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Adult health 2 > test 1 > Flashcards

test 1 Flashcards

1
Q

Nasal surgery after care

A

don’t strain, lift heavy, swim, or blow nose

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2
Q

why shouldn’t you blow nose after epistaxis or nasal surgery

A

could dislodge clot

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3
Q

rhinoplasty

A

nose job- reconstruction

could be cosmetic or post traumatic

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4
Q

septoplasty

A

reconstruction of septum

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5
Q

what should you monitor for in facial swelling

A

ABCs

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6
Q

why should you stay sitting up after nasal surgery

A

to reduce aspiration

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7
Q

what antihistamines dont make people drowsy

A

2nd generation, such as allegra

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8
Q

what is perennial allergic rhinitis

A

allergies that could happen randomly with triggers. Such as anytime you go around a cat

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9
Q

episodic allergy

A

comes and goes

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10
Q

intermittent allergy

A

happens less than 4 weeks out of year

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11
Q

persistent allergy

A

happens more than 4 weeks a year

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12
Q

what causes histamine release

A

IgE response

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13
Q

common viruses of common cold

A

rhinovirus (mild)
coxsackievirus & adenoviruses (more severe)

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14
Q

acute viral rhinopharyngitis

A

common cold

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15
Q

how does cold spread and how is it treated

A

airborne droplet- can survive for 3 days

treated symptomatically. rest

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16
Q

when is influenza season

A

sept-april

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17
Q

what route is inactivated flu vaccine

A

IM

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18
Q

what route is live flu vaccine

A

nasal

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19
Q

what infleunza viruses are worst

A

A and B

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20
Q

Diagnostics and meds for flu

A

diagnosis- symptoms, rapid flu

meds- zanamivir (relenza), oseltamivir (tamiflu), peramivir (rapivab)

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21
Q

who is at high risk for thrush

A

immunosupressed

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22
Q

acute pharyngitis

A

inflammation of throat, 90% viral

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23
Q

when can brain death occur

A

3-5 mins

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24
Q

manifestations of airway obstruction

A

choking, stridor, accessory muscles, retractions, nasal flaring, wheezing, tachycardia, cyanosis

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25
Q

when can you speak with a trach

A

when cuff is deflated

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26
Q

point of trach

A

establish airway, bypass obstruction, removal of secretions, mechanical ventilation

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27
Q

complications of trach

A

airway obstruction
body image
subcut. emphysema (crackles in skin from air)
aspiration
bleeding
infection

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28
Q

head and neck cancer causes

A

Tobacco/alcohol use
HPV

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29
Q

what gender is head/neck cancer more common in

A

Men

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30
Q

head/neck cancer symptoms and diagnostics

A

white patch, hoarseness, lump, blood

assess structures, bimanually palpate, look for leukoplakia or erythroplakia, laryngoscopy, CT

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31
Q

what does TNM staging look at

A

tumor site
nodes
metastasize

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32
Q

treatment for head/neck cancer

A

surgery
radiation
chemo
targeted therapy- targets a specific protein
brachytherapy- implants radioactive seeds

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33
Q

What surgeries are partial laryngectomy requiring only a temporary trach

A

supraglottic and supracricoid laryngectomy, and hemilaryngectomy

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34
Q

surgery requiring permanent trach

A

total laryngectomy- will cause voice loss

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35
Q

voice restoration options for voice loss

A

transesophageal puncture** best quality
electrolarynx
esophageal speech- air in esophogus

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36
Q

acute bronchitis symptoms

A

cough, clear sputum, headache, malaise, hoarseness, myalgias, dyspnea, chest pain

treatment is supportive

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37
Q

what type of infection is acute bronchitis usually caused by

A

virus

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38
Q

pertusis

A

whooping cough. caused by gram neg baccilus

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39
Q

pertusis characteristics

A

violent uncontrollable coughing
2 stages : catarhall, paroxysmal

can last 6- 10 weeks
treated by abx

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40
Q

what does CDC recomend for pertusis

A

TDAP (tetanus, diphtheria and pertussis) vaccine for ages 11 and up

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41
Q

when does pneumonia occur

A

when defense mechanisms are impaired or overwhelmed with the amounts of infectious agents

Gas exchange decreases , alveoli fill with debris and mucus production increases

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42
Q

community acquired pneumonia

A

doesn’t happen in hospital

treatment can be at home

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43
Q

medical care associated pneumonia (MCAP)

A

Occurs 48 afters of being in hospital environment, from hospital association, vent, or health care

more difficult to treat because of multidrug resistance

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44
Q

most common cause of pneumonia

A

bacterial

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45
Q

types of pneumonia

A

viral
bacterial
mycoplasma
aspiration
necrotizing
opportunistic

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46
Q

what pneumonias are treated with antibiotics

A

bacterial, mycoplasma

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47
Q

what can happen in necrotizing pneumonia

A

lung tissue becomes thick liquid mass.
will require long time antibiotics

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48
Q

what opportunistic pneumonia can spread to other organs

A

pneumocystis jiroveci (PJP)

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49
Q

pneumonia symptoms

A

cough, fever, chills, tachycardic, tachypnea, dyspnea, pleural pain, malaise, resp distress, decreased breath sounds

Older adults may present differently , may be hypothermic or normothermic

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50
Q

pneumonia care

A

vaccination for high risk or ages 65&up
antibiotics
o2
physiotherapy
rest
increase fluids
elevate HOB
ambulate
good oral care
cough
deep breaths

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51
Q

causes of lung abscesses

A

aspiration, periodontal disease, IV drug use, malignancy, PE, TB, parasitic or fungal diseases

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52
Q

lung abscess signs and symptoms

A

develops slowly

foul brown sputum
hemoptysis
fever/chills
night sweats
pleuritic pain
dyspnea
anorexia

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53
Q

lung abscess diagnosis and treatment

A

chest x-ray, decreased breath sounds, dullness on percussion, crackles

treated with o2, abx (macrolide), rest, fluid, percutaneous drainage, pneumonectomy

DONT USE CHEST PT- dont want to mobilize for progression

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54
Q

causes of lung cancer

A

smoking, pollution, radiation, asbestos

more common in males, blacks, whites

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55
Q

non small cell lung cancer (NCSLC)

A

most common cause of lung cancer

Can be treated with surgeries, chemo, radiation, targeted therapy

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56
Q

small cell lung cancer (SCLC)

A

not as common, metastasize is more likely. death is more common

chemo is main treatment

57
Q

diagnostics for lung cancer

A

chest x-ray, CT, MRI, biopsy, H&P, renal and liver labs

58
Q

lung cancer maniefestations

A

chronic cough
lobular pneumonia
blood tinged sputum
dyspnea
wheezing
chest pain

later- anorexia, fatigue, n/v. palpable lymph nodes, dysrhythmias

59
Q

segmental/wedge resection

A

small portion of lung is removed

60
Q

lobectomy

A

removes a lobe/lobes

61
Q

pneumondectomy

A

removes one lung

62
Q

pneumothroax symptoms

A

dyspnea
anxiety
cyanosis
tachycardia
pleural pain
asymmetrical chest wall expansion
decreased breath sounds

63
Q

causes of pneumothorax

A

ruptured air sac
thoracentesis
trauma
secondary infection

64
Q

pneumothorax diagnosis and treatment

A

diagnosed by chest xray, ABG

treated by chest tube, o2

65
Q

tension pneumothorax

A

Med emergency due to mediastinal shift.

Pushes on heart causing cardio and resp symptoms. Cyanotic, fast HR. clients can die from inadequate cardiac output

66
Q

trauma pneumothorax

A

from trauma such as gun shot

air enters pleural space due to opening in chest wall

emergency treatment- use vent dressing

67
Q

what is spontaneous pneumothorax usually caused by

A

ruptured blebs

68
Q

chylothorax

A

pneumothorax from lymphatic fluid

69
Q

iatrogenic pneumothorax

A

caused by med proedure puncture

70
Q

hemothorax

A

blood in plueral space

chest tubes needed

71
Q

how much fluid should plueral space have

A

5-15 mL

72
Q

pleural effusion

A

accumulation of fluid in the pleural space

classified by:
transudative- clear, pale
exudative- inflammation. treated w thoracentesis

symptoms- dyspnea, cough, occasional chest pain

diagnosed by chest xray, CT

73
Q

Emphysema

A

collection of purulent fluid space

74
Q

pleurodesis

A

helps prevent by injecting med into plueral cavity for about 8 hours with chest tube

75
Q

thoracentesis

A

removes fluid for thoracic cavity with needle’

removing too much at once can cause hypotension, pulm embolism, etc

76
Q

what veins do lethal PE commonly originate in

A

femoral or iliac

diagnosed by CAT scan

77
Q

who is at risk for PE

A

immobility, obesity, history, smokers, woman with oral contraceptives

78
Q

symptoms of PE

A

sudden sharp chest pain
dyspnea
hypoxia
tachycardia
hemoptysis

79
Q

PE nursing care

A

o2
IV fluids
vitals
low molecular heparin***, oral anticoagulants
embolectomy

meds require long term use- 6 months

80
Q

coronary artery disease (CAD)

A

plaque build up- atherosclerosis
- may be accompanied with chronic stable angina, but if not taken care of then can be unstable angina

81
Q

most common type of heart disease

A

CAD

82
Q

CAD risk factors

A

modifiable- obesity, diet, htn, smoking, metabolic syndrome

non-modifiable- age, gender , genetics

83
Q

how often should you exercise with CAD

A

30 mins/day 5 times a week

84
Q

meds for CAD

A

statins- restrict lipoprotein production. SE- muscle ache, weakness, rhabdomyolysis. This is the most common drug gaven for this.

Niacin- inhibits LDL and triglyceride synthesis. SE- Flushing

fibric acid derivatives- reduce triglycerides, increase HDL. Could increase bleeding and effect antihyperglycemic drugs

Bile acid sequestrants- GI side effects, could reduce absorption of other drugs

ezetimibe (zetia)- decrease cholesterol absorption

aspirin- antiplatelet (prevents clotting)

clopidogrel (plavix)- antiplatelet

85
Q

angina

A

Oxygen demand is greater than oxygen supply, causing ischemia, causing chest pain
usually from insufficient blood flow

s/s- pain, pressure, squeezing or heavy feeling, cold due to lack of o2

86
Q

chronic stable angina

A

PREDICTABLE. from activity, stress, etc

arteries are 70% blocked or 50% left ascending. Could be reversible but usually not.

no abnormalities on EKG

87
Q

unstable angina

A

occurs when resting. Pain last greater than 10 mins and is unpredictable. Needs immediate care. ECG shows ST depression.

88
Q

prinzmetal’s angina

A

rare. Occurs at rest with or without CAD. Patients must have history of migraines or Raynaud’s. Treatment is exercise, nitroglycerin, CCB

89
Q

microvascular angina

A

from myocardial ischemia from microvascular disease. more common in women. Pain may radiate to neck, jaw, shoulders. Brought on by physical exertion. Treatment is nitroglycerin

90
Q

EKG shows ST elevation

A

STEMI.

91
Q

angina goal

A

reduce o2 demand and/or increase o2 supply

92
Q

angina drugs and care

A

aspirin

short acting nitrates- SL. 1 tablet every 5 mins up to 3 times. Call 911 if not relieved. SE- headache, dizzy, hypotn

long acting nitrates- For reducing frequency or prizmentals. Could be PO, transdermal. Covers 24hr period

ACE and ARBs-Vasodilates and reduces blood volume

beta blockers- reduce cardiac output. SE- bradycardia, depression, hypotn. Be careful in patients with asthma and diabete

calcium channel blockers- Cause systemic vasodilation and reduce HR. SE- fatigue, headache, peripheral edema

lipid lowering agents

sodium current inhibitor- GI side effects

93
Q

gold standard to identify and localize CAD

A

cardiac catheterization

94
Q

percutaneous coronary intervention (PCI)

A

Procedure to widen narrowed arteries by balloon and stent placement

95
Q

pre procedure for cardiac cath

A

make sure patient is NPO

see if patient has allergy to dye or shrimp (similar iodines)

baseline assessment

CBC labs

administer drugs- prob heparin

pt education

96
Q

post procedure cardiac cath

A

assess site for hematoma, bruit, bleeding-Check for bruit every 15 mins for first hr after procedure

ECG

IV infusion of antianginals

monitor for complications

pt education

97
Q

acute coronary syndrome (ACS)

A

prolonged ischemia from clot leading to MI.
EMERGENCY

cardiac biomarkers need to be done- troponin is best indicator

98
Q

STEMI

A

total occlusion. only have 90 mins to fix

99
Q

NSTEMI

A

partial occlusion, want fixed within 12-72 hours

100
Q

ACS manifestations

A

pain
SNS stimulation
BP and HR go up to try and improve circulation and urine output goes gown because kidneys aren’t getting enough perfusion
crackles, JVD, hepatic enlargement
S3 or S4 heard
N/V
Fever- not as common

101
Q

ACS complications

A

dysrhythmias
HF- do daily weights
cardiogenic shock
papillary muscle dysfunction
ventricular septal wall rupture
pericarditis
dressler syndrome

102
Q

Decreased o2 and nutrients. Left ventricle issues. Require aggressive care. Need increased o2

A

cardiogenic shock

103
Q

Causes mitral valve regurgitation, murmurs. We will see rapid deterioration In this

A

papillary muscle dysfunction

104
Q

Pericarditis and fever that develops 1-8 weeks after MI. happens in immunocompromised. Indicator is pericardial friction rub, elevated wbc.

A

dressler syndrome

105
Q

ventricular septal wall rupture sign

A

loud systolic murmur

this is rare

106
Q

electrolytes to look at for cardio

A

magnesium and potassium

107
Q

Pulmonary edema

A

left ventricle fails causing increased pulmonary venous pressure, lung alveoli become filled with serosanguinous fluid

s/s- wheezing, crackles, accessory muscles, RR<30

108
Q

MAD DOG for pulmonary edema

A

morphine- helps relieve anxiety and decrease work of breathing
aminophylline- bronchodilator
digitals- helps increase cardiac output

diuretics
oxygen
Gas- ABG

109
Q

acute pericarditis

A

inflammation of pericardial sac

s/s- severe chest pain worse with deep inspiration and when supine.
Hallmark finding- pericardial friction rub

complications
pericardial effusion- fluid
cardiac tamponade-Severe complication. Causes compression on heart. Signs- narrow pulse pressure, tachypnea, decreased BP

110
Q

acute pericarditis treatment

A

NSAIDs
antibiotics
pericardiocentesis
pericardial window

111
Q

ACS diagnostics and care

A

12 lead EKG

troponin T <0.1mcg/L
troponin I <0.5mcg/L
creatine kinase (CK) <4-6% of total CK
myoglobin

chest xray
o2 stat above 93%
cardiac cath
nitro
aspirin
morphine
statin
ACE and ARB
beta blocker
thromblytic
antidysrthymic

112
Q

MONA- immediate treatment of MI

A

Morphine
Oxygen
Nitroglycerin
ASA- aspirin

113
Q

advantages of PCI over CABG

A

faster reperfusion
alternative to surgery
local anesthesia
ambulatory normal activity in 3-4 days
length of stay shorter
faster return to work

114
Q

complications of PCI

A

dissection/rupture of artery
abrupt closure
acute stent thrombosis
failure to cross blockage
in silent restenosis

115
Q

drugs for ACS

A

nitroglyc
antiplatelets
morphine
Beta blockers
ACE and ARBs
CCB
anticoagulant
antidysrhythmic
thrombolytics- for STEMIS
lipid lowering agent
stool softener

116
Q

SE and contraindications of thrombolytics

A

may cause bleeding

dont use in active bleeding, severe hypotension, post surgical patients, recent traumatic CPR pts

117
Q

ICD

A

defibrillation

administers electric shock

118
Q

infective endocarditis

A

Caused by clots or bacteria’s typically, or IV drug use

blood turbulence in heart allows organism to infect previously damaged valves or other endothelial surfaces

manifestations- can involve multiple organs, low grade fever, chills, weakness, malaise, fatigue, anorexia, murmur, heart failure

diagnosed by blood cultures (3 sets over 1 hour from 3 diff sites), echo, chest x-ray, ecg, cardiac cath

care antibiotics- long term
valve replacement

119
Q

ACS is also known as

A

MI

120
Q

STEMI vs NSTEMI

A

STEMI- elevated ST
NSTEMI- EKG is normal

121
Q

regurgitation

A

valve doesn’t close well.
can cause backflow

122
Q

stenosis

A

narrowing

123
Q

diagnostics and treatments for valve diseases

A

echo, cath

valve repair surgery
symptom management- diuretics, beta blockers, anticoagulants, vasodilation, antidysrhythmics, antibiotics
prevent future complications

124
Q

mitral valve stenosis

A

increased left atrial pressure and volume, increase in pulmonary vasculature. results in decreased blood flow from left atrium to left ventricle.

s/s- dyspnea, murmur, fatigue, palpitations, hemoptysis, hoarseness

risk for AFIB

contractures develop with adhesions

125
Q

mitral valve regurgitation

A

incomplete valve closure and backward flow of blood

s/s- thready pulse, cool and clammy, murmur

complications
acute- pulmonary edema
chronic- left atrial enlargement, ventricular hypertrophy

126
Q

mitral valve prolapse

A

mitral valve leaflets prolapse back into the left atrium during systole

usually valve closes effectively
most patients are symptomatic

chest pain unresponsive to nitrates

127
Q

aortic valve stenosis

A

obstruction of blood flow from left ventricle to aorta
-LV hypertrophy

increased myocardial o2 consumption

HIGH MORTALITY IF NOT TREATED

s/s- angina, syncope, DOE, quiet S1, diminished or absent S2, systolic murmur, S4

complication- pulmonary htn, HF

128
Q

aortic valve regurgitation

A

backward blood flow from the ascending aorta to left ventricle

acute- emergency

complication- pulmonary htn, right ventricular failure

129
Q

aortic valve regurgitation acute manifestations

A

sudden signs of CV collapse
dyspnea
chest pain
hypotension
cardiogenic shock

130
Q

aortic valve regurgitation chronic manifestations

A

could be symptomatic

DOE, orthopnea, paroxysmal dyspnea
angina
‘water hammer” if severe- strong beat but the beat collapses in the middle
soft/absent S1
S3 or S4
murmur

131
Q

tricuspid valve stenosis

A

typically always from rheumatic fever

s/s - fluttering discomfort in neck, fatigue, RUQ pain

132
Q

pulmonic valve stenosis

A

almost always congenital

causes right ventricular HTN and hypertrophy

s/s- syncope, dyspnea, angina

133
Q

Venous Thromboembolism (VTE) manifestations

A

unilateral leg edema, tenderness, dilated superficial veins, paresthesia, erythema, fever

134
Q

VTE diagnostics and treatments

A

blood studies
venous compression ultrasound
duplex ultrasound
CTV
contrast venography
magnetic resonance venogragy

treatment- prevention, anticoagulant therapy, thrombolytic therapy, surgical intervention

135
Q

post thrombotic syndrome

A

spider veins, edema, redness, cyanosis, increased pigmentation, pain during compression, venous ulceration

complication of VTE

136
Q

major complication of a VTE

A

pulmonary embolsim

137
Q

acute arterial ischemia

A

sudden interruption of arterial blood supply to tissue, organ or extremity. caused by embolus or trauma

manifestations- pain, pallor, pulseless. paralysis, paresthesias

care- anticoagulants, surgical thrombectomy, surgical bypass, amputation

138
Q

why do woman die more of CAD then men

A

dont report it

139
Q

6 Ps of acute arterial ischemia

A

pain, pallor, pulseless. paralysis, paresthesias,polar

Adult health 2 (4 decks)

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