that she:
is significantly hyperglycemic
When taking SAMPLE Hx for a Diabetic Pt it is important to ask:
When insulin was last taken? How much insulin was taken? When was the last thing eaten? What are your normal Glucose readings?
what is sickle cell disease?
an inherited blood disorder that affects the red blood cells. The blood has hemoglobin S instead of the usual hemoglobin A this caused the cells to be crescent or "sickle" shaped.
What are the four types of sickle cell crises?
Vaso-occlusive crisis: when blood flow to an organ becomes restricted
Aplastic crisis: lack of circulating red blood cells in the body
hemolytic crisis: accelerated breakdown of the Patients red blood cells
Splenic sequestration crisis: painful, acute enlargement of the spleen
Type 1 diabetes patients
-Need daily injections of insulin
-Typically develops during childhood
-Patients more likely to have metabolic problems and organ damage
-Considered an autoimmune problem
Type 2 diabetes patients
-Produce inadequate amounts of insulin, or a normal amount that does not function properly
-Usually appears later in life
-Treatment may be diet, exercise, oral medications, or insulin
what are the two Blood clotting disorders
Thrombophilia: tendency to develop blood clots
Hemophilia: not able to control bleeding by developing spontaneous clots as normal.
What are the two primary types of Hemophilia?
Hemophilia A: the most common type, due to low levels of factor VIII
Hemophilia B: second most common, associated with a deficiency of factor IX
what is the definition of an allergic reaction?
hypersensitivity reaction of the immune system to a particular allergen; symptoms can vary greatly in intensity
what is the definition of anaphylaxis?
An extreme, often life-threatening, allergic reaction to an antigen (e.g., a bee sting) to which the body has become hypersensitive
Signs and Symptoms of anaphylaxis
-Involves multiple organ systems
what is Urticaria?
how quickly can someone die from anaphylaxis?
How long can the Stinger of the honeybee can continue to inject venom?
How do you properly remove a stinger?
scrape with a hard edge such as a credit card
What is the action of epinephrine?
-Mimics the sympathetic (fight-or-flight) response
-Causes the blood vessels to constrict
-Reverses vasodilation and hypotension
-Increases cardiac contractility and relieves bronchospasm
-Rapidly reverses the effects of anaphylaxis
What are the side effects of epinephrine?
Anorexia, n/v, nervousness, tremors, pallor, headache, syncope, dizziness, and insomnia.
What is substance abuse?
is the misuse of any substance to produce a desired effect
What is a drug overdose?
a toxic dose of a drug
what is a poison
A poison is any substance whose chemical action can damage body structures or impair body function
What is your primary responsibility to the patient ?
to recognize a poisoning has occurred. Contact medical control and begin treatment if poisoning is suspected
Signs and Symptoms of Opiates
-Hypoventilation or respiratory arrest
-Sedation or coma
Signs and Symptoms of Sympathomimetics
-Agitation or seizures
Signs and Symptoms of Sedative-hypnotics
-Sedation or coma
Signs and Symptoms of Anticholinergics
-Dry skin and mucous membranes
-Sedation, agitation, seizures, coma, or delirium
-Decreased bowel sounds
Signs and Symptoms of Cholinergics
-Excess defecation or urination
-Excess lacrimation (tearing) or salivation
-Nausea or vomiting
What are examples of Opioids?
What are examples of Sympathomimetics
Cocaine, epinephrine, albuterol, methamphetamine,
What are examples of Sedative-hypnotics
diazepam [valium], secobarbital [Seconal], flunitrazepam [Rohypnol]
What are examples of Anticholinergics
atropine, Jimson weed
What are examples of Cholinergics
pilocarpine, nerve gas
What are the possible entry methods for poisons?
What entry method for poison is the hardest to treat?
What is the most common method of poisoning?
What is an antidote?
a substance that will counteract the particular poison. If wrong, the antidote itself may be deadly
What is a tolerance?
the need of increasing doses to achieve the same result
What is the proper dosage of activated charcoal?
1g per kilogram of body weight.
- typical adult dosage is 25 to 50g and the usual pediatric dose is 12.5 to 25g
What does an overdoes of acetaminophen (Tylenol cause?
massive liver failure
DTs (delirium tremens)
A severe withdrawal syndrome seen in alcoholics who are deprived of ethyl alcohol; characterized by restlessness, fever, sweating, disorientation, agitation, and seizures; can be fatal if untreated.
what is a behavioral crisis?
any reaction to events that interferes with the activities of daily living or has become unacceptable to the patient, family, or community.
What is the first step when you arrive at the call?
What is menarche?
First menstruation at puberty
What is the narrowest part of the uterus?
after ovulation fertilization has about ______ to happen before menstruation
14 days or 2 weeks
What is PID?
Pelvic Inflammatory disease: Infection of uppermost organs of reproduction, occurs almost exclusively in sexually active women, can result in ectopic pregnancy or sterility, most common sign is generalized lower abdominal pain.
Most common bacterial STI. Affects estimated 2.8 million cases Americans a year. Responsible for 25 - 50% of all diagnosed cases of PID.
What is an Ectopic Pregnancy
an egg that implants itself in the fallopian tube. Potentially fatal when zygote grows large enough to rupture fallopian tube. no way to save the fetus.
What is Bacterial vaginosis?
normal bacteria in the vagina is replaced by an overgrowth of other bacterial forms, Symptoms may include itching, burning, or pain and may be accompanied by a "fishy" foul smelling discharge.
what is Gonorrhea
bacterial infection that grows in warm moist areas (ie. reproductive tracts in women, urethra in men and women, mouth, throat, eyes, and anus)
How long does it take for gonorrhea to show symptoms?
2-10 days for men
potentially months for women
Symptoms of gonorrhea
Painful urination, with associated burning or itching; yellowish or bloody vaginal discharge usualyy with foul odor, and blood associated with vaginal intercourse.
When taking SAMPLE Hx for a gynecologic Pt it is important to:
Ensure her privacy
What type of diagnosis is rape?
a legal diagnosis nor a medical diagnosis
PCR about a sexual assault victim
is a legal document which may be subpoenaed in the case of a trial.
-keep the report concise
-record only what the Pt. stated in her own words
-use quotation marks to indicate the patient's version of events.
-do not insert your own opinion only observations during the physical examination such as (Pt. emotional state, condition of her clothing, obvious injuries, etc.)