2nd semester H& I 2 Final

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mowgli
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217927
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2nd semester H& I 2 Final
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2013-05-09 18:51:21
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final
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renal, ardiac, endocrine,DM, GI, Surg, HTN, Musc, Shock
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  1. what to do if find pt in shock
    cover pt
  2. What is shock
    • multisystem failure
    • all body systemss will be involved if not put under control
  3. what do you need to make sure of w/ shock
    • tissue get enough o2 and nutrients
    • circulation & tissue perfusion
  4. What is the main cause of shock
    • drop in BP
    • lack of profusion  blood/O2 to tissue/mai organs
  5. Stages of shock
    • 1 Compensatory
    • 2. progressive
    • 3.refactory
  6. compensatory stage of shock
    • body tries to compensate
    • BP & homeostasis maintained if working
  7. in compensatory stage of shock
    • lower bp  -> tries to shift body fluid to maintain bp
    • body takes over sympethetic Nerv syst
    • release adren
    • concentrates blood supply to needed areas
    • kidney
    •   lower output   oligurea
  8. s/s of compensatory stage of shock
    • resp > /min
    • lower urine output
    • irritable
    • restless
    • orthostatic HTN
    • 1st pulse norm then starts falling
    • rapid getting thready hr
    • pale, cool skin
    • raised blood glucose and thirst
    • resp alkalosis
  9. what does shock start w/
    drop in BP
  10. progressive stage of shock
    • lower tissue perfusion
    • not enough circulation
    • anarobic metab
    •     Na will collect in body cells / K lost
    • as conti get metab acidosis
    • get vaso constrict as fluid lossed
    • slowed blood flow


    can be reveresed
  11. what does progressive stage of shock affect
    micro circulation
  12. s/s of progressive stage of shock
    • confusion
    • listlessnes
    • lower bp
    • weak/thready pulse
    • higher resp
    • subnorm temp -except in septic
    • cold/clamy pail skin
    • cyenosis
    • dry mouth
  13. what do you worry of w/ progressive stage of shock
    perm organ damage
  14. refactory stage of shock
    • irreversable
    • vital organs have failed
    • brain damage--cells died
    • pt probably die w/in hours
  15. s/s of refactory stage of shock
    • loose concentration
    • lower systolic BP
    • dystolic BP almost 0
    • pulse slow  irregular
    • resp- shallow /irregular
    • min/no output
    • skin -cold, clammy, blue
  16. Hypovolemic shock
    • reduction in blood
    • low cardio output->low profusion to org/body tissue
  17. causes of hypovolemic shock
    • loss of fluid from extracellular compartments
    • loss in general volume-diarhea/vomit
    • hemeraging
    • severe burn
  18. how much fluid loss in hypovolemic shock before see s/s

    late s/s
    10-15%

    >30%

  19. Tx for hypovolemic shock
    • cause
    • all pt given 100% O2 n/c have low volu
    •   use nonrebreathing mask
    • Dr order ABG
    • start IV use large bore needle get fluids i fast
  20. Cardiogenic shock
    • heart fails as pump
    • L ventrical or/& L Corinary fail
  21. S/S of cardiogeic shock
    • fast/weak pulse
    • drop BP-- =/< 90 systolic
    • cold, clamy, cyanotic skin
    • urine output =/< 30mL/hr
  22. Tx for cardiogenic shock
    • support heart
    • try to find underlying causes
    • pt/ will have cardiac pain
    • Dr order morphine -b/c lower anxiety & pain
    • meds to rise heart contractability
    •    -digoxin/lenoxin
    • O2 stats, arteriol blood lab
  23. Distributive shock

    3 types
    • excessive dilition ob blood vessels
    •  
    •  1. Anaphylatic
    •  2. Septic
    •  3. Nephrogenic
  24. Anaphyalctic shock
    • sever alergic reacion
    • medical emergency
  25. Tx for anaphylactic shock
    • give adrenaline (rapid acting)- cause musc relax allow to breath
    • need to callm all down 1st
    • moitor O2 satu
    • if pt come w/ severe laryngospasm give O2
  26. s/s of anaphylactic shock
    • massive vaso dilation
    • bronchospasm
    • aracadia (itching)
    • rash
    • higher temp
    • edema
    • airway obstruction
    • high histamine
    • larygial edema
    • large amount of hystamine in bronchi, mucosa
    • circulatory callaps
  27. Septic shock
    • infection that gets into blood
    • caused by systemic infection
    •    most common bact gram neg

    • invades phagocytes release histamine
    • not enough O2 to rest of body

    •  lower glumalular filtration
    • kindies not perfuse->acute renal failure 
    •    can be revresed
  28. s/s of septic shock
    • pt feel flushed/warm
    • hypotention
    • restlessness
    • anxiety
    • tachycardia
    • pyrexia
    • higher thrist
    • renal failure
  29. Tx septic shock
    • blood cultures 2 sites
    • broad spectrum ABX
    • O2
    • put on ventilator
  30. Neurogenic shock
    • cause alt in skel muscles
    • assoc w/ CNS injury & anesthesia
    • loss of symp nerv activity
    • can be caused by brain stem/emotnal trauma
    •    spinal disease/inury
    • massive dilation of avaricals
    • veus return impaired--> lower cardiac output
  31. s/s neurogenic shock
    pt BP rapidly drop
  32. Tx neurogenic shock
    • IV fluid
    • O2
    • circul support
    • maintain blood flow to brain 1st
    • check vitals/LOC/ Coma scale
    • initial pt NPO
    • elevate legs
    • keep awake & responsive
    • insert foley b/c need monitor o/i
    • may push blood fluids
  33. short acting insulin
    R & Human

    • take  min before meals
    • onset:   30-60mn
    • peak:    2-5hr
    • Duration: up to 12 hr
  34. intermediate acting Insulin
    NPH (N) 

    • doesn't need to be given w/ meals
    • onset:   90min-4hrs
    • Peak:  4-12hr
    • Duration: up to 24 hr
  35. Long acting insulin
    Giargine (Lantus)   Determir (Levemir)

    • doesn't need to be given w/ meals
    • onset:     45min -4 hr
    • Peak:     minimal
    • Duration: up to 24 hr
  36. complications of giving insulin in same area
    • lipoatrophy/distrophy -won't absorb  
    •              will sit there   too much fatty tissue
  37. how often to test blood sugars on sick days
    • at least q8hr
    • more if blood sugar fluctuates a lot
  38. DKA
    • severe metablic d/o
    • body takes energy fro rapid ody fat breakdown-done improperly
    • *loose massive  electrolytes / fluids
    • blood glucose
    •    adults: >240 + ketones
    •    kids >300
  39. DKA S/S
    • fruity breath smell
    • Kussmaul breathing-frequent rapid, deep breathing
    • cherry red lips
    • metabolic acidosis
    • can go into coma
    • n/v
    • hot / flush /dry skin
    • electrolye imbalance
    • drowzy
  40. Tx DKA
    • insulin drip titrated down
    •   need to slowly bring down blood sugar level
    • takes several days

    monitor blood sugar Q 1-2 hr

    once back on acceptable rate get on lower dose insulin
  41. insulin shock
    • pt goes unconscience
    • can't swallow
  42. tx for insulin shock
    • give IV push  D25-50% per protocal
    •   if at home give glucagon
  43. w/ DM when don't exercise
    when >240 or <70 (cap blood)
  44. what is H A1C
    average bllod sugar for 3-4mo
  45. Ketonacedosis             
    • blood sugar >300 w/ ketones in urine
    • ER for type 1
  46. Tx for ketonacidosis
    • ICU
    • cardiac/respitory monitor
    • lower acitone levels
    •    -acitone & ketone impair fat metab,
    • slowly bring down blood sugar level
    • look at LOC
    • hlp resolve dehydration   monitor labs
    • monitor for fluid over load, intoxication, ketones
  47. HHNKS 
    (Hyperosmolar Hyperglycemic Nonketotic Syndrome)
    • severe metabolic crisis
    • can come on slowly
    • often from severe dehydration
    • blood sugar >600
    •     can go up to 1000-2000

  48. Tx of HHNKS
    • increasee fluids
    • insulin titrated -slowly go down until reach
    •   250
    • risk of death goes down once treated
  49. causes of HHNKS
    • severe dehydration
    • blood sugar >600
    • TPN
  50. s/s of HHNKS
    • shallow respiratioin
    • confusion
    • hard to arouse
    • as progresses
    •   seizures, s/s of CVS-can stroke
  51. late symp of HHNKS   ?
    • high thirst anuria
    • marked dehydration

    • w/o other illness may get elevation of ketones -rare
    • no ketosis
  52. look at in HHNKS
    • osmolarity
    • plasma/serum
    • insulin
  53. ketone
    end product of fat metabolism
  54. acitone
    • end product of protein metabolism
    • another type of ketone
  55. DM Type 1
    • insulin dependent
    • usually Dx <30 yr
    • prone to DKA
    • most prevelent b/w 23/30yr
    • rapid onset of S/S
    • by time dx 90% beta cells gone
    • get early onset of complications
  56. S/S of DM I
    • tired
    • wt loss
  57. cause of DM
    • exat cause unknown
    • 1st generation relatives or autoimmune

    • 2ndary dm is cureable-caused by outside source
    •  -drugs anti HTN, ACE inhib, steroid,betablk
  58. DM type II
    • onset >40yr
    • 20% are over 65 yr
    • 80% obese
    • insulin resistant
    • prone to a lot of type I compl excpt DKA
  59. s/S of DM II
    • low insulin utilation
    • high in  lypolysis
    • higher hepatic glucose metab
    • low in muscular glucose uptake
    • body adjusts to feeling bad
    •   -usually don't know until start to fell good
    • 3 P's poly uria/dypsia/phagia
    • more hungry
    • dry mouth
    • blurred vision
    • poor wound healing
    • tire easy
    • frequent infection
  60. Norm fasting blood sugar levels
    • 70-100mg/dL
    • ideal below 100
  61. Prediabetic fastin blood sugar
    100-125mg/dL
  62. diabetic fasting blood sugar level
    >126
  63. Complications of DM
    • nerve damage
    • kidney failure
    • HTN
    • neuropathy
    • retanopathy-eye
    • nephropathy-kidney damage
    • poor circu
    • even w/ body adjstment to leve have damage

    w/in 7yr of onset of symp -damage set in
  64. Dx of DM
    if random blood sugar level >200
  65. labs for DM
    serum fractosine-shows what blood sugar past 1-2wk

    • microalbumin-detect small amt of albumn in urine
    •  -early sing of kidney damage
    •   -should be <20
    • c peptid-tells when stopped producing insulin
  66. Hypoglycemia
    • rapid onset
    • range on cap blood adult >70 kid >80
    • req Tx if >70
    • hard to Dx if no outward s/s
  67. early S/S of hypoglyemia
    • shakey
    • sweaty
    • irritable
    • staggers
    • numb & tinling
    • pale
    • low blood glucose
  68. late S/S of hypoglyemia
    • combative
    • poor coordination
    • decreased LOC

    coma if blood sugar <20 - hard to fix
  69. Hyperglycemia
    blood glucose </=126
  70. Ejection fractioin of heart
    • measures myocardial contractibility
    • ability of L ventrical to pump blood
    • measured in %
    • Norm 60%
  71. what if pt has 46% ejection fraction
    • replace fluids carefully
    • -indicates pt has lowered heart function
    • is stroke volume div by end distolic volume
  72. what are rate and rhythem of heart controlled by
    • sympathetic
    • parasympatheic
  73. What does it mean when have dysrhythmia
    sympathetic doesn't work well
  74. Cardiac disease high risk groups
    • in order of risk
    • mex amer men
    • af amer women
    • af amer men
    • mex amer women
    • non hisp cauc
  75. what does cardiac disease do
    weakens heart muscles b/c have to work harder
  76. nurse assesment of cardiac disease
    • general appearance-can indicate prob
    •               look @ obj&subj
    • good in depth health hist pres/past/fam/smoke/deaths/hist of heart diseas

    phys exam-focus on acute problem

    • look at compliants
    •  - may not be classic
  77. what is affected by heart disease
    all systems
  78. some complaints heart disease pt may have
    • tooth/shoulder pain
    • indigestion
    • pressure in chest
    • orthopnia-labored breathing when laying flat
    •    -L ventricle failure
  79. how to asses pt w/ pain
    • ask pt to describe pain
    • radiat, location
  80. What is ojective data
    labs, test, hist & phys asses

    • skin color
    • heart sounds
  81. 1st s/s of CHF
    edema in ankle
  82. s/s of CHF
    • irregular hr-need to get EKG or heart monitor
    • jugular vain distention-R sided failure
    • resp distress-crodid artery bruits
    • itching
    • breath sounds-w/CHF pulm conjestion
    • sputum-color
  83. Dx test for CHF
    • 1st group non invasive
    • EKG-look at electric rhyth of heart
    •   -indicate myocardial ifartion
    • pulse ox -picks up O2 in tissue
    • chest xray--size & position
    • echo cardiogram
    • CT/MRI scan-same but better
    • Thalium scan
    • dippler
    • PET scan
    • exercises stress test
  84. What is TEE
    • calt to regular echochardiogram
    • used if have prob. 
    •  used if problem w/ surgery
    •  if need to see image of heart

    • NPO at least 6hr prior
    • use seditive & meds to keep calm
  85. what is a holter monitor
    • monitor worn @ hip like holter
    • keeps diary of activities & assoc symp
    • can transmit spec
    • ear 24-48 hr
  86. What is Norm sinus rhythem

    tissue profusion
    60-100

    95-100%
  87. what does echo cardiogram do
    • machine picks up sound waves
    • looks at heart valve
    • can look at funtion   
  88. thallium scan
    • uste thallium 201 IV
    • thallium acts as potassium
    • used to detect bundle branch block 
    • spec for -CAD
    • thallium doesn't enter damgaged tissue
    • pick up microcarditis

    wait 15 min before prone too hworse before better
  89. Exercise stress test
    • checkig heart function w/ activity
    • looks for blood flow
    • use IV dying--allergies to iodine/shellfish
    • if resp problem-use asthma meds
  90. how is exercise stress test done
    • begin w/ baseline info EKG, etc
    • monitor for changes
    • start of slow then increase
    • can do treadmill, climb stairs, bike, etc
    • goal increase workload of heart & monitor heart ability to respond

    stop if severe dyspnia, BP, confusion, dev cardiac dysrhythmia, chest pain
  91. Drug induced stress test
    • done when can't do exercise (treadmill, etc)
    • use meds to mimic response of exercise
    • give drugs adenosone,
    • after do thallium- to take pictures
  92. PT scan
    • costs a lot--insurance doesn't want to pay
    • picks up iscemia
    • shows myocardial profusion

    before test avoid caffine
  93. Cardiac Cath
    • diagnostic tool -help diagnose
    • invasive prcedure
    • can use to do angeoplasty/stet
    • can put in cardiac stress
    • measure fluid pressure in heart chamber
    • inect dye- see movement of dye through heart
    • take blood interiors to see blood gases
  94. when do cardiac cath
    before surgery
  95. post cardiac cath
    • after remove cath put in wax pressure
    • leg b/c  usewax may want to imobalize
    •   -no tub bath
    • dressing
    • after cath is hop protical
    • usually stay in hosp 8-9hr
    • bedrest 2-3hr after
    • check bleeding
    •  circlation distal to site/pulse/color
    • Dr should do initial explanation
  96. Pre cardiac cath
    • NPO before or light diet w/ Dr order
    • check for allergies esp to latex,dye, shellfish
    • IV fluid before procedure
    • sedative
  97. intra cardiac cath
    • go in through groin
    • scrubbed w/ badadine under ____
    • use local anesthesic
    •       camert tosee where cath threaded
    • may get nausea, chest pain, difculty breathing
  98. L side cardiac cath
    go in through brachial /femoral aorta -->aortic valve
  99. R side cardiac cath
    • go in through vena cava --> R heart chamber -->pulm artery
    • measure pulm artery wedg pressure
  100. how to assess for bleeding after cardiac cath
    press on mattress w/ gloved hand

    check cap refill, temp/color
  101. post cardiac cath assess
    • check for bleeding
    • check cap refill/temp/color
    • check both sides
    • if blue toes, cold feet, absent pulse-worry of clot
    • if bleeding reenforce
    • check disp pulse
    • numbness/tingle/pain-report
    • give fluids-to hydrate & rid of dye
  102. good discharge for cardiac cath
    • what dr ordered
    • no drivig for at least 24hr
    • change dressing in 24hr after

    • if home & get bleeding call 911
    •             if temp >/= 105--call Dr
  103. Angiography
    • pt NPO
    • may give antihystamine
    • use corinary artery, aorta
    • inject IV dye & monitor on screen
    • see where dye is going
    • can monitor R&L sides
    • use w/cardiac test
  104. what does angiography do
    • tell size / shape of heart & great vessels
    • Dx congenital abnormalites
  105. what always needed w/ angiography
    emergecy drugs at bedside
  106. anurism
    thinning/weekend area of blood vessel
  107. aortograph
    • ID anurism & other complic of vessel walls
    • can use brachial/femora artery
  108. Hemodynamic monitoring
    • use on critical pt-usually in ICU
    • asses blood volu
    •   -heart pressure in_______
    • surgically inserted
  109. methods of inserting hemodynamic monitor
    • direct method
    • radial artery-
    • brachial /femoral
  110. central venous pressure monitoring
    • asses L vent functions
    • venus retrun to R side of heart
    • measures venous pressure
    • tells of cardiac output

    use large veins  -jugular or subclavian
  111. norm central venous pressure
    • 2-7 mm
    • if in cm of water 4-10cm of water
  112. what is central venous pressure monitor used for
    • to tell if high low in volu
    • if need to correct deficiencies
    • if need to be careful
    • if have excess
  113. position of pt when monitoring central venous pressure
    supine w/ HOB slightly elevated
  114. factors that decrease preload
    • dehydration
    • hemorrhage
    • venus vaso dilation
    • atrial tachycardia
  115. Pulmonary wedge pressure
    measure afterload
  116. Norm pulm wedge pressure
    4.5-15mm-Hg
  117. what is afterload
    amount of pressure in L ventricle
  118. what decreases afterload
    vasodilation
  119. what increases afterload
    • vasoconstriction
    • HTN
    • affects rate of contration of heart
    •   -raises HR
  120. Cardiac labs
    • CBC
    • fastin blood sugars
    • PT/PTT
    • Cholesterol
    • trygicerides
    • LDL/HDL
  121. What are normal tryglyceride levels
    100-200 mg/dL
  122. what is normal cholesterol level
    <200
  123. what does abn labs help with
    Dx problems
  124. what does abn Cholesterol /Triglyceride show
    prob w/ arteriol sclerosis
  125. what do raised iso enzymesshow
    muscle strain /damage

    higher above norm levels =more damage
  126. what are enzymes
    • complex proteins
    • cause complex changes in body
  127. what are iso enzymes
    • one of severeal foms of same enzym in spec part of body
    • capable of being ID'd seperately
  128. when are large amounts of Iso enzymes released
    w/  damage
  129. triponin
    only in myocardial tissue

    released after MI
  130.  troponin T
    • shows slight damage
    • use to Dx 30 day mortality rate
    • can stay elevated for 1-2wk after MI
    • usually increases  w/in 4-6 hrs after MI

  131. enzymes used to look for heart attack
    • CK/MB
    • LDH 1&2
  132. when do CK levels usually go back to normal
    24-78 hr after hear attack
  133. LDH
    • high levels in RBC, kidneys, lungs, brain, heart
    • normal levels vary w/ machine used & gender

    • 5 types
    • LDH 1&2 - in heart
    • LDH 3 -r/t  lungs
    • LDH 4 & 5 -found in skel muscles & liver
  134. LDL  1 & 2 levels
    • under norm circumstanses 1 lower than 2
    • flip flop w/in 8-12hr after MI
    •    peak 24-48 hr
    •   -return to norm 5-6 days after mi
  135. Risk factors for MI
    • obesity
    • smoking
    • hered
    • high chol & stress
  136. Myoglobin
    • seen in blood after damage
    • w/in 1hr after MI it increases

    • peak: 4-12hr after MI
    • returns to norm w/in 18 hr
  137. inflammatory conditions of heart
    rhematic fever
  138. Rheumatic fever
    • systemic inflamatory disease
    • usually see in school kids
  139. rheumatic carditis
    • inflamation of 1-several layers of heart
    • targets mitral valve
    • affects myocardium-- myocarditis
    • leads to paricarditis
  140. rheumatic carditis process
    • antibody formation causes inflamation-
    •  they concentrate in certain parts of body
    • cross reaction of hrt, skin, nerv syst, joints
    • wbc migrate to myocardium
    •  -get debres around heart-start to get vegitation growth around heart
    • after inflam process stops & start to heal get scar tissue
    • get thickening w/ scar tisu over tissue
    • -get thickeing around valve
  141. damage from rheumatic carditis
    • in cardi tendeni
    • -backflow-murmer
    • carditendeni shorten
    • fibrus tissues grow around area-ascof bodies
  142. wher do  ascof bodies form
    • form around paricardium
    •  --inflammation of paricardium
  143. what does rheumatic carditis cause
    • heartr ro weaken
    • dev cardiac dysrhythmia
  144. s/s of rheumatic carditis
    • inflamation of hear layers
    • symp migrate to other body areas
    • polyarthrits -
    • coria -involuntary facial grimice
    • rash on trunk-quickly goes
    •     -then see red area
    • inability to use coordinate mucs
    • mild fever
    • tachy card
    • arthralgia-pain around joints
    • paricardial friction rub-paricarditus
  145. meds to treat rheumatic carditis
    • drug of choice-pencilin
    • profolactic antibiotics

    • if over 18yrs ASA
    • steroids for inflamation
  146. Dx or rheumatic carditis
    • no specific test
    • strep A test
    •  -throat culture - antitripson otiter
    •   -ESR sed-inflimation
    •   -C reative protein

    • EKG-cardiac rhthm problem
    •   -assess contractability
  147. Infective myocarditis cause
    inflemation anywhere in body -gets into blood stream
  148. worry of w/ infective myocarditis
    • possible high risk of blood clot
    •  
  149. s/s of infective myocarditis
    • fever <103
    • night sweats
    • enlarged spleen
    • betichae in mouth
    • easy fatigue
    • weight loss
    • weakness
    • weak, brittle nails
    • abd/joint pain
    • acky muscles
  150. s/s of subacute endocard 
    • gradual onset
    • low grade fever
    • general malase
    • build of fibrin & platelets

    prolaps mitral valve--big Dx
  151. Labs for infective carditis
    • sed rate
    • rate of RBC in unclotted blood
  152. Tx for infective carditis
    • IV antibiotics for 4-6wk
    • rest -want them abirile @ discharge
    • if valve damage bad enough
    •    -prob get valve replacement
  153. Myocarditis causes
    • usually after virus
    • can be infection/toxicity/heart transplant
    • med sensitivity
    • HIV/ Radiation /immuosuppression
  154. myocarditis
    • inflammatory response causes edema of heart
    • decrease in blood flow/cardiac output

    if get backflow can get CHF R -->L

    if not treated get heart necrosis
  155. S/S of myocarditis
    • can be asymptomatit
    • if severe s/s probably already have problm

    • chest pain releaved by pt sitting up
    • low grad temp 90-100
    • tachy/dysrhythmia
    • dyspnea
    • fatigue
    • anerexia
    • pale or cyanosis
    • flulike symptoms
    • ascities -abd distention -b/c fl bldup in abd
    • perital edema
    • if get CHF -- distended jugular vein
  156. what does distended jugular vein indicate
    R side HF
  157. Dx myocarditis
    • percutaneous endocardial biopsy
    •   -usualy w/in 1st 6wks of pt coming w/problm
    • gallium 367 scan
    • EKG
    • electrolyte
    • iso enzyme-- usually damaged
    • echocardiogram
  158. Tx of myocarditis
    • 1st treat underlying cause
    • bedrest
    • digoxin (digitalis, lanoxin)
    • antibiotics
    • supplimental O2
    • cardiac diet
    • digitalis--used to prevent HF
  159. what does digoxin do
    • prevent HF
    • raise contractability of the heart
    • lesson
    • dyspnea
    • orthopnea
    • decrease pulmonary crackles
    • peripheral edema
  160. what tx for myocarditis if developed cardio myopathy
    heart translplant
  161. what do you worry of w/ digoxin
    • digoxin toxicty 
    •   always do blood labs
  162. what is cardiac diet
    low/no sodium / cholesterol

    • increasing intake of magnesium, calcium and potassium, 
    •   - largely found in dairy products, nuts, grains and vegetables
  163. Paricarditis
    • inflamation of paricadium
    • heart can't contract properly

    • can effect great vessels
    • can be primary or 2ndary
    •  -w/ or w/o fluid acmululation
  164. what can paricarditis be?
    • can effect great vessels
    • can be primary or 2ndary
    •    -w/ or w/o fluid acmululation
  165. cause of paricarditis
    • low cardiac output
    • low BP

    • usually 2ndary from myocarditis or endocarditis
    • chest trauma
    • after surgery (scarring)
    • malignent tumor
    • TB
    • uremia
    • connectiv tissue d/o (lupus, RA)
    • MI
    • scleraderma
  166.  acute paricarditis
    • intracellular leak into extracellular space
    •  --fluid can be serus, serasangius, etc
    • accumulation of fluid in paricardial space
  167. s/s paricardits
    • friction rub on L lower sternal border
    • chest pain radiats to L side
    •   -worsen w/ deep inspiration /lying/turning
    •   -releaved w/ foward leaning/sittin postn
    • mild fever
    • general malase
    • raised venus return
    • lower pulse sounds
    • dyspnia
    • heavy chest feeling

    can dev atrial fib & s/s of R sided hf
  168. labs for paricarditis
    elevated WBC, ESR, C reactive protein
  169. Dx of paricarditis
    • EKG, - concave ST / depressed PR seg
    • labs
    • echocardiogram -- look for pericardial effusion

    • may have elevated creatnin & BUN -->
    •             -uremia
    • CT/MRI -thickening of pericardium

                -higher kidney work load
  170. paricarditus Tx
    • periocardiosynthesis -often used as Dx tool
    •   -drain fluid from heart
    •  start w/ combo abx
    • IV abx 4-6wk --> PO 4-6 wk
    • lots of rest- decrease heart work load
    • NSAIDS (drink lots water)
    • BRP only during acute phase w/ lots of s/s
  171. nurse care for pericarditis
    • indepth HH (heart, fam,etc)
    • asses heart sounds
    •  -s/s HF
    • vitals
    • asses pain/discomfort / complications
    • look @ labs relate them to pt
    • know meds, etc
    • teaching
    • positioning for comfort
  172. cardiomyopathy
    • chronic
    • heart muscle enlargement
  173. 3 major types of cardiomyopathy
    • 1. dilated
    • 2.Hypertrophic
    • 3. Restrictive
  174. dialated cardiomyopathy
    •   most common
    • enlarged ventrical
  175. cause of dialted cardiomyopathy
    • heredity -Af Am
    • drug abuse
    • alcoholism
    • HIV
    • Vit B/ Zinc difficiency
  176. s/s of dialated cardiomyopathy
    • dyspnea on exercioin & laying down
    • easy tired
    • legs swell
    • chest pain
    • heart palpitation
  177. Hypertrophic cardiomyopathy
    • rare
    • autosomal
    • enlarged/rigid L ventricle wall
    • slow filling of blood
    • low/ slow blood flow
    • sudden death can occur

    • seen in young adults
    • autosomic

    often don't see s/s until after
  178. Hypertrophic cardiomyopathy s/s
    • several asymptomatic
    • syncapy
    • fatigue
    • SOB
    • chest pain
    • severe s/s after exercise
  179. Hypertrophic cardiomyopathy Tx
    • bata/calc channel blocker
    • for ventricular myopathy -surgery
    • for elarged L ventricle - remove excess tissue
    • replace damaged valve
  180. Restrictive cardiomyopathy
    • rarist   / least known
    • diastolic d/o
    • impair diastolic fillin
    • usually in pedi
    • restrict L ventricle
  181. Restrictive cardiomyopathy s/s
    • seem mor in tropical
    • dependent edema in leg
    • hepatomeglia -enlargement of liver
  182. Restrictive cardiomyopathy Tx
    • restric exercise
    • no vasodialters / digoxin --won't help
    • want increase in blood flow
    • may implant auto difibulator
  183. THromboflibitus
    • affects superficial veins
    • vein inflimation
    • clotting d/o where they clot too fast
  184. causes of thromboflibitus
    • smoking
    • prolonged bedrest
    • aging
    • surgery
    • contraception
    • IV insurtion/puncture
    •   trauma
    • always asses IV sites
  185. Homan sign
    • pain on dosoflexion of foot
    • -can break loos clot
    • not all have symp
  186. don't do if suspect DVT
    • homen sign
    • exercise
    • massage on affected side
  187. Dx of DVT
    • doppler
    • dye in vein
    •  -if clot -->color doesn't change report STAT

    • tool of choice -IPG sensor-type of doppler
    •    -can record extremty blood volume
  188. Tx DVT
    • relieve pain
    • moist heat
    • anticoag -as preventative if high risk for pulm embolism

    • best-bedrest
    • warm moist compress
  189. tx if high risk of pulm embolism
    • anticoag-preventative
    • very high risk-vena cava insert w/ filter
  190. thrombectomy
    • most dangerous
    • break up blood clot
  191. TPA
    • clott buster
    • followed w/ blood thiner
    • only done if less than 6hr dev

    • breaks clot down not disolve
    • can cause majorbleeding
    • assess cogulation-see ther affect of med
  192. Nurse assesement for DVT
    • report & docu critical labs ASAP
    • teach of meds/ food to avoid /
    •   don't cross legs
    • monitor diam
    • take VS
  193. Heart disease
    • major oclusive D/o
    • lots of problems
    • major blood vessels involved
    • othroscerosis & arterioscerois
    •   -usually get both/go together
    • vascular spasm
    • venous insefficiency
    • valvular d/o-contribute to perif vasc disease
  194. Cardiac endorectom
    • remove plaque from corotid artery
    •   -which is slowing blood flow to brain
    • do one side /time
    • will have arterial line / ICU

    • be very careful w/ BP
    •   -coninuous monitor of BP w/ in range
    • neuro checks post op as ordered
  195. what will be checked for any vascular surgery
    • circ
    • pulse
    • temp
  196. Vasc surgery types
    • embolectomy/thrombolectomy
    •  
    • vascularbypass graft
    •  
    • corotid endocardectomy
  197. vascularbypass graft
    -used for anurism repair
  198. embolectomy/thrombolectomy
    • - Emergency only 
    •  -remove blood clot 
    •  -very dangerous
  199. what happens in arterio/athroslerosis
    • hardening of arteries (rigid)
    • takes years to occur
    • usually occurs in conory artery
  200. arteriosclerosis
    • affects inner lining
    • narrowing blood flow
    • due to fat
  201. athroslerosis
    • affects lumen
    • plaque forms on areteriol wall -atheroma
  202. causes of arterio/athro sclerosis
    • certai lesions
    • fatty streaks- kind of lesion
    • firious plaque-chol & cologen buld up
    • complicated lesion- really large /calcified place

    hyperlipidemia-build up in blood trigers athro scerosi
  203. causes of hyperlipidemia
    • obeisty
    • HTN
    • smoking
    • lack exercis
    • increas homsistrin

    highr risk higher iron levl
  204. s/s of arth/arterio sclerosis
    • lower extrem ities cool to touc
    • hwk puls
    • bright red extremities
    • chest pain
    • dizzy
    •  paler
    • bright red extremities
    • poor cirulan
    • lower extrem ities cool to touch
    • wk puls
  205. Dx of arth/arterio sclerosi
    • monitor blod lipid
    • often do r/o test
  206. tx of arth/arteriosclerosis
    • mediterainian diet -low fat
    • exercise
    • stop smoking

    • meds
    • statin/ lipid lowering
  207. arth/arteriosclerosis meds
    • statin
    •  lipid lowering
    • -lots s/e
    •    -chk liver enzymes Q6 mo
    •   -can damage liver
    •  
  208. CAD
    • men  more risk
    • w/serious event get major blockage
    • if tissue damage --helps to Dx MI
  209. causes of CAD
    • stress
    • genetics
    • post menopaus
    • HTN

    high risk -wt male
  210. s/s of CAD
    • classic --crest pain w/ exersion
    • sudden pain/prssure over hrt (preload pain)
    • pai understernom

    • indigestn
    • heartburn
    • high lipid
  211. Tx of CAD
    • PCTA
    • balloon angeioplasty
    • cardio stent
    • athrectomy-
    •  -  done under card cath
  212. trans miocardial revasulation
    • gt more blood flow to heart
    • improves blood flow to myocardium
    • paliative tx
    • is laser precedure
    • only for high risk groups that can't get CABG
  213. nurse care for cardiac surg pt
    • w/ corinary pt-assess what makes pain worse
    • w/ CAD pt- O2 as ordered
    • lots of teaching on pt w/ high risk factor
    • teach any s/e fo meds
  214. CABG SURG NURSING CARE
    bleeding big post CABG prob-get infection
  215. cardiac post op to report ASAP
    • sever sudden chest pain
    • abn heart rate
    • palputaion
    • pt becomes mentally confused/
    • hypotension
    • loos LOC
    • below <30ml/hr output
  216. CABG
    • done for large area occlusion
    • can revascularize myocardium
    • use synthetic prepared material for graft
    •  most used-major sofas vein
    • Iput on pulm bipass macine
  217. what will pt have during open heart surg
    • lots drains
    • chest tubes
    • vents
    • blood-preferably own
  218. what do you want for open hearrt surg

    how
    it to be bloodless

    cardiopulm bypass machine
  219. s/s of angina
    • chest pain in center
    • vise like pain
    • heavy tight feeling
    • pale
    • dyfertic


    worry of thrombosus
  220. angina
    • usual acompany MI
    • more pain w/ exersion
    • vasodiolator often release pain
    •   -sublin nitro
  221. trigger for angina
    • underlying prob
    • anything that increases heart workload
  222. types of angina
    • unstable
    • prinzmal's (varient)
    • stable
    • Silent ischemia
  223. Silent ischemia
    Objective evidence of ischemia, but pt reportsno pain
  224. objective of the management of angina
    decrease the O2 demand of the myocardium increase the O2 supply
  225. anti-platelet meds
    • Aspirin
    • Plavix
  226. Dx of angina
    • give nitro,
    • EKG,
    • stress test
    • >/=4hr holter mon
    • radioactive image
  227. increase EKG st seg
    damage
  228. angina meds
    • nitroglyc
    • beta blockers -slow hr
    • low dose ASA-thin blood prevent clots
    • atenelol
    •  -not for pt w/ asthma
    • calcium channel blockers-relax major musles
  229.  nitroglycerine
    • discard 6 mo after opening
    • can take 3 X wait 5 min each
    • if pain last more than 15 min -call DR
  230. angina diet
    • low cal
    •   sodium
    •   chol
  231. MI
    • partial or complet
    • can occur @ differant planes
    • anterior MI-- afct antr wl & mycardium
    • inferior MI-affects SA & VA node elec disturb
    • lateral wall
    • - all result in lack of O2 to myocard
  232. groups most often w/ MI
    • males >45
    • females smoke
  233. classic s/s of MI
    • crushing substernal chest pain
    • pain radiates to L side back/arm/jaw
  234. s/s of MI
    • SOB,
    • Indigestion,
    • N/V,
    • Dyspnea,
    • pallor
    • ,dyspnea,
    • fever,
    • Anxiety
  235. MI Ischemia for more than 35-45 mins
    irreversable damage
  236. Mi lasting longer than 35-45 min makes
    irreversible damage & necrosis
  237. Dx of MI
    • echocard
    • EKG -enlarged Q wave-necrosis
    •         elevated ST
    •         inverted Twave
    • serum myoglobin
    • CK
    • serum T3 &T1
    • magnesium lvel
    • lipid
    • pt/ptt
    • elevated WBC -start w/in hrs of MI
    •   lasts 3-5 days
  238. MI meds
    • aspirin,
    • nitroglycerin,
    • morphine -bolus
    • IV betablockersAce inhibitors are also used to decrease BP
    • cardiac lidicaine-a main drug
    • antiemetic/anxiety
    • stool sofner
  239. Tx for MI
    • bedrest w/ BRP
    • Swan Ganz catheter in heart to measure pressure
  240. MI diet
    • low sodium
    • fat/chol
  241. MI tx for severly damaged L ventric
    • intra aortic ballon pump
    •   -last resort
    •   -Increase heart wrk ld
  242. types aneurysm
    • abdom aortic - size usul increase w/ age
    • fsiform-dialated cir of artery
    • sacular-bulging on one side of artery
    • assecting
  243. s/s aneurysm
    • back flank pain
    • abd pain
    • pulsating in abd
    • s/s of shock
  244. dx of anerysm
    • cat scan of chest
    • aortigram
  245. tx aneurysm
    • decrease Bp
    • surg-bypass graft

    post op-maintain low BP- if high blow graft
  246. pre/post op aneurysm Teach
    • maintain arteriol line
    • no heavy lifting
  247. CHF
    • hrt fails as pump
    • blood not pumping through syst

    • worry about
    • inadeq tissue effusion/cardiac insuf
  248. CHF can be related to
     r&l sided failure
  249. causes of chf
    • low ventriculer function
    • MI
    • CAD
    • cardiomyopathy
    • prolapsed mitro valve
    • aortic insuff
    • athroslerosis
    • unreleave pulm edema -from blood backup
  250. s/s of L side HF
    • early
    • dyspnea
    • orthopnea
    • apnea
    • nypernia
    • dry hacking cough
    • w/fluid build up
    • blood tinged frothy sputum
  251. prob w/ L sided HF
    electolyte imbalance
  252. s/s r side HF
    • edema of the lower extremities (dependent edema),
    • hepatomegaly
    • ascites
    • anorexia,
    • nausea,
    • weakness
    • weight gain
  253. CHF meds
    • ACE inhibitors,
    • beta-blockers,
    • diuretics
    • digitalis
  254. when hold digoxin
    when <60 bpm
  255. s/s pulm edema

    Tx
    • crackls
    • cough up frothy sometims pink tinged sputum
    • wheezin

    • high fowlers
    • iv fl
  256. chronic HF
    • nocternal dyspnea
    • teach not to la flat
    • asses: cough crackles wheez/tachy
  257. cardiac dysrhythmia
    disruption of hr, rhyth or both
  258. cardiac rhythms
    • NSR
    • bradycard
    • tachycard
    • dysrhythmia
    • heart flutter
    • premature complex
    • heart block
    • fiberation
  259. types of dysrhythmia
    • brady <60
    • sinus
  260. sinus tachy
    • >100 -180-adult
    • constant regular rhthm

    • chest pain dizzy , chest flutter,
    • med:calc chanel & beta block
  261. ventrical dysrthy
    most common dysrthy

    •  EKG compensuray pause
    • lidocane IV bolus
  262. ventric fib
    ventricls not contracting are quivering
  263. Heart block
    • impulse fires but not get through
    • look at PR interval
    • AV blocks
    • impulse
  264. degrees of heart block
    • 1st -asymp
    • 2nd type 1  -all but 1 inpulse get through
    •             -AV impulse take longer
    • 2nd type 2 - only some impluse get through
    • 3rd no AV impulse get through 
    •   -complete heart block
  265. pace maker
    • when cardiac impulse don't work properly
    • not enough blood

    • insertion
    • transtherasic-ER us large bore needl
    • internal
  266. implanted difib
    • cell phone 6ft away
    • battery last 7yr
  267. HTN
    • 140/90 -sustained
    • often asympt
    • sodium plays major role
    • heart strained

    kidney need to be well perfused to maintaing BP
  268. HTN as bp goes up
    • pounding ha
    • blurred vision
    • insomnia
    • bounding pulse
    • flushed
    • rupured vessels

    • retinal hemerage
    • papula dema
  269. Dx of HTN
    • ekg
    • up BUN, creatnin
  270. HTN stages
    • 1- systol 140-159 diastol 90-99
    • 2-systol >/=160 or diastol >/= 100
  271. What will happen when mucosa starts to break down?
    Will develop ulcers
  272. Dx tests for GI
    • x-ray
    • upper lower gi tract study
    • lab  CBC, etc
    • breath test (for carbohydrates absorption.)stool test
    • EGD
    • gastric analysisa
    • bdominal ultrasound
    • Barrium
    • DNA
    • gastric analysis
    • MRI’s.
  273. Lab studies for GI
    • CBC – look for infection, or bleeding
    • CEA – a type of marker (19-9) for type of cancers
    • CMP
    • PT/PTT/INR
    • Livr function-
  274. GI stool teststypes of studies
    • look for abn stools esp in  loose stools
    • Closridium difficile
    • fecal leukocytes
    • calcultation of stool
  275. should be avooided 72 hrs prior blood occult blood test
    • hemorrhidal bleeding
    • red meats -3days prior
    • aspirin
    • NSAIDS
    • turnips/horesradish
  276. ABD ultrasound
    • .detect enlareged gallbladder/pancreas
    • .presence of gallstones
    • .elarged ovary
    • .appendicities
    • .Dx acute colonic diverticulits
  277. ORIF
    they make an incision and screw a pin/wire into boneto hold it into place
  278. gastritis
    inflam of stomac lining
  279. atropic gastritis
    all stomac layers involved can lead to CA & ulcer

    oftn seen in kidney failure
  280. chronic gastritis
    gi bleeding --> hemeraging

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