Med-Surg Exam 10
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. What would you like to do?
What is a micro bacterial infection that affects the lining of the heart and it's valves?
What is the cause of endocarditis?
pathogen, usually bacteria, enters bloodstream and accumulate on the heart valves/endocardium
What are the symptoms of endocarditis?
- wt loss
- night sweats
- chest/abd pain
- peas size, tender, red/purple lesion on finger tips/toes
What is the treatment for endocarditis?
- antimicrobial IV for 2-6 weeks
- monitor for s/s of infection
- prophylactic anticoagulant
- watch for s/s of heart failure
- surgical intervention: replacing valve
What are the complications of endocarditis?
- stroke and organ damage
- heart failure
- pieces of bacteria can break off and become emboli, then obstructing circulation and perfusion
What is inflammation of the heart muscle?
What is the cause of myocarditis?
- complication of pericarditis
What are the symptoms of myocarditis?
- general chest pain
What is the treament for myocarditis?
- bed rest
- anti-inflammatory drugs
What is a complication of myocarditis?
What is inflammation of the pericardium?
What are causes of pericarditis?
- AMI (Dressler's syndrome
What are the symptoms of pericarditis?
- elevated temp
- elevated WBC
- elevated ST segment
- chest pain like MI except pain increases with breathing and movement
- orthopneic: sitting up, leaning forward position relieves
What is the treatment for pericarditis?
- anti-inflammatory agent
- creation of pericardial window
- watch for heart failure
What are the complications of pericarditis?
- cardiac tamponade
- fluid in the pericardial sac
- cardiac compression
- chambers unable to adequately fill
- decrease cardiac output
- watch for heart failure
What is swelling of a vein caused by a blood clot?
Can stenosis cause backward and forward flow of blood?
What is stenosis between the right ventricle and right atrium?
What is stenosis between left ventricle and left atrium?
What is stenosis after the left ventricle?
What is pain associated with decreased perfusion that is aggravated by exercise and relieved by rest?
What forms intermittent constriction of arterioles that affects the hands primarily, although it can affect the toes and tip of the nose?
What is the treatment for Raynaud's disease?
- avoid cold temps
- adequate protection
- no smoking
- calcium channel blockers
- beta blockers
What are s/s of Raynaud's disease?
- chronically cold hands
- tingling and pallor
- changes from pallor to cyanosis to red
What CV disease is found only in men that smoke?
What are the s/s of Beurger's disease?
- claudications in arch of foot
- claudication in calf and digits
- pain may be more severe at night with shock like pain
- pulses often diminished in distal extremities
- extremities may be cool/red/cyanotic
What should you teach the pt about Beurger's disease?
- stop smoking and disease goes away
- if pt does not stop, it can result in amputation
What is the med term for a blood clot?
What is the difference between a venous thrombus and an arterial thrombus?
Venous: pain, heat, redness; positive Homan's sign; caused by damage to endothelial lining of vein.
Arterial: cold, pale, or cyanotic; c/o numbness and tingling; pain; more pain when elevated.
What is the treatment for a person with a venous thrombus?
elevate legs, compression stockings
What is the treatment for a person with an arterial thrombus?
put leg in dependent position; must be immediate
What are distended protruding veins that appear darkened and tortuous?
What types of aneurysms are there?
Where does the conduction system in the heart begin?
What order should it really be?
- O2: increased available O2 to heart
- Aspirin: prevents further occlusion
- Nitroglycerin: increases collateral blood flow and causes dilation of coronary arteries
- Morphine: helps relieve pain
What are the s/s of cardiogenic shock?
- decreased BP
- weak/rapid pulse
- cool and moist skin
- decreased LOC
What is PVC?
no P wave proceeds the QRS complex; QRS looks wide/bizarre; ventricular contraction that occurs without an impulse from the SA node.
What is ventricular tachycardia?
- QRS is distorted w/ long duration; rate 110-250 bpm;
- when you have more than 3, very life-threatening
What is ventricular fibrillation?
quivering of the ventricle
What is asystole?
flat line on monitor (CANNOT shock!)
What is the treatment for atrial flutter, atrial tachycardia, and atrial fibrillation?
What is the emergency life saving treatment for ventricular tachycardia and for ventricular fibrillation?
What restores regular rhythm and improves CO and tissue perfusion?
What is often described as chest pain, strangling of the chest?
What are the types of pacemakers?
What should you teach a pt about a pacemaker?
- count pulse for full minute
- explain wound care and healing process
- notify physician of symptoms of decreased CO
- carry id card describing type of pacemaker
What is a type of ulcer characterized by edema around the lower legs, pain, brownish skin discoloration, and stasis ulceration?
What steps do you take to control bleeding? SDEPT
- protect self!
- direct pressure
- pressure point
What are the types of external bleeding? Describe each one.
- venous: steady flow, dark red
- arterial: spurting, bright red, large amount
- capillary: oozing, bright red
What is the purpose of a crash cart?
Label the diagram:
What is the purpose of a fibrolytic?
A patient with endocarditis or known valvular disease should take antibiotics before _______ or _______ procedures.
dental or invasive procedures.
What is one major complication of pericarditis? What will eventually happen unless it is corrected?
cardiac tamponade; death.
potassium sparing diuretic
used to treat edema, HTN, and hypokalemia
c/i: renal insufficency and hyerkalemia
s/e: cause gynaclamastia (males w/boobs); may cause muscle cramps
monitor potassium levels
nitrate used for angina and CHF
can cause tachycardia, hypotension, bradycardia
pt teaching: not to d/c therapy
Treats life-threatening ventricular arrythmias
c/i: 2nd and 3rd degree AV block; causes blue color skin, bradycardia
s/e: abnormal sense of smell, respiratory distress syndrome, CHF, bradycardia, hypotension, abnormal taste
Labs: monitor thyroid function and liver enzymes
Treats HIGH cholesterol
may cause altered taste, pancreatitis, hepatitis
high dig levels
take in evening
wear sunscreen (photosensitivity)
s/e: bradycardia, CHF, pulmonary edema, erectile disfunction, drug induced lupus syndrome
drug-drug: alter effectiveness of insulins and hypoglycemic agents
monitor VS during adjustments and through therapy for signs of overdose
pt teaching: may increase sensitivity to cold
ace inhibitor for HTN heart failure
may cause angioedema, cough
drug->drug excessive hypotension w/ diuretics
monitor litheum levels, may increase
labs: may cause hyperkalemia, cough may not stop until med is stopped
calcium channel blocker, used for angina and HTN
c/e: systolic BP below 90
may cause gingival hyperplasia and peripheral edema
pt teaching: elevated serum levels; monitor pulse; may cause bradycardia; protective clothing- photosensitivity
treats HTN and prevent strokes; may cause nasal congestion, angioedema, hypoglycemia
drug->drug: NSAIDS may have low anti-hypertensive effects
labs: cause hyperkalemia and low H & H.
treats hypertensive crisis
c/i: decreased cerebral perfusion
s/e: cyanide toxicity
drug->drug: estrogen decrease response to med; monitor serum cyanide concentrations
increase heart rate, decrease LOC, seizures, almond breath smell
platelet aggregator, decreases symptoms of intermittent claudication
administer on empty stomach
teach about smoking cessation ( causes vaso-constriction)?
What happens to the BP if a vessel ruptures?
What is the treatment for a dissecting aneurysm?
What is the term that describes a condition in which tissues do not receive an adequate supply of O2 rich blood?
What will you find on an EKG for a person with ischemia? (didn't see this one in the slides...so I'm not sure)
Elevated ST segment
What are the pressure point sites?
What would you like to do?
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