med surg

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cassiekay10
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227464
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med surg
Updated:
2013-07-17 23:03:01
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cardio
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cardio
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  1. heart layers and chambers
    • epi-, myo-, endo- cardium.
    • upper - atrium
    • lower - ventricle
  2. coronary arteries
    supply bld to hrt muscle
  3. vena cava
    bld comes in R side via sup/inf vena cava
  4. pulm veins
    bld enters L atrium bringing oxygenated bld from lungs
  5. pulm arteries
    bld leaves hrt and travels to lungs thru pulm art.
  6. aorta
    o2 bld leaves L vent and travels to bd thru ascend & descend aorta
  7. atrioventricular valves
    • seperate atria from ventricles
    • tricuspid (bw R atrium and R vent)
    • bicuspid (bw L atrium and L vent)
  8. semilunar valves
    • pumonic - seperates R vent from pulm art.
    • aortic - sep. L vent from aorta
  9. bone marrow
    spongy center where RBC and plates are made
  10. liver
    urq - manufactures clotting factors and clears old, damaged cells
  11. spleen
    ulq - removes old RBCs
  12. blood
    mixture of rbcs, plates, clotting factors, plasma, wbcs, proteins, lytes, hormones, and enzymes
  13. normal amnt of bld
    6 L
  14. rbcs
    • made in bone marrow
    • transport o2 from lungs to tis and co2 from tis to lungs
    • 120 days
  15. platelets
    • made in marrow
    • activate clotting system by forming platelet plug 
    • 10 days
  16. clotting factors
    • activated c plates
    • form stable fibrin matrix over wound
  17. plasma
    clear, straw colored fluid, carries rbcs, plates, and clot factors
  18. leukocyte formation site
    red bone marrow, lymph tis, thymus, spleen
  19. leukocytes function
    combat infection
  20. wbc values
    5-10 K
  21. rbc formation site
    red bone marrow
  22. rbc function
    carries gases
  23. rbc values
    • female 4.2-5.4
    • male 4.7 - 6.1 million
  24. 3 granulocytes
    • neutrophils
    • eosinophils
    • basophils
  25. neutrophil
    • ingest bact & dispose of dead tis via phagocytosis. releases lysozyme (enzyme destroys bact)
    • 7 hour lifespan  c 6 day supply in marrow
  26. eosinophils
    active in allergic reactions and parasitic infections
  27. basophiles
    stimulated by antigens/tis injury releasing granules of histamine and heparin. active in inflammatory allergic reactions
  28. hypochromic
    lacks color
  29. hyperchromic
    intense color rbcs
  30. hemoglobin
    complex protein-iron compound, gases are transported
  31. hemoglobin values
    • f: 12-16 g
    • m: 14-18 g
  32. hemoglobin in lungs
    combines w o2 = oxyhemoglobin
  33. hemoglobin in cells
    combines w co2 = carbonhemoglobin
  34. hemotocrit
    • % of solid to liquid
    • % bld cells to plasma
  35. hematocrit values
    • f: 37-47 %
    • m: 42-52 %
  36. elevated hematocrit
    dehydration and polycythemia
  37. low hematocrit
    anemia
  38. bone marrow aspiration sites
    sternum and iliac crest, tibia
  39. bone marrow aspiration examined for
    type, #, and maturity of cells
  40. pt position bone marrow aspiration
    • sternal = supine
    • iliac = lateral/prone
  41. nsg care bone marrow asp
    • 1. explain and answer Qs
    • 2. open tray and cleanse skin
    • 3. anesth site and insert needle
    • 4. aspirate and hold pressure 5-10 min
    • 5. bandaid and check q 15 min x 1 Hr
    • 6. specimen labeled container and sent to lab
  42. bone marrow aspiration 
    pressure to site c thrombocytopenia
    up to 15 mins
  43. pernicious anemia
    • lack of intrinsic factor/cabolamin deficiency 
    • gastric secretion of intrinsic factor defective
    • which is required EXTRINSIC b12 to be absorbed in distal ileum
  44. b12 is needed for 
    and rda
    • rbc maturity
    • 2-4 mcg
  45. b12 found in
    organ meat, seafood, eggs, and dairy
  46. anemia affected older adults commonly
    perniscious
  47. anemia occurs after gastrecomy, sml bowel resection, and crohns
    pernicious
  48. Diagnosing pernicious
    Schillings test; s/s; wkness, sore tongue, numb hands/feet
  49. TX pernicous
    • b12 injected wkly
    • then bi-wkly
    • then monthly
  50. sickle cell anemia
    family of genetic disorders caused by abnormal properties where rbcs are deformed
  51. rbcs in sickle cell
    disc shape due to oxygenation, incr in viscosity of bld = stuck in sml caps obstructing blood flow
  52. s/s sickle cell
    persistant low rbc count, fatigue, jaundice, enlarged heart, severe pain w crisis
  53. sickle cell crisis
    severe pain
  54. dx of sickle cell
    screening for HgbS, bld cells seperated to determine if disease or trait
  55. inheriting disease or trait
    sickle cell
    • must have gene from ea parent to have dis
    • one parent = trait
    • trait can be passed to children as recessive gene
  56. sickling of rbcs triggered by
    infection, dehydration, overexertion, cold weather, alcohol, smoking, and stress
  57. sickling causes
    • 1. incr visc of bld = venous stasis 
    • 2. vs leads to occlusion of sml bld vessels
    • 3. venous occlusion leads to peripheral edema and pain r/t hypoxia
    • 4. severe prolonged hypoxia = infarction
  58. bd parts involved in sickle cell
    jnts, bn marrow, brain, and penis
  59. sickle cell complication 
    children under 2
    • hand-foot syndrome
    • edema
  60. TX sickle cell
    • palliative to alleviate symp
    • dehydration = hydrate
    • pain = anal
    • hypoxia = o2
  61. sickle cell teaching
    • genetic counseling
    • s/s infections and how to treat them
  62. iron deficiency
    results from low iron diet/bd not absorbing enough iron essential for rbc production
  63. s/s iron def
    fatigue, pallor, orthostatic changes, exertional dyspnea, brittle spoon nails, smooth shiny tongue, cheilosis
  64. daily iron requirement
    • m 10 mg
    • f 15 mg
  65. iron sources
    liver, oysters, red meat, fish, dried fruit, leguems, dark grn veg, iron enriched whole grain bread/cereal
  66. iron def enemia
    ferrous sulfate
    • taken orally 
    • irritates stomach
    • take c oj/vit c
  67. ferrous sulfate s/e
    • stools black and tarry
    • report nausea and diarrhea to md
  68. imferon
    iron dextrose
    • im medication 
    • Z track
    • stains skin
  69. iron def anemia 
    adequate diet for
    • formation rbcs
    • vit c
    • folic acid
  70. autoimmune hemolytic
    • bone marrow makes adequate amounts of rbcs but when released to circulation, it is dissolved
    • causes infections and cancer
    • rbc life span shortened
  71. how newborns acquire autoimmune hemolytic anemia
    • Rh factor
    • mom -, baby +
  72. DX autoimmune hemolytic
    • id cause and source of bld loss
    • replacement of bld vol to prevent shock
  73. s/s autoimmune hemolytic
    • pallor, jaundice, extreme fatigue, tachy, sob, htn
    • will see ↑ bilirubin levels from rbc brkdwn and pos result on direct COOMBS test
  74. tx autoimmne hemolytic
    bld transfusions and corticosteroids
  75. aplastic
    • one of most severe
    • congenital/acquired life threatening
    • all bld cells reduced, depletion of rbc, wbc, and plates.
  76. s/s aplastic
    • develop gradually
    • pallor, fatigue, tachy, palp, spont blding, freq infections
  77. dx aplastic
    hx, s/s, bone marrow biopsy
  78. tx aplastic
    transfuse elements deficient, eliminate case, corticosteroids, treat infections and blding tendencies, bone marrow transplant
  79. leukemia types
    • acute/chronic
    • myelogenous and lymphocytic
  80. leukemia controlled w
    • oral chemo
    • gleevec targets leuk cells and spares normal
  81. leukemia wbc level precaution
    can skyrocket in days crowding normal cells and leaves pt at severe risk for infection and blding. chemo must start immediately
  82. s/s leukemia
    ↓ rbc
  83. tx leukemia
    • chemo at high doses during induction therapy
    • then maintenance therapy for 1-3 days
  84. polycythemia vera
    • too many rbc produced
    • causes ↑ bld visc and vol
  85. s/s polycythemia
    htn, incr visc and vol, ruddy (red) complexion, cva
  86. dx polycythemia
    s/s and labs
  87. rx polycythemia
    phlebotomy of 1 unit of bld
  88. thrombocytopenia
    • lower than norm # circulating platelets
    • causes ↓ production, ↑ destruction, leuk, severe chronic infection
  89. major signs of thrombocytopenia
    • petechia, ecchymoses, purpura
    • HX of menorrhagia, epitaxis, gingival blding
  90. dx thrombocytopenia
    bleeding/coagulation test
  91. rx thrombocytopenia
    eliminate cause, corticosteroids, transfuse plates, spleenectomy, blding tendency @ 60K count, spontaneous hemorrhage at 20K
  92. hemophilia
    gen bld dis caused by defective coagulation factors a and b
  93. hemophilia a
    • factor 8 missing most common
    • considered disease in children
  94. hemophilia b
    • factor 9 missing. 
    • carried on x chromosome, women carry trait and pass on to sons whom manifest disease.
  95. dx hemophilia
    hx, lab
  96. s/s hemophilia
    uncontrolled bleeding
  97. rx hemophilia
    transfusion of clotting factor, bld, prevention of trauma
  98. cardiac cath
    pt prep
    • 1. informed consent
    • 2. ask allergies
    • 3. meals witheld
    • 4. mild sedation
    • 5. antibiotic before
    • 6. assess peripheral pulses
  99. cardiac cath 
    post op
    • 1. vs q 15 min x 1 hr, then q 30 mins x 2 hr, then q 4 hrs
    • 2. check pulses distal to insertion site
    • 3. bedrest 3-4 hours
    • 4. check for blding, edema, inflamm, tenderness, hematoma formation
    • 5. observe for hypotension & complications (Vfib)
    • 6. monitor renal status and i&o
  100. compensated chf
    c meds/bds regulatory measures heart able to meet bd needs
  101. decompensated chf
    even on meds heart unable to meet bd needs; s/s evident
  102. right sided chf
    r ventricle fails and fluid backs up into systemic vessels and bc of decr cap pressure, fluid develops in tis/organs = enlarged liver, ascites, peripheral dependant edema
  103. Left sided chf
    l vent fails and fluid backs up into pulm ves and bc of low pressure in caps, fluid develops in lungs = crackles
  104. goal/tx of chf
    • decr workload on heart and incr ventricular output
    • freq rest, low na diet, fluid restrictions, o2 therapy, manage htn, correct dysrythemias
  105. digoxin action
    • incr force of myocardial contractions
    • incr co
    • lower bld vol
    • decr cardiac output
  106. dig indications
    tx of chf, afib, atrial flutter, atrial tachy
  107. tox s/s dig
    anorexia, n/v, ha, drowsy, hallucinations, hypotension, brady, yellow vision, fatigue, halo light

    most common cause hypokalemia
  108. dig contraindicated in
    vent fib, vent tachy
  109. dig nsg care
    • ap less than 60 - hold med and recheck 1 hr
    • still less than 60 - call md
    • monitor lytes, renal and liver function test, daily wt, i&o, monitor dig level, assess pt s/s tox (hold until sympt subside and reduce dose)
  110. vasodilators
    incr emptying L vent = improves co by decr peripheral resistance = improved renal flow = incr renal output = decr bld vol = decr cardiac workload - dilates arteries and decr bp
  111. nitrates vasodilators
    nitroglycerin, isordil, isorbid, imdur, ismo, monoket
  112. vasodilator ace inhibitor
    capoten, vasotec, prinivil, zestril, lotensin, accupril, alrace
  113. beta adrenergic blocking agents
    vasodilators
    coreg, corgard, atenolol, lopressor, inderal
  114. ca channel blockers
    vasodilators
    novasc, cadicon
  115. diuretics
    • mobilize edematous fluid and reduce pulm ven pressure
    • if excess fluid is exerted = bld vol returning to heart is decr = cardiac output incr
    • act on kidnets by promoting excretion na and water
  116. diuretics
    first choice med chronic chf
    thiazide
  117. loop diuretics
    • lasix, bumex
    • act on ascend loop of henle to promote excretion of na, cl, and water
  118. diuretics
    most common for acute chf
    lasix
  119. diuretics precaution
    watch for s/s hyponatremia and hypokalemia
  120. diuretics
    k sparing
    aldactone and dyrenium

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