Patho & Interventions Flashcards

Question

ischaemic heart disease: pathophysiology

Answer 1

1. atherosclerosis leads to heart damage and necrosis of the myocardium 2. heart damage leads to cardiac arrest/ arrhythmias.

Answer 2

coronary artery disease (CAD) is the most common type of heart disease and happens with the arteries that supply blood to the heart muscle (coronary artery) become hardened and narrowed. - A gradual blockage can result in angina. - A sudden or severe blockage can result in heart attack or cardiac arrest. Risk factors - HTN - smoking - diabetes - high fat and cholesterol diet

Answer 3

lifestyle changes, medications, angioplasty and surgery. physical exercise, smoking cessation, weight loss, low fat diet GTN spray medications - statin (decreased liver’s production of harmful cholesterol) - blood thinners (helps prevent blood clots from forming, dissolves old ones) - beta blockers (slows heart rate and decreases blood pressure) - calcium channel blockers (relaxes blood vessels) - heart medications (helps reduce chest pain or pressure caused by blockage in arteries of heart) coronary stent - tube placed in the arteries of the heart to keep them open coronary angioplasty - unblocking an artery by inflating a balloon inside it. A stent may also be inserted to hold artery open coronary artery bypass surgery.

Answer 4

the build up of fats, cholesterol and other substances in and on the artery walls.

Answer 5

Atherosclerosis often has no symptoms until a plaque ruptures or the build up is severe enough to block blood flow. - chest pain. - SOB - Fatigue - tightening of the chest

Answer 6

1. an irritant is present, e.g. lipids, high blood pressure, toxins, diabetes. 2. damage occurs to the endothelium by the irritant- a crack of fissure is formed. 3. LDL cholesterol deposits accumulate in the artery wall known as fatty streaks 4. LDL oxidases and sends signals to the immune system and monocytes (WBC) arrive 5. monocytes convert to macrophages and consume the cholesterol 6. macrophages fill up on cholesterol and die = foam cells 7. formation of foam cells = release of cytokines 8. smooth muscle cells migrate into expanding fatty plaque forming a lipid cap 9. smooth muscle cells also deposit calcium into the fatty plaque, hardening it and causing bulging into the artery lumen 10. blood flow is decreased(resistance increased)and compliance is reduced (less flexibility) 11. ongoing inflammation= plaque rupture, thermogenic material inside cap is exposed= arriving platelets from a thrombus 12. a thrombus is formed and occludes the artery causing ischemia or infarction

Answer 7

high blood pressure high cholesterol high triglycerides smoking and or sources or tobacco insulin resistance, obesity or diabetes inflammation from diseases such as arthritis, lupus or infections or inflammation of unknown cause.

Answer 8

is the heart’s inability to consistently pump enough blood to organs and tissues.

Answer 9

1. MI or cardiac dysfunction / structural abnormality impairs ability of the left ventricle to fill with or eject blood 2. poor ventricular function/ myocardial damage leads to decreased stroke volume and cardiac output 3. leads to a neurohormonal response 4. either sympathetic system activated to increase cardiac workload or RAAS cc c pathways activated 5. results in vasoconstriction and sodium + fluid retention 6. further stress on the ventricular wall and remodeling leads to heart failure.

Answer 10

commonly caused by IHD (decreased contraction, ventricular filling or both). more common among the elderly. can be caused by AF, HTN, diabetes smoking, drinking excessively , HIV and some cytotoxic drugs.

Answer 11

ensure daily weights start FBC and fluid restrictions educate on healthy eating and exercise furosemide?

Answer 12

progressive irreversible loss of kidney function and decreased GFR for at least three months. can lead to AKI, interventions aim to prevent AKI

Answer 13

Nausea Vomiting Loss of appetite Fatigue and weakness Sleep problems Urinating more or less Decreased mental sharpness Muscle cramps Swelling of feet and ankles Dry, itchy skin High blood pressure (hypertension) that's difficult to control Shortness of breath, if fluid builds up in the lungs Chest pain, if fluid builds up around the lining of the heart

Answer 14

At the early stages people have no symptoms: Diabetes Hypertension Smoking Obesity Ethnicity Gender men>women Age - kidney function decreases with age Specific conditions – glomerulonephritis

Answer 15

Nursing interventions: Maintain adequate nutrition Fluid restriction Promote activity & rest as tolerated Provide skin care Provide education on condition & complications Provide culturally appropriate care Psychological/emotional l support Support for smoking cessation

Answer 16

Acute kidney injury (AKI)occurs when the kidneys are unable to remove the body's metabolic waste or perform their seven regulatory functions – in particular, for cardiac week - maintenance of BP and electrolyte regulation

Answer 17

passing less urine (pee) than usual very concentrated urine, or urine looking yellow/brown/red in colour loss of appetite nausea or vomiting fatigue and short of breath feeling confused, anxious and restless, or sleepy swelling of legs or other body parts pain in abdomen or lower back.

Answer 18

Assessments: Fluid balance chart (FBC) Daily weigh (1kg of weight = 1L retained fluid) Skin integrity Vital signs → EWS Capillary refill time (CRT) Palpate and/or scan the bladder Bloods – GFR, electrolytes, CBC Ability to manage ADLs

Answer 19

throbbing pain in 1 leg (rarely both legs), usually in the calf or thigh, when walking or standing up swelling in 1 leg (rarely both legs) warm skin around the painful area red or darkened skin around the painful area – this may be harder to see on brown or black skin swollen veins that are hard or sore when you touch them

Answer 20

DVT (deep vein thrombosis) is a blood clot in a vein, usually in the leg.

Answer 21

Deep venous thrombosis usually begins in venous valve cusps. Thrombi consist of thrombin, fibrin, and red blood cells with relatively few platelets (red thrombi); without treatment, thrombi may propagate proximally or travel to the lungs. 1. Decreased or mechanically altered blood flow 2. Trauma to blood vessels stimulates the clotting cascade 3. Platelets aggregate at the site, especially where venous statis is present 4. Platelets and Fibrin form the initial clot 5. Decreased blood flow leads to decreased oxygenation and increase in hematocrit (increase in RBC in the blood volume) 6. RBC are trapped in the fibrin meshwork 7. Clot may completely occlude blood vessel or embolus may travel to other parts of the body (lungs or brain).

Answer 22

Virchow's Triad distills the multitude of risk factors for DVT into three basic elements favouring thrombus formation: venous stasis, vascular injury and hyper coagulability. Clinical, biochemical, and radiological tests are used to increase the sensitivity and specificity for diagnosing DVT.

Answer 23

The condition where the motor activity of the bowel is impaired, usually without the presence of a physical obstruction.

Answer 24

Abdominal bloating, abdominal distension, Gas, Constipation, Nausea and vomiting, dehydration.

Answer 25

Paralytic ileus occurs when the muscle contractions that move food through your intestines (peristalsis) are temporarily paralyzed. 1. SNS activated intra operatively and bowel motility inhibited 2. Increase in cytokines and inflammatory mediators decrease bowel motility 3. Peristalsis slows then stops 4. This leads to decreased movement of faecal matter through the bowel

Answer 26

Loss of consciousness from several minutes to hours Persistant headache or headache that worsens Repeated vomiting or nausea Convulsions or seizures Dilation of one or both pupils Clear fluids draining from nose and ears Inability to awaken from sleep

Answer 27

Traumatic brain injury occurs when a traumatic event causes that brain to move rapidly within the skull, leading to damage. Damage of neuronal tissues associated with TBI fall into two categories: Primary injury, which is directly caused by mechanical forces during initial insult; and secondary injury, which refers to further tissue and cellular damages following primary insult.

Answer 28

Brain dysfunction caused by an outside force, usually a violent blow to the head.

Answer 29

Motor deficits – most obvious – include: mobility, respiratory function, swallowing and speech, gag reflex, self care abilities Hemiplegia (paralysis) / hemiparesis (weakness) Ataxia = altered coordination of movement & posture (cannot coordinate movement – lost sense of where body part is located, staggering/abnormal walking movements) Dysphagia = altered swallow Communication – Speech = aphasia (inability to use or comprehend words), expressive & receptive dysphasia – depending on area affected these will differ eg – damage to Wernickes area – may have fluent aphasia – faulty understanding of written or spoken words, might produce a string of words with no meaning (word salad), or damage to Brocca area – non fluent – inability to properly form words (know what they want to say but cannot speak the words) Intellectual Function – Both memory and judgement may be impaired, L side damage more likely to result in memory problems, R side tends to mean pt is impulsive Spatial perceptual - more common with R side – patients may deny their illness or their body parts. Neglect of one side of body (may be made worse by homonymous hemianopia) , spatial orientation – can’t judge distances, agnosia – cant recognise an object by sight, touch or hearing, and apraxia – inability to carry out learned sequential movements on command Affect - may have trouble controlling emotions, responses may be exaggerated or unpredictable, depression an issue, frustration, lability Focus in on terminology Hemianopia / diplopia Memory – short & long term affected, low attention & concentration, altered judgement & abstract thought Emotional lability Elimination – symptoms more often temporary than permanent but need to consider functional incontinence (resulting from cognitive, functional or environmental factors)

Answer 30

Ischaemic cascade: - disrupted blood flow - Anaerobic respiration - Lactic acid - Insufficient ATP Ion imbalance: - Increase in intracellular calcium - Increase Glutamate - Vasoconstriction Enlarged area of infarction into penumbra: - Cell membrane and proteins break down - Formation of free radicals - Proteins production decreased - Cell injury and death

Answer 31

Ruptured vessel: - Explosive eruption of blood from vessel into surrounding brain tissue and structure - Haematoma develops - Exposure of brain to blood, an increase in intracranial pressure caused by sudden entry of blood into the tissue, and secondary ischaemia result from reduced blood flow/perfusion. ion imbalance: - Mismatch between blood flow and metabolic demand - Breakdown of sodium/potassium pump maintaining cellular function - Anaerobic respiration to produce ATP - Increased production of lactic acid Cell death: Altered pH Cell membrane and proteins break down - Formation of free radicals - Cell injury and death

Answer 32

Modifiable contributing factors: - High cholesterol - diabetes - Obesity - Inactivity - Smoking and ETOH - Hypertension Non-modifiable contributing factors: Age More common in over 55-year-olds Gender Women have a higher incidence of stroke than men Ethnicity NZ Maori have a greater incidence than non-Maori Greater incidence in South Asian and African/Caribbean population Genetics Small vessel disease in approx. 7% of stroke in young adults

Answer 33

Nursing interventions: Maintain head of bed 30◦ to facilitate jugular venous drainage and help reduce intracranial pressure Maintain systolic blood pressure within prescribed parameters (often < 180mmHg) to reduce the potential for further bleeding or ischaemic changes Continuous neurological observations to help identify deterioration to initiate timely intervention and treatment Ensure correct positioning of paralysed limbs to prevent contractures and maximise function for rehabilitation Ensure patient is kept NBM until swallow is assessed by Speech and Language Therapist to prevent aspiration of oral fluid and food Administer prescribed aspirin orally or enterally to impede clotting and prevent further ischaemia Turn the patient regularly to maintain skin integrity and prevent pressure injury if the patient cannot move themselves

Answer 34

A spinal cord injury (SCI) is damage to the tight bundle of cells and nerves that sends and receives signals from the brain to and from the rest of the body.

Answer 35

HTN (>20mmHg pt baseline) - Bradycardia Headaches Blurred vision Facial Flushing Diaphoresis above level of injury Anxiety and restlessness.

Answer 36

1. Noxious stimulus (distended bladder, constipation etc.) 2. Signals transmitted to spinal cord to initiate SN activation (> HR, > BP - vasoconstriction, > RR) 3. HTN stimulates baroreceptors in carotid bodies. Brain initiates PN activity to reduce BP by slowing HR (bradycardia) 4. Signals to reverse SN activity sent from brain via spinal cord to vasodilate blood vessels, slow HR. This occurs ABOVE SCI level 5. Signals cant pass BELOW level of injury. if noxious stimulus continues, ascending signals continue to initiate SN activity. 6. Results in increasing HTN (associated headache, blurred vision) bradycardia, vasodilation ABOVE SCI level and vasoconstriction BELOW.

Answer 37

Transient concussion (reversible) Contusion - Bursed Laceration- Cut to cord Compression - Squashed cord Transection (irreversible) - cut straight through spinal cord

Answer 38

Interventions: Put the person into sitting position 90◦ to help lower the BP Loosen clothing Assess for the probable cause and remove Continue to assess vital signs (Q2-3min BP) Administer GTN as prescribed if SBP > 150mmHg (short acting anti-hypertensive medications only)

Answer 39

A painful and dangerous condition caused by pressure build-up from internal bleeding or swelling of tissues. The pressure decreases blood flow, depriving muscles and nerves of required nourishment. Occurs in long bone fractures.

Answer 40

Bulging or visible swelling of the muscle. Feeling like the muscle is fuller, swollen or somehow larger than normal. Numbness. Muscle pain that is stronger than you’d expect from the injury. Severe pain when you stretch the muscle. Tightness in the muscle. Tingling or burning sensation in or under your skin, called paresthesias.

Answer 41

Fluid enters a fixed volume compartment (eg from bleeding) Increase in tissue and venous pressure This pressure exceeds capillary perfusion pressure Capillaries collapse Muscle and nerve ischemia occurs OR… External compression (eg plaster cast) Decrease in size of compartment Increase in intracompartment pressure and decrease in arteriolar pressure Leads to muscle and nerve ischemia

Answer 42

Acute compartment syndrome can also occur after injuries without bone fractures, including: Crush injuries Burns Overly tight bandaging Prolonged compression of a limb during a period of unconsciousness Surgery to blood vessels of an arm or leg A blood clot in a blood vessel in an arm or leg Extremely vigorous exercise, especially eccentric movements (extension under pressure)

Answer 43

Pain, Pallor (pale appearance), pulselessness, paresthesia (burning or prickling sensation), poikilothermia (temperature control).

Answer 44

Autonomic dysreflexia is an abnormal, overreaction of the involuntary (autonomic) nervous system to stimulation. The most common cause of Autonomic dysreflexia is spinal cord injuries.

Answer 45

Hypertension Bradycardia Sweating Flushing Pupillary constriction Nasal congestion Pale cool skin Piloerection (goose bumps)

Answer 46

ingrown toenail, constipation intense pain, kinked catheter, distended bladder, urinary tract infection, pressure injury

Answer 47

1. Strong discomfort/pain stimulus sending signal into spinal cord via intact peripheral nerves below T6 lesion 2. CNS senses this input as it travels up the spinal cord evoking a massive Peripheral sympathetic response through spinal reflexes and sends the Sympathetic Nervous System signals and vessels vasoconstrict below the level of the T6 injury 3. Vessels continue to constrict as they are trying to send signals to the brain - peripheral artery hypertension occurs 4. Brain detects hypertensive crisis through baroreceptors in carotid and aortic arch but CAN’T get the signal to relax vessels and decrease blood pressure into the lower extremities because the spinal cord is severed 5. Brain attempts two maneuverers to halt hypertensive crisis May... 6. Attempts to Shut down sympathetic surge by sending descending inhibitory impulses Impulses unable to travel to most sympathetic outflow areas due to spinal cord injury at T6 or above OR.... 6. Attempts to decrease peripheral BP by slowing Heart Rate through an intact vagus (parasympathetic) nerve Compensatory bradycardia is inadequate, and hypertension continues 7. Sympathetic nerves prevail below level of spinal injury and parasympathetic nerves prevail above level of injury causing vasodilation above the level of injury (T6) and Vasoconstriction below T6 injury causes increase BP and the vagus nerve causes bradycardia. 8. Reflex hypertension eases with removal of noxious stimulus

Answer 48

A myocardial infarction (commonly called a heart attack) is an extremely dangerous condition that happens because of 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.

Answer 49

Chest pain (angina). This can be mild and feel like discomfort or heaviness, or it can be severe and feel like crushing pain. It may start in your chest and spread (or radiate) to other areas like your left arm (or both arms), shoulder, neck, jaw, back or down toward your waist. Shortness of breath or trouble breathing. Fatigue. Trouble sleeping (insomnia). Nausea or stomach discomfort. Heart attacks can often be mistaken for indigestion or heartburn. Heart palpitations. Anxiety or a feeling of “impending doom.” Sweating. Feeling lightheaded, dizzy or passing out.

Answer 50

myocardial infarction is usually due to thrombotic occlusion of a coronary vessel caused by rupture of a vulnerable plaque. Ischemia induces profound metabolic and ionic perturbations in the affected myocardium and causes rapid depression of systolic function. Prolonged myocardial ischemia activates a "wavefront" of cardiomyocyte death that extends from the subendocardium to the subepicardium. Mitochondrial alterations are prominently involved in apoptosis and necrosis of cardiomyocytes in the infarcted heart.

Answer 51

Coronary artery spasm. Rare medical conditions: An example of this would be any disease that causes unusual narrowing of blood vessels. Trauma: This includes tears or ruptures in the coronary arteries. Obstruction that came from somewhere else in your body: A blood clot or air bubble (embolism) that gets trapped in a coronary artery. Electrolyte imbalance. Eating disorders: Over time, these can damage your heart and ultimately result in a heart attack. Takotsubo or stress cardiomyopathy. Anomalous coronary arteries (a congenital heart defect you’re born with where the coronary arteries are in different positions than normal in your body. Compression of these causes a heart attack).

Answer 52

Interventions: Supplemental oxygen Medications Education

Answer 53

a type of chest pain caused by reduced blood flow to the heart

Answer 54

Discomfort, heaviness or tightness of the chest which may spread to the back, shoulders, neck or jaw. Other people describe it as a dull ache Discomfort in the arm, neck or jaw with no chest discomfort The discomfort can range from mild or dull to severe.

Answer 55

Angina is usually caused by coronary artery disease (also called atherosclerosis), which is the build-up of plaque in the walls of your arteries

Answer 56

Almost invariably, angina is associated with significant obstruction of at least one major coronary artery. Oxygen demands not met. Normally, the myocardium extracts a large amount of oxygen from the coronary circulation to meet its continuous demands. Increased demand. When there is an increase in demand, flow through the coronary arteries needs to be increased. Ischemia. When there is blockage in a coronary artery, flow cannot be increased, and ischemia results which may lead to necrosis or myocardial infarction. Schematic Diagram for Angina Pectoris via Scribd.

Answer 57

Partial or complete collapse of a lobe or the entire lung, common post op complication.

Answer 58

Atelectasis often causes no symptoms on its own, though some underlying conditions that lead to atelectasis (like COPD) can cause symptoms. However symptoms that may be experienced are: Trouble breathing/shortness of breath (dyspnea). Coughing. Chest pain. Rapid breathing (tachypnea). Skin and lips turning blue. Increased HR Decreased O2 Decreased chest expansion on one or both sides

Answer 59

Reduced ventilation or blockage Obstruction of air to and from alveoli Trapped air absorbed into bloodstream, blockage stops further air entering alveoli Area of lung becomes airless Lung collapse Respiratory distress

Answer 60

Intervention: Deep breathing exercises - DBE aim to allow as much oxygen in as possible to increase lung expansion and remove any sputum that may be present. DBE can re-expand the lung tissue such as alveoli that are unable to be inflated correctly during atelectasis. Nursing actions to prevent atelectasis: 1. Spirometer is used to help the lungs to strengthen by encourage deep, full breaths. The pt aims to breathe in slowly and hold their breath for as long as comfortable. this device should be used at least 10 times every hour to promote recovery. 2. Administer bronchodilators 3. Have pt sitting upright to increase lung expansion and gas exchange 4. Education on breathing techniques and importance of coughing to excrete mucous.

Answer 61

There are two types of meningitis, Bacterial and viral. Bacterial- the entry of bacteria into the cerebrospinal fluid (CSF) and bacterial growth in this compartment leading to inflammation within the CSF and the adjacent brain tissue. Viral - Once the virus has replicated and caused dysfunction within the immune system, it is able to cross the BBB (Blood-brain barrier) where it enters the cerebrospinal fluid

Answer 62

Not having completed childhood vaccinations, Children under the age of 5 years and adults over 50 years, living in overcrowded houses and co morbidities.

Answer 63

Infants and children- Fever, crying, unsettled, irritable, vomiting, sleeping, harder to wake, reluctant to walk, rash Teens and adults- Fever, Headache, vomiting, sleeping, confusion, delirious, Unconscious, joint pain, aching muscles, stiff neck, photophobia, rash.

Answer 64

An opening on the abdomen. connected to either the digestive system or urinary system to allow waste to divert out of the body.

Answer 65

Colostomy: Opening from the large intestine through the abdomen. can be temporary or permanent. can be located in ascending, transverse, descending, or sigmoid. Ileostomy: opening in the abdomen wall located on the right lower abdomen, at the end of the ileum. Urostomy: opening in the abdominal wall. re- directs urines away from the bladder thats diseased or injured.

Answer 66

Pouches needs to be changed every 3-7 days but the pouch needs to be emptied regularly every day to decrease the risk of infections. it can take the stoma a few days to work correctly therefore, slowly introduce foods.

Patho & Interventions Flashcards

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