Exam 3 Flashcards
(113 cards)
1
Q
Angiotensin II is a potent what?
A
vasoconstrictor
2
Q
What causes arrhythmias?
A
Electrolyte imbalance, hypoxia, structural damage, acidosis, cardiac drugs
3
Q
Blood Pressure
A
the pressure of blood pushing against the walls of your arteries
4
Q
Systolic BP
A
- the top number
- measures the pressure in your arteries when your heart beats
5
Q
Diastolic BP
A
- the bottom number
- measures the pressure in your arteries when your heart rests between beats
6
Q
Pulse Pressure
A
- the difference between the upper and lower numbers of your blood pressure.
- helps to predict heart attack or stroke
- tends to increase with age
- normal: 40-60
- wide pressure associated with heart attack
- narrow pressure associated with heart failure
7
Q
Cardiac Output
A
- how many liters of blood your heart can pump in a minute
- multiply stroke volume and heart rate
- determines the heart’s strength and health
- need more cardiac output when exercising since body’s cells need more oxygen
- measured when difficulty exercising arises or heart failure present
- normal: 4 to 8 L/min
8
Q
Perpheral Vascular Resistance
A
- force that resists the flow of blood through the vessels, mostly determined by the arterioles, which contract to increase resistance; important in determining overall blood pressure
- heart rate, stroke volume, and peripheral vascular resistance are factors that determine BP
- when there is low pressure on the baroreceptors, the medulla is stimulated to increase the sympathetic nervous system to constrict the blood vessels and increase peripheral vascular resistance
9
Q
What do we need to have a blood pressure in our body?
A
the amount of blood the heart pumps and how hard it is for the blood to move through the arteries
10
Q
EKG
A
- detects the patterns of electrical impulse generation and conduction through the heart and translates that information into a recorded pattern, which is displayed as a waveform on a cardiac monitor
- a measure of electrical activity; it provides no information about the mechanical activity of the heart
11
Q
Edema
A
- swelling caused by excess fluid trapped in your body’s tissues
- usually seen on hands, arms, feet, ankles and legs
- occurs when tiny blood vessels in your body (capillaries) leak fluid
- risk factors: CHD, lung diseases, venous insufficiency, long periods of sitting and standing
- treatment of the underlying cause (if possible), reducing the amount of salt (sodium) in your diet, and, in many cases, use of a medication called a diuretic to eliminate excess fluid, using compression stockings and elevating the legs may also be recommended
12
Q
Endothelial Layer of the Heart
A
- the innermost layer of the heart and lines the chambers and extends over projecting structures such as the valves, chordae tendineae, and papillary muscles
- endothelial cells release substances that control vascular relaxation and contraction as well as enzymes that control blood clotting, immune function and platelet (a colorless substance in the blood) adhesion
13
Q
Heart Electrical Conductivity
A
property of heart cells to rapidly conduct an action potential of electrical impulse
1. starts when your sinoatrial (SA) node creates an excitation signal
2. tells atria (top heart chambers) to contract
3. The atrioventricular (AV) node, delaying the signal until your atria are empty of blood.
4. The bundle of His (center bundle of nerve fibers), carrying the signal to the Purkinje fibers.
5. The Purkinje fibers to your ventricles (bottom heart chambers), causing them to contract.
14
Q
Hypertension
A
- Intermittent or sustained elevation of diastolic or systolic blood pressure
- HTN: Systolic blood pressure of 139 mm Hg or higher or a diastolic blood pressure greater than 89 mm Hg
- Pre-HTN: systolic pressure from 120–139 and diastolic from 80-89
Determined by
* amount of blood pumped from ventricles w/ each heartbeat
* Total PVR – resistance of muscular arteries to blood being pumped
* Baroreceptors
* RAAS
15
Q
Hyperlipidemia
A
Causes
* When the levels of lipids in the blood increase, hyperlipidemia occurs
* This can result from excessive dietary intake of fats or from genetic alterations in fat metabolism, leading to a variety of elevated fats in the blood
* Hypercholesterolemia, hypertriglyceridemia, alterations in LDL and HDL concentrations
Best Ways to Combat
* reduce intake of saturated fats in dairy and red meat
* Niacin, Fenofibrate, Omega-3
16
Q
Troponin Labs
A
chemical in heart muscle that prevents the reaction between actin and myosin, leading to muscle relaxation; it is inactivated by calcium during muscle stimulation to allow actin and myosin to react, causing muscle contraction
Normal Values:
* Troponin I: 0 - 0.04 ng/mL.
* Troponin T: 0 - 0.01 ng/mL.
High Levels Correlate with
* Heart surgery.
* Infections or inflammation in your heart.
* Cardioversion (this is the use of an electric shock to make an irregular heart rhythm return to normal).
17
Q
Creatine Kinase Labs
A
An enzyme that’s found in your skeletal muscle, heart muscle and brain.
When any of these tissues are damaged, they leak creatine kinase into your bloodstream.
Elevated CK levels may indicate muscle injury or disease.
Normal
* 22 to 198 U/L
Three Types
* These are CK-MB, CK-MM, and CK-BB. CK-MB is the substance that rises if your heart muscle is damaged. CK-MM rises with other muscle damage. CK-BB is found mostly in the brain.
18
Q
Myoglobin Labs
A
measures the amount of myoglobin, a protein found in your skeletal and heart muscles, in your blood or urine.
* Myoglobin is a protein that’s found in your striated muscles, which includes skeletal muscles (the muscles attached to your bones and tendons) and heart muscles. Its main function is to supply oxygen to the cells in your muscles (myocytes).
* High levels generally indicate muscle damage; though, the test cannot determine the cause or location of the muscle damage.
Normal
* For men: Less than 91 ng/mL (nanograms per milliliter).
* For women: Less than 63 ng/mL.
19
Q
Triglycerides
A
lipids that give the body energy from the food we eat
Pure cholesterol cannot mix with or dissolve in the blood. Instead, the liver packages cholesterol with triglycerides and proteins called lipoproteins. The lipoproteins move this fatty mixture to areas throughout the body.
* High triglycerides combined with high cholesterol raise your risk of heart attack, strokes and pancreatitis
Levels: 150 or less
20
Q
Phospholipids
A
a class of lipids whose molecule has a hydrophilic “head” containing a phosphate group and two hydrophobic “tails” derived from fatty acids, joined by an alcohol residue
antiphospholipid syndrome
* autoimmune disorder that causes blood clots by the body’s immune system attacking proteins bound to phospholipids
* These antibodies make it much more likely that you will have blood clots in your arteries or veins
21
Q
Cholesterol
A
found in large quantities in the membrane, and it works to keep the phospholipids in place and the cell membrane stable
* necessary component of human cells that is produced and processed in the liver and then stored in the bile until stimulus causes the gallbladder to contract and send the bile into the duodenum via the common bile duct; a fat that is essential for the formation of steroid hormones and cell membranes; it is produced in cells and taken in by dietary sources
* Normal: less than 200 mg/dL
22
Q
Chylomicrons
A
carrier for micelles or lipids in the bloodstream, consisting of proteins, lipids, cholesterol, and so forth
* chylomicrons pass through the wall of the small intestine, are picked up by the surrounding intestinal lymphatic system, travel through the system to the heart, and then are sent out into circulation
23
Q
VLDL
A
produced in the liver and released into the bloodstream to supply body tissues with a type of fat (triglycerides)
* High levels of VLDL cholesterol have been associated with the development of plaque deposits on artery walls, which narrow the passage and restrict blood flow.
* An elevated VLDL cholesterol level is more than 30 milligrams per deciliter
24
Q
IDL
A
are formed from the degradation of very low-density lipoproteins as well as high-density lipoproteins
* enable fats and cholesterol to move within the water-based solution of the bloodstream
* refers to a density between that of low-density and very-low-density lipoproteins.
25
LDL
tightly packed fats that are thought to contribute to the development of coronary artery disease when remnants left over from the LDL are processed in the arterial lining
* enter circulation as tightly packed cholesterol, triglycerides, and lipids, all of which are carried by proteins that enter circulation to be broken down for energy or stored for future use as energy
* Lab: 100 or less
26
HDL
loosely packed chylomicron-containing fats, able to absorb fats and fat remnants in the periphery; thought to have a protective effect, decreasing the development of coronary artery disease
* enter circulation as loosely packed lipids that are used for energy and to pick up remnants of fats and cholesterol that are left in the periphery by LDL breakdown
* Lab: 40 or more
27
Orthostatic Hypotension
A form of low blood pressure that happens when standing up from sitting or lying down
Causes include dehydration, long-term bed rest, pregnancy, certain medical conditions and some medications.
* commonly seen in the elderly because of age-related impairment in baroreflex compensatory reflexes (maintains blood pressure at constant rate) to upright position
* Hypovolemia: Loss of fluid within the blood vessels is the most common cause of symptoms linked to orthostatic hypotension. This could be due to dehydration brought about by diarrhea, vomiting, and the use of medication, such as diuretics or water pills.
28
Myocardial Infarction
blockages in coronary arteries within the heart
heart does not get enough O2 from the blockage
29
Plaque Rupture
Plaques inside the coronary arteries sometimes break open or "rupture." This is what causes most heart attacks. When a plaque breaks open, it causes a blood clot to form inside the artery. As the clot grows, it can completely block off the flow of blood through the artery.
30
RAAS
the system of hormones, proteins, enzymes and reactions that regulate your blood pressure and blood volume on a long-term basis
1. When your blood pressure falls, your kidneys release the enzyme renin into your bloodstream.
2. Renin splits angiotensinogen, a protein your liver makes and releases, into pieces. One piece is the hormone angiotensin I.
3. Angiotensin I, which is inactive (doesn’t cause any effects), flows through your bloodstream and is split into pieces by angiotensin-converting enzyme (ACE) in your lungs and kidneys. One of those pieces is angiotensin II, an active hormone.
4. Angiotensin II causes the muscular walls of small arteries (arterioles) to constrict (narrow), which increases blood pressure. 5. Angiotensin II also triggers your adrenal glands to release aldosterone and your pituitary gland to release antidiuretic hormone (ADH, or vasopressin).
6. Together, aldosterone and ADH cause your kidneys to retain sodium. Aldosterone also causes your kidneys to release (excrete) potassium through your urine.
7. The increase in sodium in your bloodstream causes water retention. This increases blood volume and blood pressure, thus completing the renin-angiotensin-aldosterone system.
31
7 P's of Arterial Occulusion
condition involving partial or complete blockage of blood flow through an artery, stops flow of oxygen, causing ischemia
1. pistol pain
2. pallor
3. polar (coldness)
4. pulselessness
5. pain
6. paresthesia (pins and needles sensation)
7. paralysis
32
What regulates the smooth muscles in the heart?
the sinoatrial node of the heart
the pacemaker
33
Thrombin
an enzyme in blood plasma which causes the clotting of blood by converting fibrinogen to fibrin
34
One-Way Valves
supports the return of blood flow to the heart through venous circulation
35
Virchow's Triad
three contributing factors in the formation of thrombosis: venous stasis, vascular injury, and hypercoagulability
36
Risk Factors for Venous Stasis
1. immobility
2. spinal cord injury
3. CHF
4. venous obstruction
37
Acute Coronary Syndrome
Patho: Blood supply to the myocardium is interrupted from occlusion of one or more of the coronary arteries.
Causes:
* Atherosclerosis
* Thrombosis
* Platelet aggregation
* Coronary artery stenosis or spasm
Types:
* Unstable angina
* Variant or Prinzmetal’s angina
* Non–ST-elevation myocardial infarction (non-STEMI or non–Qwave MI)
* ST-elevation myocardial infarction (STEMI or Qwave MI)
S/S
* Chest pain, radiating shoulder pain, NV, DOE, SOB
Complications: Damage caused by an MI:
* Reduced contractility with abnormal wall motion
* Altered LV compliance
* Reduced SV
* Reduced EF
* Elevated LV end-diastolic pressure
Treatment
* Treat chest pain
* Stabilize heart
* Reduce cardiac workload
38
Aneurysms
Patho: a bulge or ballooning in a blood vessel in the brain
may occur in any part of the aorta or major arteries
Causes:
* Usually caused by atherosclerosis (thickening of the arterial walls)
* infection
* trauma
* congenital abnormalities
S/S
* Back pain
* Cough
* Weak, scratchy voice (hoarseness)
* Shortness of breath
* Tenderness or pain in the chest
39
Atherosclerosis
leading cause of coronary heart disease
Risk Factors:
* age
* male
* women after menopause
* family history
* lifestyle: smoking, obesity, diet
* type 1 and 2
Clinical Manifestations
* Atherosclerosis is the buildup of fats, cholesterol and other substances in and on the artery walls. This buildup is called plaque. The plaque can cause arteries to narrow, blocking blood flow. The plaque can also burst, leading to a blood clot.
Complications:
* ischemic heart disease, stroke, peripheral vascular disease
40
Hypercholesterolemia
a lipid disorder in which your low-density lipoprotein (LDL), or bad cholesterol, is too high
* This makes fat collect in your arteries (atherosclerosis), which puts you at a higher risk of heart attack and stroke
* 190 mg/dL or higher without other risk factors.
Higher than 160 mg/dL with another major risk factor.
Above 130 mg/dL with two risk factors.
Risk For:
* stroke
* coronary artery disease
* peripheral artery disease
41
Vasculitis
inflammation of the blood vessels
* The inflammation can cause the walls of the blood vessels to thicken, which reduces the width of the passageway through the vessel. If blood flow is restricted, it can result in organ and tissue damage.
42
Arterial Disease of Extremities
peripheral artery disease
* narrowing or blockage of the vessels that carry blood from the heart to the legs
* primarily caused by the buildup of fatty plaque in the arteries, which is called atherosclerosis.
43
Arterial Anerysms
An aortic aneurysm is a balloon-like bulge in the aorta, the large artery that carries blood from the heart through the chest and torso.
Aortic aneurysms can dissect or rupture: The force of blood pumping can split the layers of the artery wall, allowing blood to leak in between them.
44
Cardiomyopathy
a disease of the heart muscle that makes it harder for the heart to pump blood to the rest of the body
Causes:
* Infectious disease
* Diabetes
* Renal failure
* Pregnancy complications
* Alcohol / drug toxicity
* Ischemia, HTN
* Systemic inflammatory disorders
* Nutritional disorders
* Genetic predisposition
* Idiopathic
Types: dilated, hypertrophic, restrictive
* dilated: causes the heart chambers (ventricles) to thin and stretch, growing larger
* hypertrophic: the heart muscle becomes abnormally thick.
* restrictive: the muscles of your heart's lower chambers (ventricles) stiffen and can't fill with blood
45
Coronary Artery Disease
Fatty, fibrous plaques progressively narrow the coronary artery lumens reducing volume of blood flow through them.
* Causes the loss of oxygen and nutrients to myocardial tissue because of poor coronary blood flow.
Causes
* Modifiable vs Nonmodifiable
* Atheroma: Fatty tumors in intima of heart vessels
* Atherosclerosis: Narrowing of the heart vessels
* Angina Pectoris: “suffocating of chest”
* Prinzmetal’s angina: spasms of vessels + narrowing
* MI: Cells in myocardium become necrotic & die
Types
* Stable: No damage to heart; reflexes restore blood flow
* Unstable: Episodes of ischemia occur at rest
* MI: completely occluded coronary vessel unable to deliver blood to heart, that area becomes ischemic and then necrotic -> excruciating pain, NV, and severe sympathetic stress reaction
S/S
* unstable or stable angina
Complications
* heart attack
46
Right-Sided Heart Failure
In right-sided heart failure, the heart’s right ventricle is too weak to pump enough blood to the lungs. As blood builds up in the veins, fluid gets pushed out into the tissues in the body. Blood clots or thrombus usually causes this.
* The right side of your heart pumps “used” blood from your body back to your lungs, where it refills with oxygen.
* Blood builds up in your veins, vessels that carry blood from the body back to the heart.
* This buildup increases pressure in your veins.
* The pressure pushes fluid out of your veins and into other tissue.
* Fluid builds up in your legs, abdomen or other areas of your body, causing swelling.
47
Left-Sided Heart Failure
The left ventricle of the heart no longer pumps enough blood around the body.
* As a result, blood builds up in the pulmonary veins (the blood vessels that carry blood away from the lungs).
* This causes shortness of breath, trouble breathing or coughing – especially during physical activity.
* Left-sided heart failure is the most common type
48
Neural BP Regulation
PSNS, SNS, baroreceptors, chemoreceptors
* PSNS causes relaxation of blood vessels, decreasing total peripheral resistance. It also decreases heart rate. As a result, the blood pressure comes back to the normal level.
* SNS: The increase in sympathetic activity is a mechanism for both initiating and sustaining the blood pressure elevation
* baroreceptors: are sensors located in the carotid sinus and aortic arch. They sense the blood pressure and relay the information to the brain, so that a proper blood pressure can be maintained. Increases in the pressure of blood vessel triggers increased action potential generation rates and provides information to the central nervous system
* chemoreceptors: special nerve cells or receptors that sense changes in the chemical composition of the blood. That information is sent from the chemoreceptors to the brain to help keep the cardiovascular and respiratory systems balanced.
49
Humoral BP Regulation
RAAS
vasopressin: vasoconstriction and increasing blood pressure
50
Long-Term BP Regulation
Renal Mechanisms
Diuresis
Sodium Control
51
Primary HTN
Essential (primary) hypertension occurs when you have abnormally high blood pressure that’s not the result of a medical condition. This form of high blood pressure is often due to obesity, family history and an unhealthy diet. The condition is reversible with medications and lifestyle changes.
52
Secondary HTN
Secondary hypertension is high blood pressure caused by another condition or disease. Conditions that may cause secondary hypertension include kidney disease, adrenal disease, thyroid problems and obstructive sleep apnea.
53
Hypertensive Crisis
A hypertensive crisis is a sudden, severe increase in blood pressure. The blood pressure reading is 180/120 millimeters of mercury (mm Hg) or greater. A hypertensive crisis is a medical emergency. It can lead to a heart attack, stroke or other life-threatening health problems.
* Urgent hypertensive crisis. Blood pressure is 180/120 mm Hg or greater. There are no signs of organ damage.
* Emergency hypertensive crisis. Blood pressure is 180/120 mm Hg or greater. There is life-threatening damage to the body's organs.
54
HTN Modifiable Factors
diet, obesity, alcohol intake, OCP's, stress
55
HTN Non-Modifiable Factors
family history, age, race, insulin resistance, metabolic abnormalities, circadian variations, lifestyle factors
56
HTN and the Heart
damages the arteries by making them less elastic, which decreases the flow of blood and oxygen to your heart and leads to heart disease
* causes hypertrophy - thickening of the heart - to pump the blood
57
HTN and the Brain
dementia and cognitive issues
58
HTN and PVD
atherosclerosis
59
HTN and the Kidneys
sclerosis of nephrons
60
HTN and the Eyes
retinal complications
61
Peripheral Artery Disease
An accumulation of plaque (fats and cholesterol) in the arteries in your legs or arms. This makes it harder for your blood to carry oxygen and nutrients to the tissues in those areas.
* PAD is a long-term disease, but you can improve it by exercising, eating less fat and giving up tobacco products.
62
Myocardial Infarction
A lack of blood flow to your heart muscle. The lack of blood flow can occur because of many different factors but is usually related to a blockage in one or more of your heart’s arteries.
* Without blood flow, the affected heart muscle will begin to die. If blood flow isn’t restored quickly, a heart attack can cause permanent heart damage and death.
63
Varicose Veins
Varicose veins are swollen blood vessels that appear just under your skin’s surface in your lower body. When your vein walls are weak and your valves aren’t working right, blood backs up in your vein. This causes the blue and purple bulges you see on your legs, feet or ankles. Several treatment options can work, but varicose veins can return.
* venous circulation disorder
64
Thrombophlebitis
An inflammatory process that causes a blood clot to form and block one or more veins, usually in the legs. The affected vein might be near the surface of the skin (superficial thrombophlebitis) or deep within a muscle (deep vein thrombosis, or DVT).
65
Peripheral Vascular Disease
A slow and progressive circulation disorder. Narrowing, blockage, or spasms in a blood vessel can cause PVD.
* PVD may affect any blood vessel outside of the heart including the arteries, veins, or lymphatic vessels. Organs supplied by these vessels, such as the brain, and legs, may not get enough blood flow for proper function. However, the legs and feet are most commonly affected.
66
DVT
Occurs when a thrombus (blood clot) develops in veins deep in your body because your veins are injured or the blood flowing through them is too sluggish. The blood clots may partially or completely block blood flow through your vein.
* Most DVTs happen in your lower leg, thigh or pelvis, but they also can occur in other parts of your body including your arm, brain, intestines, liver or kidney.
67
Incompetent Vascular Function
Chronic venous insufficiency occurs when your leg veins don’t allow blood to flow back up to your heart.
* Normally, the valves in your veins make sure that blood flows toward your heart. But when these valves don’t work well, blood can also flow backwards. This can cause blood to collect (pool) in your legs.
68
Stasis Dermatitis
A common type of eczema that develops in people who have poor blood flow. Because poor blood flow usually develops in the lower legs, stasis dermatitis often appears near your ankles.
69
Venous Ulcers
A wound on the leg or ankle caused by abnormal or damaged veins.
* Venous ulcers are due to abnormal vein function. People may inherit a tendency for abnormal veins. Common causes of damaged veins include blood clots, injury, aging, and obesity.
70
Breathing
nose humidifies the air, travels down the trachea into the bronchi, then into the bronchioles, then the lungs.
* alveoli: where gas exchange occurs
* breathe in O2, breathe out CO2
71
Ventilation
the movement of air through the conducting passages between the atmosphere and the lungs
* mechanical movement
72
Respiration
gas exchange
* CO2 goes from blood into alveoli
* respiratory center in the brain: medulla oblongata
* chemoreceptors monitor CO2 and O2 in blood
73
Asthma
Patho:
* Form of COPD that’s a chronic reactive airway disorder that can present as an acute attack
* Causes episodic airway obstruction resulting from bronchospasms, increased mucus secretion, and mucosal edema
Causes
* genetic
* environmental
S/S
* Marked respiratory distress
* Marked wheezing or absent breath sounds
* Pulsus paradoxus greater than 10 mm Hg
* Chest wall contractions
Complications
* Status Asthmaticus
* Can progress to ARF.
* Intubation of an asthmatic is rarely a good thing. It takes them a long time to come off the vent, if they do.
Treatment
* Long-acting bronchodilators
* Corticosteroids
* Combined medications
* Leukotriene modifiers
* Mast cell stabilizers
* Immunomodulators
74
COPD
Patho:
* lower respiratory disease, permanent and chronic obstruction of airways
* air is trapped in the lower respiratory tract
* alveoli degenerate and fuse together
* airflow obstruction on expiration
* overinflated lungs and poor gas exchange
Causes:
* smoking
Types:
* emphysema
* chronic bronchitis
S/S:
* SOB
* Impaired gas exchange –altered ABGs
* Clubbing of fingers
* “pink puffer” vs “blue bloater”
Treatment:
* Bronchodilators
* Judicious oxygen use – too much can knock out drive to breath (over saturating with oxygen decreases CO2 accumulation)
* Symptomatic treatment
* Education on smoking cessation
75
Chronic Bronchitis
inflammation of bronchi to bronchioles
productive cough
increased mucus and inflammation within the bronchi
76
Emphysema
poor gas exchange in alveoli
Form of COPD that’s the abnormal, permanent enlargement of the alveoli accompanied by destruction of the alveolar walls
77
Chronic Respiratory Disorders
* get flu shots
Go to PCP
* More breathless than usual
* Less energy for your daily activities
* Increased amounts or change in consistency of your phlegm/mucus
* Needing to use your rescue inhaler or nebulizer more often
* Coughing more than usual
* Feel like you have a “chest cold”
* Awakening at night due to breathing problems
* Feeling like your medicine is no longer helping
Go to Emergency Room
* Severe shortness of breath (with rest or activities)
* Unable to do any activities because of your breathing
* Unable to sleep because of your breathing
* Fever or shaking chills
* Confusion or drowsiness
* Coughing up blood
* Chest pains
78
Hypoxemia
when oxygen levels in the blood are lower than normal
* Hypoxemia can happen if you can’t breathe in enough oxygen or if the oxygen you breathe in can’t get to your blood. Air and blood flow are both important to having enough oxygen in your blood. This is why lung disease and heart disease both increase your risk of hypoxemia.
* use supplemental oxygen, CPAP, bronchodilators, inhalers, steroids, meds to get rid of fluid in lungs
79
Hypercapnia
excessive carbon dioxide in the bloodstream, typically caused by inadequate respiration
80
Pneumonia
Acute infection of the lung
* A cough that produces thick, blood-tinged or yellowish-greenish sputum with pus.
* Viruses attacking bronchiolar epithelial cell
* Bacterial or viral invasion of the tissue
S/S
* Dyspnea on exertion (DOE)
* SOB
* CRACKLES – focal assessment
Assessment
* low body temperature, an increased respiratory rate, low blood pressure, a fast heart rate, or a low oxygen saturation
81
Pneumothorax
Accumulation of air in the pleural cavity that leads to partial or complete lung collapse
* spontaneous or traumatic
* very life threatening
* NEEDLE Decompression
* Symptomatic treatment
* Oxygen
82
Pulmonary Embolism
Obstruction of the pulmonary arterial bed caused by a dislodged thrombus, heart valve growths, or a foreign substance
S/S:
* Tachycardia
* “Air hunger”
* Productive cough
* Low-grade fever
* Pleural effusion
Originates:
* in the leg veins or pelvis
Complications in Body
* shock
* cardiac death
* arrythmias
* cor pulmonale
* severe hypoxia
83
Scoliosis: Restrictive Lung Disease
Scoliosis results in a restrictive lung disease with a multifactorial decrease in lung volumes, displaces the intrathoracic organs, impedes on the movement of ribs and affects the mechanics of the respiratory muscles
84
Spinal Hardware: Restrictive Lung Disease
helps to fix scoliosis and improve lung functioning
85
Kyphosis
Hunchback (kyphosis) usually refers to an abnormally curved spine.
Causes extrapulmonary restriction of the lungs and gives rise to impairment of pulmonary functions
86
Pectus Excavatum
A condition in which a person's breastbone is sunken into his or her chest.
* Can compromise lung and heart capacity, especially when the condition is severe, causing fatigue, shortness of breath, chest pain, and a fast heartbeat
87
Sinusitis
A condition in which the cavities around the nasal passages become inflamed.
88
Nephrons
functional unit of the kidney
very vascular and filter/clean blood
7 functions
1. volume regulation
2. electrolyte control
3. regulate BP
4. erythropoietin production
5. acid-base balance
6. medication/waste excretion
7. Ca-P balance
89
Renal Tubules
reabsorb electrolytes and water to maintain homeostasis
90
Glomeurlar Filtration
* blood goes to glomeurlus
* flows to Bowman's capsule
* proximal convoluted tubules
* loop of Henle
* distal convoluted tubules
* lastly to collecting duct
what is not absorbed becomes urine
91
ADH
holds onto water and sodium
92
Aldosterone
holds onto water and sodium while excreting potassium
93
Atrial Natriuretic Peptide
hormone secreted from the right atrium in response to atrial stretch from hypervolemia as well as in response to hypertension
* excretes sodium
94
Benign Prostatic Hyperplasia
Age-associated prostate gland enlargement that can cause urination difficulty.
doxazosin (Cardura) & Alpha-adrenergic blocker
95
BUN
blood, urea, nitrogen
can fluctuate with protein intake
indicator of hydration
6 to 24 mg/dL
96
Urine Changing Color
Pigments and other compounds in certain foods and medications can change your urine color.
Bacteria can make it cloudy.
Darker urine means dehydration.
97
Chronic Kidney Disease
Progressive and irreversible
* End result of gradual tissue destruction and loss of kidney function
Will Disrupt
1. volume regulation
2. electrolyte control
3. regulation of BP
4. erythropoietin production
5. acid-base balance
6. medication/waste excretion
7. Ca-P balance
98
Creatinine
a breakdown product of creatine phosphate from muscle and protein metabolism
men: 0.7 to 1.3 mg/dL
women: 0.6 to 1.1 mg/dL
elevated levels: sign of poor kidney function
99
Erythropoietin
tells bone marrow to make more RBC's
increases O2 carrying capacity
100
GFR
Rate at which glomeruli filter blood
based on permeability of capillary walls, Vascular pressure, Filtration pressure
indicator of renal function and number of functional nephrons in the kidneys
* Normal rates 107 and 139 mL/minute for males
* 87 and 107 mL/minute for females
101
Glomerulonephritis
Inflammation of the glomeruli, commonly following streptococcal infection
* The epithelial layer of the glomerular membrane is disturbed and Goodpasture’s disease cause this
102
Menses: Regulation of Cycle
OCP: combination of estrogen and progesterone
28d packs or 91d packs
* less bleeding for those with iron deficiency anemia for 91d
103
Nephrotic Syndrome
A kidney disorder that causes your body to pass too much protein in your urine.
Nephrotic syndrome is usually caused by damage to the clusters of small blood vessels in your kidneys that filter waste and excess water from your blood.
* Symptoms include swelling around the eyes and in the feet and ankles, foamy urine, and weight gain due to excess fluid retention.
* Treatment addresses underlying conditions and might include blood pressure medications and water pills.
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Nephritic Syndrome
The nephritic syndrome is a clinical syndrome that presents as hematuria, elevated blood pressure, decreased urine output, and edema.
* The major underlying pathology is inflammation of the glomerulus that results in nephritic syndrome.
* It causes a sudden onset of the appearance of red blood cell (RBC) casts and blood cells, a variable amount of proteinuria, and white blood cells in the urine.
* The primary pathology can be in the kidney, or it can be a consequence of systemic disorders.
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Acute Kidney Injury
Sudden interruption of renal function from poor circulation or kidney disease
* Prerenal: occurs when a sudden reduction in blood flow to the kidney (renal hypoperfusion) causes a loss of kidney function. In prerenal acute kidney injury, there is nothing wrong with the kidney itself. From Intravascular volume depletion either from dehydration or excessive fluid loss
* Intrarenal: a disease process causes damage to the kidney itself
* Postrenal: when an obstruction in the urinary tract below the kidneys causes waste to build up in the kidneys
Need to treat the underlying cause of these three
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Pylonephritis
The inflammation of the kidney is due to a specific type of urinary tract infection (UTI). The UTI usually begins in the urethra or bladder and travels to the kidneys.
* Fever, frequent urination, and pain in the back, side, or groin are symptoms.
* Treatment includes antibiotics and often requires hospitalization.
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Renal Calculi
Hard deposits made of minerals and salts that form inside your kidneys. Diet, excess body weight, some medical conditions, and certain supplements and medications are among the many causes of kidney stones.
* very painful, may see N/N
* Calcium Calcli: avoid nuts, seeds, beets, spinach, and buckwheat flour
* Uric Acid Calcli: avoid red meat, organ meats, beer/alcoholic beverages, meat-based gravies, sardines, anchovies and shellfish
* Oxilate Calculi: avoid beets, chocolate, spinach, rhubarb, tea, and most nuts
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Stress Incontinence
happens when physical movement or activity — such as coughing, laughing, sneezing, running or heavy lifting — puts pressure (stress) on your bladder, causing you to leak urine
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Urge Incontinence
When you have a strong, sudden need to urinate that is difficult to delay. The bladder then squeezes, or spasms, and you lose urine.
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UTI
Infection anywhere in the urinary tract
Hematuria
S/S
* Bladder pain/spasms, Burning, stabbing w/urination, Dysuria, Cloudy urine, Disorientation/confusion in older adults, Pyuria, Urinary frequency
* Acute pyelonephritis –chills, fever, flank pain, and tenderness
Neonates: Bacteria and other infection-causing microbes may enter the urinary tract when an infant has a dirty diaper or when babies are wiped from back to front.
Toddlers: not wiping properly
Elderly: decreased urine flow, decreased mobility, incontinence, catheters, weaker immune systems
Catheters: germs can travel along the catheter and cause an infection in your bladder or your kidney
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Vitamin D
kidneys make this vitamin usable
helps body to absorb Ca and use it
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Costovertebral Tenderness
Located on your back at the bottom of your ribcage at the 12th rib
* Pain in this flank area may indicate a kidney infection
Assessment
* Patient in sitting position.
* Gently press the costovertebral angle.
* Percuss the costovertebral angles.
* Feel the paravertebral muscles to assess the tone.
* Assess tenderness of ribs, paraspinal muscle and spine.
* Auscultate the costovertebral angle for bruit.
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Diuretics
used for fluid removal of the heart, HTN, renal disease, pulmonary edema
