Test 2 week 6-9 Flashcards

Question

Manifestations of hemothorax

Answer 1

hypoxemia, decreased ventilation, increased effect, tachypnea, dullness, decreased air entry, S/S hypovoemia

Answer 2

Diagnosis - CXR, CBC, ABGs Treatment - Chest tube, fluid replacement, oxygen therapy Collab - decompression, heimlich valve, chest tube, surgery, supportive - O2, IV, analgesia

Answer 3

Inflammation of the pleura 2nd to respiraotry infections * sudden onset, unilateral pain * exacerbated by inspiration * treat underlying disease & inflammation * NSAIDS

Answer 4

Incomplete expansion 2nd to airway obsturction, lung compression or increased recoil (loss of surfactant) - collapsed alveoli S/S * tachypnea, tachycardia, dyspnea, cyanosis, decreased expansion & absent breath sounds, m/b tracheal & mediastinal shift away from affected lung

Answer 5

Characterized by chronic, recurrent inflammation of the intestinal tract - periods of remission interspersed with periods of exacerbation No cure - treatment relies on medication to treat inflmmation and maintain remission UC and Crohns

Answer 6

Diffuse inflammation beginning in the rectum and spreading up the colon, continuous (inflammation and ulceration occur in mucosa and submucosa) Multiple absecesses develop in the intestinal glands (abscessses break through into the submucosa, leaving ulcerations)

Answer 7

* Inflammation involves all layers of the bowel wall * skip lesions - segments of normal bowel occurring between diseased portions * ulcerations are deep and longitudinal, & penetrate between islands of inflamed edematous mucosa, causing the classic cobblestone appearance * narrowing of the lumen with stricture development - may cause bowel obstruction * microscopic leaks can allow bowel contents into peritoneal cavity

Answer 8

* exacerbation & remission * intermittent diarrhea * colicky pain (RLQ) * weight loss * fluid & electrolyte disorders * malaise * low grade fever * depends on the anatomic site of involvment, extent of the disease process, nonbloody diarrhea, malabsoprtion, nutirontal deficiencies * **non bloody dairrhea & colicky abdominal pain **

Answer 9

* relpasing periods of diarrhea, bloody, mucousy stools * mild abdmonial cramping, fecal incontinence, noctural diarrhea, anorexia, weakness, fatigue * chronic disorder with mild-to-severe acute exacerbation, unpredictable intervals, nonspecifc complaints (abdominal pain, weight loss, fever) tensemus & rectal bleeding * **bloody diarrhea and abdominal pain**

Answer 10

* obstruction & fistulas malabsorption, dehydration, fluid & electrolyte imbalances, anemia

Answer 11

* HX & physical exam * sigmoidoscopy * colonoscopy * biopsy * barium enema * stool specimens * ESR * electrolytes, CBC * invasive - scopes - usually not in presence of active disease

Answer 12

Crohns * DRUGS: corticosteriods, immunosuppressants, aminosalicylates, antidiarrheals, anti-TNF agents (prednisone, biologic agents, antibacterials) * lifestyle - stress reduction, decreased physical activity, vitamins, eliminating high fibre foods, dairy, spice, fat, coffee - TPN for bowel rest during acute excerbations * Surgery - last resort - 75% will require surgery, it produces remission but high recurrence rate, ileostomy * GOALS of treatment : rest the bowel, control inflammation, combat infection, correct malnutrition, alleviate stress, symptomatic relief, improve quality of life

Answer 13

Colitis * Drugs : corticosteriods, immunosuppressants, aminosalicylates, antidiarrheals, anti-TNF agents (prednisone, biologic agents, antibacterials) * Diet - low residue diet, drink suppments, TPN if required * Surgery - surgical therapy - total colectomy * GOALs of treatment - rest the bowel, control inflammation, combat infection, correct malnutrition, alleviate stress, symptomatic relief, improve quality of life

Answer 14

* importance of rest and diet management * perianal care * action and side effects of drugs * symptoms of recurrence * when to seek medical care * use of diversional activites to reduce stress

Answer 15

* insulin increase the permeability of many cells to potassium, magnesium and phosphate ions * the effect on potassium is clinically important - insulin activates sodium-potassium pump in many cells, causing a flux of potassium into cells

Answer 16

* diabetic ketoacidosis * hyperglycemic hyperosmolar nonketotic syndrome * hypoglycemia

Answer 17

* macrovascular disease: CAD, CVD, PVD * Microvascular disease : kidneys & eye * neuropathic : involving nerves, depends on what nerve is involved

Answer 18

only occurs in type 1 diabetes * hyperglycemia * ketonuria * acidosis - kussmaul resp, abdominal tenderness, N/V, altered LOA * dehydration - tachycardia, dry mm, poor turgor, poor perfusion, hypotension, altered LOA, orthostatic drop * ketosis - acetone odor to breath * hyperosmoality - altered LOA, polyuria, polydipsia

Answer 19

* combination of insulin deficiency & metabolic stress * insulin deficiency - new onset, omitted dose, insufficient dose to compensate for illness stress * Metabolic stress - glucagon, cortisol, epinephrine (released 2nd to illness/deficiency) - increase glucose production, impair peripheral uptake, increase proteolysis & lipolysis * lipolysis, proteolysis, ketosis - met. acidosis * hyperglycemia - hyperosmolaity, osmotic diuresis, dehydration, urinary electrolyte loss

Answer 20

* increased glucose * ketonuria, glycosuria * sodium - prolonged hyperglycemia can depress sodium but dehydration can increase - evlaute after fluid resusitation * potassium - initally appears increased but actual body potassium is depleted * bicarbonate (HCo3) - <4 severe, 4-14 moderate, 12-20 mild * CO2 10-20 * ph - <7.3 * CBC - increased wbc 2nd to stress or infection * serum ketones - positive

Answer 21

IV Insulin & fluids (note insulin will decrease serum potassium, & no rapid fluid resuscitation) - IV insulin only way to reverse DKA * ensure patent airway, O2 as needed * IV NS until BP stable - output 30-60ml/hr * insulin infusion - for aciodsis 0.1U/kg/hr (bc decreases lactic acid prodcution, increases glucose availability) * Switch to D5W when Blood glucose apporach 14mmol/L * after inital treatment correct fluids loss, plus K+

Answer 22

Mild - pale, sweaty, tachyacrdia, usually self-treat Moderate - impaired concentration, slurred speech, H/A blurred vision, awkward gait severe - may be incapacitated, uncooperative seizure Risk factors - >50% nocturnal, too much insulin or oral medication, not compensating (wt loss, menses, execrise, ETOH, decreased caloric intake)

Answer 23

Mild to moderate - 15g of glucose as concentrated carbohydrate, retest BG in 15mins & repeat if BG <4mmol/L (ex. glucose tablets, sugar, juice, lifesaver, honey) Severe - Img of glucagon sc or IM, 20-50ml D50W over 1-3min, conscious pt 20g carbohydrate, check BS 15 min later if OK recheck in 2-3 hours

Answer 24

Post anesthesia Care Unit - patient is coming out of anesthesia lots of concerns with resp function & LOC considered critical care area as patients are unstable, after transfer there is indepth assessment performed and intiation of postoperative order * early ambulation for muscle tone, gastrointestinal and urinary function, stimulation of criculation, and normal respriatry function

Answer 25

goals, anxiety, fear & hope, health hx, current medications, ROS (review of systems) physical exam

Answer 26

* check documented informaiton prior to interview * occurs in advance or on day of surgery * PURPOSE - obtain health infromation, determine expectations, provide and clarify infromaiton on procedure, assess emotional state and readiness, begin some post-op teaching * Overall goal - idenitfy risk facotrs, plan care to ensure client safety * Note - scheduled surgery process is much smoother compared to emergency

Answer 27

* determine psychological status to reinforce coping * psycholgical factors of procedure contrubting to risks * identify cultural and ethnic factors that may affect surgical experience * determine receipt of adequate infromation from surgeon in order to sign infromed consent * identify any psychosocial needs of the client * establish baseline data * idenitfy meidcations and herbs taken that may affect surgical outcome * identify, document, and communciate results of labroatory/diagnostic test * surgeons obligation is informed consent

Answer 28

age, past experience, current health, socioecnomic status

Answer 29

* anxiety can impair cognition, decision making & coping * anxiety may arise from conflict with interventions (i.e. blood transfusions) & religious beleifs * lack of knowledge - information lessens anxiety * unrealistic expectations * identify beleifs in nonjudmgental way and discuss with surgeon and operative staff

Answer 30

* death or disability (may prompt postponement, influence outcome) * pain - consult APS, reassure drugs will be available * mutiliation/alteration in body image (be nonjudgmental) * anesthisa - assess malignat hyperhtermia risk * disruption of life functioning - range form fear of permanent disbaility to temporary loss, family & financial concerns, consultations (CCAC & social work b4 surgery) * lack of control

Answer 31

* hope is strongest positive coping mechanism - never deny or minmize, assess and support * do not need to agree wiht them but also do not need to decline

Answer 32

* medical conditions * previous surgeries and problems (c-section counts*) * menstrual/obstetric hx * familial diseases * reactions/problems to anesthesia (client or family) * analgeisa/pain conversation

Answer 33

* prescription and OTC * herbs * vitamins * recreational - drugs, alcohol, tobacco * need to ask abt recreational, often they will not come out and say it, or do not think they are alcoholic but with the amount they drink need to be aware of withdrawl and damage to liver with metabolism of medication * smoking alters defense mechanism - build up, less movement with anesthesia

Answer 34

* Report - problems for effective monitoring, use of cardiac drugs, presence of pacemaker/MI * vitals preop for baseline * bleeding/clotting time * lab results * possible prophylactic antibiotics

Answer 35

* inquire about recent airway infections - procedure should be canceled if risk for laryngo/bronchospams or decreased SaO2 * hx of dyspnea, coughing, hemoptysis * COPD/ asthma - high risk for atelactasis & hypoxemia * smokers should be encouraged to quit 6 weeks b4 procedure - decrease risk of complications

Answer 36

* evaluation of neurolgical functionning - vision/hearing loss * cogntive function - postop delirium can be labeled as dementia but it is not - can occur with dehydration, hypothermia, and medications * if there are declines in cogntive funciton that are not permanent need to correct b4 surgery ex lyte imbalances

Answer 37

* HX of urinary or renal disorders * renal dysfunction contributes to - fluid/lyte imbalance, coagulaopthies, impaired wound healing, altered response to drugs and elimination * renal function tests * problems voiding

Answer 38

Presence of liver disease - jaundice, hepatitis, alcohol abuse Liver function tests : ALT, AST, ALP, bilirubin

Answer 39

* hx of skin and musculoskeletal problems - extra padding during procedure, affest postop bleeding * hx of pressure ulcers

Answer 40

* idenitfy joints affected with arthritis * mobility restrictions may affect positiong and ambulation * bring mobility aids to surgery * report problems affecting neck or lumbar spine - can affect airway managmnet and anaesthesia delivery * want them mobile ASAP post-op

Answer 41

Clients with diabetes are at risk for * hypo/hyperglycemia * ketosis * cardiovascular alterations * delayed wound healing * infection * cap. blood glucose tests- baseline clients with thyroid dysfunction * hyper/hypothyroidism - risk due to altered metabolic rate * verify with anesthesiologist about giving medications

Answer 42

* clients with hx of compromised immune system or use immunosuppressive drugs can have - delayed wound healing or increased risk for infection | *

Answer 43

* vomiting, diarrhea, or difficulty swallowing can cause imbalance * identify drugs that alter status - diuretics * evaluate serum lyte levels * NPO status - may require additional fluids and lyts prior to surgery if dehydration occurs

Answer 44

obesity * stresses caridac and pulmonary systems * increased risk of wound dehiscence and infection * slower recovery from anaesthesia * slower wound healing Extra padding to prevent pressure ulcer identify dietary habits that may affect recovery (caffeine) *when cutting through all the layers of skin need proper nutrion to build them back up

Answer 45

* explain to client what to expect, how to participate (increases client satisfaction, reduces fear, anxiety, stress, pain) * limited time - so address highest priority - focus on client concerns and provide written material * provide edcuation several days before surgery - determine what teaching still necessary, anxiety/fear can hinder learning * must be documented and reported to postop nurses * teach deep breathing, coughing, moving postop * inform if tubes, drainage, monitoring or special equipment will be used post op * basic info - time/place, fluid/food restriction, need for enema or other prep, need for shower

Answer 46

* informed consent - must include adequate disclosure, understanding, comprehension, voluntary - surgeon is responsible for getting conset nurse can be witness signature * blood transfusion * advance directives * POA * all required forms are signed and in chart (esp with minor) * medical emergency can override need for consent

Answer 47

* final preop teaching * assessment Head to toe * verify consent * labs * hx and physical examination * baseline vitals * consualtion records * nurses notes * chart review * surgical site marked - ID band, allergy band, VS, valubles * client - no cosmetics, dark nail polish, * void before surgery to avoid accidental involuntary elimination under anestheisa or urinary retention (often foley catheter but still important)

Answer 48

* benzodiazepine and barbiturates for sedation and anti-anxiety * anticholinergics - reduce secretions * narcotics - decrease intraoperative anaesthetic requiremnts & pain * antiemetics - decrease post op nausea and vomiting * antibiotics (prophylaxis) * eyedrops (eyes may dry out) * routine prescription drugs

Answer 49

Older adult - greater risk with anestheisa, surgery, postop complications

Answer 50

* **obstruction** - blockage from tongue LOC, supine, sleepy, laryngospams, retained secretions, laryngeal edema * **hypoxemia** - agitation, hypertenison/hypotension, tachy/brady. ABG to confirm * **hypoventilation** - depression of central respiratory drive/ poor muslce tone, causes - anesthesia, narcotic analgesia * **RISK** - general anesthesia, are older, smoke heavily, with lung disease, who are obese, undergoing thoracic, airway or abdominal surgery

Answer 51

*** atelectasis -** from postop hypoxemia, bronchial obsutrction from retained secretion or decrease excursion * **pulmonary edema** - caused by accumulation of fluids in alveoli, fluid overload, left ventricular failure, prolonged airway obstruction, sepsis, aspiration --- S/S hypoxemia, crackles * **aspiration of gastric contents** - clients at risk can be given histamine H2 receptor antagonist before induction of anesthesia to prevent HCI secretion - usually minimized bc NPO but can give PPI * **Bronchospams **- results from increase in bronchial smooth muscle tone, with resultant closure of small airways - edema develops causing secretions to build up, S/S - wheeze, dyspnea, accessory muscle use, hypoxemia, tachypnea

Answer 52

* assess temp, oximetry, resp rate, pattern, breath sounds (temp norm elevated post op * airway patency - chest symmetry * sputum teach deeo breathing & coughing - prevents alveolar collapse, move secretions to larger airway passages, deep breathing 10 times every hour while awake, incentive spirometer, splinting abdominal incision

Answer 53

Note - postop - often have positive fluid balance however there is normal & excessive (stress response - fluid retention) PACU * **hypotension** - bc unreplaced fluid & blood loss, dysrhythmias, low systemic vascular resistance, incorect cuff *** hypertension** - results from sympathetic stimulation form pain, anxiety, bladder distension or resp compromise, hypothermia, pre-exisiting, revascularaization during surgery * **dysrhythmias** - often from identifiable cause - hypokalemia, hypoxemia, hypercarbia, alterations in acid-base status, circulatory instability, preexisiting Clinical unit *** hypokalemia** - can result from urinary or gatro losses, affects contractiltiy of heart * **stress resonse** - increased clotting facotrs, DVT and PE * **syncope** - can indicate decreased CO, fluid deficit, deficit in cerebral perfusion, postural hypotentions on ambulation, common with immobile & elderly

Answer 54

* frequent VS * apical, radial pulse * skin color, temp, turgor * NOTIFY anaesthesiologst if - systolic < 90, or >160, pulse < 60, or >120, pulse pressure narrow, irregualr cardiac rhythm develops, significant variations * I & Os, lab findings, mouth care, leg exercises * elastic stockings or compressive devices * unfractured or LMWH * ambulation - slowly, monitor pulse, assess for pre-syncope

Answer 55

* emergence delirium (or violent emergence) - can induce restlessness, agitation, disorientation, thrashing, shouting. Caused by anesthetic agent, hypoxia, bladder distension, pain, electrolyte abnormalities, anxiety * delayed awakening - commonly caused by prolonged drug action - can be poor liver or kidney metabolism

Answer 56

* LOC - AVPU, GCS * orientation, follow commands, PERRLA, sensory/motor status * PACU - attention on resp function, sedation (controlling agitation) side rials up, secure IV, aritifical airways, monitor * Clinical - some alterations related to pain medication, lack of sleep or sensory overload, complete CNS, those getting pain meds ensure alert/oriented x3, assessing sensation in those with spinal/epidural anesthetic

Answer 57

**PACU** - may be diffciult to assess, often still sedated, behavioural cues and increased pulse **Clinical -** charactersitics, location, measure before and after treatment, new pain can be complication **Post op- first 48 hours** narcotic analgesic to relieve moderate - severe pain, after non-narcotic **before giving analgesic** nature of pain, chest/leg can be complication, gas pain can be worsened by narcotic **PCA** - pt can give themsleves boluses (some have background infusion) **Epidural** - delivers directly to opiod receptors in spincal cord, can decrease resp. symptoms of narcotics, anesthetic in spinal cord can cause resp problems.

Answer 58

**PACU ** - hypothermia - loss of heat to cold or form body organs exposed to air (risk - age, debility, intoxication, prolonged anesthetic adminstrations) - complications (compromised immue function, pain, increased bleeding, MI, delayed drug metabolism) **Clinical ** - temp elevation - mild elevation (38 in first 48 hours ) is normal, stress response, after 48 hrs moderate to marked elevation could mean infection (wound infection, fever spiking in afternoon, tender, warm, red, purulent- if intermittent high with shaking chills & diaphoresis indicates sepsis ) - rule out pneumonia & Cdiff

Answer 59

* VS (possibly rectal temp bc most accurate) * color & temp of skin * PACU - rewarming, heated blanket, etc, monitor temp q15min when using external warming device, o2 therapy - monitor for malignant hyperthermia * Clinical - measure temp q4hr first 48hrs postop, assess wound and IV site, airway clearance, chest x-ray/culture if infection suspected, anti-pyretic over 39.4

Answer 60

* **N/V -** esp after abdominal surgery - caused by anesthetic, opiods, delayed gastric emptying, slowed peristalsis, resumption of oral intake too soon postop - may have swallowed air & secretions can accumulate - distension & gas pain, releived by exercise/walking * **Paralytic ileus** - small bowel obstruction when peristalsis stops, produces severe N/V, noticed on clinical unit, may be neuro or muscular impairment, assess for distension & absence of bowel sounds, if passing gas - do not have * **hiccups (singultus)** - spasm of diaphragm by irritation of phrenic nerve - direct (gastric distension, intestinal obstruction, intra abdominla bleeding, subphrenic abscess) indirect ( acid-base & electrolyte imbalance), reflex irritation - drinking hot / cold liquid or presence of NG tube

Answer 61

* N/V - document vomitus * paralytic ileus - auscultate * antiemtic drug * suction at bedside * upright position * slow, deep breathing * resume intake upon return of gag reflec * for abdominal surgery NPO until bowel sounds returm (IV/NG decompression) * clear liquids - advance as tolerated * mouth care when NPO * ealry & frequent ambulation to prevent abdominal distension & relief of gas pain

Answer 62

* low urinary output expected in first 24 hours (increase aldosterone, ADH from stress, fluid losses during surgery, anestheisa depresses nervous system) opiods use can also interfere * examine urine colour, amount, consistency, & odor * if in-dwelling catheter assess - 30 ml/hr output * or void 200ml following surgery * use running water, drinking water, pouring water over perineum, ambulation, bedisde commode * may need to reestablish foley catheter

Answer 63

* adequate nutrition - need protein, can have nutritional deficits from chronic disease * impaired wound healing - in older adult & those with chronic disease * accumulation of fluid in wound can impair healing & predispose to infection (jackson-pratt drain, closed system) * wound infection - can be from flora in environment on skin, oral or intestinal flora * increase incidence of wound spesis in those who are - malnourished, immunosuppressed, older adult, proonged hospital stay * wound infection evident 3rd-5th day post op (redness, edema, pain, tenderness, leukocytosis, fever)

Answer 64

* type of wound & expected drainage needs to be known * drainage should go from sanguineous, serosanguineous to serous with decreased output * would dehiscence - may get sudden brown, pink or clear discharge * note type, amount, color, consistency and odor of drainage * notify surgeon of excess or abnormal drainage & significant changes in vital signs * clean gloves & sterile technique

Answer 65

* anxiety & depression - do they have hx, may lack knowledge, resources * confusion & delirium - from psychological & physiological sources - fluid & electrolyte imbalance, hypoxemia, drug effects, sleep depreivation, sensory alteration/overload - delirium tremors (DTs) from alcohol withdrawl * provide adequate support - listen and talk with client, discuss expectations of activtiy and assistance, include in discharge planning, report unusal behavior * recognize alcohol withdrawl syndrome

Answer 66

* pt gradually assumes greater responsibility for self-care during post-op period pt should know * care of wound site, dressings, bathing * action, side effects, when and how to take medications * activties allowed/prohibited * dietrary restrictions/modifications * symptoms to report * intructions for follow-up care * answer questions concerns * follow-up call/visit - work discharge planner, can be done with CCAC

Answer 67

* reversible (temporary) myocardial ischemia = angina (chest pain) - when oxygen demand is more then oxygen supply * primary reaons for insufficient blood flow is narrowing of coronary arteries by atherosclerosis - for ishcemia to occur artery usually 75% or more stenosed * pain usually lasts 3-5 minutes - subsides whem the precipitating factor is releived ex stop walking and sit, ECG shows ST segment depression

Answer 68

Precipitating * physical exertion, temperature extremes * strong emotions * heavy meal, tobacco use, sexual activity * circadian rhythm - early morning after waking Diagnostic * health hx & physical examination * laboratory studies * 12-lead ECG * chest x-ray * echocardiogram * excerise stress test

Answer 69

* **Silent ischemia** - asymptomatic, assoicated with diabetes mellitus * **Nocturnal angina **- occurs only at night but not necessarily during sleep * **angina decubitus** - chest pain that occurs while lying down, relieved by standing or sitting * ** prinzmetals (variant) angina **- occurs at rest usually in response to spasms of major coronary artery, seen in clients with a hx of migraine headaches or raynauds, may be relieved by moderate exercise, there is ST elevation but after spams is over ST normal

Answer 70

* give O2 or decrease O2 demand * short acting nitrates - sublingual nitro * long acting nitrates - isordil * B-adrenergic blockers or calcium channel blockers * angiotension-converting enzyme inhibitors * maybe antiplatelet therapy & lipid-lowering drugs * manging risk factors of CAD * possible PCI or CABG

Answer 71

Acute coronary syndrome * when ischemia is prolonged and not immediately reversible, acute coronary syndrome develops * deterioration of a once stable plaque that stimulates platelet aggregation and local vasocontrition with thrombus formation Results in * parital occlusion of coronary artery - UA or NSTEMI * total occulsion of coronary artery STEMI

Answer 72

* it is unpredictable and represents medical emergency * acute intensive drug therapy * nitroglycerin * low-molecualr weight heparin * clopidogrel (plavix) - antiplatelet * glycoprotein llb/llla inhibitors * PCI

Answer 73

* result of sustained ischemia (>20minutes), causing irreversible myocardial cell death (necrosis) * necrosis of entire thickness of myocaridum tales 4-6 hours * the degree of altered function depends on the area of the heart involved and the size of the infarct * contractile function of the heart is disrupted in areas of myocardial necrosis * most MI involve the left ventricle

Answer 74

* **pain ** - total occlusion you will get anaerobic metabolism and lactic acid accumulation - severe immoblizing chest pain not releived by nitro, heaviness, constriction, burning, pressure, curhsing * pain location - substernal, retrosternal, epigastric areas, pain can radiate to arm and jaw * Sympathetic nervous system stimulation from catecholamines released from ischemic myocardial cell - release glycogen, diaphroesis, vasocontriciton of peripheural - skin - ashen, clammy, cool to touch * initally increase HR and BP - then decreased BP (bc decreased CO) - crackles, jugular vein distension, heaptic engorgemnt & peripheral edema * abnormal heart sounds - S3, S4, holosystolic murmur * Nausea and vomiting - result from stimulation of the vomiting centre by the severe pain * fever - increases during first 24 hours and may persist for 1 week * systemic manifestation of the inflmmaotry process caused by cell death

Answer 75

* within 24 hours leukocytes infiltrate the area of cell death * enzymes are released form the dead cardiac cells * proteolytic enzymes of neutrophils and macrphages remove all necrotic tissue by second/third day * development of collateral circulation improves areas of poor perfusion * necortic zone identifed by ECG changes & nuclear scans * 10-14 days after MI, scar tissue is still weak and vulnerable * by 6 weeks after MI, scar tissue has repalced necortic tissue - area is healed but less compliant * ventricular remodeling - in an attempt to compensate for the infarcted muslce, the normal myocaridum will hypertorphy and dialte - can lead to development of late heart failure

Answer 76

* Dysrhythmias * heart failure * cardiogenic shock - occurs when inadequate oxygen and nutrients are supplied to the tissues becasue of severe LV failure * papillary muslce dysfunction - causes mitral valve regurgitation and aggravates an already compromised LV * ventricular aneurysm - results when the infarcted myocardium wall becomes thinned and bulges out during contraction * acute pericarditis - inflmmation of pericardium - chest pain different form MI, may result in cardaic compression, decreased LV filling and emptying, heart failure - friction rub * dressler syndrome - characterized by pericarditis with effusion and fever that develop 4-6 weeks after MI , arthralgia

Answer 77

* emergent PCI - treatment of choice for confirmed MI, balloon angioplasty + drug-eluting stent * fibrinolytic therapy - major complication is bleeding, resuce PCI if thrombolysis fails - does not dissolve clots only breaks apart

Answer 78

detailed hx, 12-lead ECG, ST segment elevation for STEMI serum caridac markers (troponin, CK-MB, myoglobin) coronary angiography excersise stress testing, echocardiogram

Answer 79

* IV nitroglycerin * morphine sulphate * B-adrenergic blockers * angiotensin-converting enzyme inhibitors * antidysrhtyhmia drugs * cholesterol-lowering drugs * stool softners

Answer 80

* ICU for first 24-36 hours * pulmonary artery catheter for measuring CO, & hemodynamic parameters, intraarterial line for BP, chest tubes, continuous ECG, endotracheal tube (extubation within 12 hours) * epicardial pacing wires for emergency pacing * catheter * NG tube for gastric decompression

Answer 81

* bleeding and anemia form damage to RBCs and platelet * fluid & electrolyte imbalance * hypothermia as blood cooled as it passes through bypass machine * nursing care focsued on assesseing for bleeding, monitroing fluid status, replacing electrolytes & restoring temperature

Answer 82

ph - 7.35-7.45 PO2 80-100mmHg SaO2 -95% above PaCO2 - 35-45 HCO3 - 22-26 mmol/L