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Med Surg 1 > Exam 4 > Flashcards

Exam 4 Flashcards

(70 cards)

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1
Q

Bronchoscopy

A

Direct visualization of bronchi with a fiber optic bronchoscope, Need: informed consent NPO status vital signs Assess labs Remove dentures Prepare suction equipment Begin IV/administer sedative Emergency equipment available

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2
Q

Lung biopsy

A 
purpose to obtain tissue, cells, or secretions for evaluation
Transbronchial approach
Percutaneous or Transthoracic needle
Video-assisted thoracic surgery (VATS) 
Open lung biopsy (surgery)
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3
Q

Transbronchial Approach or Transbronchial Needle Aspiration

A

Obtain consent, NPO, Sensation of pressure may be felt during needle insertion and aspiration
Monitor VS
Apply dressing and monitor for drainage or bleeding
Monitor for signs of respiratory distress/notify MD
Monitor for signs of pneumothorax/notify MD

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4
Q

Thoracentesis

A

Used to obtain pleural fluid for diagnosis, remove pleural fluid, or instill medication

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5
Q

Epistaxis

A

Nose bleed pinch nose and lean slightly forward
Causes:
Trauma Foreign bodies topical corticosteroid use Nasal spray abuse Street drug use Anatomic malformations Allergic rhinitis tumors
Any condition that prolongs bleeding time or alters platelet counts
If it does not stop pack it or get nasal sling

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6
Q

Acute Pharyngitis

A

Acute inflammation of pharyngeal walls which may include the tonsils, palate, and uvula.
Can be caused by Bacteria Virus Fungus

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7
Q

Acute Bronchitis

A

Most common symptom- cough (10-20 days) Clear mucus Headache Malaise shortness of breath on exertion sometimes low-grade fever Chest discomfort
Diagnosis: chest xray or history

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8
Q

Acute bronchitis treatment

A

Usually self-limiting
Treatment supportive: fluids Rest Anti-inflammatory agents
Cough suppressants & bronchodilators for nocturnal cough or wheezing Humidifier or steam in bathroom
Antibiotics only if prolonged infection associated with systemic symptoms
Antiviral drugs (oseltamivir-Tamiflu) if started within 48 hours of onset of infection

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9
Q

Pneumonia

A

Acute Inflammation of one or both lungs caused by microorganisms
Pneumonia results when the defense mechanism become incompetent or overwhelmed by the virulence or quantity of infectious agents
Can reach lungs by aspiration inhalation of microbes from air or hematogenous spread from other place in the body

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10
Q

Clinical manifestations of pneumonia

A 
Fever, chills, or sweats
Respiratory rate greater than 20
Heart rate greater than 100
Crackles heard on auscultation; dullness with percussion
Chest discomfort
Dyspnea
Rusty colored sputum
Cough
Fatigue, muscle aches, headache, nausea
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11
Q

Atypical pneumonia

A

Pneumonia that manifests with a more gradual onset, a dry cough, and extrapulmonary manifestations (fever, headache, sore throat, nausea, vomiting, and diarrhea

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12
Q

Labs and diagnosis of pneumonia

A 
Chest x-ray
Sputum gram stain and culture
CBC
ABG
Blood cultures
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13
Q

More H+ =

A

decrease PH- acid

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14
Q

Less H+ =

A

Increased PH - base

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15
Q

normal arterial blood PH

A

7.35-7.45

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16
Q

PH lower than 6.8 and higher than 7.8 are

A

fatal

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17
Q

pCO2 normal level

A

35-45, controlled by the lungs

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18
Q

pCO2 higher than normal is ____ lower is _____

A

acidosis, alkalosis

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19
Q

HCO3 normal level

A

22-26, controlled by the kidney

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20
Q

HCO3 higher than normal _____ lower is _____

A

alkalosis, acidosis

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21
Q

buffer system

A

acts immediately, acts chemically to change strong acids into weaker acids or to bind acids to neutralize their effect, first line of defense at the cellular level to buffer excess acid or base

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22
Q

decrease PH Increased acid= ____ K

A

increase

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23
Q

increase PH increase alkaline = ____ K

A

decrease

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24
Q

hold pressure for ___ minutes after ABG

A

5

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25
ROME
respiratory opposite metabolic equal
26
If uncompensated or partially compensated
the pH remains outside the normal range
27
If fully compensated
the pH has returned to within the normal range (the other values may still be abnormal)
28
Complications of hypertension
Blindness stroke mi heart failure kidney failure
29
Cultural diffderences for hypertension
Hypertension is increased in African Americans Hypertension affects African American females more than African American males Hypertension in Whites and Hispanics is more prevalent in males than in females African Americans acquire hypertension at a younger age and are more at risk for hypertensive kidney disease. The highest rate of hypertension in the United States occurs among African Americans living in the southeastern states
30
How to prevent and control hypertension
``` Healthy weight Reduce sodium intake Increase physical exercise Limit alcohol Monitor B/P and know what is normal Take medication as directed ```
31
For bp to rise
CO or SVR must increase
32
Primary hypertension
90-95% of all cases, unknown cause
33
Risk factors for primary hypertension
Age alcohol cigarette use diabetes excess sodium or fat diet elevated lipids gender family history obesity ethnicity sedentary lifestyle socioeconomic status stress
34
Secondary hypertension
Elevated BP with a cause that can be identified and corrected, people over 50 that suddenly have high BP
35
Causes of secondary hypertension
Cirrosis , congenital narrowing of the aorta , endocrine disorders medications, pregnancy induced, renal disease, sleep apnea
36
Clinical manifestations of hypertension
Often called silent killer (asymptomatic) Patient with severe hypertension may experience symptoms secondary to: effects on blood vessels in various organs, increased workload of heart Symptoms may include: Fatigue, reduced activity tolerance, Dizziness, Palpitations, Angina, Dyspnea, Headache
37
Complications of hypertension
Heart Disease (Coronary Artery Disease Heart failure) Cerebrovascular Disease Peripheral Vascular Disease Retinal damage
38
Diagnostic studies of hypertension
Because most HTN is primary, testing for secondary causes is not routinely done Basic lab studies are performed to: identify or rule out causes of secondary HTN, evaluate target organ disease, determine overall cardiovascular risk, establish baseline levels before initiating therapy U/A, BUN, creatinine, serum electrolytes Lipid profiles
39
DASH diet
Dietary approaches to stop hypertension,Rich in grains, fruits, vegetables and low fat dairy products Limits fat, saturated fat, cholesterol, and salt
40
Dietary sodium reduction
A low sodium food should contain less than 140 mg/serving or less than 5% of daily allowance of sodium Foods with more than 400 mg of sodium/serving should be avoided Read labels for sodium content It takes 2-3 months for the taste buds to adapt to changes in salt intake
41
Drug therapy for hypertension
Diuretics, Beta-blockers, ACE inhibitors, ARBs, Calcium channel blockers Two main actions: decrease volume of circulating blood Decreases systemic vascular resistance
42
Orthostatic hypotension
Orthostatic hypotension (if any of the following occur from supine to standing position) A decrease of 20 mmHg or more in SBP A decrease of 10 mmHg or more in DBP Increase in heart rate of greater than or equal to 20 beats/min Causes Intravascular volume loss Inadequate vasoconstrictor mechanisms related to disease or medications
43
Hypertensive crisis
Severe and abrupt elevation in systolic and/or diastolic B/P. Occurs most commonly in patients: with a history of HTN who have failed to comply with their meds, those who have been under medicated Also cocaine or crack amphetamines phencyclidine (PCP), and lysergic acid diethylamide (LSD) Less damaging (hypertensive urgency) no evidence of organ damage developed over days to weeks
44
Hypertensive emergency
More damaging, Classified by the degree of organ damage and the rapidity with which the B/P must be lowered, develops over hours to days, is a situation in which a patient’s B/P is severely elevated (systolic greater than 180 & diastolic greater than 120) with evidence of: acute target organ damage, Stroke, Change in level of consciousness, Heart attack, Eye or kidney damage, Angina, Pulmonary embolism
45
Serious manifestations of CAD
``` Unstable angina (UA) ,myocardial infarction (MI), and SCD (sudden cardiac death) are more serious manifestations of CAD termed acute coronary syndrome (ACS) ```
46
Coronary artery disease
A type of blood vessel disorder that is included in the general category of atherosclerosis Begins as soft deposits of fat that harden with age Referred to as “hardening of arteries”
47
Modifiable risk factors of CAD
Hyperlipidemia, Hypertension, Tobacco use, Physical inactivity, Obesity Contributing factors: Metabolic syndrome, Psychological state, Homocysteine level, Diabetes Mellitus, Periodontal disease, Sleep apnea
48
Risk factors in women for CAD
Premature menopause birth control pills hormone replacement therapy
49
Therapy for CAD
Cholesterol-lowering drug therapy, Antiplatelet therapy, Low dose aspirin (81 mg.) Garlic, Niacin, Psyllium, Omega 3 Fatty acids, Plant sterols, Red yeast rice, Soy, Stress management
50
Chronic stable angina
Angina pectoris (chest pain) is the clinical manifestation of reversible myocardial ischemia, Primary reason for insufficient blood flow is narrowing of coronary arteries, For ischemia to occur the artery is usually obstructed 75% or more
51
Therapy for chronic stable angina
Drug therapy (NRS 255): Antiplatelet therapy, Cholesterol lowering drugs, Nitrates (NTG), Beta blockers, Calcium channel blockers, Reduction of risk factors
52
Precipitating factors of angina
Physical exertion, Temperature extremes, Strong emotions, Consumption of a heavy meal, Tobacco use, Sexual activity, Stimulants, Circadian rhythm patterns
53
Acute intervention for anginal shock
Administration of supplemental oxygen & upright position unless contraindicated, Assess vital signs, 12-lead ECG, Prompt pain relief first with a nitrate followed by an opioid analgesic if needed, Auscultation of heart sounds
54
Diagnostic studies of stable angina
Health history/physical examination, Laboratory studies, CK-MB, Cardiac troponin, Myoglobin, Lipid panel, CBC, Chest x-ray, Exercise stress test, holter monitoring (recordes electrical activity), echocardiogram (ultrasound waves), coronary angiography, PTCA
55
PTCA percutaneous transluminal coronary angioplasty
Can be done with a balloon or stent, opens area occluded by plaque
56
Heart failure
An abnormal condition involving impaired cardiac pumping and/or filling, Heart is unable to produce an adequate cardiac output (CO) to meet metabolic needs
57
Heart failure risk factors
Primary risk factors: Coronary artery disease (CAD), Advancing age Contributing risk factors: Hypertension, Diabetes, Tobacco use, Obesity, High serum cholesterol, African American descent
58
Systolic heart failure
characterized as a weakened heart muscle
59
Diastolic heart failure
stiff heart muscle making ventricular filling difficult
60
The heart attempts to compensate for its inability to pump efficiently by
Increasing the rate of contractions Increasing the size and strength of the ventricular muscle (hypertrophy) Increasing the capacity of the ventricle (dilation)
61
Left-sided HF
(most common) from left ventricular dysfunction | Backup of blood into the left atrium and pulmonary veins Pulmonary congestion Pulmonary edema
62
Right-sided HF
``` Backup of blood into the right atrium and venous systemic circulation Jugular venous distention Hepatomegaly, splenomegaly Vascular congestion of the GI tract Peripheral edema ```
63
Treating CHF: UNLOAD FAST
Up right, Nitrates, Lasix, Oxygen, Ace inhibitors, Digoxin, Fluid decrease, After load decrease, Sodium restriction, Test like Dig ABG potassium
64
HF diagnostic studies
``` Primary goal is to determine underlying cause: History and physical examination, Chest x-ray, 12 lead ECG, Lab studies (e.g., cardiac enzymes, BNP- B-type natriuretic peptide; liver function studies), ABG, liver enzymes Endomyocardial biopsy (EMB), Hemodynamic assessment, Echocardiogram, Nuclear stress testing, Cardiac catheterization, Ejection fraction (EF) ```
65
Drug therapy for HF
Diuretics (hydrochlorothiazide; HydroDIURIL), ACE inhibitors, ARBs, Vasodilators, Beta adrenergic blockers, Positive Inotropes (digoxin), Digitalis toxicity-anorexia, nausea, vomiting, visual disturbances (yellow vision) Digoxin immune Fab (Digibind)
66
Acute Decompensated Heart Failure Clinical Manifestations
Pulmonary edema (lung alveoli become filled with fluid) often life-threatening Early: Increase in the respiratory rate Decrease in PaO2 Later: Tachypnea, Worsening blood gas values
67
Acute Decompensated Heart Failure Clinical Manifestations of Pulmonary Edema
Anxious, pale, possibly cyanotic Cool, clammy skin Orthopnea, Dyspnea, tachypnea, Use of accessory muscles; distended jugular veins, Cough with frothy, blood-tinged sputum, Breath sounds: Crackles, wheezes, rhonchi, Tachycardia, Hypotension or hypertension
68
MAD DOG pulmonary edema treatment
Morphine, Aminophylline, Digitalis, Diuretics, Oxygen, blood Gases
69
Ultrafiltration (UF)
removes extracellular and intravascular fluid volume
70
Chronic HF FACES
``` Heart Failure Society of America (HFSA) F—fatigue A—limitation of activities C—chest congestion/cough E—edema S—shortness of breath ```

Med Surg 1 (4 decks)

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