Com t 3

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  1. What is metabolic syndrome
    • a cluster of conditions which occur together and increase your chances of having heart disease, stroke, and diabetes—
    • increased blood pressure
    • high blood sugar
    • excess body fat around the waist
    • abnormal cholesterol or triglyceride levels
  2. AAA S/S
    • *Abdominal Aortic Aneurysm
    • Pain is in back or abd
    • May palpate pulsatile mass
    • only 40% have sx
    • Loss of voice/dysphagia
  3. Cellulitis s/s
    • pain/swelling
    • fever/chills
    • redness
    • *usually have hx of venous insufficiency
    • ex: MRSA
  4. DVT s/s
    • calf swelling
    • redness
    • pain in calf
    • *positive Homan sign (may not be accurate, if +, use doppler to double check)
  5. DVT tx
    • Coumadin - (INR btwn 2-3) (normal is 1)
    • bedrest
    • elevate affected limb
    • compression stockings (graduated
    • warm moist packs (avoid drying skin)
  6. PAD assessment
    • *Peripheral Artery Disease
    • Peripheral pulses unequal btwn extremities, may need to assess with doppler
    • Ankle/brachial index (Ankle systolic/brachial sys ratio)
    • Intermittent claudication - sx of atherosclerosis and PAD, aching pain relieved at rest
  7. Raynauds Nursing Dx
    • Ineffective tissue perfusion
    • *recall this is arterial issue, episodic vasospasm of peripheral arteries.
    • results in numbness, tingling and burning pain in cold temps
    • doesn't cause irreversible tissue injury
    • is benign
  8. Venous assessment strategies
    • CRP = C-reactive protein is lab test that is sensitive marker of vascular inflammation
    • Also use Duplex untrasonography
  9. Venous leg ulcers nursing care
    • Promote adequate nutrition: high protein diet, vitamins, calcium, iron and zinc
    • Positioning-elevate legs
    • *Protein is building blocks for healing, will also get fluid back into venous system
  10. BP reading procedure:
    • Check BP after pt has rested for at least 5 mins
    • (*30 mins after cigarettes or caffeine)
    • Forearm supported at heart level on firm surface, feet on ground
    • Correct cuff size
    • May need to check frequently if unstable, until stable
  11. Health promotion for hypertension
    • Exercise
    • smoking cessation
    • Weight loss
    • low sodium, low fat diet

    Blood lipid panels yearly
  12. DASH diet
    • Dietary approach to stop HTN
    • 1500 mg sodium
    • whole grain 6-8 servings
    • fish/dairy instead of red
    • legumes, nuts, seeds, 
    • F/V 4-5 servings
  13. Hypertensive crisis goals
    • Decrease MAP (Mean Arterial Pressure) 20-25% in first hour, BUT don't bring down too fast
    • To 160/100 over 6 hrs
  14. hypertensive treatment
    • Get pt involved:
    • monitor bp
    • medications: ABCD (*Ace inhibitors, Beta blockers, Calcium channel blockers, and Diuretic) 
    • Teach about fall risk/ortho hypotension
    • Watch for hydration w/ diuretic
    • may need to check K+ (can cause dysrhythmias)
  15. Hypertension risk factors
    • (11)
    • Hispanics and african am.
    • Obesity 
    • diabetics
    • Age (change in circulatory system)
    • Dyslipidemia
    • Increased salt
    • Other CV issues (CVA, CAD, CHF)
    • Smoking (doesn't increase BP, but smoking w/ HTN increases risk for dying)
    • Metabolic syndrome
    • Sedentary lifestyle
    • OSA (Obstructive Sleep Apnea)
  16. Stages of hypertension
    • Normal <120/80
    • Pre  120-129/80-89
    • Stage 1  140-159/90-99
    • Stage 2  > or = 160/100
    • Goal 104/90 or lower
  17. Sequelae of hypertenstion
    • *condition that is consequence of previous disease or injury
    • retinal blood vessel damage (blurred vision, decreased visual acuity)
    • CVA
    • Renal failure
    • Heart disease
  18. ACS assessment priority
    • *Acute coronary syndrome
    • 12 Lead EKG
  19. ACS medical treatment
    • *the coronary artery is not completely occluded, so pt will have MI is not treated promptly
    • Bedrest
    • MONA (Morphine, O2, Nitro, ASA)
  20. ACS nursing care
    • Goal is to balance myocardial O2 supply with demand
    • treat as an acute coronary episode
  21. ACS signs/symptoms
    • Unstable angina
    • cold, clammy skin
    • dyspnea
    • fatigue
    • cyanosis
  22. Angina assessment
    • Important to ask "What precipitates it?"
    • Physical exertion precipitates an attack
    • EKG T-wave shows inversion
  23. Angina Nursing Dx
    Ineffective impaired cardiac tissue perfusion
  24. Desired goal for cholesterol levels
    • LDL = less than 100
    • Total = less than 200
    • HDL = greater than 40 in males, 50 in females
    • Triglyceride = less than 150
  25. Health promotion and cholesterol control
    • manage cholesterol, diabetes, HTN
    • tobacco cessation
    • Metabolic syndrome
  26. MI pathophysiology
    • Complete occlusion of artery leading to ischemia and necrosis
    • Cells are deprived of O2, causing ischemia, cellular injury, and eventually death of cell
  27. Risk factors for MI
    • obesity
    • race
    • family hx
    • smoking
    • HTN
    • Diabetes
    • Age
    • cholesterol levels
    • metabolic syndrome
  28. Medications for Heart Failure
    • ABCDD:
    • Ace Inhibitors
    • Beta Blockers
    • Cessation of Smoking
    • Diuretics
    • Digoxin
  29. Ace inhibitors
    • slow progression of HF by decreasing workload of heart and improving ventricular emptying
    • SE: cough, hypotension, alter renal function and hyperkalemia
  30. Beta blockers:
    • decrease afterload, affecting both systolic and diastolic HF
    • SE: decreased HR, dizziness, fatigue, hypotension, depression
  31. SE of diuretics
    hypokalemia, dizziness, nocturia
  32. Digoxin
    • increases force of contraction
    • SE: lowers HR, visual disturbance, confusion, anorexia
    • *with hypokalemia, effect of dig is enhanced so risk of toxicity
  33. Nursing Dx for HF
    • Ineffective tissue perfusion
    • decreased cardiac output
    • excess fluid volume
    • acute pain
    • ineffective breathing pattern
  34. Pulmonary edema nursing care
    • STAY WITH PT
    • Sit them up in high fowler's, let legs dangle over side of bed
    • Simple concise infomation
    • monitor urine output
  35. Sequalae risk factors for HF
    • PPICCS
    • Cardiogenic shock - hrt can't pump enuf to meet body's needs
    • Cardiac tamponade - fluid in pericardial sac
    • Intracardiac thrombus - Blood swirling around and creates clot
    • sudden death - duh
    • Pericardial effusion - lower sys press during inspiration (pulus paradoxus)
    • Pulmonary edema - productive cough w pink tinged sputum, SOB, cyanosis, crackles
  36. Right sided heart failure, S/s
    • Right side isn't pumping and blood is backing up into the body
    • S/S: JVD, edema, Ascites, weight gain, fatigue, anorexia, complains of GI distress
  37. Left sided Heart failure, S/S
    • Blood backs up into lungs
    • Crackles heard in lungs
    • dyspnea on exertion
    • SOB
    • Orthopena
    • CONFUSION
    • Pulmonary sx
  38. Pt education for Coronary and Heart Failure
    • MAWDS
    • Meds: must continue, maybe rest of life
    • Activity: daily, avoid hot/cold extremes
    • Weight: daily, report > 2-3 lb/day or 5 lb wk
    • Diet: 2 gm sodium, avoid excess fluids
    • Symptoms: ortho hypto
    • *Recognize s/s of worsening HF: unusual SOB, swelling, increase pillows to sleep, profound fatigue
  39. Anaphylaxis lab value assessment
    • Eosinophils will be high (nor 1-4%)
    • Basophils may be high? (Nor 0-0.75%)
    • Serum tryptase levels 
    • Histamine
  40. Anaphylaxis teaching
    • Carry epi-pen at all times
    • Epinephrine helps prevent release of more histamines, prostaglandins, leukotrines and further progression of reaction
  41. Dermatitis:
    Atopic vs contact
    Atopic: severe itching, raw skin, small raised bumps, red scaly patches (TYPE 1)

    Contact:  red rash, bump that drain fluids, crusting, itching swelling (TYPE 4)
  42. Fibromyalgia teaching (what is it)
    • Chronic form of muscle pain, many factors that can cause it
    • Pain is caused by overstimulation of CNS
    • Need to limit caffeine and nicotine
    • get reg sleep schedule
  43. Fibromyalgia outcomes
    • Manage pain
    • rest to maximize function 
    • maintain ADL's
    • increase strength
    • deconditioning exercises, PT
  44. Food allergy teaching
    • Child may grow out of allergies
    • Can do food testing
    • Try to find allergens by taking away foods or adding foods to test
  45. Immunotherapy indications
    • People qualify after pharmacotherapy and avoidance therapy has been tried
    • Must be around allergens you can't avoid
  46. RA exercise goals
    • increase function by performing exercises with ROM
    • Do whatever to prevent deformities
  47. RA med Tx
    • no cure
    • physical therapy & meds can help slow progression
    • Severe cases can be managed w antirheumatic drugs (DMARDS)
  48. RA nursing care/home assessment
    • Manage pain
    • Maintain/increase strength and function
    • home assessment to determine probs with level of ability
    • assistive devices and equip
  49. RA patho
    • immune complex forms when antigens bind to antibodies 
    • This is then deposited in tissues or vascular endothelium
  50. RA treatment
    • PT
    • Assistive devices
    • NSAIDS
    • DMARD (Disease-Modifying Antirheumatic Drugs)
    • methotrexate
    • Sulfasalazine

    heat
  51. Scleroderma
    • *This is a hardening of connective tissue, inside the sclera. Can affect skin, but on inside affects vessels. etc. 
    • Affects L ventricle of heart, resulting in HF
    • Progressive kidney failure
    • Digestive disturbances, hardening of intestinal mucosa
    • Esophagus hardens = dysphagia
    • Lungs harden & impede respiration
  52. SLE s/s
    • *Systemic Lupus Erythematosus
    • Fatigue
    • "butterfly" rash over nose
    • alopecia
    • fever
    • muscle pain
  53. Types of hypersensitivity reactions
    • Anaphylactic (Type 1)
    • AntiBody mediated (Type 2)
    • ImmuneComplex (Type 3)
    • Delayed (Type 4)

    *Remember, types 1-3 are Antibody Mediated! Type 4 is Cell mediated!!!
  54. Type 1 Hypersensitivity reactions
    • Allergic, Anaphylaxis & Atopy:
    • Mast cells release large amts of histamine 
    • Stridor, angioedema, Hypotension, Hives
  55. Examples of type 1 hypersensitivity reactions
    • atopic dermatitis
    • allergic rhinitis
    • extrinsic asthma
    • insect stings
  56. Type 2 Hypersensitivity reactions
    • Antibody is where is shouldn't be
    • Occurs when IgG or IgM antibody bind to an antigen, leads to cell and tissue damage
    • *mistaken identity*
  57. Examples of type 2 hypersensitivity reactions
    • Goodpasture syndrome
    • Graves disease
    • Rheumatic Fever
    • Transfusion reaction
    • Hemolytic anemia
    • Myathenia Gravis

    "That's a GOOD PASTURE for all the GRAVES. After RHEUMATIC FEVER swept threw, the blood TRANSFUSIONs caused HEMOLYTIC ANEMIA. Oh MY THE GRAVES!"
  58. Type 3 hypersensitivity
    immune complex formes when antigens bind to antibodies and are deposited in tissues
  59. type 3 hypersensitivity examples
    • lupus
    • RA
    • farmers lung
    • serum sickness
  60. Type 4 hypersensitivity
    • Occurs 1-3 days after exposure
    • mediated by sensitized Tcells
    • Macrophages stimulated and work overtime
    • s/s: itching, erythema and raised lesions
  61. Type 4 hypersensitivity examples
    • contact dermatitis
    • MS 
    • Type 1 diabetes
    • PPD test
    • Graft vs host disease
  62. Amputation complications prevention
    • Apply tourniquet for hemorrhaging
    • Aseptic technique in wound care
    • Control edema with rigid or soft compression dressing
    • Dont put on pillow-cause flexion and contracture of hip
    • Turn side to side
  63. Amputation rehab goals
    • Self care goals: Increase level of function & participation, positive attitude
    • Assistive devices - depends on pt condition, balance & weight bearing status
  64. Amputation phantom pain
    • Pain perceived in amputated section may last for a year
    • 60-80% of pt experience soon after surgery
    • Acknowledge feelings as real
    • Encourage to verbalize
    • Strong Opioids!
    • Beta blocker may relieve dull, burning discomfort
    • Antiseizure meds for stabbing and cramping pain
  65. Back strain education
    • Use quadriceps and thighs for lifting
    • Avoid lifting more than 1/3 of weight w/o help
    • Lift objects close to body with smooth motion
    • Body mechanics and posture
    • exercise program
  66. Foot surgery assistive devices
    • Depends on pt condition, balance and weight bearing status
    • Pt usually decides on type
    • Increases level of function
  67. Foot surgery care
    • Extremely painful
    • Keep elevated to help with pain and keep edema out of foot
  68. Fractured hip complication/prevention
    • Complications:
    • Avascular necrosis (fracture damages vascular system
    • DVT's (prevention = hydration & mobility)
  69. Gout teaching
    • caused by hyperuricemia (excess uric acid)
    • Avoid foods with uric acid
  70. Hip fracture positioning
    Use pillow btwn legs to prevent adduction
  71. Long bone fracture care plan
    • Immobilize in proper alignment
    • Control edema - elevation/ice
    • Monitor neurovascular status (circ, motion, sensation)
    • Treat for shock
  72. Long bone fracture complication
    • Shock
    • Fat embolism - enter bloodstream, occurs 24-72 hrs after. Chest pain, tachycardia, tachypnea, coughing, hypoxia
    • Tx is supportive (intubation, fluids, monitoring)
  73. Osteomyelitis prevention in DM
    Footcare in diabetes
  74. Osteomyelitis teaching
    • dental procedures or invasive procedures should get prophylactic antibiotics... everytime, forever!
    • Postpone elective surgery if current infection
    • Discontinue catheters and drains ASAP
  75. Septic arthritis tx
    • Prompt!!
    • IV antibiotics
    • Support and immobilize joint
    • analgesic agents
  76. Sprain vs strain
    Strain is muscle or tendon, caused by overuse

    Sprain is ligaments or tendons surrounding joint, caused by twisting or hyperextension
  77. Sprain education
    • 3rd degree may need surgery, splint, brace or cast
    • RICE = rest, ice, compression, elevation
    • After 72 hrs heat may be applied intermittently
  78. Strain types
    1st, 2nd, and 3rd degree
  79. 1st degree strain
    • involved tearing of a few muscle fibers
    • minor edema and tenderness
    • No loss of function
  80. 2nd degree of strain
    • partial tearing of muscle or tendon
    • Loss of strength
    • edema
    • tenderness and muscle spasm
    • eccymosis
  81. 3rd degree strain type
    • severe muscle or tendon ruptue and tearing involved tissue
    • significant pain
    • muscle spasm
    • ecchymosis
    • edema
    • loss of function
    • seen on MRI

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Author:
jskunz
ID:
318055
Filename:
Com t 3
Updated:
2016-03-30 16:49:15
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Common disorders 3
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