AH 1 exam 2 Flashcards
(113 cards)
1
Q
What is the accurate assessment when taking BP?
A
● 2-3 readings spaced out ● sitting - feet flat - NO talking ● correct size CUFF ➢ too BIG = LOW reading ➢ too SMALL = HIGH reading
2
Q
What can interaction with BP?
A
● interactions ➢ STRESS - pn, anxiety ➢ temp changes ➢ barometric pressure ➢ smoking, ETOH
3
Q
HTN risk factors?
A
Modifiable ● CKD - chronic kidney disease ● Diabetes ● HIGH cholesterol ● Poor DIET ● obesity ● stress ● SEDENTARY lifestyle, sleep apnea ● tobacco use
Non-Modifiable ● age ➢ vasculature stiffens ● ethnicity/race ➢ African American ● gender ➢ men ➢ women (> 65) ● family hx/genetics ● (social determinants of health)
4
Q
HTN lifestyle modifications
A
● weight loss ➢ ↓↓ demand on body ➢ ↓↓ cholesterol = have to work against atherosclerosis ● diet ➢ DASH diet ➢ ↑ K+/ ↓ Na+/↓ fat ● exercise ➢ HR = more efficient ➢ ↓↓ weight & cholesterol ● ETOH ➢ leads to DEHYDRATION ● smoking ➢ clogs arteries → ATHEROSCLEROSIS
5
Q
HTN medications, AE, pt ed
A
FIRST line: ➢ ACE, ARBs, Ca channel blockers, thiazide diuretic ● HOLD meds: ➢ HR<60bpm ➢ SYSTOLIC < 90 mmHg ● start LOW & go SLOW
SECONDARY line:
➢ loop diuretics, beta blockers, K+ sparing
AE - orthostatic hypotension, hypotension
6
Q
Effects of Long-Term HTN
Target organ Damage
A
Retina/eye changes renal damage myocardial infraction cardiac hypertrophy heart failure stroke
7
Q
What are the effects of HTN on EYES?
A
● microaneurysms in the eye, papilledema
● cotton wool spots
● ↑ intraocular pressure = damages vessels
8
Q
What are the effects of HTN on Kidneys?
A
● renal damage
● affected by ↑ in pressure
● proteinuria, Dec. urine output
● ↑↑ BUN/creatinine
9
Q
What are the effects of HTN on the heart?
A
● angina/palpitations, MI, cardiac hypertrophy
● peripheral pulse = bounding
● dyspnea
10
Q
What are the effects of HTN on neuro?
A
● neuro deficits - motor speech, stroke
● headaches/dizziness
● falls, weakness, gait changes
11
Q
Hypertensive emergency
A
signs & symptoms ● chest pain ● neuro changes ● ha ● ↑↑ BP = target organ damage
cause
abrupt in ↑↑ BP
SBP >180 or DBP >120
treatment ● in ICU ● IV anti-HTN meds ● SLOWLY lower BP ● tx target organ damage (Encephalopathy, Ischemic stroke, MI, Heart failure, Dissecting aortic aneurysm, Renal failure
12
Q
HYPERTENSIVE URGENCY
A
signs & symptoms
more stable
→ NO target organ damage
Cause
SBP >180 or DBP >120
treatment
● usually w. oral meds
● get to the ROOT of WHY they
aren’t adherent
13
Q
HTN primary vs secondary
A
Primary unknown
Secondary: related to another disease Cushing's Hyperaldosteronism Aortic coarctation Pheochromocytoma Stenosis of renal arteries.
14
Q
Cardiovascular modifiable vs. non-modifiable risk factors
A
modifiable
Smoking, HTN, cholesterol, activity level, diet, stress, obesity, diabetes
non-modifiable
Age, gender, race, Family history
15
Q
cardiovascular - considerations for older adults?
A
Hypertrophy Changes in the cardiac structure and function Conduction system Vasculature thickening of rigidity of AV valves
16
Q
Cardiovascular older adult consideration
hypertrophy
A
thickening of heart walls
➢ ↓↓ VOLUME of blood into the chamber ➢ ↓↓ STRENGTH of contraction
17
Q
Cardiovascular older adult consideration
● ↓↓ cardiac output
A
➢ fatigue, exercise intolerance, HF, VENTRICULAR arrhythmias
18
Q
Cardiovascular older adult consideration
thickened AV valves
A
➢ doesnt close properly → leads to BACKFLOW
○ hear murmur
(why they are so common in older adults)
19
Q
Cardiovascular older adult consideration
conduction system
A
➢ SA node = pacemaker
➢ CONNECTIVE tissue develops in SA/AV node, and bundle branches = less tissue that can conduct electricity
○ s/s = bradycardia, blocks, ECG changes
20
Q
Cardiovascular older adult consideration
stiffened vasculature/loses elasticity
A
➢ must work harder to pump against it
➢ leads to → ventricular hypertrophy
○ ↑↑ systolic BP
(why older adults have high BP)
21
Q
Cardiovascular older adult consideration
↑↑ size of left atrium
A
➢ atrial arrhythmias
22
Q
Cardiovascular older adult consideration
↓↓ sympathetic nervous system
A
➢ doesn’t react to demand of O2 → intolerance to EXERCISE
23
Q
Cardiovascular older adult consideration
↓↓ sensitivity in BARORECEPTORS
A
➢ in CAROTID artery and AORTA
➢ unregulated response to HR/vascular changes → orthostatic hypotension
24
Q
Cardiovascular older adult consideration
falls
A
➢ fx, head injuries
25
BUN Lab
8 - 20 mg/dL
26
Creatinine lab
0. 6 - 1.2 mg/dL (male)
| 0. 4 - 1 mg/dL (female)
27
Calcium lab
8.8 - 10.4 mg/dL
28
Magnesium Lab
1.8 - 2.6 mg/dL
29
Potassium lab
3.5 - 5 mEq/L
30
Sodium lab
135 - 145 mEq/L
31
RBC lab
4. 2 mil - 5.4 mil/ mm3 (male)
| 3. 6 mil - 5.0 mil/ mm3 (female)
32
Hemoglobin/ Hematocrit labs
14 - 17.4 g/dL 42 - 52% (male)
| 12 - 16 g/dL 36 - 48% (female)
33
Platelets lab
140,000 - 400,000/mm3
34
WBC lab
140,000 - 400,000/mm3
35
aPTT lab
21 - 35 sec (use w. heparin)
36
PT lab
11 - 13 sec (use w. warfarin)
37
INR lab
0.8 - 1.2 (use w. warfarin)
38
Lipid Tests:
● HIGH LDL/triglycerides = ↑↑ risk of heart disease
● HIGH CRP = indicates INFLAMMATION
● B-type = related to HEART FAILURE
● HOMOCYSTEINE = ↑↑ risk of disease and stroke
39
electrocardiogram (ECG)
= tests CONDUCTION in the heart
| ● normal sinus or dysrhythmias
40
exercise stress test
= how well pt tolerates ↑↑ HR and BP
● on treadmill with tele
● for: chest pn/CAD/big changes in HR and BP
41
pharmacologic stress test
for people who can’t tolerate being on the treadmill
42
echocardiogram
= STRUCTURE of the heart
| ● valves, silhouette of heart, measuring chamber SIZE
43
cardiac test - chest x-ray
= SIZE of heart
● just a silhouette of heart
44
fluoroscopy
```
= see CLOT/NARROWING of arteries
● like a moving x ray
● in cath lab
● w. contrast dye
→ takes pictures of where is GOES and STOPS
```
45
CARDIAC CATHETERIZATION
= for CORONARY & PERIPHERAL arteries
pre - op
● baseline coag studies (INR,PT,PTT)
➢ compare labs - before and after
➢ on HEPARIN
● electrolyte panel and CBC for baseline
● ↑↑ risk
➢ KIDNEY issue: CKD, renal insufficiency, diabetic patients ○ check renal fxn before (BUN/creatinine)
➢ HF
➢ dehydration
➢ other nephrotoxic med (metformin) ➢ older adults
46
cardiac Catheterization is and can cause
● iodinated contrast dye
➢ iodine allergy or shellfish allergy!
➢ pretreat with benadryl or steroids
47
CARDIAC CATHETERIZATION Post - op
● bleeding
➢ usually in FEMORAL artery (maybe radial)
➢ must be SUPINE for several hours
➢ constantly monitor for signs of bleeding
➢ usually a clear dressing over insertion site
➢ hematoma development
➢ changes in vitals - ↓↓ bp ↑↑ hr = BLEEDING
○ back pain = retroperitoneal bleeding
● peripheral neurovascular assessment
➢ compare bilaterally
➢ lose pulse/cold = clot/dec blood flow to limb (need to go back to cath lab)
➢ temp/color/cap refill
● on tele
➢ ↑↑ risk of DYSRHYTHMIAS
● edu:
➢ supine 2-6 hrs
➢ report chest pain/bleeding
48
Normal duration of the QRS complex is
< 0.12 seconds
49
Duration of normal PR interval is
0.12-0.2 seconds.
50
Arteriosclerosis
hardening of of arteries
| Muscle fibers/endothelial lining become thickened (small arteries/arterioles)
51
Atherosclerosis
(narrowing)
• Large/medium sized arteries
• Accumulation of fats, calcium, blood components, carbs, fibrous
tissues
● Forms plaques - atheroma ➢ stable & unstable
52
Path to MI
```
● arteriosclerosis (hardening) or atherosclerosis (narrowing)
● ↓ blood flow to myocardium = ↓ o2
● angina (ischemia)
● plaque ruptures
● causes thrombus
● complete obstruction = MI
```
53
ANGINA
ISCHEMIA of blood flow to heart muscle → painful
54
ACUTE CORONARY SYNDROME (ACS)
Unstable - no biomarker changes
NSTEMI - less tissue damage, transient occlusive - increased biomarkers
STEMI - ST elevation + biomarkers - emergency - complete/prolonged occlusion
55
MI is
= complete occlusion
● ↓ O2 supply and ↑ O2. demand
● causes: blood loss, rapid HR, drug use, thyroid storm
56
stable angina relieved by
REST & NITRO
57
unstable angina
= ↑ severity/freq of symptoms; NOT relieved by REST & NITRO
58
intractable/refractory angina
= severe pain
59
variant angina
= pain at REST - caused by
| VASOSPASM
60
silent angina
no pain - ECG changes & ischemia are present
61
CORONARY ARTERY DISEASE (CAD) lab values
```
total cholesterol < 200 mg/dL
LDL cholesterol < 100 mg/dL
HDL cholesterol
> 40 mg/dL (males)
> 50 mg/dL (females)
triglycerides < 150 mg/dL
```
62
```
ACS & MI cardiac enzymes lab values
Troponin?****
creatine phosphokinase (CPK)?
CKMB?
myoglobin?
```
```
troponin < 0.35 ng/mL
creatine phosphokinase (CPK)
50 - 325 mU/mL (males)
50 - 250 mU/mL (females)
CKMB 0-5ng/mL
myoglobin 0 mcg/mL
```
63
STEMI VS NSTEMI ECG changes
STEMI - ST eleveted
| NSTEMI - ST depression
64
CAD Clinical manifest.
```
depends on LOCATION and amnt of NARROWING
● epigastric distress/indigestion
● angina
● weakness/lightheaded/nausea
● shoulder pain
● SOB
```
65
Angina Clinical manifest.
```
● chest pain
● indigestion
● choking/heavy sensation
● feeling of impending doom
● radiating pain (shoulder)
● pallor
● N/V/lightheaded
```
66
ACS & MI Clinical Manifest.
```
● similar to unstable angina
● DIFFERENCE = biomarkers
➢ MI = biomarkers
● cool, pale, moist skin
● elevated HR & RR
● chest pain
● indigestion
```
67
CAD risk factors and managment
Risk factors - smoking, obesity, stress, sedentary lifestyle, high fat diet (saturated fats)
```
● diet - eat more plants (fiber - omega3 fatty acids)
● physical activity
● medications
● tobacco cessation
● HTN management
● diabetes control
```
CHOLESTEROL = statins
BLOOD PRESSURE = ACE’s, ARB’s, beta blockers, Ca channel blockers, thiazide diuretics
68
Angina managment
```
● medications
➢ stable - nitro, beta blocker, Ca channel blocker, anticoags
➢ unstable - heparin
● oxygen therapy
➢ ↓ demand on heart
● PCIs/CABG
```
PCIs - balloon-tipped catheter is inserted into a coronary artery to open the artery; stents are put in place
CABG - 1. borrowed piece of blood vessel used to bypass a blocked artery in the heart
2. Traditional, alternative, endoscopic
69
ACS and MI managment
GET PT TO CATH LAB ASAP
● pain management ➢ oxygen & morphine
● bed rest - elevates HOB
● manage fluid volume ➢ risk of HF
● adequate tissue perfusion
● anxiety ➢ ↓ workload on heart
● prevent complications
➢ ↓ cardiac output (↓BP, cool ext, ↓ pulses)
➢ fluid/electrolyte imbalances (labs, dysrhythmias)
➢ impaired cerebral circ (LOC, neuro symp)
● serial cardiac enzyme levels
70
ACS/MI MEDS
● nitroglycerin
● analgesics - pain and ↓ O2 demand
● anticoagulants - aspirin, heparin
71
PERIPHERAL ARTERY DISEASE
| eti/patho
atherosclerosis in LE
| arteriosclerosis
72
CHRONIC VENOUS INSUFFICIENCY
| eti/patho
● blood NOT returning to heart
| ● ↑↑ venous pressure → distended veins → causes BACKFLOW = venous stasis
73
PAD Clincial manifest.
```
● limb cool or numb
● pale skin
● absent pulses
● intermittent claudication - ↓ blood supply to the tissue causes pain
● ARTERIAL ulcers
➢ small, round, dry, black sores
➢ on TOES and FEET
```
74
Chronic venous insufficiency Clincial manifest.
```
● dull, achy pain
● ruddy skin
● VENOUS ulcers
➢ bigger, red sores
➢ wet & weeping
➢ on MEDIAL & LATERAL malleolus
```
75
PAD management
```
● #1 nicotine cessation
● medication
➢ anti-platelet (aspirin, clopidogrel)
➢ direct vasodilator - for intermittent
claudication
● maintain circulation ➢ legs BELOW heart
● promote vasodilation
➢ warm temperatures
➢ avoid cold and trauma
● good nutrition
● meticulous hygiene
```
76
Chronic venous insufficiency
| pt edu and managment
```
● monitor skin - keep clean & dry
● DONT:
➢ dangle or cross legs
➢ wear constrictive clothing
● elevate legs at rest
```
```
● apply:
➢ compression stockings
➢ SCD’s
● encourage exercise
● good nutrition
```
77
DVT PREVENTION:
● early ambulation
● prophylaxis meds ➢heparin, lovenox
● SCDs/ted hose
● ankle exercises
78
PE PREVENTION:
● bed rest until anticoag therapy
● no exercise → can throw clot to the lungs
● IV heparin
● initiate anti-coag therapy ➢ lovenox, heparin IV (therapeutic levels - draw aPTT)
79
DVT and PE DIAGNOSIS:
● chest x ray, arterial blood gasses, D-dimer (inflx)
| ● GOLD STANDARD = CT scan w contrast
80
DVT and PE NURSE MANAGEMENT
● anticoagulation meds
● endovascular intervention = remove clot
● thrombolytics = clot busters (Alteplase)
● reduce discomfort/manage pain
● relieve anxiety
● mange O2 therapy/ encourage exercise
81
Lymphangitis
inflammation, acute influx of lymph channels (red streaks that outline lymph vessels as they drain)
82
Lymphadenitis
involves lymph node; become larger, red, and tender
caused by strep or staph
83
Lymphedema
tissue swelling due to inc lymph and
obstruction of the lymphatic vessels;
begins soft/pitting, then hard/non pitting
84
Cellulitis Clinical manifest.
● strep or staph usually
| ● acute onset of redness, swelling, tenderness
85
Cellulitis Nurse management
● outline to monitor progression
● cool, moist packs until influx goes does
● don't use heat
● often recurs - edu about foot care, inspecting between toes ➢ keep clean and dry
Ankle Brachial Index (ABI)
86
muscleskeletal and aging
* Loss of height due to osteoporosis
* Kyphosis – forward curvature of the thoracic spine
* Thinned intervertebral discs, compressed vertebral bodies
* Flexion of knees and hips
* Menopausal withdrawal of estrogen contributes to osteoporosis
* Loss of muscle strength
* Collagen structures less able to absorb energy
***Many effects of aging can be slowed if the body is kept healthy and active
87
Neurovascular assessment
```
6's P's
• Pain - ask
• Paresthesia - ask for numbness
• Pulse - palpate, if none use doppler
• Pallor - inspect - temperature
• Pressure - can they tell the difference between pressures
• Paralysis - too far gone
```
88
muscleskeletal - Diagnostic evaluation
* X-ray - “go to” check for texture, breaks, density, bone heal - serial x-ray
* Bone Densitometry - DEXA - bone mineral density - used to diagnose osteoporosis
* Bone Scan - Used to detect tumors, osteomyelitis, and breaks. Requires education, uses radioactive isotope, sits and waits, then gets scanned. Isotope causes a warm flushed sensation, needs an empty bladder.
Arthroscopy - Scope used therapeutically and diagnostically in joints
Arthrocentesis - Aspirate joint synovial fluid - thera. and diagn.
Electromyography (EMG) - test to look at nerve conduction - carpal tunnel - used to determine if its a muscle or nerve issue
89
osteoarthritis (OA) Risk Factors
older adult, female, post-menopausal, Hispanic and African American, obesity, previous joint injuries
90
osteoarthritis (OA) diagnosis
X-ray
91
osteoarthritis (OA) treatment
decrease pain and stiffness - weight loss, incorporate exercise - NSAIDS, Tylenol, steroids, physical therapy, assistive devices,
lastly invasive - surgery
92
osteoarthritis (OA) CM's
* Insidious, progressing over multiple years
* Pain – aggravated by movement, relieved at rest
* Stiffness – especially in the morning
* Functional Impairment – decreased ROM
* Joint enlargement
* Crepitus
93
Total Joint Arthroplasty/Replacement
Surgical removal of unhealthy joint surfaces and replacement with metal artificial surfaces
94
Total Joint Arthroplasty/Replacement
| *Nursing Interventions (Post-op)*
* Preventing DVT - pain, swelling, change in color, tenderness, warmth - compression devices, ambulation, ankle ROM, anticoagulation meds
* Preventing Infection - fever, high WBC’s, purulent drainage, pain, CHG baths, prophylactic antibiotics
* Managing Pain - ICE, pharm, non-pharm, promote ambulation
* Promoting Ambulation
* Monitoring Wound Drainage
* Preventing Dislocation (THA) HIP - affected extremity will be shorter and external rotation, pain, unable to bear weight, adduction
* Clinical Manifestations of Joint Dislocation
* Hip Precautions - bending over at 90 degree angle, do not cross legs, hips cannot be lower than knee, turn on non-operated side, no internal/external rotation
95
Osteoporosis
Degenerative disease of the bone characterized by reduced mass, deterioration of matrix, and diminished architectural strength 🡪 Leads to bone fractures
96
Osteoporosis * Risk factors *
women, post-menopause, small Frame women, Asian and caucasian, calcium and vit D insufficiency, corticosteroid use
97
Osteoporosis diagnosis
DEXA
98
Osteoporosis *prevention*
identify people at risk, exercise, no smoking
99
Osteoporosis * Foods high in calcium and vitamin D?*
dairy, eggs, almonds, OJ, steamed broccoli
100
Osteoporosis - education regarding calcium/vitamin D supp and bisphosphonate?
avoid carbonated soft drinks... ?
101
Osteoporosis nursing interventions
* Promoting Understanding of Regimen
* Relieving Pain - heat
* Preventing Injury ** - fall precautions
* Improving Bowel Elimination (r/t immobility and medication) - w/fiber & fluids
102
Osteomalacia
Metabolic bone disease characterized by inadequate mineralization of bone - weak, soft bones w/deformities
103
Osteomalacia treatment & Clinical Manifestations:
```
Skeletal softness and weakness
Skeletal deformities
Pain
Bowing of bones and spinal kyphosis
Pathologic fractures
```
treatment?
104
Osteomyelitis - infection of the bone
Causes?
blood-borne infection, contamination during surgery, vascular insufficiency
105
Osteomyelitis Risk Factors?
malnourished, obesity, long-term steroid use, IV drug use, older adults, chronic illness
106
Osteomyelitis Treatment? **
long-term antibiotics, PICC
| line then oral
107
Osteomyelitis diagnosis
Arthrocentesis
108
Osteomyelitis CM’s ***
Pain
Swelling
Extreme tenderness
109
Osteomyelitis Nursing Interventions:
Relieving Pain
Improving Physical Mobility at comfort level
Controlling the Infectious Process - lots of assessing, antibiotics, lab draws
110
Low Back Pain Nursing Interventions: **
Relief of Pain
Improved Physical Mobility
**Use of Back-Conserving Tech. of Body Mechanics**
Weight Reduction
111
Low back pain causes
improper lifting during activity, weak muscles, comorbidities - depression, stress, obesity, smoking
112
Low back pain diagnosis
x-ray, CT, MRI
113
Low back pain CMs ****
Pain
Acute (less than 3 months) vs Chronic
Muscle spasms
Radiculopathy(nerve involvement w/pain) shooting, sharp, electric, burning pain/Sciatica(shooting feeling down the leg)
