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NURS 232 > midterm #1 > Flashcards

midterm #1 Flashcards

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1
Q

systemic inflammatory response system
(SIRS)

A
  • response by a variety including: infection, ischemia, infarction, injury
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2
Q

SIRS is characterized by 2 of the following

A
  • fever
  • edema
  • hypotension
  • tachycardia
  • impaired oxygenation
  • increased WBC count
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3
Q

septic shock

A

a subset of sepsis; greater risk of mortality than w/ sepsis alone
- persistent hypotension -> tissue hypoxia -> tissue death
SBP <90 MAP <65

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4
Q

SIRS criteria

A
  • HR >90 bpm
  • RR >20
  • temp >38 or <36
  • WBC >12.0 or <4.0x10^9/L
  • altered LOC (GCS)
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5
Q

when is an adult at risk for developing SEPSIS?

A

if they have a suspected or confirmed source of infection
symptoms:
- OA, pts w/ chronic conditions
(DM, HF, CKD)
- immunosuppressed pts

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6
Q

SEPSIS
- 4 key interventions

A

1 ) labs & diagnostics
- cultures and lactate
2 ) broad spectrum abx
3 ) IV bolus
4 ) monitoring (VS)

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7
Q

SEPSIS
- monitoring and assessment

A

VS: SpO2 Q1h x6h -> Q4h x12h
GCS Q1h x6hr
monitor urine output -> 25cc/hr
- minimum urine output 25-30 mL/h

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8
Q

SEPSIS
- call MD for…

A

RR <10 or >30
O2 sat <90%
P <40 or >140
systolic BP <90 mmHg
sudden change in LOC
urine output <100mL in 4h
OR
hypotension is not resolving even w/ IV bolus fluids

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9
Q

Type 1 (S/S)

A

polyuria
polydipsia (thirst)
polyphagia
cachexic

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10
Q

Type 1
pathophysiology

A

DM is a metabolic disorder
B-cells regulate insulin
alpha-cells regulate glucagon

↑glucose → ↑insulin & ↓glucagon
↓glucose → ↓insulin & ↑glucagon

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11
Q

pathophysiology of type 1

A

lack of insulin secretion
destruction of B-cells

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12
Q

pathophysiology of type 2

A

insulin resistance
desensitization of B cells to hyperglycemia

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13
Q

diagnosis of type 1 & 2

A

A1C <6.5%
FBG >7mmol/L
RBG >11.1 mmol/L

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14
Q

goals of care of DM

A

1 ) reduce sx
2 ) prevent/ manage acute sx
3 ) delay onset + progression chronic complications
4 ) obtain ideal body weight

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15
Q

ABCDESSS of diabetes care

A

A1C targets (<6.5)
BP targets
Cholesterol targets
Drugs for CV and cardiorenal prot.
Exercise goals and healthy heating
Screening for complication - chronic
Smoking cessation
Self management

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16
Q

sick day management for DM

A

hold SADMANS
Sulfonylureas & other secretagogues
ACE inhibitors
Diuretics, direct renin-rehibitors
Metformin
Angiotensin receptor blockers
Non-steroidal anti-inflammatory drugs
SGLT2 inhibitors

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17
Q

DKA

A

hyperglycemia & dehydration
fats metabolized in absence of insulin -> ketosis & acidosis
1 ) illness, infection (stages of stress)
2 ) inadequate insulin dosage or omission
3 ) undiagnosed T1 or poor self management

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18
Q

S/S of DKA

A

> 14 mmol/L
polyuria, polydipsia
ketones in blood and urine
dehydration, lethargy, weakness, orthostatic hypotension, N/V

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19
Q

HHS

A

enough insulin to prevent DKA but not enough to prevent severe hyperglycemia
- osmotic diuresis, ECF depletion
S/S >34 mmol/L
somnolence, coma, seizures, hemiparesis, aphasia

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20
Q

chronic complications (DM)

A

macro:
CAD (atherosclerosis)
hypertension, stroke, PVD
micro:
retinopathy
neuropathy
neuropathy
- sensory: extremities
- autonomic: internally
infections

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21
Q

CAD: atherosclerosis

A

c-reactive protein CRP inflammation
progression of atherosclerosis
a. fatty streak
b. fibrous plaque
c. complicated lesion

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22
Q

CAD risk factors

A

non-mod:
age
M>F
ethnicity
family hx
genetics
mod:
hypertension
elevated serum lipids
physical inactivity

smoking cessation
meds
DM management
diet

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23
Q

chronic stable angina

A

reversible (temporary) myocardial ischemia = angina
primary reason for insufficient blood flow = atherosclerosis

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24
Q

unstable angina

A

new and onset
occurs at rest
worsening pattern
chest pain isn’t sustained

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25
clinical manifestations of ACS
pain obj: anxiety, fear, restlessness, cool, clammy skin, diaphoretic, pale/grey, tachy/ bradycardia, dysrhythmias, BP change goals of care: 1 ) ensure they're resting 2 ) adding O2 3 ) nitroglycerin 4 ) morphine or analgesic for pain
26
diagnostic study for ACS
12-lead ECG, chest x-ray, echo, exercise stress test serial troponins fasting lipid profile: HDL to LDL
27
unstable angina/ NSTEMI
ECG serial troponins stress test urgent angiogram/-plasty
28
STEMI
ECG serial troponins emergent angioplasty and stenting
29
meds for CAD
restrict lipoprotein production "statin" drugs
30
systolic HF -> HFrEF
EF<40% impaired contractile function increased afterload or hypertension mechanical abnormalities inability of heart to pump blood effectively
31
diastolic -> HFpEF
EF > 50% LV hypertrophy myocardial ischemic valvular disease cardio myopathy inability of V to relax and fill during diastole - decreased SV and CO
32
compensatory mechanism - increased SNS stimulation
1st but least effective increased epinephrine and NE -> ↑ HR, myocardial contractility, peripheral vascular constriction
33
compensatory mechanism - neurohormonal responses
activating renin-angiotensin-aldosterone mechanism > vasoconstriction and leads to an increase in aldosterone secretion -> retention Na + H2O increase preload helpful at first but becomes excessive -> systemic venous congestion & peripheral edema
34
compensatory mechanism - cardiac decompensation
compensatory mech. no longer maintain adequate CO + insufficient tissue perfusion results
35
compensatory mechanism - ventricular remolding
cardiac myocytes > large abnormal cells increased ventricular mass, changes in ventricular shape, impaired contractility bigger but less effective pump
36
compensatory mechanism - ventricular dilation
enlargement of heart chambers due to elevated pressure over time - ↓ elasticity in the muscle fibers leads to ↓ CO
37
compensatory mechanism - ventricular hypertrophy
increased muscle mass and cardiac wall thickness due to overwork and stress
38
Lt. sided HF
pulmonary edema severe dyspnea >30 improve LV function by: 1 ) ↓ intravascular volume - diuretics 2 ) ↓venous return (preload) - positioning 3 ) ↓ afterload - managing BP 4 ) improving gas exchange & oxygenation - byPAP 5 ) improving cardiac function - inotropes, infusion, ICU 6 ) reducing anxiety - pain/ perception O2 administration self-management teaching regular exercise & activity /daily weight
39
medications for HF - diuretics
loop, thiazide - reduces preload by ↓ intravascular pressure volume
40
meds for HF - ACE inhibitors
ramipril and enalapril 1st line therapy vasodilator (↓BP), ↓ systemic vascular resistance (afterload), CO
41
meds for HF - B-adrenergic blockers
↓ cardiac O2 demand ↓HR + ↓BP
42
meds for HF - vasodilators
nitrates reduces afterload by dilating peripheral blood vessels ↑ myocardial O2 supply by dilating cardiac blood vessels 1st line meds for managing chest pain
43
meds for HF - digitalis
↑ CO ( ↓HR -> ↑ ventricular filling and contractility) apical pulse >60
44
nursing diagnosis for HF (I)
inadequate CO
45
nursing diagnosis for HF (II)
reduced gas exchange
46
strokes incidence + risk factors
non-mod: - age >65 - gender, race, family hx mod: - smoking, alcohol - obesity, inactivity - high cholesterol - illicit drug use - oral contraceptives, HRT contributes: - DM - hypertension - heart ( afibb.) - disease/ CAD
47
strokes - factors that affect blood flow
- systemic BP - high BP - CO - blood viscosity
48
strokes - etiology + pathophysiology
thrombosis, embolism, hemorrhage = cerebral ischemia check notes for diagram lol
49
strokes - clinical manifestations
BE FAST motor function communication: - expressive aphasia -> Broca's - receptive aphasia - amnesic aphasia - global aphasia affect intellectual function spatial-perceptual alterations (rt.) elimination (incontinence)
50
strokes - diagnostics
CT scan = 1st lumbar puncture RBC in CSF lab work: - CBC, platelets, PT, INR, PTT) - low INR = high risk for stoke - blood glucose - renal + hepatic study - cholesterol cardiac assessment - why? embolic stroke from afibb - ECG - chest x-ray - cardiac markers: troponins - echocardiographs
51
strokes - collaborative care
drug therapy - antiplatelet > aspirin - statins > lower cholesterol - oral anticoagulants > apixaban & dabigatran nutritional therapy
52
strokes - acute nursing management
goals: - preserving life - prevent further brain damage - reduce disability assessment: - ABCs, VS, LOC, A+O (GCS), PERLLA - neuro assessment for baseline
53
strokes - ICP
S/S of ICP - N/V > projectile - headache - decreasing GCS - swelling - cerebral edema - hemorrhagic stroke Cushing's triad: - ↑ systolic BP, ↓ P, ↓ RR *opposite of Sepsis* - ↓ BP, ↑P, ↑ RR
54
strokes - nursing interventions
promote rest reduce visual overstimulation avoid straining while pooping ↑ ICP medical induced coma - reduce brain activity & swelling meds
55
strokes - rehab
first 3-6 months are where the most relearning happens baseline
56
PVD - PAD risk facors
risk factors - atherosclerosis - high BP - smoking - high cholesterol - obesity - DM - age
57
PVD - PAD complications 6 P's
Pain Pallor Pulselessness Paresthesia Paralysis Perishingly cold
58
PVD - PAD complications cont.
continuous pain at rest gangrene limb threatening disease elevating foot = pain S/S: - intermittent claudication - dependent rubour - skin change: cool to touch, pallor, increased cap refill, loss of hair, taut and thin skin - decreased circulation signs
59
PVD - PAD interventions
femoral popliteal bypass percutaneous transluminal angioplasty (PTA) of the femoral arteries endarterectomy amputation = last resort
60
PVD - nursing management of PAD
nutritional therapy: - low cholesterol - high fiber - low glycemic indexic food (DM) exercise therapy: - increase blood flow risk factor modification: - control BP, weight control - smoking cessation - blood glucose control - similar to stroke - diet
61
PVD - SVT and DVT risk factors
blood clots > Virchow's Triad - stasis: afibb, valve dysfunction, obesity - hypercoagulability: cancer, smoking, dehydration, ↑clotting fac. - cell wall injury/damage
62
PVD - clinical characteristics of SVT
- palpable, firm - cord-like subq veins w/ surrounding area tender, reddened and warm - pain / discomfort around area
63
PVD - clinical characteristics of DVT
- unilateral leg edema - extremity pain - sense of fullness in thigh or calf - warm skin, erythema, cyanotic - temp >38
64
PVD - nursing management
intervention: early & aggressive mobilization - 4-6x/day bedrest pt - changing positions, dorsiflex feet, rotate ankles Q2-4h compression stockings sequential compression devices
65
PVD - anticoagulants + nursing management
warfarin (vit K = antidote) 48-72 hr to work CHECK INR (high = thinner) thrombin inhibitor (indirect) - heparin (HIT) - LMWH (dataperin/ enoxaparin) thrombin inhibitor (direct) - hirudin, orgatroben - directly inhibit thrombin enzyme
66
PVD - nursing diagnosis
ineffective tissue perfusion 1 ) walking, feet down, avoid tight socks/shoes, protective clothing impaired skin integrity 1 ) turning & repositioning 2 ) prevent damage & injury (roomy shoes) 3 ) check H2O w/ fingers Acute pain 1 ) effective tissue perfusion: walk 2 ) MEDS activity tolerance 1 ) staggering exercise program ineffective therapeutic regimen Mgmt. 1 ) education 2 ) do they know/ understand ?? 3 ) can they do it themselves? - open the bottle

NURS 232 (5 decks)

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