Medical Nursing Week 2

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Gia_bella
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172748
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Medical Nursing Week 2
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2012-10-11 17:25:31
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Medical Nursing Week
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Week 2
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  1. Cardiovascular
    Anatomy
    • Heart
    • Artery
    • Veins
    • Capillaries
  2. Cardiovascular
    Purpose
    Transport Nutritients and oxygen throughout the entire body
  3. Cardiocascular
    Normal Heart Rate
    • Dog = 70 - 120 bpm
    • Puppy = up to 220
    • Toy breed = up to 180bpm

    Cat= 120-240bpm
  4. Cardiovascular
    Pathologic symptoms
    • Coughing
    • Dyspnea and wheezing
    •  Pulse deficits
    • Heart Murmurs based on a scale of 1-6
    • 1. Very soft murmur, occasionally hear it
    • 6. loud with cardiac thrill- can see heart without stethoscope
    • Ascites- edema
    • Syncope- Fainting
    • Exercise intolerance
    • Jugular pulse
  5. Diagram of a Heart
  6. Cardiovascular
    Terminology
    • Dyspnea- Difficulty Breathing
    • Tachycardia- abnormally high heart rate
    • Arrhythmic- Abnormal heart rhythem
    • Syncope- Fainting
    • Tachypnic or panting- Fast and rapid breathing rate
    • Cyanotic- Bluish discoloration, lack of oxygen
    •                  1. not circulation oxygen
    • Ascites- Abdominal Effusion
    • Pulse deficit- Heart rate does not match with pulse
  7. Cardiovascular
    Diagnostic Tests
    • Radiographs
    • EKG
    • Blood Pressure- Hypertension
    • Ultrasound
    • Blood Panel
  8. Cardiovascular
    Diseases
    CHF- Congestive Heart Failure
    History
    • Many signs normal until heart decomensates
    • Coughing
    • Wheezing
    • Dyspnea
    • Exercise Intolerance
  9. CardiovascularDiseases
    CHF- Congestive Heart Failure
    Etilogy
    • Old Age animals
    • Mitral valve regurgitation leads to heart enlargement
  10. CardiovascularDiseases
    CHF- Congestive Heart Failure
    Clinical Signs
    • Heart Murmur
    • Pulmonary Crackles and wheezes
    • Pulse Deficits
    • Jugular Distension
    • Syncope
  11. CardiovascularDiseases
    CHF- Congestive Heart Failure
    Diagnostic tests
    • Radiographs
    •    Cardiomegaly
    •    Pulmonary Edema
    •    Ascites
    •    Hepatomegaly (enlarged liver) and Slenomegaly  (enlarged spleen)

    • EKG
    •    Atrial and ventricular enlargement
    •   Arrythmia

    • Ultrasound
    •     Contractility
    •     Doppler Flow
  12. CardiovascularDiseases
    CHF- Congestive Heart Failure
    Treatment
    • Diuretics
    • Reduce blood volume to heart, decreasing work load.
    • Lasix
    •   2-4 mg/kg IV q 2-6 hrs
    •   1-4 mg/kg PO SID to TID
    •    Patient Na+ and K+uptake decreases thus H20 absorption decreases
  13. CardiovascularDiseases
    CHF- Congestive Heart Failure
    Treatment
    Vasodialators
    • Causes dialation of arterioles and veins
    • Decrease blood pressure (systemic and pulmonary) to allow hear to pump blood through aorta (increase stroke volume)
    • Hydralazine
    •    0.5-2mg/kg PO BID
    •    Arterial dialator
    • Nitroglycerin Ointment
    •    1/4-1 inch strip q4-6hrs continuous
    •    Venodialator
  14. CardiovascularDiseases
    CHF- Congestive Heart Failure
    Treatment
    Bronchodialators
    • Theophylline
    •    6-11mg/kg TID to QID
    •      IV, IM, PO
    • Aminophylline
    •    10mg/kg TID
    •       IV, IM, PO
  15. CardiovascularDiseases
    CHF- Congestive Heart Failure
    Treatment
    Pimobendan
    • Inodilator- both vasodilator and positive inotropic
    • Used for mitral valve disease
  16. CardiovascularDiseases
    CHF- Congestive Heart Failure
    Treatment
    Angiotensin
    • Converting enzyme inhibitors (ACEI) Vasodilator
    •   Decreases ateriole tone to reduece systemic blood pressure and after load.
    •   Decreases aldosterone secretion so less secretion of sodium and water retention
    •    Captopril -0.5-2 mg/kg PO BID to TID
    • Enalapril- 1.5mg/kg PO SID to BID
  17. CardiovascularDiseases
    CHF- Congestive Heart Failure
    Treatment
    Positive Inotropes
    • Increase heart contractions
    • Causes increased heart myocardium muscle contractions
    • Works at sodium- potassium- atpase pump of myocardium
    • Digitalis glycosides- Digoxin
    •    Heart Failure
    •    Supraventricular tachycardia
    •    Side Effect- Tachycardia
    •     0.005-0.01 mg/kg PO Bid
    •  
  18. CardiovascularDiseases
    CHF- Congestive Heart Failure
    Treatment
    Antiarrythmics
    • Must do an EKG before putting animal on any antiarrythmics!
    • Slow or stop heart arrhythmias
    • Lidocaine
    •    Ventricular arrhythmias
    •     4mg/kg IV
    •     CRI: 40-80mg/kg/min IV
    • Procainamide
    •   Ventricular arrhythmias
    •    5-10mg/kg IV
    •    CRI: 20-50 mg/kg/min IV
    •    5-15 mg/kg PO QID to TID
  19. Canine Dilated Cardiomyopathy
                              Heart Muscle
    Fatal disease, usually seen in larger dogs
    • Myocardial wall functionally abnormal
    •   Dilated and thin ventricular and atrial walls of myocardium (dilated)
    • Hypertrophic  (very thick) cardiomyopathy
    •     Left centricular hypertrophy of myocardium with   thickened muscle mass
    •     Less common in dogs
    •    Similar diagnositc tests and treatments
  20. Canine Dilated Cardiomyopathy                      
                              Heart Muscle
    Fatal disease, usually seen in larger dogs
    Etiology
    • Unknown
    • Possible carnatine and taurine deficiency
    •   Seen in Boxers and cockers
    • Congenital
    • Breeds: cocker spaniels, boxers, great Danes, Doberman Pinchers, wolfhounds, and Newfoundland
  21. Canine Dilated Cardiomyopathy  
                              Heart Muscle
    Fatal disease, usually seen in larger dogs
    Clinical Signs and History
    • Coughing
    • Dyspnea
    • Syncope and weakness
    • Arrythmias
    • Ascites
    • Can occur 6 months to 15 years
    • Murmur- most do not have a murmur
  22. Canine Dilated Cardiomyopathy               
                              Heart Muscle
    Fatal disease, usually seen in larger dogs
    Diagnostic tests
    • Radiographs
    •    Cardiomegaly
    •    Ascites, pulmonary edema
    •    Plueral effusion(excessive amounts of fluid around the chest and lungs)
    • EKG
    •   Arrhythmeias
    •   PVC's
    • Cardia Ultrasound
    •   Definitive diagnosis
    •   Dilates or hypertrophic ventricular or atrial walls
    • Blood Panel- checking kidney function
  23. Canine Dilated Cardiomyopathy  
                            Heart Muscle
    Fatal disease, usually seen in larger dogs
    Treatment
    • Based on clinical signs and problems
    • Thoracocentesis of pleural effusion
    • Diuretics
    •    Ascites, pulmonary edema
    • Digoxin
    •   Positive inotrope
    • Enalapril- (ACEI)
    • Antiarrhythmic therapy
    •   Lidocaine
    •   Procainamide
    • Taurine or corrective therapy
  24. Canine Dilated Cardiomyopathy                        
                              Heart Muscle
    Fatal disease, usually seen in larger dogs
    Long term prognosis
    Poor- 6 months to 1 year
  25. Cardiovascular
    Feline Hypertrophic Cardiomyopathy
    Most common form
      Dilated Cardiomyopathy is less common and may be associated with Taurine Deficiency
    • Etiology
    •    Unknown
    •    Possible Taurine deficiency
    •     Occurs most common in purebred cats
    •           Persians, Himalayan, Main Coons, etc.
  26. Cardiovascular
    Feline Hypertrophic Cardiomyopathy
    Most common form
    Clinical signs
    • Dyspnea
    • Coughing
    • Wheezing
    • Ascites
    • Murmur
    • Arrhythmias (gallops)
    •  Hindleg paralysis (from blood Clot)
  27. Cardiovascular
    Feline Hypertrophic Cardiomyopathy
    Most common form
    Diagnositc Tests
    • Radiographs
    • EKG
    • Ultrasound
    • Blood Panel
    •   Many times shows hyperthyroid
  28. Cardiovascular
    Feline Hypertrophic Cardiomyopathy
    Most common form
    Treatment
    • Diuretics
    •    1. Lasix
    •    2. Pulmonary edema
    •    3. Ascites
    • Beta Blockers( to slow down heart)
    •     1. Propranolol
    •      2. Atenolol
    •            Specific Beta 1 blocker
    •      3. Slows tachycardia and out flow problems
    • Calcium Channel Blockers
    •   1. Diltiazem- slows muscle contraction
    • ACEI
    •   1. Enalapril
    • Thromboemboli- Saddle Thrombus
    •     1. Aspirin
    •         25mg/kg POq 72 hours
  29. Cardiovascular
    Feline Hypertrophic Cardiomyopathy
    Most common form
    Prognosis
    • Poor long term
    • 4months - 1 year
  30. Respiratory system
    Anatomy
    • Upper respiratory
    • Nose
    • Pharynx
    • Larynx
    • Trachea
  31. Respiratory system
    Purpose
    • Oxygen and CO2 exchange
    • Protective barrier
    •   Mucous and ciliated cells filters the air
    • Thermoregulation
    •   Warms air
    •   Panting to dissipate heat
  32. Respiratory system
    Terminology
    • Epistaxis- Bleeding from nostrils
    • Tachypnic- rapid and fast breathing
    • Stridor- Harsh inspiratory respiratory sound
    • Dyspnea- Dificult breathing
  33. Respiratory System
    Pathologic Symptoms
    • Sneezing
    • Coughing
    • Gagging
    • Ocular or nasal discharge
    • Epistaxis
    • Dyspnea
  34. Repiratory system
    Diagnostic Tests
    • Rhinoscopy
    •     Otoscope Exam
    •      Rhinoscopy fiber optic endoscopy
    • Radiographs
    • Cultures
    • Cytology and tissue biopsy
    • Blood Panel
    • Tracheal Wash
  35. Respiratory system
    Diseases
    Upper respiratory Infection
    Clinical signs and History
    • Sneezing
    • Coughing
    • Ocular or nasal discharge
    • Febrile
    • anorexia
    • Lethargic
    • Inspiratory wheezing
    • stridor
  36. Respiratory system
    Diseases
    Upper respiratory Infection
    Etiology
    • Infections
    •    Viral
    •    Bacterial
    •    Mycoplasma
  37. Respiratory system
    Diseases
    Upper respiratory Infection
    Diagnostic Tests
    • Radiographs- of the lungs
    • Blood Panel
    • Cultures
  38. Respiratory system
    Diseases
    Upper respiratory Infection
    Treatment
    • Antibiotics for secondary
    • Eye Ointments
    • Fluid therapy
    •   In extremely ill patients
  39. Respiratory system
    Diseases
    Collapsing Trachea- congenital malformation
    Clinical Signs and History
    • Coughing when excited
    • Goose honk sound of cough
    • Coughing during tracheal palpation
  40. Respiratory system
    Diseases
    Collapsing Trachea- congenital malformation
    Etiology
    • Collapsing of trachea rings during inhalation
    •     Weakened tracheal rings due to congenital cartilage 
    • deficit
    •     Weakened tracheal muscle
    • Congenital
    • Breeds
    •    Yorkshire Terrior, Pomeranians, Poodle, Chihuahua
  41. Respiratory system
    Diseases
    Collapsing Trachea- congenital malformation
    Diagnostic Tests
    • Radiographs
    •   Narrow Trachea
    • Fluoroscopy
    • Endoscopy- putting the tube down the trachea
  42. Respiratory system
    Diseases
    Collapsing Trachea- congenital malformation
    Treatment
    • Medical Management- Usually first step
    •    Surgery not successful
    • Control anxiety and excitment
    •    Behavior discipline
    •     Keep cool
    •       Body Clip
    •       Air conditioning
    • Acepromazine
    •     0.05-2.0mg/kg PO Bid
    • Walk on Harness
    •   No Choker chain or leash around neck
    • Corticosteroid
    •   Decreases tracheal inflammation
    •    Dex Po4 (Dexamethasone Sodium Phosphate)
    •          1-2mg/kg IV BID
    • Pregnisone
    •      0.5-1mg/kg PO SID to BID
    • Bronchidialators
    •    Aminophylline
    •    Theophylline
    •    Terbutaline
    •    Albuterol
    • Antiboitics
    • Cough Suppresents
    •    Hycodan
    •     Torbutrol
    • Surgery Tracheal Stunt
  43. Respiratory system
    Diseases
    Brachycephalic Syndrome because of the shape of their head, muzzle and throat
    History
    • Sneezing
    • Wheezing
    • Panting
    • Snoring
    • Respiratory Distress
  44. Respiratory system
    Diseases
    Brachycephalic Syndrome
    Clinical Signs
    • Stenotic Nares- narrow nostrils
    • Elongated soft palate
    • Collapsing trachea
    • Hypoplastic trachea-congenital, abnormal growth of the rings of cartilage that make up the trachea
    • Laryngeal mucous edema
    • Everted Laryngeal saccules
    • Breeds
    •    English Bull Dog, Boston Terrier, Pugs, Shih-Tzu, Lhasa Apso, Pekingese
  45. Respiratory system
    Diseases
    Brachycephalic Syndrome
    Diagnostic Tests
    • Physical exam
    • Radiographs
    • Sedation for examination of oral cavity
  46. Respiratory system
    Diseases
    Brachycephalic Syndrome
    Treatment
    • Medical Management
    •     Corticosteroid
    •      Brochodiolators
    • Surgery
    •   Tracheostomy tube
    • Excise stenotic nare
    • Laryngeal tie back
    • Reduce elongated soft palate
  47. Doliocephalic
    having a relatively long head
  48. Lower Respiratory System
    Anatomy
    • Bronchi, Bronchioles
    • Alveoli- where gas exchange occurs
    • Diaphragm
  49. Lower Respiratory System
    Purpose
    • 02 and Co2 exchange
    • Acid Base regulation
  50. Lower Respiratory System
    Pathologic Symptoms
    • Coughing or gagging
    • Dyspnea or tachypnea
    • Cyanosis- blue or purple coloration of the skin or mucous
    • Wheezing
    • Excerise intolerance
  51. Lower Respiratory System
    Diognostic Tests
    • Auscultations
    •   Crackles and wheezes
    • Radiographs
    •      Pneumonia
    •     Asthma
    •     Pleural Effusion
    • Blood Panel
    •     Leukocytosis
    • Tracheal Wash- Definite Test
    •     Infections
    •     Allergic
    •     Cancer
    • Ultrasound
  52. Lower Respiratory System
    Diseases
    Chronic Bronchitis COPD
    Clinical Signs and History
    • Wheezing Cpughing
    • Dyspnea
    • Exercise Intolerance
    • Wheezes or crackles on auscultation
  53. Lower Respiratory System
    Diseases
    Chronic Bronchitis COPD
    Etiology
    • Old Age
    • Environment
    •    Smoke
    •     Dust
    • Allergic
    • Infections
    • Unknown
  54. Lower Respiratory System
    Diseases
    Chronic Bronchitis COPD
    Diagnostic Test
    • Radiographs
    •    Peribronchial infiltration
    •    Allergic asthma- bronchiolar pattern
    • Bronchoscopy- putting a scope down
    •    airway irregular shape
    •    Red mucosa and excessive mucous production
    •    Bronchi collaspe on expiration
    • Tracheal wash
    •      Inflammation
    •          Neutrophils and Macrophages
    •     Asthma
    •     Allergic  
    •         Eosinophil
    • Culture sensitivity
    •    Bacteria
    • Blood Panel
    •     Eosinophilia
    •          Parasites or allergic
    • Allergy screen
  55. Lower Respiratory System
    Diseases
    Chronic Bronchitis COPD
    Treatment- oxygen
    • Corticosteroid
    •    Dex SP4
    •    Prednisolone
    • Antibiotics
    • Antitussives
    •     Hycodan
    •         0.22 mg/kg PO SID to TID
    •     Torbutrol
    •        0.05-0.1 mg/kg POor SQ SID to TID
    • Bronchodialators
    •     Treophylline
    •     Albuterol
    •      Terbutaline
    •          cats
  56. Lower Respiratory System
    Diseases
    Pneumonia-  (Bacterial infections )Inflammatory
    Clinical Signs and History
    • Fever
    • Anorexia
    • Lethargic
    • Tachypnic
    • Depression
    • Couging and Wheezing
    • Ocular or nasal discharge
  57. Lower Respiratory System
    Diseases
    Pneumonia-  (Bacterial infections )Inflammatory
    Etiology
    • Infections
    •     Bacterial
    •     Viral
    •      Fungal
    •     Mycoplasma
    • Systemic infection or URI (Upper Respiratory Infection)
    • Immunosuppresion
    • Penetrating wounds or migrating foreign body
    •     Foxtails, animal fights, pellet wound, etc.
  58. Lower Respiratory System
    Diseases
    Pneumonia-  (Bacterial infections )Inflammatory
    Diagnostic Tests
    • Radiographs
    •    Intestinal infiltrations
    •     Bronchopnuemonia
    •           Cranial ventral pattern
    • Blood panel
    •       Leukocytosis with a left shift
    • Tracheal wash and culture
    •      Elevated WBC count and bacterial culture
  59. Lower Respiratory System
    Diseases
    Pneumonia-  (Bacterial infections )Inflammatory
    Treatment
    • Antibiotics
    •    Type used depends of sensitivity to culture
    •     Continue on medications a minimum of 2 weeks after all clinical and radiographic signs have resolved - 4-8 weeks total
    • Coupage chest and Nebulization
    • Bronchodialators
    • Fluids and oxygen if needed
    • Doxycycline or Isoniuzil Rifumpin
    •     Mycoplasma (tuberculosis)
    • Ketoconizole or Intraconazole
    •    Fungal pneumonia

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