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test 1 Flashcards

1
Q

the flow of blood through arteries and capillaries delivering nutrients and oxygen to cells and removing cellular waste

A

tissue perfusion

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2
Q

blood supply from coronary arteries to the myocardium is decreased but not absent is called ___ and the chest pain produced is called ____

A

myocardial ischemia, angina pectoris. function of the myocardial cells is reduced, but cells do not die

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3
Q

Death of myocardial tissue with inability to regenerate

A

myocardial infarction after prolonged ischemia and necrosis

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4
Q

mechanisms for blood delivery, generated by cardiac output

A

central perfusion

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5
Q

volume of blood that flows through target tissues

A

tissue perfusion or local perfusion.from capillary hydrostatic pressure created by force of ventricular contractions. inadequate amount could be a prob with central perfusion, a blocked artery leading to area or excessive edema interference

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6
Q

At risk for impaired perfusion

A

adults and oder adults (atherosclerosis), especially males and african americans. also infants with congenital heart defects. children and young adults as a result of trauma. Genetics Modifiable: Smoking (nicotine vasoconstricts) Elevated serum lipids- contribute to atherosclerosis sedentary lifestyle/ obesity (increases risk for type 2 diabetes and atherosclerosis) Diabetes Mellitus (atherosclerosis) and hypertension (increase workload on heart)

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7
Q

characterized by plaques of cholesterol and other lipids lining the inner layers of arteries, which results in obstructed blood flow

A

atherosclerosis

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8
Q

Types of shock due to impaired perfusion

A

Cariogenic-inadequate cardiac output Hypovolemic - inadequate volume Anaphylactic, neurogenic or septic- systemic vasodilation

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9
Q

Perfusion Primary Prevention

A

heart healthy lifestyle, including eating a healthy diet, exercising most days of the week, taking a daily low dose aspirin and not smoking

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10
Q

Perfusion secondary prevention

A

routine screening monitoring blood pressure and serum lipids

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11
Q

Left coronary artery divides into____ and supplies what areas of the heart

A

Left anterior descending and left circumflex artery. supply the left atrium, the left ventricle, the inter ventricular septum and a portion of the right ventricle

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12
Q

Right coronary artery supplies

A

right atrium, right ventricle, a portion of the posterior wall of the left ventricle. Also supplies AV node and budge of HIS in 90% of population

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13
Q

Attributes of Perfusion

A

blood pressure wnl, capillary refill

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14
Q

antecedents to perfusion

A

functioning cardio pulmonary system, adequate fluid volume, free from clots and atherosclerotic blocks

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15
Q

perfusion interrelated concepts

A

elimination, tissue integrity, fluid and electrolytes, gas exchange and clotting

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16
Q

drugs for hypertension

A

diuretics or vasodilators (beta blocker, ace inhibitor, calcium channel blockers)

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17
Q

drugs for impaired perfusion

A

vasodilators, vasopressors, antidysrhythmics, anticoagulants (thin), Anitplatelet (less sticks, ASA), thrombolytics (break clot during heart attack), or lipid lowering agents

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18
Q

Mean Arterial Pressure

A

(systolic + 2diastolic)/3 should be 70-110

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19
Q

Attributes to Fluids and electrolytes

A

Balanced Intake and Output Potassium 3.5-5.0 mEq/L Sodium 135-145 mEq/L Total Calcium 8.6-10.2 mg/dL Magnesium 1.3-2.3 mg/dL Phosphorus 2.5-4.5 mg/dL Serum Osmolality 280-300 mOsm/Kg CVP 2 to 6 mm Hg

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20
Q

Antecedents to fluids and electrolytes

A

Fluid & Electrolyte Intake and Absorption Normal Functioning of Renin- Angiotensin Aldosterone System Sufficient Cardiac Output Adrenal, Thyroid, Parathyroid, Pituitary Glands Functioning Within Normal Limits Regulation of Body Fluid Compartments Through Osmosis, Diffusion and Active Transport

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21
Q

Antidiuretic hormone (ADH)

A

synthesized by neurons in hypothalamus that release it from the posterior pituitary gland. They circulate to the kidneys acting on the collecting ducts, causing renal cells to reabsorb water. increases when body fluids become more concentrated or blood volume decreases, it decreases when body fluids become more dilute (and when drink alcohol)

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22
Q

Renin Angiotensin Aldosterone System

A

Cells in the kidneys monitor blood volume and when it is low (hemorrhage, dehydration) they release enzyme Renin- who converts angiotensinogen (protein secreted by liver) into angiotensin 1, other enzymes cover to angiotensin 2, who is a vasoconstrictor AND stimulates aldosterone release from the adrenal cortex. Aldosterone causes reabsorption of water and sodium in the kidneys and increases excretion of potassium and hydrogen ions

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23
Q

Atrial Natriuretic Peptide ANP

A

Released by cells in the atria when they sense stretching. Is a hormone that inhibits ADH thereby increasing the loss of sodium and water in urine

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24
Q

ECF Imbalances

A

Volume imbalance- disturbance in amount of fluid in ecf. osmolality imbalance- disturbance in concentration of ecf

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25
Q

ECV deficit

A

Insufficient isotonic ECF. Hypervolemia means decreased vascular volume. symptoms: sudden weight loss, postural hypotension, tachycardia, thready pulse, neck veins flat or collapsing with supine inhalation, slow vein filling, dry mucous membranes, thirst, confusion, cold clammy. Lab: increased hematocrit. If body isotonic, give isotonic saline (normal saline or Lactated Ringers (LR))

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26
Q

ECV excess

A

excess isotonic ECF. symptoms: sudden weight gain, edema, neck veins full when upright, crackles in dependent portion of lungs, pulmonary edema. Lab: decreased hematocrit

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27
Q

Hypernatremia IV, symptoms, Lab

A

osmolarity imbalance caused by a water deficit- hypertonic situation. (high salt, low water) water leaves cells and they shrink. symptoms: extreme thirst, dry and flushed skin, postural hypotension, fever, restlessness, confusion, agitation, coma. Lab: serum Na+ level greater than 145 mEq/L and serum osmolarity greater than 295 most/kg and urine specific gravity 1.03. give hypotonic saline (half normal saline)

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28
Q

Hyponatremia IV, symptoms, Lab

A

hypotonic solution- gain of more water than salt. Symptoms: apprehension, nausea and vomiting, headaches, decreased LOC. Lab: serum na+ less than 135, and osmolality less than 280, specific gravity of urine below 1.01. give hypertonic saline (D5 half normal, 3% sodium chloride or D10W)

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29
Q

Clinical Dehydration

A

EFV deficit + hypernatremia. decreased volume of fluid AND hypertonic.

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30
Q

Sodium

A

Determines whether water is retained, excreted or moved. imbalances cause neuro problems. normal 135-145 ** Major EXTRAcellular electrolyte (cation)

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31
Q

Potassium

A

Normal 3.5-5. Increased with poor kidney function, decreased with excessive urination, diarrhea vomiting, imbalances (hyper and hypokalemia) may cause cardiac problems, muscle weakness when high or low **Major INTRAcellular electrolyte (cation)

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32
Q

Calcium

A

Normal 0-10.5. transmission of nerve impulses, heart and muscle contractions, blood clotting, formation of teeth and bone. Vitamin D required for absorption. inversely related to phosphate levels. Imbalance hyper or hypocalcemia. hypo related to acute pancreatitis. cation

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33
Q

Phosphate

A

normal 3-4.5. balance is intertwined with calcium. Anion

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34
Q

Tests for fluid and electrolyte levels

A

Sodium: 135-145 Potassium 3.5-5 Chloride 96-106 anion Calcium 9-10.5 Phosphate 3-4.5 BUN 6-20 Creatinine 0.6-1.3 Hematocrit males 42-52% Hematocrit females 37-47% total protein, albumin

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35
Q

Chloride

A

normal 96-106. works with sodium to maintain osmotic pressure. increased with poor kidney fxn, decreased with excessive vomiting and diarrhea

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36
Q

Extracellular vs Interstitial

A

Extracellular- fluid outside the cell, normal ecf is isotonic with Na to hold water out. 17% of body weight (12 Liters) Interstitial- fluid that surrounds the cell (more specific) 8 Liters

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37
Q

Transcellular

A

fluid enclosed by an epithelial membrane AKA Organ Fluid (1 Liter)

38
Q

Electrolyte

A

mineral salts that split into ions when placed in water. regulated by both intake and output, acid base balance, hormones and cell integrity.

39
Q

Electrolyte functions

A

Function: maintain fluid balance, contribute to acid base regulation, facilitate enzyme reactions, and transmit neuromuscular reactions

40
Q

Fluid spacing

A

First spacing- normal distribution of fluid in ICF and ECF. Second spacing- electrolytes a little off, fixable. abnormal accumulation of interstitial fluids (edema) Third spacing- fluid accumulation in part of body where it is not easily exchanged with ECF. It is neither in the vascular nor the interstitial compartments. Harder to fix.

41
Q

Regulating intake and output of fluids

A

Must have same intake and output. Intake- oral fluids, solids, oxidative metabolism Output: Kidneys (main component), skin, lungs, gI tract, possibly wounds

42
Q

Risk factors for fluid and electrolyte imbalances

A

very old and young, serious injuries (bleeding), significant health conditions (cancer)

43
Q

Pediatric fluid and electrolytes

A

infants highest proportion of water (70-80%). have larger ECF volume, careful not to overcorrect replacements

44
Q

Gerontological fluid and electrolytes

A

normal physiological changes of aging that may alter the responses of the elderly to F&E imbalances: Structural changes in kidneys decrease ability to conserve water, hormonal changes lead to decrease in renin and aldosterone, increase in ADH and ANP, loss of subcutaneous tissue leads in increase loss of moisture, and reduced thirst mechanism results in decreased intake.

45
Q

Nursing assessment fluid and electrolytes

A

History: nutrition, eating changes, etoh intake, kidney or endocrine disorders, medications? Current status: intake and output, skin burger, edema, general appearance. Measurements: Daily weights, vital signs, intake and output

46
Q

Diagnostic tests for fluid and electrolytes

A

CBC, Osmolality- serum and urine, electrolyte panel and urine specific gravity.

47
Q

fluid and electrolyte balance defined

A

the process of regulating extracellular fluid volume, body fluid osmolality, and plasma concentrations of electrolytes.

48
Q

ECV deficit cause caused by:

A

caused by normal output but deficient input: lack of access to Na and water. caused by increased output, not balanced by increased input: vomiting, acute or chronic diarrhea from any cause (even laxative abuse), draining GI fistula, gastric suction or intestinal decompression, hemorrhage or burns, overuse of diuretics, lack of aldosterone from adrenal insufficiency or addison’s disease

49
Q

ECV deficit from rapid fluid shift from ECV into a third space

A

Acute intestinal obstruction or ascites that develops rapidly

50
Q

water weight infants, adults and older adults

A

70-80% 60% 45-55% factors affecting total body fluid varies with gender, body mass and age

51
Q

Intracellular fluids

A

fluid within the cells. 42% of total body weight. 2/3 of body water.20-28 Liters

52
Q

Clinical manifestation of 3rd spacing

A

Decreased urinary output, increased HR, decreased Bp, Decreased central venous pressure, edema, increased body weight, imbalanced I&O. Fluid in peritoneal cavity = ascites

53
Q

ECV Excess caused by:

A

Output less than excessive or too rapid intake of Na and water caused by: Excessive IV infusion of Na-containing isotonic solution (.9%NaCl, or Ringers), or High oral intake of salty foods and water with renal retention of Na and water. Decreased output not balanced by decreased intake of na and water caused by: Oliguria (e.g.. acute kidney injury, acute glomerulonephritis, end stage renal disease),aldosterone excess (e.g.. cirrhosis, chronic heart failure, primary hyperaldosteronism), High levels of glucocorticoids (e.g.. corticosteroid therapy, cushings disease)

54
Q

Hypernatremia (body fluids too concentrated; osmolality too high) caused by:

A

No access to water or inability to respond to or communicate thirst. Tube feeding without additional water intake vomiting of diarrhea with replacement of na but not enough water diabetes insipidus (lack of antidiuretic hormone)

55
Q

Hyponatremia (body fluids too dilute; osmolality too low)

A

IV D5W infusion with excess rate or amount Rapid oral ingestion of massive amounts of water overuse of tap water enemas or hypotonic irrigating solutions massive replacement of water without na during vomiting or diarrhea excessive antidiuretic hormone

56
Q

hypokalemia (plasma k deficit) caused by

A

prolonged anorexia or diet lacking in k rich foods no oral intake plus IV solutions containing K vomiting acute or chronic diarrhea from any cause, including laxative abuse use of K wasting diuretics or other drugs that increase renal k excretion excessive aldosterone effect (e.g. large amounts of black licorice, cirrhosis, chronic heart failure, primary hyperaldosteronism) high levels of glucocorticoids (corticosteroid therapy, cushings disease) alkalosis, excessive beta-andrenergic stimulation or excessive insulin

57
Q

antecedents to immunity

A

Intact non specific defenses or barriers functional lymphatic system optimal innate immune response functional inflammatory response appropriate adaptive (acquired) immune response- active or passive

58
Q

attributes of immunity

A

lab- norml WBC and differential counts negative bacterial and viral cultures soft, non-tender lymph nodes recognition of self recognition of foreign proteins

59
Q

Innate immunity

A

present at birth

60
Q

active acquired immunity

A

develops after the into of a foreign antigen resulting in the formation of antibodies or sensitized T lymphocytes. may be obtained artificially through immune response to an immunization or it may be obtained naturally through the immune response obtained naturally through the immune response to exposure to infectious pathogens

61
Q

passive acquired immunity

A

occurs by the intro of preformed antibodies, either from an artificial route, such as transfusion of immunoglobulin (Ig), or from a natural route, such as from a mother to her fetus through placental blood transference or through colostrum transfer during breast feeding

62
Q

Antecedents to immunity

A

intact non specific defenses or barriers functional lymphatic system optimal innate immune response functional inflammatory response appropriate adaptive (acquired) immune response- active and passive

63
Q

the optimal innate immune response is dependent upon the activities of

A
  1. phagocytosis and chemotaxis- performed by neutrophils and macrophages. occurs at site of organism entry, inflammation may be present at site (redness, swelling pain) and 2. complement system- plasma proteins that tag organisms for destruction
64
Q

lymphocytes

A

second most common wbc. produce antibodies, regulate the immune system and fight viruses and tumors. 10-45%. B and T lymphocytes

65
Q

monocytes or macrophages

A

wbc involved in fighting bacterial infections, after they circulate the blood stream, these cells settle in various tissues and become macrophages

66
Q

eosinophils

A

wbcs usually involved in allergic type and parasitic reactions. They make up only a small portion of the wbc

67
Q

IgA

A

protects nasal and intestinal lining. special secretory form in intestinal tract and gallbladder

68
Q

antigens

A

foreign proteins that induce an immune response when they enter the body. antigens can be found within microorganisms, vaccines, transplanted organs, and allergens such as animal dander, pollen and foods.

69
Q

the optimal innate immune response is dependent upon the activities of

A
  1. phagocytosis and chemotaxis- performed by neutrophils and macrophages. occurs at site of organism entry, inflammation may be present at site (redness, swelling pain) and 2. complement system- plasma proteins that tag organisms for destruction
70
Q

chronic inflammation response

A

cause of inflammation remains active tissue destruction continues scar tissue may continue to form rather than normal functional tissue response to infections is inadequate pt experiences chronic symptoms (pain)

71
Q

IgG

A

produced by B lymphocytes when body attacked by the same microorganism a second time. Also involved in food allergies. provides long term resistance to infections after immunizations. should have normal levels of all sub classes 1-4, not just total.

72
Q

immune system disorder assessment of first line of defenses- innate-barrior protection (3)

A

mucous membranes of nose and mouth, skin, GI, Respiratory

73
Q

IgA

A

protects nasal and intestinal lining. special secretory form in intestinal tract and gallblader

74
Q

inflammatory response

A

non-specific response to something that is harmful to the body (infection, injury or allergen) Inactivates and eliminates harmful antigens, removes destroyed tissue, and initiates tissue repair and healing.

75
Q

acute inflammatory response

A

increased blood flow increased vascular permeability migration of blood to tissues

76
Q

immune disorder assessment of immune system structure and cells (2)

A

after history/ info. Bone marrow, thymus gland, spleen, tonsils, adenoids, appendix, white blood cells, heart, blood, blood vessels

77
Q

immune system disorder assessment of first line of defenses- innate-barrior protection (3)

A

mucous membranes of nose and mouth, skin, GI, Respiratory

78
Q

nursing care assessment for immune disorders

A
  1. history/info 2. immune system structure and cells 3. first line of defense (innate barrier protection) 4. nonspecific defense responses 5. evidence of specific immune responses (common lab/diagnostic tests)
79
Q

Immune disorders assessment for nonspecific defense responses

A

fever, rashes, lesions, redness, swelling, tenderness

80
Q

immune disorders assessment for evidence of specific immune responses

A

CBC, Erythrocyte sedimentation rate (ESR), Enzyme immunoassay & enzyme-linked immunosorbent assay (ELISA), Immunoglobulins, polymerase chain reaction and rapid HIV tests, radioallergosorbent test, skin reactions, western blot test, complement, C reactive protein (CRP), computerized axial tomo

81
Q

chemotaxis

A

signals histamine to swell (capillary leak) creates permeability for WBCs to move to site. hot red and swollen- normal reaction

82
Q

corticosteroids

A

mask inflammatory response. give to organ transplant (prednisone) effect calcium and potassium- need to take calcium

83
Q

exaggerated immune response advice

A

avoid the trigger

84
Q

Selye’s General Adaptation Syndrome

A

Any event (stressor) that threatens an individual leads to a 3 stage response: 1. Alarm, 2. Resistance, 3. Exhaustion the response is fight or flight

85
Q

autoimmune advice

A

reduce stress

86
Q

chemotaxis

A

signals histamine to swell (capillary leak) creates permeability for WBCs to move to site. hot red and swollen- normal reaction

87
Q

attributes to coping

A

calm affect, effective and appropriate communication, ability to perform ADLs and IADLs as needed, appropriate use of available resources and support systems

88
Q

antecedents to coping

A

individual perceptions (insights and honesty, individual boundaries), life experiences (anticipation, positive defense mechanisms) which lead to the ability to cognitively and emotionally appraise and manage internal of external situations,availability of adequate resources and support systems

89
Q

Selye’s General Adaptation Syndrome

A

Any event (stressor) that threatens an individual leads to a 3 stage response: 1. Alarm, 2. Resistance, 3. Exhaustion the response is fight or flight

90
Q

screening tools for coping

A

Global mental health assessment tool Self-HARM assessment tool Cage-Alcohol misuse screening tool Assessment Scales: Mini Mental State Examination Sleep Scale Beck Anxiety Inventory Scoring for Children Mainz coping inventory Coping Strategy inventory

91
Q
A

1128 (2 decks)

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