SEMESTER 2 FINALS Flashcards
(55 cards)
1
Q
Myocardial Infarction definition
A
- (STEMI or NSTEMI)-ST elevated or not
- DEATH OF HEART MUSCLE
MYOCARDIAL CELLS PERMANENTLY DESTROYED (necrosis) - SECONDARY TO PARTIAL OR COMPLETE BLOCKAGE OF CORONARY ARTERY
- emergency event Tx needed ASAP
- caused by CAD
- if blood supply to LADA is blocked that’s really bad, supplies 50% of blood to heart
- necrosis can be min. If Tx within 1 hr
2
Q
M.I. S/S normal and atypical
A
- angina main s/s: crushing pain radiating to either shoulder/arm & jaw that don’t stop with nitro
- SOB, restlessness , dizzy, nausea, sweating, s3/s4 gallop
- atypical S/S: women, no pain, epigas./abd. Pain, chest cramping, fatigue, anxiety/doom, falls
- tx: M.O.N.A
3
Q
M.I. Labs and prehospital care
A
- labs— potassium, magnesium, CK-mb shows heart damage
- prehospital— if 3 nitro tabs & sitting don’t work for angina, TAKE 1 ASPIRIN/2 BABY ASPIRIN, CALL 911, DONR SELF DRIVE
4
Q
C.A.D
A
- blood can’t flow to coronary artery»s/s ischemia, angina, caused by atherosclerosis
- -STATIN meds: lowers LDLs (bad cholesterol), don’t take with grapefruit, s/e rhabdomyalsis, hepatotoxicity,i.e. Atvorstatin
- low cholesterol diet, no smoking, workout
- tx: PTCA (artery compress balloon), atherectomy (removes plaque), stents (mesh plasty), CABG (vessel graft for block..Leg, mammary..hug a pillow)
5
Q
Cardiac biomarker
A
- CK, troponin, myoglobin…will be elevated in M.I.
- c-reactive : CAD / MI risk, <10 normal
- troponin 1&2 show MI , stay high 5-7 days
6
Q
Modifiable & non modifiable risk factors HEART
A
- modify—wt, diet/liquor, smoking, workout,diabetes
- non-modify—sex, genes, family history, race, diabetes
7
Q
DVT
A
- form of thrombophlebitis ..in deep veins usually in LE
- discoloration, swelling, warmth, redness, edema
- can cause pulmonary embolism
- tx: low wt or regular heparin, Coumadin, rest, TEDs, thrombectomy, vena cava filter, elevate legs, skin integrity (ulcers)
- nursing: risk factors, relieve pain, administer meds per INR PT
8
Q
Diuretics
A
- reduces blood vol./ARTERY PRESSURE, By urinating out electrolytes and water
- used for HTN, HF (CHF esp.), etc
- K-sparing: Spironolactone (Aldactone)..Watch potassium lvl for elevations
- k-wasting: thiazide (hydrochlorothiazide) (chlorothiazide) potassium for decrease
- Loop: furosemide (lasix), torsemide (demadex)…daily wt. & I/O
- oldest most studied antiHTN med
- PTs should swing legs on bed’s edge for some minute before standing to avoid syncope
9
Q
Beta blockers
A
- used for HTN because they relieve blood pressure / HR/decrease cardiac output
- TREAT HTN HF , CHF, A. fib, can prevent MI
- S/E: bradycardia, fatigue, dizzy
- avoid with COPD/asthma PTs
- if its a HR under 60 HOLD med call HCP
- -LOL drugs i.e. metroprolol
- stopping use=rebound HTN
- Beta 2 agonist: bronchodilation
Beta 2 blocker: bronchoconstriction
Alpha 1 agonist: vasoconstriction
Alpha 1 blocker: vasodilation
10
Q
Heart failure
A
- L-side: blood backs up from l vent to l atrium»_space;to lungs»alveolar/pulmonary edema ..MI. regurgitation/sentosis causes
- R-sided: fluid backs up in lungs causing pulmonary pressure from L sided-failure ..Systemic
- r sided– cor pulmonale, L side H.F., stenosis
- heart will compensate for this by working harder but that can make it worse
- r-side s/s: jvd, peripheral edema, organmegaly- RUQ pain, alt asp elevated, hepatic venous stasis, wt. gain
- l-side s/s: paroxysmal noc., lung congestion, restlessness, fatigue, confusion, orthopnea, fatigue, cyanosis
- tx: ACE & diuretic, report dry cough (from ACE), daily wt. 2-3lb wt gain..report to Dr.
11
Q
Cardiac valve replacement
A
- mechanical: durable, creates fast flow…thrombus risk, anticoagulant forever
- bio: I.e. pig, cow etc, needs to be replaced more because it’s organic
- Ineffective Endo. can occur from vegetation growth
12
Q
Pulmonary edema
A
- life threatening (resp. distress), l side HF complication ..from alveolar fluid build up
- s/s: orthopnea, paroxysmal dyspnea, frothy bloody coughs, pallor, wheezing/gurgling, crackles on ascultation, diaphoresis, anxiety
- dx: X-ray, abg, ecg, hemo monitoring..respiratory acidosis risk
- tx: vitals, digoxin/lanoxin, diuretics, high Fowler, M.O.N.A., output
- NANDAs–impaired gas, decresed C.O., fl. vol. excess, anxiety r/t suffocation fear
13
Q
Cholesterol
A
- fatty material, too much in arteries causes plaque»_space;CAD, atherosclerosis, heart issues
- LDLs bad <100, HDLs good,>60 total cholesterol: 200<
- treat with betas, -STATIN meds
- to lower LDL, low fat low low salt diet, no smoking, workout
14
Q
Aneurysm
A
- balloon in a brain artery…if under 4 cm PT may not have s/s
- AAA most common …pulsing abd. mass & pain , rupture, back/flank pain
- saccular-1 side dilated, fusiform-entire artery dilated, dissecting—tear causing cavity
- care: med regimen, avoid stress, betas, no lifting
15
Q
Cardiac angiography
A
- dye inserted to see vessels, blood flow, vessels for graft use, sees clots
- get consent, dye allergies, NPO 4 hrs preop, v.s., pulses, inj site assess, npo until gag reflex back, hemorrhage monitor
16
Q
Cardiac Cath
A
- sees heart anatomy & flow, coronary pressure/chambers/ great vessels, assess CO/O2 sat.
- dye injected into cath»femoral vein
- pre: consent, dye allergies, NPO/conscious sedation
- post: monitor bleeds, pressure device bedside, no flexing leg, v.s. P pulses taken, fluids to flush dye
17
Q
Nitroglycerin
A
- vasodilator drug used for angina
- take pre-activities that causes angina
- rise slow after taking»_space;dizzy
- keep in dark bottle
- max 3 pills 5 mins apart…have PT sit down. If that doesn’t work start emergency procedures
18
Q
Venous insufficiency
A
- chronic ; damaged/aging valves cause blood pooling in LE
- can cause venous ulcers»on ankles, discolored hard leathery skin with edema
19
Q
Peripheral Artery Disease
A
- chronic worsening artery narrow
- reduced blood supply…ischemia
- labs: MRI CT, arteriography, ankle-brachial index
- s/s: intermittent claudication (activity pain), cold red-purple skin, faint/absent pulses, hair loss/dry skin
- tx: low fat low car low cholesterol diet, -STATINs, thrombolytics, PTA, atherectomy, stents, aortic-femoral bypass, DON’T elevate LE
- NANDAS: pain, ineffective tissue perfusion, activity intolerance, info deficit
20
Q
HTN Emergency
A
- normal : 90/60-129/79, stage 1 HTN: 130/80-139/89, stage 2: 140/90>
- >180/120, organ damage, PT should rest while 911 is called
- BP needs to be lowered ASAP, kidneys heart brain at risk…gradual approach to fix
- caused by non compliance, stopping meds
- HTN caued by increasing blood vol., blood vicosity, PVR
21
Q
Orthostatic hypotension
A
- caused by repositioning
- lying to standing or sitting or vice versa causes BP
- take BP/HR lying sitting and standing, 3 minutes/reading
- reading differences >20 mm decline SYS, >10 mm DIA
- with different readings, use arm with higher reading
22
Q
Cardiac Tamponade
A
- from non penetration trauma..Becks triad (low BP, JVD, muffled heart sounds), life threatening, pericardiocentesis ASAP, steroids & NSAIDs >pain, inflammation
- pericarditis complication, fluid around membrane»_space;pericardi. Effusion
23
Q
Pericarditis
A
- pericarium inflamed» vent. Fill reduced, from Lyme disease/ drug reaction/post-MI/neoplastic disease/rheumatic/trauma
- s/s: substernal radiating/grating angina, friction rub, dyspnea (sit PT up)
- labs: ECG, echo, CT, MRI, WBC, c-reactive
- tx: pericardiocentesis, antibiotics, NSAIDs, hemodialysis, pericardial window, pericardiectomy , rest
24
Q
Aortic regurgitation
A
- blood backflow to LV because A. Valve doesn’t close»reduced CO
- rhemautic/endocarditis/Aortic dissection cause
- s/s: none early, dyspnea, fatigue, corrigan’s (forceful/quickly collapsing pulse), angina, wide pulse pressure
- labs: echo, Doppler/TEE, cardio MRI, cardio cath
- tx: vasodilator, valve replacement with propylactic antibiotic
25
Cardiac blood flow
* **inferior/superior vena cava>>R atrium>> tricuspid>>R vent.>>pulmonic valve>>pulmonary arteries>>lungs>>pulmonary veins(4)>>L atrium >>mitral>>L vent.>>aortic valve>>aorta>>systemic circulation**
26
Cardiac Output
* **amt of blood ejected from L vent. In 1 minute …stroke vol. X HR**
* avg. 60-80 mL/beat, avg. resting 5-6 L
* L has to pump 5x harder to accommodate CO for body
* CO drop can activate angiotensin and sympathetic systems
* measures heart’s efficiency
27
Arrhythmias
* rhythm disturbance in conduction
* instead of SA node, impulse begins at AV, atrial or ventricles
* s/s: angina, syncope, dyspnea, tachy, palpitations, faint pulses, dizzy
* emergency: V Tachy, V Fib, Asystole
* tx: if stable amiodarone (antiarrythmic) & magnesium. betas, ca channel blocks, digoxin, ablation (heart scarring), cardioversion, CPR, vasopressin (BP low med), epinephrine , pacemaker, defibrillation , blood thinners
28
Blood transfusion
* used for hemorrhaging, fe deficit anemia, sickle cell, HIV/AIDS, hemolysis
assess for reactions, monitor V.s., Id PT by DOB & blood type
* washed, warmed, infuse w/ NSS
* reactions : febrile (fever), urticaria (hives), hemo (incompatible, cells burst) , anaphylactic allergy (use frozen blood), circulatory Overload, Warm Angina, SOB
* cross match for compatibility prior
29
rheumatoid arthritis
* **chronic, progressive systemic inflammation of synovial joints/connective tissues/major organs/joint cartilage..may be pathogen caused, destroys joints**
* pannus>>bony tissue>>mobility loss..any connective tissue can be hurt with RA
* early s/s: with exacerbations, **bilateral**, symmetrical, **swollen warm painful stiff joints**, **stiff post-rest**, activity relieves pain, low fever, fatigue, weakness, anorexia .. pain early A.M/wake up
* late s/s: joint deformed, secondary osteoporosis
* no test for dx..RF, RBC, ESR, C-reactive high..xray
* tx: NSAIDs, gold salts, antimalarials, fish oil, antioxidants, corticos, capsaicin cream, antibiotics, warm compress
30
arthritis
* autoimmune disease, wears/tears joint cartilage, inflammation, swelling of joint ...infection or injury
* osteoarthritis: bone on bone (crepitus)>>bone spurs, narrow joint space, joint deteriorates, hebdens--high, bouchards-below....tx: NSAIDs, synvec in knees, pain with activity, unknown cause
* age, obesity, mechanical stress on joint
* S/S - Joint pain or stiffness, problems with ADLs, bony nodes on the joints of their fingers (Heberden’s and Bouchard’s)
31
Traction
* pulleys/weights applying force after major fracture..skin traction or skeletal traction, can be used for wks.-mos.
* maintain extremity alignment, avoid soft tissue injury, immobilize fracture
* rope know not on bed, wts hang free, Pt bed centered
* **skin**-- wt pulls on tape/boot, is attached to skin, **buck's**--hip fracture waiting for surgery..5-10 lb wt. bedrest..sponge boat**russell's**--kids/adults..hip/femur fracture.. popliteal sling, knee flexed...check pulse,check for integrity, HOB flat FOB up for countertraction..lifting trapeze..pills for leg..rest, **bryant's**--kids/infants >30lbs, **pelvic**--herniated disc, **.cervical**-herniated disc too..sling to weights
* Pt may have Orthostatic hypotension once out of traction
32
skeletal traction
* **directly in bone>>osteomyelitis risk**, metal pin, pins tx asepsis, no ointment no Betadine (corrodes),bedrest w/ continuous traction
* LE traction-no feet drop, trochanter roll/Pt care on unaffected side, UE traction--**TOTAL CARE**
33
fracture
* bone break (Trauma, patho.), open--skin breaks..tachy, HTN can happen..closed--no break... soft tissue edema, muscle hemorrhage, ruptured nerves, severed tendons 48-72 hr--hematoma..1 week--callus (union)
*6 wks.-1 yr to heal, vit. c&d/calcium/protein/water to heal
* s/s--pain, decreased ROM, limb rotation, edema, bruising, crepitus, spasm..complete: 2 piece, incomplete--not 2 pieces
* pain control, prevent more injury..**in emergency: splint PT, dont realign/straighten, bleed control, cover openings**
* closed red.--manual bone align..open red.--realign with hardware, usually hip..fixator: outer hardware>>myelitis risk
* elderly (women esp.) fractures caused by osteoporosis (i.e. pathological fx), phosphoric acid
* comminuted, spiral fracture, impacted(bone into bone), a
34
MSK Meds
* Bone resorption inhibitors: alendronate,risedronate--osteoporosis/hypercalcemia/paget's, s/e diarrhea/nausea/headahce/ bone pain
* Uric inhibitor: allopurinol, febuoxtat--uric acid decrease/serum acid..for/prevents gout attacks..s/e: diarrhea/abd. pain/naursea
* skeletal relaxants--muscle/back pain & strains, spascity, relieves pain but not not fully understood
* DMARDs--hydroxychloroquine, sulfasalazine,suppress inflammation, used for R.A., used with -SONEs/NSAIDs, dont used with active infection
* usually take med with milk/food/frink
35
Gout
* arthritis ...built up uric acid from purine breakdown, found in men more, s/s: inflamed joints/big toe(acute), renal stones (chronic)..
* find high acid crystals >>joint fluid analysis
* attacks--NSAIDs, cholicine, steroids, indocin, zyloprim
* care--avoid aspirin ASA&Diuretic, no alcohol/anchovies/shellfish/organ meat, encourage fluids
36
Amputations
* surgical (diabetes, gangrene), trauma (accident/lawnmower)>>keep body part on ice until ER, may be savable
* prosthetic fitting, support/adjustment, keep tourniquet bedside, dressing assessment
* phantom pain from brain/spine, phantom pain--is real pain..tx Lyrical, inderal, alevil, neurotonin, lie PT prone 30 mins
37
Cirrhosis
* clay colored stool...bile duct
* clotting deficiences, hepatorenal syn., encephalopathy,
* caused by liquor, Hep B&C..liver scarring
* s/s: jaundice, LLQ pain,
38
Hiatal Hernia
* lay down post meal
*stomach slides up through diaphragm hiatus to thorax; lower esophageal doesn’t close
* s/s: burning substernal pain, indigestion, full feeling, dysphagia, bleeds, common in smokers, obese PTs, PTs >50, pregnant PTs, hiatal hernia usually w GERD
* dx: barium swallow , esophagoscopy
* sliding vital hernia most common, para esophageal rare …complications : Barrett’s esophagus, esophagitis, aspiration pneumonia
39
Ostomy
* diet: low residual (leaves gut fast) used for PTs prep for surgery
* stoma should be beefy red..moist, not dusky/purple/blue
* cramping during irrigation>>pinch tube
* normal soft stool reg. diet, fresh ostomy..liquid
40
appendicitis
* Appendix inflamed,
* s/s: McBurney's point--pain travels to R low side, rebound tenderness, RLQ pain, WBCs elevated,fever,
* CBC, CT, ultrasound, Keep NPO, surgery asap unless peritonitis (burst>>infection) infection ..surgery on hold
* abscess/perforation--fever, pain
41
General Med Surg
* pre-op: find out what PT ate >>aspiration, GI needs to be clear prior to surgery
* fresh Post-OP: fever normal>>inflammatory response
* ASA toxicity
*
42
THR (hip replacement)
* when other options have been exhausted, cement/bone graft, most common: hip, **any synovial joint can be replaced**
* No adduction 90 degrees past midline, no internal rotation, no flexion past 90 degrees, A frame should always be in room, no leg crossing, teach PT to push off from chair using armrests, raised commode, no waist bending/armless chairs, no pillow under knee
* trochanter roll, dislocation>>"POP", pain, usually from rotating, limb can shorten, early ambulation OOB same day as Op, discharge assessment on admission, prophylactics>>infection
* post=op: hypovolemia observe, incision site check, V.S., wt bear pr Dr.'s order, protein for healing, calcium for bones, vit. D for absorption
43
TKR (knee replaced)
* TKR--pillow under ankle>>edema prevention, no flexing>>scar tissue
44
Hepatitis Vaccines and M.O.T.
Hep A --fecal to oral, shell fish/undercooked meat, has vaccine, water contamination
Hep B--blood/body fluids, B vaccine covers Hep D too
Hep C--needle, has vaccine
Hep D--blood
Hep E--traveler's diarrhea, water contamination ...no vax in USA yet
45
GI Meds
* **Antacids**, **Lactulose** (lowers Ammonia lvls), **PPIs (OMEPRAZOLE..lowers acid..GERD, Mallory-Weiss, Gastric bleed)**, **antiemetic (stops vomiting)**, ASA (PUD, ) H2 antagonist, antibiotics for infection (appendicitis), **Corticos (-SONEs..tx inflammation..crohn's)**, antidiarrheals,
46
Tubes and Things
* GI tubes: for feeding, removing gas/secretions, nutrition/meds/hydration, post-op healing, Motility view...**NG** thru nose into stomach..temp., free water, PT high fowler's, assess patency and residual, **check placement, stop feed is too much residual/Pt cramping or pain/aspiration & CALL HCP**
47
Ulcerative colitis
* inflammation in lg colon/rectum, autoimmune/allergy response
* s/s: abd. pain, diarrhea, butt bleed, poop emergency, 5-20 liquid stools/day...hemorrhage/perforation/obstruction/peritonitis can occur
* scopies and biopsies to see issue..avoid irritating food, colon may be removed, PN, fluids, same meds as crohn's
48
Diverticulitis
* bowel hernia/outpouching, diverticulum inflamed, >60 at risk, usually in sigmoid, caused by poor fiber intake or constipation
* s/s: constipation& diarrhea, LLQ pain. weakness, bleed, fever..sigmoidoscopy, barium enema to dx
* NG tube, pain control, NPO, surgery to treat, slow increase of soft, high fiber food
49
GI diagnostics
* Lab: CBC, electrolytes, CEA, bilirubin, Liver/pancreatic enzymes
* stool: black/tar--upper GI bleed, frank--rectal bleed, Occult--not visible to naked eye, clay--bile absent, fresh blood--low GI Bleed
* 3 series test: occult-- no meat 2-3 pre-test, bleeding can cause +/-, ova--parasite, NO URINE, sample fresh/warm
* Barium --#1 test for GI diagnostics, poop immediately post-op(clay, white), fluids...**swallow:** fluoroscopy, NPO 6-8 hrs pre-op, long test time, esophagus/duodenum seen, laxatives, poop normal color after 3 days, fluids (12 cups), watch constipation, **enema**: for colon, low res/clear liquid diet 2-5 days & laxes pre-op, cant use with perforation or obstruction
**WITH GI STUDIES BOWELS MUST BE CLEAR OR OP RESCHEDULED**
50
Anemias
* low hemoglobin>>bad amt. O2 to tissues>>impaired RBCs made, blood loss..**nutritional**--low fe, folic, B12..**fe anemia**--less RBCs, red meat..**pernicious**..no B12 absorption, **sickle cell**--sickle shaped RBCS clump>>pain..**aplastic**--marrow turns fatty
* dx: CBC, marrow biopsy, fe profile, sig./colonoscopy, occult test, Hgb, WBC count, smear (sickle)
* S/s: pallor, fatigue, SOB, dyspnea, dizzy, tachy(pnea/cardia), **sickling**(sickle), ecchymosis/bleeding/death (aplastic), organmegaly (sickle)...black/asian/mediterranean PTs at risk
* tx: marrow transplant (aplastic), eliminate cause, fe foods, **safety>>dizzy=falls**, B12 shots(pernicious..absorption), Iv can discolor skin, take with Vit. C, dont take with Ca, liquid iron (stains..straw), steroid/hormone therapy (aplastic), correct O2 lvls (sickle)**correct identifying issues..alot of anemia are irreversible**, Blood transfusion
## Footnote
**NANDA: RISK FOR ACTIVITY R/T HYPOXIA**
51
Hemophilia
* hereditary, low clotting factors (thrombocytopenia), blood doesnt clot..Hemophilia A&B most common, A: 80% of all..VIII lacking, B: 15%..IX lacking
* S/s: females: carriers, from dads..males: affected..injury/random(maybe bleeding joints), hemarthrosis, elbow/knee/ankle joint deformity, severe or moderate random bleeds
* dx: factor lvl test, long PTT
* TX: incurable, prolong life, blood trans. post surgery/injury, cryoprecipitate,DDAVP, VII/IX reconstituted via IV, **LOOK FOR BLEEDING**, no contact sports, acute: hypovolemia risk..V.S...pain..
52
Blood Transfusion & complications
* assess V.S., ID PT DOB/blood type, blood washed/warmed, **blood administered 30 mins after leaving blood bank)**
* febrile(fever), urticaria (hives), hemolysis(warm chest/ back pain, SOB), anaphylaxis (Will re'c frozen blood til stable)
* circulatory overload (crackles, SOB), stay with PT 15 mins post-transfusion, V.S. before/during/after
53
HTN Crises
* Urgency: high BP w/ no organ damage..headache, nosebleed, SOB, anxiety
* **EMERGENCY: BP >180/120, reduce BP have PT rest, CALL 911, organs at risk r/t damage, heart brain kidneys at risk...caused by untreated HTNM, med noncompliance..USE NITROPRUSSIDE!**
54
Multiple Myeloma
* plasma cell cancer interfering with with RBC production (marrow)..Ca leaking out of bone into blood **antibodies made are useless**, incurable tx with pain/symptom management, usually men, 3-7 yrs to live, multiple tumors devour bone, possibly from chemical or toxin exposure/allergies&sensitivities
* dx: xray (swiss holes), CBC, marrow biopsy, urine studies
* s/s: pain, joint swelling, neuro. symptoms. malaise, fractures
* tx: **manage disease**, chemo, hi-dose corticos (-SONEs) for bone destruction, laminectomy/calucil tx., stem cells transplant..assess neuro(spine>>back/leg pain), assess renal(stones), evalute PT free from injury/infection, monitor hypercalcemia
* Risk for infection r/t compromised immune function, Risk for injury: fracture r/t weakened bones; complications of immobility; complications of hypercalcemia
55
Hodgkin's Lymphoma
* Hodgkin's s/s: night sweats, piritus, fever,
