Lifespan midterm

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Lifespan midterm
2012-05-30 19:46:45
Life Span

mid term
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  1. osmotic pressure
    • water-pulling pressure
    • hypertonics have a greater osmotic pressure than blood
  2. hypotonic solutions
    • hydrates cells
    • when given as an IV, water leaves the blood and other ECF areas and enters cells
    • lower osmotic pressure than blood
    • 0.45% saline
  3. isotonic solutions
    • expand ECF volume
    • same tonicity as blood
    • 0.9% saline, lactated ringer's solution, 5% dextrose in water (D5W),
  4. hypertonic solution
    • expands plasma volume
    • water leaves cells and enters the blood
    • 5% dextrose in lactated ringer's solution, 5% dextrose in 0.45% saline, 10% dextrose in water
  5. What can eleveated BUN and hematocrit levels indicate?
  6. What is the most reliable indicator of fluild loss or gain?
    weight; losing 1 or 2 lb per day indicates fluid loss
  7. signs and symptoms of hypervolemia
    • bounding pulse
    • increased B/P
    • respirations are increased and shallow
    • pale and cool skin
    • distended neck veins
  8. respiratory acidosis
    • too much CO2 in the blood
    • low ph [< 7.35] and high pCO2 [> 45]
    • associated with chronic respiratory disease; emphysema, chronic bronchititis et al.
    • decreased mental status, shallow respirations and muscle weakness
  9. metabolic acidosis
    • Not enough HCO3 (bicarb) in the body; too much acid in the body
    • low PH [< 7.35] and low HCO3 (bicarb) [< 20]
    • pts with severe diarrhea or prolonged intestinal suctioning, uncontrolled diabetes and end-stage renal failure are at risk
    • serum potassium tends to increase
    • decreased mental status and muscle weakness
    • kussmauls respirations (deep and rapid) rids the body of excess CO2
  10. respiratory alkalosis
    • not enough CO2 in the blood
    • caused by hyperventilation or mechanical ventilation
    • high PH [> 7.45] and low CO2 [< 32]
    • heart rate increases and pulse is weak and thready
    • use a rebreather mask or plain paper bag
  11. metabolic alkalosis
    • too much HCO3 (bicarb) or not enough acid in the body
    • high PH [> 7.45] and high bicarb [> 26]
    • causes: prolonged vomiting or gastric suction; abusing antacids
    • signs and symptoms similar to hypokalemia and hypocalcemia
  12. Control of Acid-Base balance
    • 1. cellular buffers: first line; proteins, hemoglobin, bicarb, phosphates
    • 2. lungs: 2nd line; rapid deep breathing reduces CO2 content if blood is acidic; shallow respirations conserve CO2 if alkalosis present
    • 3. kidneys: last line; regulates bicarab by releasing or absorbing
  13. what is used to flush central venous access devices?
    heparin; anticoagulant
  14. what is used to flush peripheral intermittent devices?
    sodium chloride; saline
  15. IV site assessment
    • insert cannula into most distal site of the extremity
    • tourniquet 6 - 8 inches above the insertion site dilates the vein
    • blood pressure cuff at 30 mm hg dilates veins
    • check for infiltration, phlebitis or hematoma
  16. peripherally inserted central catheter
    • PICC line
    • catheter inserted into the arm and ends in central circulation (the heart)
    • therapy that lasts more than 2 weeks or meds thats to caustic for peripheral administration
  17. Port
    • resrvoir implanted under the skin
    • allows pt to shower and swim without contamination
  18. Cardiogenic shock
    • cardiac failure
    • characterized by pulmonary edema
    • signs/symptoms: dysrhythmias, labored respirations, hypotension, cyanosis, oliguria, altered mental status, distended jugular and peripheral veins, CHF symptoms
  19. extracardiac obstructive shock
    • blockage of blood flow in the cardiovascular circuit outside the heart
    • i.e. pulmonary embolism, pericardial tamponade (fluid in pericardium), tension pneumothorax
    • Signs/symptoms: tachycardia, tachypnea, hypotension, cyanosis, oliguria, altered mental status, distended jugular veins
  20. distributive shock
    • excessive dilation of the venules and arterioles
    • massive vasodilation of peripheral circulation
    • types: anaphylactic, septic, neurogenic
  21. neurogenic shock
    • injury to the nervous system
    • spinal cord injury, general anesthesia, fever, metabolic, brain injury
    • early phase: hypotension and altered mental status, bradycardia, warm dry skin
    • late phase: tachycardia, tachypnea and cool clammy skin
  22. anaphylactic shock
    • severe allergic reaction
    • most severe distriubutive shock
    • characterized by urticaria, laryngeal edema, bronchospasm
  23. septic shock
    • most common distributive shock
    • systemic infection and inflammation
    • early phase: skin warm and flushed with full veins. possible fever or subnormal temp
    • late phase: tachycardia, tachypnea, hypotension, oliguria, flat jugular and peripheral veins, cool clammy skin
  24. Mild shock
    • heart rate: tachycardia
    • pulse: bouding pulse
    • B/P: normal b/p
    • Respirations: increased and deep respirations
    • Consciousness; anxious, restless, irritable, alert, oreiened,
    • sense of doom
    • skin: cool, clammy, pale
    • normal urine output
    • normal bowel sounds
  25. moderate shock
    • heart rate: tachycardia
    • Pulse: weak thready pulse
    • B/P: decreased b/;p
    • Respirations: tachypnea, crackles, shallow breathing
    • Temperature: decreased temp, may rise in septic shock
    • Consciousness: confused lethargic
    • skin: moist, cold, clammy, pale
    • urine: less than 20 ml/hr
    • bowel sounds: decreased
  26. Late shock
    • heart rate: slowing
    • Pulse: absent
    • B/P: systole below 60, diastole decreasing to 0
    • Respirations: slow, irregular, shallow
    • Temperature: decreasing
    • Consciousness: unconsc\ious, comatose
    • skin: moist: cyanosis, mottled, cold, clammy
    • urine: 15 ml/hr to anuria
    • bowel sounds: absent
  27. epicardium of the heart
    • innermost layer of the heart membranes
    • found on the surface of the heart muscle
    • aka visceral pericardium
  28. what does central venous pressure measure?
  29. what does elevated troponin 1 levels indicate?
    • Myocardial infarction, levels may be elevated for 7 days
    • no special care
    • cardiac cell protein
  30. signs and symptoms of right sided heart failure
    • distended jugular veins
    • edema in extremities
    • anorexia, nausea and abdominal pain
    • hepatomegaly
    • splenomagaly
    • hypertrophy of the heart
  31. signs and symptoms of left sided heart failure
    • pulmonary edema
    • hypertension
    • shortness of breath
    • cyanosis
    • fatigue
    • chest pain
    • syncope
    • angina
  32. signs and symptoms of acute heart failure
    • aka pulmonary edema
    • pink, frothy sputum
    • tachycarida
    • high b/p
  33. Stages of HTN
    • pre-hypertension: 120-139 / 80-89
    • stage 1 hypertension: 140-159 / 90-99
    • stage 2 hypertension: >159 / >99
  34. Primary hypertension
    • aka essential hypertension
    • chronic elevation of b/p from an unknown cause
  35. secondary hypertension
    • known cause
    • if cause treated; b/p returns to normal
  36. isolated systolic hypertension
    • systolic greater than 140
    • diastolic less than 90
    • usually found in elderly
  37. hypertensive emergency
    b/p > 180/120; risk for target-organ dysfunction
  38. target-organ disease
    • organs affected by htn
    • heart, kidney, brain, eyes
  39. HTN meds
    • diuretics: hydrochlorothiazide (excrete sodium and chlorine)
    • alpha blockers: prazosin
    • beta blockers: metoprolol
    • calcium channel blockers:
  40. reserpine
    Reserpine is used to treat high blood pressure. It also is used to treat severe agitation in patients with mental disorders. Reserpine is in a class of medications called rauwolfia alkaloids. It works by slowing the activity of the nervous system, causing the heartbeat to slow and the blood vessels to relax
  41. prazosin
    Prazosin is used alone or in combination with other medications to treat high blood pressure. Prazosin is in a class of medications called alpha-blockers. It works by relaxing the blood vessels so that blood can flow more easily through the body
  42. clonidine
    Clonidine is in a class of medications called centrally acting alpha-agonist hypotensive agents. It works by decreasing your heart rate and relaxing the blood vessels so that blood can flow more easily through the body
  43. the 6 p's of arterial occlusion
    • pain
    • pallor
    • pulselessness
    • paresthesia (numbness)
    • paralysis
    • poikilothermia (temperature)
  44. signs and symptoms of PAD
    • don't elevate legs
    • calf pain during exercise (intermittent claudication)
    • cool skin
    • hair loss on lower calf, ankle and foot
    • dry, flaky, scaly, pale or mottled skin
    • thickened toenails
  45. abdominal aortic aneurysm
    • most common aneurysm
    • back or flank pain (classic symptom)
    • abdominal pain
    • fullness
    • nausea
    • pulsating abdominal mass
  46. carotid endarterectomy
    • plaque dissected from the lining of the arterial wall
    • vascular surgery
  47. dvt (deep vein thrombosis) prophylaxis
    • hydrate elderly
    • no smoking
    • knee or thigh hig stockings
    • compression devices
    • low molecular weight
    • heparin
    • coumadin
    • ROM exercise
    • early ambulation
  48. signs and symptoms of dvt (deep vein thrombosis)
    • swelling
    • edema'
    • pain
    • warmth
    • venous distention
    • homans sign: calf pain with sharp dorsiflexion
  49. myocarditis
    • inflammation of the myocardium that destroys muscle fiber
    • heart is sensitve to digoxin; monitor closely for digoxin toxicity
  50. coumadin (warfarin) lab values
    • INR = 2.0 - 3.0 for aortic valve replacemts
    • INR = 2.5 - 3.5 for aortic or mitral valve