Exam 2 Flashcards
(35 cards)
epidural hematoma
An epidural hematoma results from bleeding between the dura and inner surface of the skull. An epidural hematoma is a neurologic emergency. It is usually associated with a linear fracture crossing a major artery in the dura, causing a tear.
Venous epidural hematomas
Venous epidural hematomas are associated with a tear of the dural venous sinus and develop slowly
Arterial Hematoma
With arterial hematomas, the middle meningeal artery lying under the temporal bone is often torn. Hemorrhage occurs into the epidural space, which lies between the dura and inner surface of the skull. Because this is an arterial hemorrhage, the hematoma develops rapidly.
Classic signs of an epidural hematoma
Classic signs of an epidural hematoma include an initial period of unconsciousness at the scene, with a brief lucid interval followed by a decrease in LOC. Other manifestations may be a headache, nausea and vomiting, or focal findings
Primary purpose of the respiratory system
Gas exchange: Transfer of oxygen (O2) and carbon dioxide (CO2) between atmosphere and blood
* BALANCE NEEDED! Adequate Oxygen from a healthy respiratory system AND adequate perfusion for distribution to body tissues
What structures are included in the Upper respiratory tract?
Nose
—Warm, filter, humidify
Mouth
Pharynx
Epiglottis
Larynx
Trachea
—Carina—bifurcation
What structures are included in the lower respiratory track?
Bronchi
Bronchioles
Alveolar ducts
Alveoli
Surfactant
a lipoprotein lowers the surface tension in the alveoli-> stops collapsing
SaO2
(SaO2); normal greater than 95% amount of O2 bound to hemoglobin in comparison to the amount of O2 the Hgb can carry
95 % of hgb attachments for O2 have O2 bound to them
PaO2
(PaO2); normal 80 to 100 mm Hg amt of O2 dissolved in plasma
Ventilation
Inspiration and expiration occur due to intrathoracic pressure changes and muscle action REMEMBER !
Expiration—passive
Elastic recoil—lungs return to original size after expansion
carotid endarterectomy
carotid endarterectomy (CEA), the atheromatous lesion is removed from the carotid artery to improve blood flow.
Transluminal angioplasty
Transluminal angioplasty is the insertion of a balloon to open a stenosed artery in the brain and improve blood flow. The balloon is threaded up to the carotid artery through a catheter inserted in the femoral artery.
Stenting
Stenting involves intravascular placement of a stent to try to maintain patency of the artery. The stent can be inserted during an angioplasty. Once in place, the system can be used with a tiny filter that opens like an umbrella. The filter catches and removes the debris that is stirred up during the stenting procedure before it floats to the brain, where it can trigger a stroke.
fibrinolytic action of tPA
The fibrinolytic action of tPA occurs as the plasminogen is converted to plasmin, whose enzymatic action then digests fibrin and fibrinogen, thus breaking down the clot. Control of BP (SBP less than 185 mm Hg) is critical during treatment and for 24 hours following.
Respiratory Drugs: Anticholinergic drugs
Promote bronchodilation by preventing muscles around bronchi from tightening
Less effective than SABAs for asthma
Used more with COPD
Not used in routine management; except for severe acute asthma attacks
Ex: Atrovent HFA
Three classes of anti-inflammatory drugs
Corticosteroids
Leukotriene modifiers
Monoclonal antibodies
—Anti-IgE
—Anti-Interleukin 5
Corticosteroids
Corticosteroids—reduce bronchial hyperresponsiveness, block late-phase response, and inhibit migrations of inflammatory cells
Most effective long-term control drug
Examples: beclomethasone, prednisone, methylprednisolone
Oral corticosteroids—use 1 to 2 weeks for maximum effect for severe chronic asthma
Inhaled corticosteroids (ICS)—effects in 24 hours; used in long-term control on a fixed schedule
Little systemic absorption except for high dose (easy bruising, reduced bone density)
Leukotriene modifying agents (LTMAs)
Examples: zafirlukast, montelukast, zileuton; administered orally
Interfere with synthesis or block the action of leukotrienes; produce both bronchodilator and antiiflammatory effects
Taken for prophylaxis and maintenance; not for acute attacks
Anti-IgE (monoclonal antibody)
Example: omalizumab
Reduced circulating IgE levels
Prevents IgE from attaching to mast cells, preventing release of chemical mediators
Subcutaneous administration every 2 to 4 weeks for moderate-severe asthma
Risk of anaphylaxis-observe pt. for minimum of 2 hours post administration
Anti-Interleukin 5 (monoclonal antibody)
Examples: mepolizumab and reslizumab
Inhibits interleukin 5 (IL-5) to inhibit the production and survival of eosinophils
Used with severe asthma attacks despite current asthma medications
Sodium
135-145
maintain cxn and volume of extracellular fluid and influencing water distribution between ECF and ICF
-generates and transmits nerve impulses, muscle contractility, and regulation acid-base balance.
Potassium
-neuromuscular and cardiac function
-Kidneys are primary route for potassium loss.
-Pt’s on diuretics- Large urine output can cause excessive potassium loss CKD pt’s
-Impaired kidney function can cause potassium retention.
Calcium balance
Metabolic processes, blood clotting, transmission of nerve impulses,myocardial contractions, and muscle contractions. Major cation in bones and teeth.