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Unit E Flashcards

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1
Q

What is an ischemic stroke
What are the common causes and risk factors

A

Partial or complete occlusion of artery
Common cause: a fib, artherosclerosis, CAD, hypertension
Risk factors: older age, male, African American, tobacco, diabetes, obesity

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2
Q

What is a hemorrhagic stroke
What care the common causes

A

Bleeding in brain tissue or into subarachnoid spaces. Rupture of blood vessels
Causes: uncontrolled hypertension that ruptures an aneurysm or AVM

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3
Q

What would happen if there was an CVA in brain stem

A

Lot of problems with basic needs of life
LOC, breathing, etc.
protect the airway with ventilators

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4
Q

What is an AVM

A

In an AVM, blood passes quickly from artery to vein causing swelling of vessels
Usually caused by HTN

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5
Q

What is BEFAST

A

Balance
Eyes
Face
Arm
Speech
Time (911) (when was first symptoms)

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6
Q

What happens first in door to needle initiative

A

Non contrast head CT

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7
Q

What other labs after CT do you do

A

12 lead EKG
UA, glucose, WBC, drug screen
—done to rule out other causes

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8
Q

What is the detrimental parameter for stroke

A

High blood pressure dislodges clots, its the body’s compensating tactic
220/120 is determinate parameter
Protective vs detrimental

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9
Q

T/F patients with a stroke typically worsen in first 24-48 hours

A

T

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10
Q

In stroke asssessment what LOC question do they ask

A

Month and age
0 both correct
1 answers one correct
2 incorrect

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11
Q

What is the 60 min goal

A

Door to physician 10 minutes
Door to stroke team 15 min
Door to CT 25 min
Door to CT interpretation 45 min
Door to needle 60 min

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12
Q

What is tPA

A

Only given once
First line treatment for ischemic strokes
Administer 3-4.5 hours after symptom onset
Double RN check
Assess BP

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13
Q

What is post administration care after tPA

A

No anti platelets or anticoagulants for 24 hours
Neurochecks
Assess for hypotension, bleeding, intracranial hemorrhage, angioedmea

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14
Q

What is the eligibility criteria for tPA

A

Older than 18
Head CT consistent with ischemic strokes
Blood glucose >50
Duration less that 4.5 hours
Onset of symptoms well established

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15
Q

What are exclusion criteria for tPA

A

Previous history of intracranial hemorrhage
History of GI blled in past 3 weeks
Head trauma in 3 month
Any blood thinners
Persistent after treatment SBP >185/>110

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16
Q

What is mechanical thrombectomy

A

Surgical procedure that uses a stent retriever device to remove a clot
Can be done in combination with thrombolytic therapy
Done within 24 hours of last known well
CT reveals large vessel occlusion
Only done at specialized stroke facilities

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17
Q

What is management of hemorrhagic stroke

A

Medication therapy focuses on managing HTN
—<160
Surgical: clipping or coiling, resection or embolization, evacuation of hematoma

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18
Q

What are two common IV medications for blood pressure management after hemorrhagic strokes

A

Nicardipine —-watch for hypotension
—usually first choice, quickest achievement for longer
Labetalol—watch for bradycardia

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19
Q

What is a TIA

A

Stroke Iike event but goes away
Caused by temp blockage
Can be warning sign for future CVA
5min—24 hours

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20
Q

MI
What is unstable angina

A

Unpredictable
Unbelievable w rest
Lasts >10 minutes
10 min=heart hypoxia
20 min=dead tissue

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21
Q

STEMI vs non STEMI

A

STEMI—main artery blockage, cath lab
—ST elevation
Non STEMI—partial blockage->thrombolytics->cath lab
—ST depression

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22
Q

What is symptoms of MI

A

Severe midstrenal chest pain
Unrelieved heart burn
Inc HR and BP
Cool and clammy
Abnormal heart sounds
N/V
Low grade fever

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23
Q

What are labs for an MI

A

Troponin
CKMB
Myoglobin

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24
Q

What are emergency protocol action for MI

A

Sit pt upright
Apply O2
Vitals and pain
12 EKG
Labs and X-ray
Assess for contraindications
Start 2 IVs

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25
What are the emergency protocol meds
ONAM is accronym Oxygen Nitroglycerin x3 0.4 mg (headache) Aspirin 325mg Morphine TPA High dose statin (low cholesterol) Anti dysrhythmics Glycoprotein inhibitors
26
Angioplasty, what is post op care
Supine for 6 hours Meds: ACE inhibits, beta blockers, anti-dysrhythmics, lipid lowering agents, glycoprotein inhibitors Stool softeners ;manage anxiety
27
What is bypass machine do
Unoxygenated blood removed from rat atria Oxygenated returned to body through ascending aorta
28
What is pump head
Confusion High risk of stroke Arrhythmias Renal failure
29
What are the three harvest veins that dr could pick from
Internal mammary artery Saphenous vein (more prone to stenosis) Radial artery
30
What is endocarditis
Infection to overgrowth in valve (Strep)
31
Mechanical valves vs tissue valves
Mechanical last longer, long term anticoagulants, durable Tissue valves hav more natural flow, less durable, short term anticoagulants, last approximately 10 years
32
What are some pre op meds for valve replacement
Beta blockers Amiodarone— dysrhymias Pain meds NSAIDS— toradol
33
When do you want to extubate valve replacement pts
4-6 hours to prevent pneumonia
34
Why do we test ABGs post op
To assess if they are metabolic acidosis or alkalosis
35
What are these meds used for Reglan Magnesium D4 w K Ancef or Vanco Albumin
Reglan—N/V—prophylactic for aspiration Mag—prophylactic for a fib D5–a lot of output-> dec electrolytes..dysrhymias Ancef- antibiotic Albumin—pulls water into veins
36
What are inotropes and some expamples
Inotropes increase contractility Dobutamine Epinephrine
37
What are vasopressors
Increase vessel contraction Dopamine Phenylephrine Norepinephrine
38
What are some vaso relaxers
Nitroglycerin Nipride Hydralazine —labetalol=beta blocker
39
What do you need to watch when giving toradol
Kidney function Bun creatine
40
What is pericardial pacing
Temporary external pacin
41
What indications for epicardial pacing
1. Increase HR—Increase CO 2. 3rd degree heart block/brady cardia 3. Increased CO
42
Pacer wires must be kept ___ and ____
Dry and intact
43
What is post op intransal mupirocin used for
Prevent staph infection which can cause valvular heart disease
44
What is one way to assess for a UTI
Foley w temp gauge
45
What is Becks triad
Hypotension JVD Muffled heart tones Assess for cardiac tamponade
46
What is cardiac tomponade
Large pericardial effusion=compression of heart
47
What is a pericardialcentesis used for
Pulsus paradoxus Decrease in BP when breathing in
48
When can heart surgery patients have sex
When they can climb 2 sets of stairs easily without complications Or brisk walking for 20 minutes
49
Deep diffuse chest pain is a symptom of what kind of aneurysm
Thoracic
50
Coughing SOB and hoarseness is what kind of aneurysm
Thoracic
51
Bruit is what kind of aneurysm
AAA
52
Back pain is what kind of aneurysm
AAA
53
Blue toe syndrome
AAA
54
JVD, what aneurysm
Thoracic
55
Neck and facial edema
Thoracic
56
The aneurysm is 4 cm, what do you do
Schedule CT every 6 months
57
5 cm what do you do
Schedule CT every 6 months
58
T/F if aneurysm greater than 5 cm, prepare for surgical intervention
Yes
59
Sudden severe back pain with flank accymosis is a sign of what
Bruising and bleeding Aortic rupture Hemorrhagic shock occurs
60
What are complications of an aneurysm surgical repair
Endoleak Regrowth Rupture Dissection AKI Intrabdominal HTBN Compartment syndrome
61
What are nursing management for post op aneurysm repair
Blood pressure management (100-120) Continuous ECG Labs: WBC, electrolytes, ABGs, creatinine, BUN NG w LIS Neurological Hourly pedal pulse
62
MI vs dissection
MI= midsternal w referred pain Dissection= stabbing and ripping and tearing High pitched murmur Ischemia occurs in lower extremities
63
What are manifestations of cardiac tamponade
Blood leaks in pericardial sac Hypotension Narrowed pulse pressure JVD Muffled heart sounds Pulsus paradoxus
64
What are nursing actions for a cardiac tamponade
Start esmolol gtt to maintain HR less than 60 and SBP between 100-110 Morphine Limit stress Semi Fowler Art line for continuous vitals Neuro checks Q1 hours
65
Differenciate pain in obstruction of small bowel vs large bowel
Small bowel: cramping, centrally located Large bowel: spasms, long lasting, lower abdomen
66
What does bowel obstruction sound like
Above— high pitched murmur Ischemia Below—absent or hypoactive
67
Constipation SB vs LB
SB late finding LB early finding
68
What are nursing management for a bowel obstruction
NPO NG to LIS—relieve pressure to prevent performation Watch electrolytes— ECG Seizure precautions and neuro checks IV fluids and electrolyte replacement Encourage mobility as tolerated —post op ileus Antimetics to decease abdominal pressure from N/V
69
What is autodigestion
Enzymes are activated in the pancreases and are breaking down pancreatic tissue—severe pain LUQ
70
What are the labs to indicate pancreatitis
HIGH: lipase, amylase, glucose triglycerides Low: calcium
71
What are manifestions of pancreatitis
Sudden onset of LUQ pain or mid epigastric Radiates to back NV flushing Low grade fever, leukocytosis Hypotension, tachycardia, jaundice
72
What are diagnostics for pancreatitis
X ray, ultrasound, CT
73
What are some complications with pancreatitis
Pseudocyst—accumulation of fluid, pancreatic enzymes, tissue debris, and exudate surrounding by a wall next to pancreas Pulmonary—enzymes induced inflammation of the diaphragm Tetany—d/t hypocalcemia Increased clotting dt trypsin activation Sepsis
74
What meds to give w pancreatitis
Antibiotics if necrotizing pancreatitis Insulin PRN for hyperglycemia Albumin is hypovolemic shock present Calcium gluconate if tetany present Pain meds PPI usually omeprazole

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