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Adult Health I > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

What is heart failure?

A

Inability of the heart to pump sufficient blood to meet the needs of the tissues for oxygen and nutrients.

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2
Q

Systolic dysfunction is

A

problem with contraction of the heart

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3
Q

Diastolic dysfunction is

A

problem with filling the heart

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4
Q

What is “Left-Sided” heart failure?

A

When the left ventricular cannot pump blood out efficiently into the aorta and the systemic circulation.

this leads to pulmonary congestion

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5
Q

What is “right-Sided” heart failure?

A

When the right ventricle fails and cannot eject blood or accommodate all the blood flowing in from VC.

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6
Q

What is the pathway that leads to HF?

A

-Systolic HF (not enough blood going out to body)
-sympathetic NS stimulated epinephrine and norepinephrine
-Decrease in kidney perfusions stimulates RASS system to increase BP and retain fluid
-Reduction on contractility of muscle fibers in heart due to increased work load
-Heart compensates for increased workload which increased thickness of heart muscle.

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7
Q

What are different things that can cause HF?

A

-Coronary artery disease (atherosclerosis)
-Ischema
-Cardiomyopathy
-Systemic or pulmonary hypertension
-Valvular heart disease

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8
Q

What are the manifestations of “Left-sided” heart failure?

A

-Dyspnea (SOB)
-Cough - dry nonproductive
-Crackles
-Low oxygen levels

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9
Q

What are the manifestations of “right-sided” heart failure?

A

-Edema
-Peripheral
-JVD
-Enlargement of the liver (due to venous engorgement)
-GI distress (due to build-up of fluid and extra pressure)
-Loss of appetite due to engorgement of GI organs.

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10
Q

How is HF diagnosed?

A

ECG
Chest Xray
Sonograms
Stress test
PET scan
Cardiac catherterization

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11
Q

What labs are being asses with HF?

A

-Liver enzymes
-Cardiac drug levels (Digoxin)
-Bleeding / clotting times
-Electrolytes
-Pulse oximetry
-ABGs
-BUN/Creatinine
-Serum albumin
-CBC
-ESR
-Thyroid studies

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12
Q

What are medications used to treat HF

A

-RAAS inhibitors (ACEi, ARB, Aldosterone, Reinin inhibitors)
-Beta Blockers
-Calcium Channel Blockers
-Diuretics
-Dilators
-Digoxin

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13
Q

CAN therapies for HF

A

-Restrict Sodium
-Supplemental Oxygen
-CRT (pacemaker)
-Ultrafiltration (for pts with severe fluid overlaod)
-Cardiac transplant

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14
Q

How should a nurse assess for HF?

A

-Auscultate lung sounds
-Auscultate for S3 heart sounds
-Assess for JVD
-LOC
-Liver for hepatojugular reflux
-Measure I/O
-daily weight

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15
Q

What is Hypertension?

A

Any BP over 140/90

***based on average of 2 or more accurate BP measurements during 2+ consultations with the provider.

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16
Q

What is a Normal BP

A

Systolic: >120
Diastolic: >80

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17
Q

What is prehypertension / elevated BP range

A

Systolic: 120-129
Diastolic: >80

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18
Q

What is Stage 1 Hypertension?

A

Systolic: 130-139
Diastolic: 80-89

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19
Q

What is Stage 2 Hyptertension?

A

Systolic: 140 or higher
Diastolic: 90 or higher

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20
Q

What is Hypertensive Crisis?

A

Systolic: higher than 180
Diastolic: Higher than 120

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21
Q

What are different factors / causes for hypertension?

A

-Excess sodium (increased body to hold onto water)
-Obesity
-Genetic Alteration
-Increase in sympathetic NS
-Increase in renal reabsorption
-Increase in RAAS
-Decreased vasodilation (due to damage)

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22
Q

How does hypertension manifest?

A

-headache (Oxygen is not getting to the brain)
-Dizziness (Oxygen is not getting to the brain)
-Chest Pain (decreased Oxygen)
-Blurred vision (too much constriction of blood vessels in the eye)

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23
Q

What are some client education on how to prevent hypertension?

A

-Weight Reduction
-DASH diet (heavy in fruits and veggies and l ow in fat dairy)
-Reduce salt
-increase physical activity
-reduce alcohol to no more than 2 drinks per day (men) 1 (women)

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24
Q

What can hypertension lead to?

A

-Heart failure
-MI
-Impaired vision
-Renal failure

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25
Q

What medications are used to treat hypertension

A

a lot of the same meds that are used to treat HF
-Ace i, angiotension i, ARBs, CCBs, Reinin i
-Thiazide Diuretics

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26
Q

What is Angina Pectoris?

A

Chest pain

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27
Q

What causes angina?

A

insufficient blood flow to heart muscles

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28
Q

What are the different types of angina?

A

Stable
Unstable
Intractable or refactory
Variant
Silent

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29
Q

What is stable angina?

A

Predictable and consistent pain, but is relieved by nitroglycerin

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30
Q

What is unstable angina?

A

symptoms increase in frequency and severity, and may or may not be relieved by nitro

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31
Q

What is intractable or refractory angina?

A

Severe incapacitating chest pain

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32
Q

What is variant angina?

A

pain while at rest with reversible ST-segment elevation and may be caused by coronary artery vasospasm

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33
Q

What is silent ischemia?

A

objective evidence of ischemia, but no pain

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34
Q

What is common pathophysiology for angina?

A

Atherosclerotic disease
Major coronary artery obstruction
Oxygen demands are not met
Increase of oxygen required goes up, but can’t be met
-Ischemia (blockage in a coronary artery)

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35
Q

What are common causes for angina?

A

Physical exertion (increase need for O2)
Exposure to cold (vasoconstriction with elevated BP)
Eating a heavy meal (increased blood flow to digestion and takes away from heart)
Stress

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36
Q

How does angina manifest?

A

Chest pain felts deep in chest behind the sternums that may radiate to neck, jaw, and shoulders!

Numbness, weakness in arms, wrist and hands

SOB

Pallor - due to inadequate blood supply

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37
Q

What are gerontological considerations regarding angina?

A

-May not exhibit typical pain profile due to diminished responses of neurotransmitters
-Dyspnea
-Silent angina is common
-encourage them to recognize chest pain symptoms like weakness

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38
Q

What are complications that result from angina?

A

MI (This happens if angina is left untreated)
Cardiac arrest (heart pumps more and more blood to compensate, and cardiac muscle fails)
Cardiogenic shock (MI predisposes them to this)

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39
Q

How do we diagnose angina?

A

ECG
24 hr ECG (Holter)
Exercise or pharm stress electrocardiography
Cardiac enzymes
Chest Xray
Pco2, potassium, myocardial lactate
Serum lipids
Nuclear imaging
MUGA
Cardiac cath w/ angiography

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40
Q

What are the different types of therapies that can be used to treat angina?

A

Oxygen
Nitro
Beta Blockers
Calcium channel blockers
antiplatelet meds
anticoagulants

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41
Q

What is atherosclerosis?

A

Artery wall thickens as a result of fatty material build up (cholesterol LDL and Triglycerides)

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42
Q

How do triglycerides affect the arteries?

A

cause inflammation of arterio-vascular endothelium

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43
Q

Why is atherosclerosis hard to diagnose?

A

Many people are unaware they have it since arteries are not always blocked completely. They will not know they have it until they get an MI or stroke.

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44
Q

What is PAD/PVD

A

Venous insufficiency (Venus is return of blood to the heart

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45
Q

What are things that can lead to PAD/PVD

A

Damaged Vein valves
Accumulation of blood in damaged veins
Formation of clot

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46
Q

How does PAD manifest?

A

-leg pain, aching or cramping
-burning or itching in skin
-leg or ankle swelling
-“heavy” legs
-skin discoloration/texture changes
-open wounds or sores
-restless legs
-varicose veins

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47
Q

What puts individuals more at risk for developing PAD?

A

Gender
age
heredity
pregnancy
standing occupation
obesity
prior injury or surgery
sedentary life

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48
Q

What is ABI

A

Ankle Brachial Index
-Used to diagnose PAD and prevent progression.

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49
Q

How is ABI calculated?

A

Divide blood pressure in artery of ankle by blood pressure in arm.

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50
Q

How should pts manage PAD/PVD?

A

-increase activity
-compression socks
-pneumatic compression

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51
Q

What is DVT?

A

Deep vein thrombosis - when a blood clot (thrombus) forms in one or more of the deep veins in the body (usually the legs)

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52
Q

Why is DVT so serious?

A

The clot can break loose and travel through the bloodstream into the lungs which would block blood flow.

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53
Q

What is the pathophysiology of DVT?

A

-Reduced blood flow
-damage to lining of blood vessels
-phlebitis
-platelet aggregation
-Tail - can flow or propagate in direction of blood flow
-Fragmentation

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54
Q

What are different causes for DVT?

A

-Direct Trauma
-Blood coagulability
-Oral contraceptives
-Pregnancy
-Repetitive motions

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55
Q

How does DVT manifest?

A

-Edema
-Phlegmasia cerulea dolens (massive iliofemoral venous thrombosis - entire extremity becomes massively swollen, tense, painful and cool to touch)
-Tenderness
-Pulmonary embolus

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56
Q

How can DVT be prevented?

A

Graduated compression stockings
Pneumatic compression device
Leg exercises

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57
Q

What types of medications are used for DVT?

A

-Heparin
-Warfarin
-Aspirin
-Factor Xa inhibitor
Thrombolytic therapy
-Low molecular weight heparin

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58
Q

What are two major diuretics?

A

Furosemide
HCTZ

59
Q

What are two major Antihypertensives?

A

Metoprolol
Lisinopril

60
Q

What is a main antilipidemic

A

Atorvastatin

61
Q

What are the major anticoagulants?

A

Heparin
Warfarin
Enoxaparin sodium

62
Q

What are the different types of anemia?

A

Iron Deficiency
B12
Sickle Cell

63
Q

What is Thrombophilia?

A

Blood has an increased tendency to form clots

64
Q

What do RBCs do?

A

Transport Oxygen through the body to the tissues

65
Q

What does Hemoglobin do?

A

molecule that is part of RBC that the O2 attached to so it can be carried throughout the body

66
Q

What is a hematocrit?

A

measures the % of cells in the whole body

67
Q

What is Erythropoietin?

A

A hormone secreted by the kidneys to increase the production of red blood cells created by the body

68
Q

What is Epoetin alfa (Epogen)?

A

This is synthesized from erythropoietin to stimulate RBC production from bone marrow.

69
Q

What is Anemia?

A

Condition where hemoglobin concentration is lower.

70
Q

What is Aplastic Anemia (hypoproliferative anemia)

A

marrow cannot produce adequate number of RBC

71
Q

What is hemolytic anemias?

A

There is a premature destruction of RBCs that result in liberation of hemoglobin from RBCs into plasma. Then the released hemoglobin is converted into bilirubin

72
Q

How does hyperproliferative anemia manifest?

A

Decreased hemoglobin (levels between 9-11)
Fatigue
tachycardia
dyspnea
pallor

73
Q

How can someone prevent hyperproliferative anemia?

A

Iron rich diet
Iron supplements

74
Q

What can hyperproliferative anemia lead to?

A

HF
Paresthesia (muscles don’t get enough Oxygen)
Delirium

75
Q

What is iron deficiency anemia?

A

When the body stores of iron drops

76
Q

What are causes of iron deficiency anemia?

A

diet
hemorrhage
malabsorption
Iron-Refractory iron deficiency anemia (IRIDA)

77
Q

Iron deficiency manifestations

A

Fatigue
Difficulty focusing
crazy sore muscles
apathy
brittle nails
pale skin
pink or red urine
frequent infections
trouble doing normal workout
breathlessness
below average body weight
anorexia (loss of appetite)
growth retardation
listlessness (lethargic / out of it)

78
Q

What are foods rich in Iron?

A

Dark leafy greens
broccoli
liver
Egg yolk
Beef, Pork, chicken
shrimp, clams
Rasins
Potato’s with skin

79
Q

What is B-12 Deficiency

A

Pernicious anemia
Lack of B12 and Folate for RBCs to form

-Diet deficiency
-Malabsorption
-GI disturbances
-Alcohol

80
Q

What is Sickle Cell anemia?

A

Severe hemolytic anemia
RBCs are moon shaped
Both parents must have the gene, and kids will have 25% chance of getting it. 50% chance of becoming carriers

81
Q

What is the BIG danger with sickle cell anemia?

A

Sickle cells do not flow smoothly through blood and can get stick together forming clots

82
Q

What are causes for sickle cells to clot

A

cold temp (aggravates the sickling process due to vacosonstriction slowing blood flow
-Tissue hypoxia (hypoxia and necrosis causes sickle crisis)
-Human parvovirus (Aplasic crisis - results from HP virus)
-Splenic infaction (Sequestration crisis) - organs pool the sickeled cells, like the spleen)

83
Q

Infhow does sickle cell anemia manifest?

A

Anemia is always present (7-10 hemoglobin levels)
-jaundice
-Dysrhythmias
-Enlargement of bones

84
Q

What are major complications of sickle cell anemia?

A

Infection
stroke
rental failure
Hf

85
Q

Is sickle cell anemia painful?

A

Yes!!
Chronic pain and substance abuse needs to be emphasized in nursing plan

86
Q

What is Thalassemia?

A

Autosomal recessive
Affects: alpha and beta
Mutation causes incomplete formation of hemoglobin which limits O2 binding capacity

87
Q

Who is more at risk for Thalassemia?

A

Mediterranean
African
SE Asian
(1/3 of ppl in SE Asia)

88
Q

How does Thalassemia manifest?

A

Anemia
fatigue
pallor
Irritability
Anorexia

89
Q

What is medical management for Thalassemia?

A

Splenectomy
Transfusion
Bone Marrow Transplant
Diet
Antipyretics
Antihistamines
chelating agents
corticosteroids
antibacterial comibinations
vitamines
vaccines

90
Q

What are the different bleeding disorders?

A

-Hemopheliia (A & B)
-Von Willebrad disease
-Antiphospholipid antibody syndrome
-Disseminated intravascular coagulation
-Polycythemia vera

91
Q

What is Hemophilia A?

A

X-linked, recessive disease
-deficiency factor VII (8)

92
Q

What is Hemophilia B?

A

X-linked, recessive disease
-deficiency factor IX (9)

93
Q

What is Hemophilia c?

A

Autosomal Recessive
-Deficiency of factor XI (11)
-RARE

94
Q

What is Von Willibrand Disease?

A

Autosomal dominant trait
-Deficiency of VW factor

95
Q

Who is Ryan White?

A

Had Hemophilia A and developed HIV due to a blood transfusion. He started the process to better screen blood.

96
Q

How does Hemophilia manifest?

A

-Hematuria
-general symptoms (weakness, orthostasis may occur)
-musculoskeletal (tingling, cracking, warmth, pain, stiffness)
-CNS (headache, stiff neck, N/V, Lethargy, irritability, spinal cord syndromes)
-Genitourinary (painless, or hepatic/splenic tenderness and peritoneal signs_

97
Q

What is medical management for hemophilia?

A

Gene Therapy
Surgery/labor and delivery
-make sure to have factors available

98
Q

What are nursing interventions for hemophilia?

A

-Relieve pain
-Maintain optimal physical motility
-Assist in coping
-Prevent bleeding
-Prevent injury

99
Q

What is Thrombophilias?

A

-Factor V Leiden
-Antiphospholipid antibody syndrome
-Disseminated intravascular coagulation
-Polycythemia vera

100
Q

What is Factor V LEiden?

A

Gene mutation
-causes excessive clotting ability
-Risk for DVT & Pulmonary Embolism

101
Q

What are treatment options for Factor V Leiden?

A

Warfarin
Eliquis
Heparin
ASA

102
Q

What are risk factors for Factor V Leiden?

A

-Two faulty Genes: One from each parent
-Immobility (extended periods from sitting to long or a long flight)
-Estrogen (oral contraceptives)
-Surgeries or Injuries
-Non-O blood type

103
Q

What is Antiphospholipid antibody syndrome?

A

Autoimmune disorder where antibodies affect certain proteins in the blood.

Risks and treatments are similar to Leiden V.

104
Q

What is DIC

A

Disseminated Intravascular Coagulation

-Clotting factors are exhausted which results in massive hemorrhage.
-Can be caused by trauma or infection (sepsis)

105
Q

What medication can be used to treat DIC?

A

Heparin…. yes, heparin!

106
Q

What is Polycythemia Vera?

A

A form of cancer
-Excessive RBX
-Causes excessive clotting
-Risks and treatment are similar to other clotting problems

107
Q

What are the different blood products for transfustion?

A

Whole
PRBCs
Platelets
FFP
Albumin
Granulocytes

108
Q

When is whole blood indicated for transfustion?

A

Pts who need both increased oxygen carrying capacity and restoration of blood volume when there is no time to prepare or obtain the specific blood components needed.

Transfused over 2-4 hours

109
Q

Does Whole blood require ABO typing and crossmatch?

A

Yes

110
Q

When is PRBCs indicated for transfusion?

A

This is the most commonly transfused blood.
Transfused over 2-4 hours

111
Q

Does PRBCs require ABO typing and crossmatch?

A

Yes

112
Q

When are platelets indicated for blood transfusion?

A

When platelet levels are depleted
-These assist with clotting
-Given a lot to cancer patients
-Can be transfused as fast as possible

113
Q

Do platelets require ABO typing and crossmatch?

A

Yes

114
Q

When are FFP indicated?

A

Used for volume expansion when fluids alone are insufficient
-Contains clotting factors
-Can be transfused as fast as possible

115
Q

Does FFP require ABO typing and crossmatch?

A

Yes

116
Q

When is Albumin indicated for transfusion

A

Used for fluid expansion & hypoalbuminemia
-Primary protein of whole blood
-Can be transfused as fast as possible

117
Q

When are granulocytes indicated for blood transfusion ?

A

Neutropenic Patients
Similar risks as other transfusions

118
Q

Do Granulocytes require ABO type and crossmatch?

A

Yes

119
Q

What are the S/S for Allergic reaction to blood transfusion ?

A

Flushing
Rash
Hives
pruritus’
Laryngeal edema, difficulty breathing

120
Q

What are the S/S for Febrile reaction to blood transfusion ?

A

Sudden chills and fever
flushing
headache
anxiety

121
Q

What are the S/S for Septic reaction to blood transfusion ?

A

Rapid onset of chills
vomiting
marked hypotension
high fever

122
Q

What are the S/S for circulatory overload caused by blood transfusion ?

A

rise in venous pressure
dyspnea
crackles or rales
distend neck veins
cough
elevated BP

123
Q

What are the Hemolytic reaction to blood transfusion ?

A

lower back pain
chills
feeling of fullness
tachycardia
flushing
tachypnea
hypotension
bleeding
vascular collapse
acute renal failure

124
Q

What are S/S of volume excess

A

-Abnormal breath sounds: crackles
-Altered electrolytes
-Anxiety
-Azotemia
-BP changes
-Change in mental status
-Change in resp pattern
-Decreased Hgb or Hct
-Edema
-Increased central venous pressure
-intake exceeds output
-JVD
-Restlessness
-Oliguria
-Change in specific gravity
-SOB
-Tachycardia
-3rd heart sound S3

125
Q

What are S/S of volume deficient

A

-Altered mental state
-Pt complains of weakness
-excess thirst
-tachycardia
-weak pulse
-weight loss
-concentrated urine
-decreased urine output (under 30 ml / hr in 2 hrs)
-dry mucous membranes, sunken eyeballs
-decreased skin turgor
-decreased BP
-postural hypotension

126
Q

What are nursing interventions for excess fluid?

A

-Limit salt
-monitor fluid intake
-administer diuretics
-elevate edematous extremities
-Administer iv fluids through infusion pump
-semi fowlers
-reposition every 2 hours
-educate

127
Q

What are nursing interventions for excess deficit

A

-Encourage oral fluids
-Monitor hypovolemia
-Start IV
-Administer fluids
-Adminiser blood (if needed)
-maintain flow rate
-Monitor I/O
-provide measures to prevent excessive electrolytes
-advance diet in volume and composition once ongoing fluid
-educate

128
Q

What is Normal Range for Sodium?

A

136 - 145

129
Q

What is Normal Range for Potassium?

A

3.5 - 5.0

130
Q

What is Normal Range for Chloride

A

98 - 106

131
Q

What is Normal Range for Total calcium?

A

9-10.5

132
Q

What is Normal Range for Magnesium?

A

1.3 - 2.1

133
Q

What is Normal Range for Phosphorus?

A

3 - 4.5

134
Q

How long does the preoperative phase last ?

A

From the time the client is admitted in the surgical unit, to the time they are prepared physically, psychosocially, spiritually, and legally for procedure, until they are transported into operating room.

135
Q

What needs to be prepared before surgury?

A

-skin
-full bath to remove microorganisms
-Prep GI tract
-NPO
-Preparing for anesthesia
-No Alcohol or smoking 24 hours before
-promote rest and sleep
-Administer sedatives

136
Q

How long does post operative last?

A

From the time a client is admitted to the recovery room to when they are transported back to surgical unit, discharged from hospital, until the follow-up care.

137
Q

What are the goals of post op?

A

-Maintain adequate body system functions
-Restore homeostasis
-Alleviate pain / discomfort
-Prevent postoerative complications
-Ensure adequate discharge planning and teaching

138
Q

What happens during admission to the PACU?

A

-Promote safe recovery from anesthesia
-administer O2
-Continuos monitoring for ECG, pulse ox, and BP
-Assess surgical site and dressing
-check patency of catheter, drains and tubes
-measure body temp
-provide warming blanket
-control shivering (Meperidine *Demerol)
-VS every 5-15 minutes

139
Q

What are the different types of anesthesia?

A

Local
Regional
General
Conscious Sedation

140
Q

What is local anesthesia?

A

-cause loss of following sensation: temp, touch, proprioception, skeletal muscle tone
-Never bockers
-cause temporary interruption of production and conduction of nerve impulses

141
Q

Examples of local anesthisia

A

Lidocaine
marcaine
Novocain
benzocaine
cocaine

142
Q

When is local anesthesia indicated?

A

infiltration anesthesia
peripheral ad sympathetic nerve blocks
central nerve blocks
spinal and caudal anesthesia
topical anesthetic

143
Q

When is local anesthesia contraindicated or must be used with caution?

A

-Allergy
-Heart block
-shock
-decreased plasma esterase
-pregnancy, lactation

Adult Health I (10 decks)

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