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Health and Healing > Midterm > Flashcards

Midterm Flashcards

1
Q

Describe the pathophysiology of a deep vein thrombosis (DVT)

A

 triad - stasis of blood; vessel wall injury; increased blood coagulability
 past DVT biggest risk for future DVT after surgery: increased in the presence of impaired cardiac function (acute MI/CHF)
 venous stasis, hyperreactivity of blood coagulation and vascular trauma are all risk factors of DVT
 immobility of an extremity or the entire body causes decreased blood flow, venous pooling in the lower extremities and increased risk of DVT
 A piece of a clot becomes dislodged and travels to the lung - can cause pulmonary infarction

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2
Q

 What are the signs and symptoms of a DVT?

A

 many are asymptomatic; vein not totally occluded or collateral circulation,
 pain, swelling, deep muscle tenderness (redness or warmth of leg, pain or cramp in calf, swellling of leg, areas feel hard to touch)
 fever, general malaise (chills, diaphoresis)
 elevated WBC and sedimentation rate
 any client complaining of tachypnea, dyspnea, tachycardia, especially when already receiving O2 therapy
 chest pain, hypotension, hemoptysis, dysrhythmias or HF.
 fainting, orthostatic hypotension,

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3
Q

 How can you prevent DVT’s in post operative clients?

A

 Pharmacological
 anticoagulation drugs - heparin
 Non-pharmacological
 leg exercises q1-2 hrs, flex and extend all joints
 apply TEDS or AES - thrombo embolic deterrent or antiembolic stockings
 early ambulation
 avoid positioning that disrupts blood flow to extremities
 adequate fluid intake

 regular CV assessment - BP, HR, perfusion (pulses), hemorrhage, CSM

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4
Q

 How do we treat a DVT?

A

 goal is to prevent further thromi, prevent extension and embolization of existing thrombi and minimize venous valve damage
 anticoagulation therapy to treat and prevent
 15-20 degree elevation of legs to prevent stasis
 footboard enables person to perform leg exercises, ankle flexion and extension while in bed
 surgical removal under selected circumstances when at risk for experiencing pulmonary emboli

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5
Q

 What risk does a DVT pose?

A

 postphlebitic syndrome - damage to vessel
 Blood clot in the kidney, called renal vein thrombosis.
 Blood clot in the heart, leading to heart attack.
 Blood clot in the brain, leading to stroke.
 blood clot in the lung, leading to pulmonary embolism

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6
Q

 Describe the rationale for deep breathing and coughing in the post operative patient

A

 helps to clear the anesthesia from system

 prevents atelectasis and pneumonia

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7
Q

 How do you assess perfusion distal to a surgical site or area of injury?

A

 Peripheral perfusion assessment consisted of capillary refill time (CRT), peripheral perfusion index (PPI) and forearm-to-fingertip skin temperature gradient to measure the strength of the pulse as the assessment area
 collect Perfusion prior to surgery, immediately following and d1,2 & 3.

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8
Q

 What findings indicate normal perfusion? What findings indicate abnormal perfusion

A

 cap refill time - 3 is delayed)
 bilateral pulse rates - normal between 60-100, gradient scale 0-4 - 0 = absent to 4= bounding, non-bilarterally equal
 forearm-to fingertip skin temperature gradient - warm, (cold and hot are abnormal)
 colour - wnr (cynotic, pale, red, flush)

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9
Q

 What is your priority intervention if you notice your patient’s distal extremities to be pale and cold with decreased cap refill?

A

 place O2 on the client at .5L via NC

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10
Q

 What is a paralytic ileus? How is it treated? How do you assess for it?

A

 defined as cessation of peristalsis - complaints of abdominal pain, distension, nausea, vomiting and poor appetite
 monitor for distension, auscultate all four quadrants to determine presence, frequency and characteristics of bowel sounds
 absent or diminished and abdomen sounds tympanic to percussion
 normal bowel movements are accompanied by flatus

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11
Q

 Review total parenteral nutrition (TPN). What is it and how is it administered?

A

 IV administration for the delivery of 100% of a patient’s calculated nutritional requirements (carbs, fat, protein, vitamins, minerals and often fluid)

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12
Q

 Review post operative care of patients following gastrointestinal surgery – Initial admission to the acute care floor and ongoing management.

A

 usually NPO therefore NG tube - care for tube -
• proper placement through nose to stomach (measure from the nare to the top of ear to base of xiphoid)
• intermittent suctioning
• irrigate to avoid occlusion - flush with 30mL of water to ensure that no residual food will occlude the tube
• measure/record drainage
• monitor and record losses
 medicate for nausea
 Assess bowel sounds Q4 for paralytic ileus
 inspect for distension (tympanic/dull)
 monitor constipation

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13
Q

 What is the normal range for glucose?

A

 non-diabetic is random 4.4-6.6 and fasting 4.0-6.0

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14
Q

how you would interpret abnormal high BG

A 
	abnormal highs means hyperglycemia 
	diabetes mellitus 
	acute stress respone
	cushing's syndrome
	pheochromocytoma
	chronic renal failure
	glucagonoma
	acute pancreatitis
	diuretic therapy
	corticosteroid therapy
	acromegaly
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15
Q

how you would interpret abnormal lows BG

A

 insolinoma - no reflex feedback loop present to “turn off” production
 hypothyroidism - thyroid hormones effect glucose metabolism
 addison’s disease - cortisol affects glucose metabolism - diminished levels effect glucose to fall
 extensive liver disease
 insulin overdose
 starvation

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16
Q

 What is a hemoglobin A1C and why is it measured?

A

 used to monitor diabetes treatment. accurate long-term index of the average BG levels

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17
Q

Which test would you wish to have done on a patient on the medical floor who complains that they feel shaky and fatigued

A

test random BG

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18
Q

Which test would you wish to have done on a patient on the medical floor who has significant weight loss and being checked to see if the patient has developed diabetes

A

hemoglobin A1C, fasting BG, urine glucose level

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19
Q

Which test would you wish to have done on an outpatient who reports that they have had fairly normal blood sugar levels since their last visit 2 months ago

A

• Hemoglobin A1C

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20
Q

 What labs measure kidney function and explain why

A

 Blood Urea Nitrogen (BUN) - normal 3.6-7.1 mmol/L
 measures the amount of nitrogen in blood that comes from the waste product urea - rises when the kidneys cannot remove urea from the blood
• used to evaluate and diagnose kidney function and acute or chronic kidney failure
• heart failure, dehydration or a diet high in protein can elevate BUN

Creatinine (Cr) - normal males (53-106) female (44-97)
 is a breakdown product of creatine, used in muscle contraction
 removed entirely by kidneys. increased levels means kidney function is abnormal
 good indicator of glomerular filtration and chronic renal damage

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21
Q

 What labs measure liver function and why?

A

ALT - normal -4-36 u/L

 found predominantely in the liver - more specific test
for detecting hepatocellular disease

AST - normal 0-35u/L

 AST found in the liver, heart, muscle, brain and
kidney tissue - damage to any can raise levels

GGT - 8-38 u/L

 sensitive indicator of hepatobiliary disease and chronic alcohol abuse

Albumin - 3.5-5g/dL

 main protein in blood that is made by the liver.
 purpose is to maintain colloidal osmotic pressure and transport drugs, hormones and enzymes.
 in disease the liver looses its ability to synthesize albumin and so albumin decreases while dehydration can increase albumin levels

bilirubin - 0.3-1.0 mg/dl

 produced from b/d of RBC hemoglobin
 liver clears bilirubin from the body so elevated levels can indicate a disorder or blockage of the bile ducts

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22
Q

Electrolytes Labs

A 
Potassium
Sodium
Chloride
Calcium
Magnesium
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23
Q

Liver Labs

A

ALT/AST
GGT/Albumin
Bilirubin

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24
Q

Renal Labs

A

BUN

Creatinine

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25
Q

Diabetic Labs

A

A1C

BG - fasting/random

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26
Q

Cardiac Labs

A

Troponins
CK
CK-MB

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27
Q

Cholesterol Labs

A

cholesterol
triglycerides
LDL
HDL

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28
Q

Discuss Anemia

A

refers to a deficiency of either erythrocytes or hemoglobin - low RBC count contributes to anemia
3 types
- hypovolemic anemia - caused by blood loss
- inadequate/abnormal erythrocyte production = iron deficiency, pernicious, folic acid deficiency, sickle cell anemas
- hemolytic anemia - destruction of normally formed RBC

29
Q

discuss INR and what abnormal value means

A 
International Normalized Ratio
- prothrombin time > 20sec for individuals not taking anticoagulants and >3.6 for those on anticoagulants
- used to evaluate the adequacy of the extrinsic system and common pathway in the clotting mechanism
^ levels
- liver disease
- hereditary factor deficiency
- vit K deficiency
- bile duct obstruction
- coumarin ingestion
- disseminated intravascular coagulation
- massive blood transfusion
-salicylate intoxication
30
Q

WBC count

A

normal range 5-10x 109/L
- used as an indicator of infection inflammation, tissue necrosis or leukemic neoplasia
decreased - bone marrow failure, dietary deficiencies or autoimmune diseases

31
Q

Red blood Cell Count

A

normal findings RBC x 1012/L
adult/older adult - male - 4.7-6.1 female - 4.2-5.4
closely related to hemoglobin and hematocrit levels - reps different ways of evaluating the number of RBCs in peripheral blood.

erythrocytosis
Congenital Heart disease
sever chronic obstructive pulmonary disease
polycythemia vera
severe dehydration

decreased
anemia
hemoglobinopathy
cirrhosis
hemolytic anemia
hemorrhage
dietary deficiency
bone marrow failure
prosthetic valves
renal disease
normal pregnancy
rheumatoid/collagen-vascular diseases
lymphoma
multiple myeloma
leukemia
hodgkins disease
32
Q

Platelet count

A

adult - adult/older adult 150,000 /mm3 to 400,000/mm3

malignant disorders
polycythemia versa
postplenectomy syndrome
rheumatoid arthritis
iron-deficiency anemia or following hemorrhagic anemia

decreased levels (thrombocytopenia)
hypersplenism
hemorrhage
immune thrombocytopenia
leukemia
thrombotic thrombocytopenia
graves disease
inherited disorders
dic
systemic lupus erythematosus
pernicious anemia
hemolytic anemia
cancer chemotherapy
infection
33
Q

Potassium

A 
adult/older adult - 3.5-5 mmol/L
^
excessive dietary intake
excessive iv intake
acute/chronic renal failure
addison's disease
hypoaldosteronism
aldosterone-inhibiting diuretics
crush injury
hemolysis
transfusion of hemolyzed blood
infection
acidosis
dehydration
decreased
deficient dietary or iv
burns
GI disorders
diuretics
hyperaldosteronism
cushing's syndrome
renal tubular aidosis
licorice ingestion
alkalosis
insulin administration
glucose administration
ascites
renal artery stenosis
cystic fibrosis
trauma/surgery/burns
34
Q

Sodium

A

normal adult - 136-145 mmol/L
hypernatremia

increased sodium intake
- excessive in dietary/IV

decreased sodium loss

  • cushing’s syndrome
  • hyperaldosteronism

excessive free body water loss

  • GI loss
  • excess sweating
  • extensive thermal burns
  • diabetes insipidus
  • osmotic diuresis

hyponatremia

decreased sodium intake
-iv/dietary

increased sodium loss

  • addison’s dissease
  • diarrhea, vomiting, nasogastric aspiration
  • intraluminal bowel loss (ileus, obstruction)
  • diuretic admin
  • chronic renal insufficiency
  • large volume aspiration of pleural or peritoneal fluids

increased free body water

  • excessive oral water intake - oral/iv
  • hyperglycemia
  • CHF
  • peripheral edema
  • pleural effusion
  • intraluminal bowel loss
  • syndrome of inappropriate or ectopic secretion of ADH
35
Q

troponin & creatine kinase

A
  • measures the levels of proteins called troponin T and troponin I in the blood which are released specifically in cardiac muscle injury
  • creatine raises when skeletal, neurological or heart muscle are injured
36
Q

cholesterol/triglycerides

A

two forms of lipid or fats
cholesterol - normal <200 mg/dL
-is associated with arteriosclerosis vascular disease - necessary for building and maintaining cells and making essential hormones
triglycerides - male 40-160 mg/dL ; female 35-135 mg/dL
- associated with risk of CHD in patients w/ fat metabolism disorders

37
Q

LDL/HDL Labs

A

75% of blood cholesterol bound to LDL and 25% to HDL
LDL - normal 40 mg/dL - removes excess cholesterol

when there are too many LDL - too much cholesterol is delivered for HDL to remove. therefore buildup of fat in arteries and veins - narrowing

38
Q

Isotonic Solutions

A

o.9% NaCL (NS)
Ringer’s Lactated

used to expand vascular volume
watch for signs of bounding pulse and SO

D5W - 5% dextrose in water - dextrose is rapidly metabolized providing only free water to expand extra in intracellular spaces

39
Q

Hypotonic Solutions

A

o.45% NaCl - (1/2 NS)
0.33% NaCl - (1/3 NS)
used to provide free water and treat cellular dehydration - promote waste elimination by the kidneys

40
Q

Hypertonic solutions

A 
5% dextrose in NS (d5NS)
5% dextrose in o.45% NaCl (d5 1/2 NS)
5% dextrose in Lactated Ringers 
used to draw fluid out of intracellular and intrastitial compartements into vascular - expand vascular volume
- do not use iwth kidney/hd patients
- watch for signs of hypervolemia
41
Q

respiration

A

process by which bodies cells are supplied o2 and co2 is eliminated
external respiration - movement of gases across alveolar-capillary membrane
internal respiration - movement of gasses across systemic capillary membranes - cell membranes

42
Q

ventilation

A

mechanical movement of airflow to and from the atmosphere and the alveoli - actual work of breathing and requires adequate functioning of the lungs and airways, thorax, ventilatroy muscles and nervous system control.

43
Q

inspiration

A

air moves because intrathoracic pressure changes. contraction of diaphragm increases chest dimensions

44
Q

expiration

A

passive - elastic recoil of chest wall and lungs

45
Q

Compliance

A

measure of elasticity of lungs and thorax
when decreased, lungs are more difficult to inflate
can be altered due to any condition that affects lung tissues - emphysema, pulmonary fibrosis, pulmonary edema, pleural effusion

46
Q

Diffusion

A

O2 & CO2 move across the alveolar capillary membrane by diffusion; area of high to low pressure
ability of lungs to axygenate arterial blood adequately determined by looking at PaO2 and SaO2

47
Q

O2-Hemaglobin Curve

A

Oxygen transport - O2 carried in blood in 2 ways - bound to hemoglobin or dissolved in plasma
PaO2 - arterial blood o2 tension - represents the amount of O2 dissolved in the plasma - expressed in mmHg
SaO2 - arterial blood oxygen satruation - measue of te % of Hgb in arterial blood sample that is occupied by O2 molecules- expressed as a percentage
if Sa)2 is 0% than 90% of the hemoglobin attachments have oxygen bound to them
Affinity of hemoglobin for O2
Large changes in PaO2 result in small changes in SaO2
as hemoglobin becomes desatruarted, SaO2 levels will fall rapidly

48
Q

80-100 PaO2 mmHg means….

A

> 95% SaO2 (normal)

49
Q

60 PaO2 mmHg means….

A

90% SaO2 adequate

50
Q

55 PaO2 mmHg means….

A

88% SaO2 problematic - may need continuours O2 therapy

51
Q

<40 PaO2 mmHg means….

A

<75% SaO2 - tissue hypoxia, cardiac arrhythmia - when you get to this point your patient will die.

52
Q

Arterial Blood Gases

A
  • measured to determine oxygenation status and acid-base balance
    measures PaO2, PaCO2, PpH, bicarbonate (HCO3) in arterial blood
    CO2 is very acidic if retained in the blood.
53
Q

Spirometry Studies - Pulse Oximetry SpO2

A

probe on finger, toe, ear to measure light waves - oxygenated blood absorbes light differently
tissue in the tissues have only 60 receoptros so if probe is below 95% then critical issues as only about 40 receptors have O2

54
Q

s/s Pneumonia

A

inspection
- tachypnea - use of accessory muscles, cyanosis
palpation
- unequal movement with lobar in involvement; fremitus over infected area

percussion 
     - dull over affected areas
auscultation 
     - early bronchial sounds
     - later - crackles; wheezes
55
Q

s/s & possible complications bronchitis

A

viral
persistant cough following an acute upper airway infection - rhinitis, phayngitis
cough accompanied by production of clear, mucoid sputum, sometimes purulent
fever, headace, malaise, sob on exertion
elevated pulse, RR, either normal breath sounds or expiratory weezing. no radiographic evidence of congestion.

  • usually self-limiting
    COPD patients may be prescribed antibiotics to deal wit bacterial infections that develop with broncitis
56
Q

s/s & possible complications acute asthma attack

A

s/s - wheezing, breathlessness, sensation of chest tightness, coughing, combination of these
prolonged expiration - instead of 1:2 - 1:3, 1:4
wheezing, air trapping and hyperinflation due to mucous plugs
silent chest is an ominous sound
usually sit upright or bent forward, intercostal pulling,
pursed lips, anxiety/panic
moderate/severe - hypoxemia behaviour - increased pulse, bp and a drop in systolic pressure during inspiratory cycle of more than 10 mm Hg.
significantly increased resp rate >30bpm
difficult completing sentences
hyperresonence on purcussion

57
Q

ss COPD

A

subjective:
anorexia, weight loss or gain, early satiety, difficulty eating
decreased level of activity and ability to perform ADLs or exercise
dyspnea, palpitations, recurrent cough, use of sitting-up position for sleeping, paroxysmal nocturnal dyspnea, ortopnea, swelling of feet
constipation, gas, bloating
headace, loss of memory, inability to concentrate
fatigue, insomnia, depression, anxiety , panic

Objective:
general -
weight weigh BMI
distress, increased work of breathing, use of compensatroy mechanisms for breating, anxiety, depression, restlessness

integumentary
cynosis, bronchitis, pallor or ruddy colour, poor skin turgor, thin skin, easy bruising, peripheral edema (cor pulmonale),

respiratory - rapid, shallow, accessory muscle use, inability to speak at al, prolonged expiratory phase, pursed-lip breating, wheezing, crackles, diminished breath sounds, decreased chest excursion and diaphramatic movements, hyper resonant or dull chest sounds on percussion

cardio - tachycardia, dysrythmias, jugular vein distension right-sided third heart sound (cor pulmonale), edema

GI - ascites, hepatomegaly (cor pulmonale)

MS - muscle atropy, increased anteroposterior diameter barrel-chest)

58
Q

ss & possible complications atelectasis

A

collapsed airless alveoli - results from retained exudates and secretions - postoperative
deep breathing exercises prescribed

59
Q

ss & possible complications emphysema

A

x

60
Q

assessment and care associated with respiratory disorders - specifically asthma & COPD

A

x

61
Q

understand bronchodilators, corticosteroids & differences

A

bronchodialators - cause the relaxation of the bronchial smoot muscle - rescue therapy

corticosteroids - anti-inflammatory medication to reduce bronchial hyper-responsiveness by blocking the late-phase reaction that inhibits migration of inflammatory cells - long-term therapy

62
Q

peritonsillar abscess - risks

A

treat to airway patency - s/s hig fever, leukocytosis, chills
iv therapy of antibiotics
needle aspiration or incision and drainage of abscess
either an emergency tonsillectomy or scheduled once infection has subsided

63
Q

sleep apnea

A

complete or partial upper airway obstruction during sleep

64
Q

nursing considerations for tracheostomy

A

provide care - suction, clean around stoma, change ties, inner cannula cleaning

65
Q

tidal volume, capacity and residual volume

A

volume of air inspired or expired during normal breathing (0.5L)
vital capacity - volume of air exhaled after maximal inspiration (3L)
residual capacity - volume of air left in eac lung after maximal exhalation - 1.2 L

66
Q

IPPA review for a patient presenting with a respiratory complaint

A

I - inspect, P - palpate, P- percuss, A-auscultate

67
Q

possible complications Pneumonia

A

complications -
pleurisy - inflammation of te pleura
pleural effusion - may require aspiration via thoracentesis
atelectsis - collapsed airless alveoli
delayed resolution - persistent infection
lung abscess - not common
empyema - accumulation of purulent exudate in pleural cavity
pericarditis - infection spreads to sac around heart
bacteremia -
meningitis - patient disoriented, confussed should have lumbar puncture
endocarditis - attacks the endocardium and/or valves of heart

68
Q

possible complications COPD

A

cor pulmonale

emphysema

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