Midterm 2 Flashcards
(126 cards)
1
Q
Lab tests HF
A
electrolytes , HGB, HCT, BNP, Urinalysis, ABGs
2
Q
Imaging HF
A
CX, electrocardiography, ECG, pulmonary artery catheter
3
Q
interventions for HF and improving oxygenation
A
ventilation support, monitor RR 1-4 hrs, high fowler’s, keep that O2 at 90%
4
Q
activity intolerance
A
dyspnea on exertion, associated with decreased cardiac output
5
Q
Drugs that reduce preload
A
diuretics, oxygen, venous vasodilators
6
Q
drugs that reduce afterload
A
ACE, ARBs, human BNP
7
Q
first line drug for fluid overload
A
diuretics
8
Q
causes of LHF
A
HTN, CAD, valvular disease
9
Q
S/S LHF
A
Weakness, fatigue, dizziness, acute confusion, pulmonary congestion
LEFT LUNGS
10
Q
Causes of RHF
A
Left heart failure, right ventricular Mi, pulmonary HTN
11
Q
S/S of RHF
A
JVD, increased in abdominal girth, asities, dependent edema, hepatomegaly
12
Q
1 thing for RHF
A
Daily weights and strict I/Os
13
Q
pericarditis
A
inflammation of the pericardium
14
Q
assessment of pericarditis
A
substernal precordial pain, pain worsens by swallowing, breathing, coughing, and supine positioning, pericardial friction rub
15
Q
relieving pain of pericarditis
A
sit them up and lean them forward, NSAIDs, antibiotics
16
Q
S/S of pericarditis
A
JVD, paradoxical pulses, decreased CO, muffled heart sounds, circulatory collapse
17
Q
valve disease patient ed
A
importance of prophylactic antibiotic therapy before any invasive dental or oral procedure because of the risk of infection
18
Q
TAVR
A
procedure for valve disease
Transcatheter aortic valve replacement
19
Q
endocarditis
A
microbial infection of the endocardium
strep and staph
20
Q
S/S of endocarditis
A
fever with chills, anorexia and weight loss, cardiac murmur, petechiae, osler’s nodes, janeaway lesions, positive blood cultures
21
Q
digoxin
A
inotropic drug used to increase contractility, reduce HR, slows conduction through AV node in HF
not as common anymore
22
Q
dig toxicity
A
associated with digoxin not being in therapeutic range (.5-2) and has associated symptoms of anorexia, fatigue, blurred vision, changes in mental status, PVCs( Watch those K levels)
23
Q
examples of diuretics
A
lasix and hydralazine
24
Q
things to watch for with diuretics
A
hypokalemia and hypernatremia
25
venous vasodilators
oxygen, nitric oxide, nitroprusside, sildefanil (all decrease preload)
26
beta blockers
metoprolol, carvedilol, atenolol, nadolol (decrease afterload)
27
beta blocker patient ed
take pulse for 1 minute and it should be greater thn 60 prior to taking the medication
28
AceI and ARBs
decrease afterload and are given first line with diuretics for HF, with aces look for angioedema
29
diabetic peripheral neuropathy
progressive deterioration of nerve functioning that results in loss of sensory perception
30
factors that lead to Peripheral neuropathy
```
hyperglycemia
damaged blood vessels
autoimmune neuronal infection
genetic predispositions
smoking and alcohol use
```
31
loss of integrity can cause
infection --> increased glucose levels --> decreased immunity --> more infection
32
PT ed for feet and diabetes
inspect your feet daily, wash your feet daily with lukewarm water, change for clean, cotton socks daily, trim your nails, do not smoke, do not wear tight socks/stockings. no really hot water (no more than 110)
33
DKA
uncontrolled hyperglycemia typically seen in patients with type 1 diabetes which leads to increased ketone production, metabolic acidosis
34
causes of DKA
insulin deficiency, dehydration
35
S/S of DKA
polyuria, polydipsia, polyphagia, Kussmal's respirations ( deep, rapid respirations), fruity smelling breath, increased potassium
36
What to watch for in DKA when insulin is started
hyperkalemia becomes hypokalemia so watch for K levels because PVCs
37
Treatment of DKA
insulin regular in isotonic solution then switch to hypotonic
38
Type 2 diabetes
insulin resistance and usually adult in onset
39
risk factors for type 2 diabetes
BMI greater than 25, first degree relative with diabetes, hypertensive, HDL levels less than 35, GDM
40
fasting blood glucose
normal less than 100
| greater than 126 on two separate occasions is diabetes
41
glucose tolerance test
normal: greater than 140
| greater than 140-200 on two separate occasions is diabetes
42
A1C test
4-6% is normal
5.7-6.4%- increased risk
>6.5% diabetes
43
2nd generation sulfonylurea
glipzide
MOA- insulin stimulators
considerations: s/s of hypoglycemia, take before or with meals, check with doctor with otc meds, side effects - nausea, vomiting, and weight gain
44
biguanides
metformin
MOA: insulin stimulators
NC: do not drink alcohol, diarrhea, nausea, indigestion, and abdominal pain are common side effects, monitor Cr levels
45
Thiazolidinedione
Pioglitazone
MOA: lower blood glucose levels by decreasing liver glucose production, and improve the sensitivity of insulin
NC: not used as much anymore due to the side effects of worsening HF and women at increased risk of bone fractures
46
S/S of hypoglycemia
weakness, fatigue, confusion, seizures, loss of consciousness, brain damage, shaky, heart pounding, sweaty, hungry, tingling
47
Causes of hypoglycemia
too much insulin with food intake and physical activity, insulin injected at the wrong time, wrong type of insulin, decreased food intake, decreased liver glucose production after alcohol ingestion
48
conscious treatment for hypoglycemia
4 glucose tablets, 4 oz fruit juice, 8 oz non-fat milk
49
Unconscious treatment for hypoglycemia
IM and SubQ glucagon
| IV D50
50
Rapid insulin
humalog and aspart novalog
peak- 1 hr
take with food. give the shot when the food is hot
51
Short acting insulin
Novalin
peak 2.5-3
covers insulin needs for meals eaten within 30-60 mins
IV DKA and HHS
52
Intermediate acting
NPH
peak 8 hrs
covers insulin needs for about half the day or overnight. this type of insulin is often combined with short acting insulin. Clear before cloudy(NPH)
53
Long acting
Glargine
long-acting insulin needs for about one full day.
no peak time
54
hyperglycemic hyperosmolar state
hyperglycemia typically seen in diabtetes type 2. Like DKA it is caused by hyperglycemia and dehydration there is no increased ketones Sustained osmotic diuresis. Decreased kidney perfusion
55
HHS treatment
FLUID REPLACEMENT
rapid fluid infusion start
.9 NS and then switch to hypotonic .45
56
diabetes type 1
no insulin production and pancreatic beta cell destruction
57
S/S of IDDM
abrupt onset, thirst, hunger, increased urine output, weight loss, thin, always insulin dependent
58
Exercise and diabetes
do it only if bg is between 100-250, do not exercise if insulin was given 1 hr ago, stay hydrated
59
alcohol and diabetes
do not drink on metformin, and alcohol consumption can alter BG levels because of the amount of carbs
60
Blood analysis for DKA
increased ketones and metabolic acidosis
61
interventions for ICP
elevate head of bed 30 degrees, oxygen therapy, head midline, avoid clustering activities, hyper-oxygenate before suctioning, keep lights low to limit photosensitivity
62
First sign of ICP
decreased level of consciousness
63
cushings triad
widened pulse pressure, bradycardia, deep shallow respirations, HTN
64
meds for ICP
Mannitol- strict I/Os (between 310-320)
65
Seizures health history
how often they occur, date, time, and duration, change in pupil size, eye fluttering, aura before, body part first involved, level of consciousness
66
aphasia
inability to speak or comprehend language
67
hemiparesis
flaccid paralysis
68
ataxia
gait disturbance
69
hypotonia
weakness on one side of the body
70
agonosia
inability to use an object correctly
71
unilateral inattention - body neglect
unaware of body part
72
parathesia
numbness, tingling, unusual sensation
73
dysphagia
inability to swallow
74
visual field defecit
unable to visualize entire field of vision
75
gaze deviations
eye movement abnormalities
76
dysarthria
cannot control mouth and tongue to form words
77
generalized seizure
both hemispheres
78
absence
blanking out
79
tonic
stiffness and rigidity then loss of consciousness
80
clonic
rhythmic jerking of extremities then relaxation
81
myoclonic
jerking of extremities - unilateral or bilateral
82
atonic
sudden loss of muscle tone, usually resulting in a fall
83
partial
focal or local, begin in part of one hemisphere
84
complex
may cause blackouts
85
simple
aura and one sided movement
86
idiopathic seizures
no brain abnormalities
87
secondary seizures
metabolic disorders, alcohol withdrawal, heart disease
88
management of seizures
AEDs , lorazepam, dilantin
89
VNS
recognizes the aura of a seizure and a shock is sent. this should limit the amount of seizures a person has
90
TIA
transient ischemic attack
visual deficits: blurred vision, diplopia, blindness
motor: weakness and ataxia
speech: aphasia and dysarthria
91
FAST
face, arms, speech, time
92
MAWDS
medications, activity, weight, diet, symptoms
93
IV thrombolytics
tpa - given 3-4.5 hours post stroke
| 10% bolus over 1 minute and then 90% over the next hour
94
stage 1 PD
unilateral limb movement, minimal weakness, tremor
95
stage 2 PD
bilateral limb movement, masklike face, slow shuffling gait
96
stage 3 PD
postural instability, increased gait disturbances
97
stage 4 PD
severe disability: akinesia, rigidity
98
stage 5 PD
complete ADL dependence
99
drugs for PD
Mao-B inhibitors and Sinemet
100
Mao-B teaching
no foods high in tyramine and no alcohol
101
things to look for with sinement
signs of depression -suicide
102
exercises for PD
active and passive ROM activities
103
hallmark symptoms of PD
tremor, stiffness, bradykinesia, unsteady gait
104
Alzheimer's
progressive, degenerative disorder of the brain
105
plaques
clumps of protein fragments
106
tangles
twisted microscopic strands of the protein tau
107
loss of connection among brain cells
memory, learning, and communication problems
108
eventual death of brain cells
severe memory problems
109
stage 1 alz
general forgetfulness, independent in ADLs, forgets names, subtle changes in personality, problems with judgement
110
stage 2 alz
wandering, neglect of hygiene, disoriented, money problems, progressive memory loss, dependent in ADls
111
stage 3 alz
weight loss, loss of written and verbal communication, not recognizing family and objects, bowel and bladder incontinence, completely dependent in ADLs, loss of mobility, agonosia
112
important questions for alz patients
onset, duration, and progression of symptoms. Changes in symptoms, ADL changes, financial charges,
113
exercises for MS
ROM exercises, stretching and strengthening, no exercises that increase body temp because that can lead to increased fatigue and decreased motor ability
114
primary MS
steady and gradual, 40-60 yrs in onset, no acute attacks, without remission of symptoms
115
secondary MS
relapsing-remitting course
116
progressive relapsing MS
frequent relapses, does not return to baseline, deterioration overall several years
117
S/S of MS
muscle weakness and spacisity, fatigue, tremors, dysmetria, numbness and tingling, ataxia, dysphagia, diplopia, tinnitus, impaired sexual functioning, depression
118
S/S of autonomic dysreflexia
sudden significant rise in BP, bradycardia, perfuse sweating, flushing, goosebumps
119
interventions of autonomic dysreflexia
sit them up (number 1) and check for bladder distention
120
S/S of MG
muscle weakness, poor posture, ocular palsies, ptosis, diplopia, respiratory compromise, loss of bowel and bladder control, fatigue, muscle achiness, decreased sense of smell and taste
121
tensilon test
shows a positive diagnosis of MG
122
myasthenic crisis
an exacerbation of MG symptoms caused by not enough anticholinesterase drugs
123
cholinergic crisis
an acute exacerbation of muscle weakness caused by too much anticholinesterase drugs
124
S/S Guillian Barre
ascending symmetric muscle weakness, flaccid paralysis, decreased deep tendon reflexes, respiratory compromise, paresthesia, pain, facial weakness, dysphagia, diplopia, difficulty speaking, labile blood pressure, cardiac dysrhythmias, tachycardia
125
diagnostic test GB
lumbar puncture
126
IVIG complications
used for GB, chills mild fever, myalgia, headache, anaphylaxis, aseptic meningitis, retinal necrosis, acute renal failure.
