Exam 2 Flashcards
(100 cards)
1
Q
What are the nursing considerations for diabetic foot ulcer management?
A
Skin assessments, monitor blood glucose, provide patient education
These considerations are essential for effective management of diabetic foot ulcers.
2
Q
What is one thing that should not be done in a hospital setting regarding diabetic patients’ feet?
A
Trim patients’ toe nails
This is to prevent injury and complications.
3
Q
What is one of the ‘Do’s for diabetic foot ulcer care?
A
Inspect your feet daily
Regular inspection helps in early detection of problems.
4
Q
What is one of the ‘Don’ts’ for diabetic foot ulcer care?
A
Soak your feet in water
Soaking can lead to skin breakdown.
5
Q
List three ‘Do’s for caring for diabetic feet.
A
- Wash your feet daily with warm water
- Dry your feet well
- Wear well-fitting shoes
These practices help maintain foot health.
6
Q
List three ‘Don’ts’ for caring for diabetic feet.
A
- Cut off corns or calluses
- Apply lotion between the toes
- Walk barefoot
These actions can increase the risk of injury and infection.
7
Q
What are some complications of diabetes that increase the risk for diabetic foot ulcers?
A
- Neuropathy
- Peripheral arterial disease
- Immunocompromised status
These conditions can impair foot health and healing.
8
Q
(4) What are other risk factors for diabetic foot ulcers?
A
- Duration of diabetes
- Age
- Male
- Hispanic, Native American, and African-Caribbean descent
These factors contribute to the likelihood of developing foot ulcers.
9
Q
What are some complications that can arise from diabetic foot ulcers?
A
- Osteomyelitis
- Gangrene
These are serious complications that may require intensive treatment.
10
Q
What are the treatments available for diabetic foot ulcers?
A
- Debridement
- Amputation
- Infection Control
- Wound Care
- Improving Circulation
These treatments aim to manage the ulcer and prevent further complications.
11
Q
What is a dysrhythmia?
A
Abnormal heart rate/rhythm or both.
12
Q
List some risk factors for dysrhythmias.
A
- History of heart disease
- Hypertension
- Coronary artery disease
- Myocardial infarction
- Cardiac surgery
- Cardiac congenital disease
- Endocrine diseases
- Diabetes mellitus
- Electrolyte imbalances
- Thyroid disorders
- Sleep apnea
- Alcohol misuse
- Use of stimulants (caffeine, nicotine)
13
Q
What factors affect pulse?
A
- Age
- Gender
- Exercise
- Fever
- Medications
- Hypovolemia
- Stress
- Position changes
- Pathology
14
Q
What is the role of the sinoatrial (SA) node?
A
Acts as pacemaker and creates impulse 60-100 times/minute.
15
Q
What is the pathway of impulse conduction in the heart?
A
SA node -> atria -> AV node -> bundle of His -> right and left bundle branches -> Purkinje fibers.
16
Q
What does a healthy pulse reflect?
A
Heartbeat.
17
Q
What is the life-threatening dysrhythmia?
A
Atrial fibrillation.
18
Q
What is the function of
beta adrenergic blockers
in dysrhythmias?
A
Reduce HR and contractility; help slow ventricular response to afib.
19
Q
What is a common side effect of beta adrenergic blockers?
A
Can cause bronchospasms.
20
Q
What do calcium channel blockers do?
A
Reduce AV node conduction and myocardial contractility.
21
Q
What is digoxin used for in dysrhythmias?
A
Cardiac glycoside that slows heart rate.
22
Q
How should dig toxicity be monitored?
A
Count apical pulse for a full 60 seconds.
23
Q
What are the goals of collaboration in managing dysrhythmias?
A
- Identify dysrhythmia
- Treat underlying causes
- Provide appropriate treatment
24
Q
What diagnostic tests are used for dysrhythmias?
A
- Electrocardiogram
- Cardiac monitoring
- Electrophysiology studies
25
What should patient education focus on for dysrhythmias?
* Following prescribed treatment plan
* Managing risk factors
* Monitoring pulse
* Keeping a diary of results
26
What are some expected outcomes for patients with dysrhythmias?
* Reduced frequency of dysrhythmia episodes
* Appropriate response to dysrhythmia episode
27
What nursing diagnoses may apply to patients with dysrhythmias? (what is the nurse worried about when looking at the patient)
* Potential for ineffective cerebral tissue perfusion
* Decreased cardiac output
* Inability to tolerate activity
* Spiritual distress
* Fear
28
What is synchronized cardioversion?
Timed delivery of impulse to the QRS complex.
29
What is ablation in the context of dysrhythmias?
Used to destroy ectopic electrical focus.
30
symptoms of dysrhythmias?
* Shortness of breath/Dyspnea
* Palpitations
* Dizziness
* Light-headedness
* Fainting
31
What aspects should be assessed in a patient with dysrhythmias?
* History
* medications
* Vital signs
* peripheral pulses
* ECG analysis
32
What is the role of Prostaglandin in congenital heart defects?
Prostaglandin may be used to maintain fetal circulation.
33
What are some treatment options for congenital heart defects?
* Medications
* Surgery
* Transplantation
* Interventional catheterization
34
Can many congenital heart defects be completely repaired?
Yes, many can be completely repaired.
35
What is a characteristic of complex congenital heart defects?
Complex treatment may be palliative.
36
What are mixed defects in congenital heart defects?
Combination of defects where oxygenated and deoxygenated blood results in systemic desaturation.
37
Name three examples of mixed defects.
* TGA (Transposition of the Great Arteries)
* Truncus arteriosus
* Total anomalous pulmonary venous return
38
What are some risk factors for congenital heart defects?
* Maternal diabetes
* Infection with rubella during pregnancy
* Certain medications during pregnancy
* Consumption of alcohol and cigarettes during pregnancy
* Heredity
39
What can women do to prevent congenital heart defects during pregnancy?
* Vaccination for rubella
* Manage chronic medical conditions
* Discuss risks associated with medications with healthcare provider
* Avoid harmful substances
* Take multivitamin including folic acid
40
What is the prevalence of congenital heart defects?
8 infants per 1000 live births.
41
What are common clinical manifestations of mixed congenital heart defects?
* Cyanosis
* Symptoms of CHF (Congestive Heart Failure)
* Pulmonary congestion
42
What are the cardinal signs of defects that obstruct systemic blood flow?
* Diminished pulses
* Poor color
* Delayed capillary refill time
* Decreased urinary output
43
What is the pathophysiology of defects that obstruct systemic blood flow?
They prevent sufficient blood from traveling to the body.
44
What are examples of anatomical defects that obstruct systemic blood flow? (the name of defects that obstruct BF)
* Anatomic stenosis of the pulmonary artery
* Anatomic stenosis of aorta
* Aortic stenosis
45
What are the most common congenital heart defects that increase pulmonary blood flow?
* ASD (Atrial Septal Defect)
* VSD (Ventricular Septal Defect)
* PDA (Patent Ductus Arteriosus)
46
What clinical manifestations indicate defects that increase pulmonary blood flow?
* Heart murmur
* Increased respiratory rate with feedings
* Sweating
47
What are the symptoms of defects that decrease pulmonary blood flow?
* Dyspnea
* Loud murmur
* Cyanosis that doesn’t respond to oxygen
48
What is a tet spell in the context of congenital heart defects?
A hyper cyanotic episode that can occur in children with severe obstruction to pulmonary blood flow.
49
What is the risk associated with polycythemia in congenital heart defects?
Increased risk for thromboembolism development.
50
What are the common clinical signs of hyper cyanotic episodes? if your HYPER cyanotic as a baby, what we seeing
* Increased respiratory rate
* Increased heart rate
* Irritability and crying
* Increased cyanosis
51
What is the etiology of congenital heart defects?
Alteration in fetal development or persistence of fetal structures.
52
True or False: Most people with congenital heart defects do not survive into adulthood.
False. Most people with congenital heart defects survive to live active, productive lives.
53
What can women who are or plan to become pregnant do to control some risk factors?
Vaccination for rubella, manage chronic medical conditions, discuss risks associated with medications, avoid harmful substances, take multivitamin including folic acid
54
What is the significance of detecting abnormalities before birth?
Enables timely intervention at birth, improves post delivery survival, gives family the opportunity to learn and prepare
55
What common clinical manifestation may indicate a heart murmur?
Higher-than-normal pressure of blood, narrowed valve or vessel, flowing through a shunt
56
What are minor defects that may be indicated by a heart murmur?
Small ASD (Atrial Septal Defect), murmur may be only sign
57
What symptoms are associated with defects that increase pulmonary blood flow?
Increased pulmonary blood flow, increased heart rate, increased respiratory rate, increased metabolic rate
58
What can happen if a child with a defect that increases pulmonary blood flow cannot consume enough calories?
Poor weight gain
59
What are symptoms of defects that decrease pulmonary blood flow?
Dyspnea, loud murmur, cyanosis that doesn’t respond to oxygen, chronic hypoxemia, hyper cyanotic episodes
60
What are common signs of hyper cyanotic episodes in children?
Increased rate and depth of respirations, increased heart rate, irritability and crying, increased cyanosis
61
What cardinal signs indicate a defect that obstructs systemic blood flow? obstructs = everything is low
Diminished pulses, poor color, delayed capillary refill time, decreased urinary output
62
What physiological changes occur due to low cardiac output in obstructive defects?
Blood backs through left heart chambers into pulmonary venous vasculature, resulting in stronger pulses and higher BP in upper extremities
63
What are the common symptoms of mixed defects?
Cyanosis, symptoms of congestive heart failure (CHF), pulmonary congestion
64
What are some risk factors for congenital heart defects?
Maternal diabetes, infection with rubella during pregnancy, certain medications during pregnancy, consumption of alcohol and cigarettes, heredity
65
What are the most common congenital heart defects that increase pulmonary blood flow?
ASD (Atrial Septal Defect), VSD (Ventricular Septal Defect), PDA (Patent Ductus Arteriosus)
66
What does polycythemia result from in congenital heart defects that impede blood flow? What causes the polycythemia in these cases?
Bone marrow stimulated to produce more RBCs to increase available hemoglobin
67
What risks are associated with congenital heart defects that impede blood flow?
Risk for thromboembolism development, impaired clotting factors, increased risk for hemorrhage
68
What are examples of defects that obstruct systemic blood flow?
Coarctation of Aorta, Aortic Stenosis
69
What is the pathophysiology of mixed defects?
Combination of oxygenated and deoxygenated blood results in systemic desaturation
70
What therapies are used in the collaborative care of individuals with congenital heart defects?
Medications, surgery, transplantation, interventional catheterization
71
What is the prevalence of congenital heart defects?
8 infants per 1000 live births
72
What factors contribute to the etiology of congenital heart defects?
Unknown etiology, hereditary, teratogenic factors
73
True or False: Most people with congenital heart defects do not survive to live active, productive lives.
False
74
What is a stroke
a cerebrovascular accident/ brain attack
- neurologic deficits result from a sudden decrease in blood flow to a localized area of the brain
75
A stroke can be either of these 2 things
Ischemic and hemorrhagic
76
Pathophysiology of a Stroke
- Blood flow and oxygenation to cerebral neurons decrease
- Core of dead or dying cells surrounded by penumbra
- characterized by gradual or rapid onset of neurologic defects
77
Pathophysiology of Ischemic Stroke
Blockage and/or stenosis of the cerebral artery
- leads to brain infarction
78
What are the 3 classifications od an ischemic stroke
Classification:
- Transient
- Thrombotic
- Embolic
79
Pathophysiology of a TIA
- the neurologic manifestations depend on...
Transient ischemic attack
- deficits last < 24 hrs
- sudden onset and disappear within minutes or hours
Depend on:
- location, size of cerebral vessel
80
TIA, embolic, and thrombotic strokes are what types of strokes
Ischemic
81
Pathophysiology of Embolic stroke
- what are its origins
A blood clot traveling through cerebral vessels becomes lodged in a vessel too narrow for further movement
- origins from cardiogenic embolic stroke
82
Pathophysiology of Hemorrhagic Stroke
Ruptured cerebral blood vessel that leads to bleeding
83
Hemorrhagic stroke causes what?
- 5 things
Hypertension (most common)
- rupture of plaque-encrusted artery wall
- ruptured intracranial aneurysm
- trauma
- anticoagulant therapy
84
Risk factors for Hemorrhagic stroke
- 6 things
- Anything that increases the risk for:
- damage to vessel walls/plaque buildup
- clot formation
bleeding
aditonally
- Race
- TIA Hx
- Drug abuse
85
FAST acronym
Facial drooping
Arm weakness
Speech slurred
Time: Call 9-1-1 if signs/symptoms present
86
additional signs for when to call 911 for a stroke
Signs to call 9-1-1
▪ Sudden weakness, numbness in face, arm, or leg
on one side of the body
▪ Sudden confusion, difficulty speaking or
understanding speech
▪ Sudden trouble walking, dizziness, loss of
coordination
▪ Sudden difficulty with vision in one or both eyes
▪ Sudden severe headache with no cause
87
Clinical Manifestations of a Stroke
* Vary according to cerebral artery involved, area of brain affected
* Sudden, focal, usually one sided
* Most common: weakness of face and arm, sometimes leg
* Others:
– Unilateral numbness
– Loss of vision
– Dysarthria and dysphagia
– Imbalance
– Sudden severe headache with rapid onset
* Woman more likely to report nontraditional manifestations
– Nausea, SOB, palpitations, generalized weakness,
disorientation, confusion
88
Complications with a stroke
* Cognitive, behavioral changes
– Changes in consciousness
– Emotional lability
– Loss of self-control
– Decreased tolerance for stress
– Intellectual changes
▪ Memory loss
▪ Decreased attention span
▪ Poor judgment
▪ Inability to think abstractly
89
Complications of a Stroke:
It affects 5 dominant features of a person
What 4 types of Aphasia are there?
- speech
- language
- memory
- reasoning
- emotions
Aphasia (difficulty speaking/communication after a stroke)
- expressive
- receptive
- mixed or global
- Wernicke
90
What are the motor deficits in a stroke
- Mild weakness to severe limitation
– Hemiplegia
– Hemiparesis
– Altered mobility
91
What is an elimination disorder related to a Stroke
Partial loss of sensations that trigger elimination
92
What are the treatment stages for a stroke
- Stroke prevention
- Acute care immediately after stroke
- Rehabilitation
93
Diagnostic tests of a stroke
- CT scan
- MRI/ Magnetic resonance angiography
- Carotid doppler ultrasound
94
Pharmacologic Therapy for a Stroke
- what are the prevention
- What is given for acute Ischemic stroke
Prevention
- anti platelet agents (aspirin or clopidogrel
- Antihypertensive therapy/ cholesterol-lowering drugs (statins)
- Acute Ischemic Stroke (Anticoagulants, platelet inhibitors, and thrombolytics)
- Fibrinolytic Therapy using rt-PA, tPA
(Gold standard for acute ischemic stroke) most effective when givin with IV wihtin 3 hrs of onset
- Corticosteroids to treat Cerebral edema related to stroke
95
I there is increased intracranial presure present, we give...
Osmotic diuretic or loop diuretic may be used
- anticonvulsants and barbituates if seizures occur
96
Type of surgery for Stroke
- Carotid endarterectomy
- Extracranial-intracranial bypass
- Carotid angioplasty with stunting
97
Type of rehab for stroke
Physical therapy
- OT
- Speech/ language therapy
98
Lifespan considerations for Stroke
* Neonates
– Labor and delivery can increase stress on arteries and veins in the head
– Newborns in hypercoagulable state
– Often missed due to rarity/difficult to diagnose signs
* Children and adolescents
– Common causes of adult strokes are rare in children
* Pregnant women
– Pregnancy increases risk of stroke
– Treated the same as stroke in other adults
99
Nursing Process during a Stoke
* Complex and multidimensional
* Continuity of care is vital
* Knowledge and skill to meet patient’s needs during both acute phase and
rehabilitation
* Promote achievement of maximum potential, quality of life
* Communication critical to high quality care
* Rehabilitation focuses on what the patient can do and less on functional losses
* Assess and identify needs of individual, family
* Care focuses on
– Cerebral tissue perfusion, physical mobility, communication, self-care,
sensory-perceptual deficits, bowel and urine elimination, and swallowing
100
