Nursing 171 Exam II

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Nursing 171 Exam II
2011-02-23 20:03:15
Nursing Exam II

Nursing 171 Exam II
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  1. common cholesterol containing foods
    • eggs
    • shellfish
    • organ meats
    • whole milk
  2. these interfere with tissue healing
    • low protein
    • vit C
  3. used to treat RA
    • corticosteroids
    • NSAIDS
    • Methotrexate
  4. limited effect on platelet function
    fewer GI effects

    -treatment:OA, RA, acute pain
    • COX-2 inhibitors
    • celebrex
  5. Tx of mild to moderate OA, RA, and gouty arthritis
    -severe GI toxicities
    • Oxicams
    • (meloxicam, peroxicam)
  6. general term for any of several disorders charac. by inflamm., degeneration or metabolic derangement of connective tissue, esp. joints, muscles, tendons, bursar, fibrous tissue and ligaments
  7. inhibits the enzyme xanthine oxidase, which prevents uric acid production
  8. reduces the inflamm. response to the deposites of urate crystals in joint tissue

    -used to treat gout
  9. supplies the anterior portion of the heart and a portion of the RV
    left anterior descending artery (coronary)
  10. passes around to the left and back between the LA and LV to supply blood to those areas
    left circumflex (coronary)
  11. supplies RA and RV and a portion of the posterior LV
    right coronary artery
  12. amount pumped by each ventricle in 1 min
    stroke vol X heart rate
    5-6 L
    Cardiac Output
  13. amount of blood ejected from the ventricle per heart beat
    stroke volume
  14. amount of blood ejected from the ventricle at the end of the diastole
    pre load
  15. peripheral resistance or pressure the LV must overcome to eject during systole
  16. increase HR
    increase speed on impusle conduction through the AV node
    increase force of atrial and ventricular contraction
    Sympathetic nervous system
  17. decrease HR
    slowed SA node rate
    slowed contraction through AV node
    parasympathetic nervous system
  18. causes decreases HR and peripheral vasodilation
  19. stimulate the casomotor center to increase cardiac activity
  20. peak pressure exerted against the arteries when the heart contracts
    systolic BP
  21. the residual pressure of the arterial system during ventricular relaxation
    diastolic BP
  22. increased with atherosclerosis
    decreased in cardiac failure of hypovolemia
    pulse pressure
  23. perfusion pressure felt by organs of the body
    mean arterial pressure
  24. blood studies for this system include serum lipids, c-reactive protein, homocysteine
  25. when taking a stress tests hold beta-blockers for ___ hours
  26. injection of contrast media allows visualization of the coronary arterier and the heart chambers
    -used to diagnose severity of CAD
    cardiac cath
  27. major cause of CAD
  28. nonspecific marker of inflamm.
    increased in patients with CAD
    C-reactive protein CRP
  29. CAD
    earliest lesions; potentially reversible
    characterized by lipid-filled smooth muscle cells
    Fatty Streaks
  30. CAD
    beginning of progressive changes in the arterial wall
    collagen forming a fibroud plaque that appears grayish or whitish
    result=narowing of vessel lumen
    fibrous plaque
  31. continued inflamm. can result in plaque instability, ulceration and rupture
    platelets accumulate and a thrombis forms
    increased narrowing of total occlusion of lumen
    complicated lesion
  32. drugs that restrict lipoprotein production;
    Statins, niacin
  33. drugs that increase lipoprotein removal
    bile acid sequestrants
  34. drugs that decrease cholesterol absorption
  35. antiplatelet therapy
    • clopidogrel
    • ASA
  36. intermittent chest pain that occurs over a long period with the same pattern of onset, duration, and intensity of symptoms, rarely sharp or stabbing; does not change with position or breathing
    chronic stable angina
  37. reversible myocardial ischemia=
    O2 demand>O2 supply
    angina(chest pain)
  38. occurs in the absense of any subjective symptoms; confirmed with ECG changes; prevalent in persons with diabetesumn
    silent ischemia
  39. occurs only at night but not necessarily during sleep
    nocturnal angina
  40. chest pain that only occurs while lying down; relieved by standing or sitting
    angina decubitus
  41. unpredictable and unrelieved by rest
    characterized by progressive severity
    unstable angina
  42. occurs usually in response in coronary spasm; may occur in the absence of CAD;
    prinzmetals angina
  43. myocardial ischemia occurs as a result of two factors
    • increased oxygen deman
    • decreased oxygen supply
  44. most MIs involve the _____ ____
    left ventricle
  45. described as heaviness, constriction, tightness, burning, pressure or crushing

    common locations: substernal, retrosternal or epigastric areas; pain may radiate
  46. initially increased HR and BP and then decreased BP; crackles, jugular vein disten., vasoconstriction
  47. requires cardiopulmonary bypass; uses arteries and veins for grafts
    coronary artery bypass graft
  48. elevated BP with a specific cause
    secondary hypertension
  49. produces increased vasoconstriction, increased heartrate, increased Renin release
    Primary hypertension
  50. weight loss of ____ may decrease SBP by approx______-_____mm Hg
    • 10 kg 22 lbs
    • 5-20
  51. with hypertension a person should reduce sodium to ____
    <2.4g Na a day
  52. heart is unable to produce an adequate cardiac output to meet metabolic needs
    heart failure
  53. increase in the muscle mass and caridc wall thickness in response to chroin dilation; heart muscle has ^O2 needs, poor contractillity, poor CA circulation
  54. most common type of HF
    left sided
  55. ventricular dysfunction, back up of blood in atrium and pulmonary veins
    1.pulmonary congestion
    2.pulmonary edema
    left sided HF
  56. ventricular MI, backup of blood into the atrium and venous systemic circulation
    1. jugular vein distention
    2. hepatomegaly
    3.Ascites(fluid in body cavity)
    4. peripheral edema
    right sided HF
  57. S/S: fatigue, dyspnea, persistent, dry cough, unrelieved with position change or OTC cough suppressants, dependant edema, sudden game >3lbs
    chronic heart failure
  58. diagnostic studies to determine HF:
    • chest X-ray;
    • ECG;
    • Labs: cardiac enzymes, BNP;
    • stress testing;
    • cardiac cath
  59. these drugs are used in the treatment of HF
    • diuretics
    • digitalis
    • Ace inhib
    • Nitrates
    • Beta blockers
  60. used in heart failure and to control ventricular response to Afib, or flutter; drug levels must be monitored; love K increases its toxicity
    digoxin(cardiac glycosides)
  61. ^in force and velocity of myocardial contraction, w/o ^ in O2 consumption; results in reduced heart rate and improved cardiac efficiency; avoid high Fiber foods; visual disturbances
    digoxin(cardiac glycosides)
  62. these bypass the liver and experience a lrg first-pass effect
    potent dilator of coronary arteries
  63. cause vasoconstriction due to relacation of smooth muscles, results in reduced O2 demand; alleviate coronary artery spasms
    1. used for treatment of ischemic heart conditions(angina)
  64. used in the Tx of angina, HTN, cardiac disrhythmias

    especially used in the treatment of exertional angina
    Beta blockers
  65. decreased HR, resulting in decreased myocardial O2 deman and ^ O2 delivery to the heart; decreased myocardial contractility, helping to conserve energy or decrease demand
    Beta blockers
  66. block the harmful effecs of catecholamines, thus improving survival after MI
    1. cause constipation
    2. never be abuptly dicontinued
    beta blockers
  67. first line drugs for treatment of angina, HTN, and supraventricular tachycardia, coronary artery spasms (prinzmetals angina), short term A-fib and flutter
    Ca channel blockers
  68. cause coronary artery vasodilation, peripheral arterial vasodilation, decreasing systemic vascular resistance, reduce the workload of the heart,
    RESULT: decreased myocardial O2 demand
    Ca Channel blocker
  69. block the enzyme in the kidneys that converts angiotension 1 into angiotension II; recommended for anterior wall MIs or MIs that result in decreased lft vent function
    ACE inhib
  70. can prevent of slow the progression of HF; results in dilation of peripheral blood vessels; ^ ejection fraction
    ACE inhib
  71. results in the removal of sodium and water
  72. inhibits sodium and chloride resorption; potent diuresis and subsequent loss of fluid
    1. causes K depletion, ototoxicity
    loop diuretic
  73. word in collecting ducts and distal convuluted tubules; block the resoption of sodium and water usually induced by aldosterone
    spironolactone(K-sparing diurectics)
  74. prevents K from being pumped into the tubule, thus preventing its secretion; blocks the aldostone receptors and inhibit its action
    1. hyperkalemia
    2. weakness
    spironolactone (K-sparing diurtetics)
  75. act primarily in the dital convoluted tubule to inhibit tubular resorption of sodium, chloride, and potassium ions
    RESULTS: water, sodium and cholirde excretion; dilate the arterioles by direct relaxation
    thiazide and thiazide-like diuretics
  76. monitored by activated partial thromboplastin times (aPTTs)
  77. effects reversed by protamine sulfate
  78. monitored by prothrombin time (PT) and INR (PT-INR)
  79. this is given for warfarin toxicity
    Vitamin K
  80. drugs that break down or lyse, preformed clots; reestablish blood flow to the heart muscle via coronary arteries, preventing tissue destruction
    thrombolytic drugs
  81. most potent LDL reducers
    lower the rate of cholesterol production
    Statins or HMGS
  82. inhibit the synthesis of cholesterol in the liver by blocking HMG-CoA reductase, which is used by the liver to produce cholesterol
  83. this antilipidemics can cause myopathy, possibly leading to the serious condition rhabdomyolysis
  84. inhibits synthesis and secrection of VLDL and LDL; thought to ^ activity of lipase which breaks down lipids
  85. effective in lowering trigylceride, total serum cholesterol, and LDL levels; ^ HDL level
  86. believed to work by activating lipase, which breaks down cholesterol;
    1.suppress release of free fatty acid from the adipose tissue, inhibits sythesis of trigylcerides in the liver
    fibrates (fibric acid derivatives)
  87. decrease the triglyceride levels
    ^HDL by as much as 25%
  88. prevent resorption or bile acids from the small intestine; used in the relief of pruritus associated with partial biliary obstruction
    Bile Acid sequestrants
  89. inhibits absorption of cholesterol and related sterols from the small intestine
    -results in reduced total cholesterol, LDL, triglyceride level, also increases HDL levels
    cholesterol absorption inhibitor

  90. this antihypertensive is bad for CHF and renal failure
    Calcium channel blocker
  91. results in the depression of smooth and cardian muscle leads to depression of contraction, decreases contractiliy
    Ca Channel blockers
  92. these medications end in "pril"
    ACE inhib
  93. these meds end in "olol"
    Beta Blockers
  94. these meds end in "azosin"
    Alpha Blockers
  95. these meds end in "ilol and alol"
    -Carvedilol (Coreg)
    Alpha and Beta blockers
  96. these meds end in "sartan"
    ARB-Angiotension II receptor-Anagonist
  97. these meds end in "dipine, azem, amil"
    Calcium Channel Blockers
  98. these med end in "ide"
    Loop Diuretics
  99. these are present in muscle tissue and are released into the blood stream following myocardial damage, and aid in the diagnosis of MI
    cardiac enzymes
  100. -this is a specific indicator of myocardial damage (0-6%)
    -rises in the bloodsteam w/in 4-6 hours following myocardial damage, peaks in 18-24 hours
    -returns to normal in 72-96 hours
  101. -protein found in both cardiac and skeletal muscle(12-75 or 20-90)
    -released from myocardium w/in 2-6 hr and peaks at 8-12 hr.
  102. -^concentration in the heart, skeletal muscles, RBC's, liver, kidney, lung and brain
    -high levels occur 12-24 hours after MI, peak occurs 2-5 days and remains elevated 6-12 days
  103. myocardial injury marker that helps to distinguish true myocardial injury from non cardiac causes
    -diagnositic window ends 24 hours after MI
    Troponin I (cTnI)
  104. -sensitive and specific indicator of an MI
    -levels elevated for 5-7 days
    Troponin T (cTnT)
  105. -not usually present in body
    -produced primarily by the liver buring the inflammation process due to tissue injury
    -appears 6-10 hr after acute inflammation and tissue injury
    -peaks 48-72 hr
    C-Reactive Protein (CRP)
  106. this marker is increased in ruptured or eroded plaque
    -normal <10ml/UL
    PAPP-A antigen
  107. -end product of fibrin breakdown and indicated an ongoing process of thrombus formaiton and dissolution at the site of active plaques in acute coronary syndromes
    -Should be NEG
    Plasma d-Dimer
  108. -the ventricular myocardium releases these peptides in response to ventric. dilitation and pressure overload
    -associated with larger MI
    -normal <80
  109. -it predicts a future MI in healthy persons as well as mortality in the elderly
  110. a serious side effect of of inamrinone
  111. druges that influence the condustion of electrical inpulses
  112. drugs that influence the rate of the heartbeat
  113. drugs that influence the force of cardiac muscle contractions
  114. a property of the pacemaker cells of the heart that allows self-activation
  115. the period during the myocardium is unable to respond to electrical stimulation
    refractory period
  116. a condition that leads to an increased potential for digoxin toxicity
  117. a condition which may indicate the need for treament with digoxin-immune fab
  118. a common cardia dysrhythmia involving atrial contractions
    A Fib
  119. -causes complete emptying of ventricle during systole
    -^force and velocity of myocardial contraction and total peripheral resistance
    -reduces HR
    -slows conduction thru AV node and bundle of HIS
    Digitalis-Cardiac Glycosides
  120. binds with digoxin and digitoxin to neutralize action and rapidly reduces serum levels
    Digoxin Immune Fab (Digibind)
  121. rare, recurrent inflammatory vasoocclusive disorder of the small and medium sized arteries, veins and nerves of the U.E and L.E
    -damages arterial wall
    -eventually thrombosis and fibrosis cause tissue ischemia
    Buerger's Disease
  122. S/S of this disease include claudication of the feet, hands and arms
    -color and temp changes in affected limb
    -cold sensitivity
    Buergers Disease
  123. TX for this disease include:
    -antiplatelet agents
    -Ca Channel Blocker
    -Alpha Blockers
    Buergers Disease
  124. episodic vasospastic disorder of the small cutaneous arteries
    -most fequently involving the fingers and toes
    -color changes (white, blue then red)
    -coldness, numbness, followed by throbbing, aching, then tingling and swelling
    Raynauds Phenomenon
  125. Tx for this disease includes:
    -stress reduction technique
    -Calcium Channel Blocker
    Raynauds Phenomenon
  126. localized platelet aggregation and fibrin entrap RBCs, WBCs, and more platelets
    -50% of patients have no S/S
    Venous Thrombosis
  127. -palpable, firm, cardiac vein
    -area around vein is tender, reddened and warm
    superficial thrombophlebitis
  128. Tx of thrombophelbitis include:
    • elevate extremity
    • heat to relieve pain and tenderness
    • compression stockings
    • analgesics
  129. manifestations of this include:
    -unilateral edema
    -systemic temp >100.4
  130. Tx for DVTs include:
    • TED hose and SCDs
    • LMWH and Coumadin
    • elevation
    • warm compress
    • analgesics
  131. -abnormally dilated, tortuous superficial veins
    -ache and pain after prolonged standing
    -pressure or cramping sensation
    Varicose Veins
  132. -valves in the veins are damaged which results in retrograde veonous blood flow, pooling of blood in the legs and swelling
    Chronic Venous Insufficiency
  133. S/S of this disease are as follows:
    -leathery skin
    -brawny discoloration
    -area warmth to touch
    chronic Venous Insuff
  134. -located above the medial malleolus; can also occur near lateral malleolus
    -wound margins irrg. shaped
    -tissue is ruddy in color
    -infection and cellulitis possible
    -occasionally amputated
    Venous stasis ulcers
  135. Tx of this disease is as follows:
    -compression thru elastic wraps, Unna Boot
    -moist dressing for wound healing
    -diet with protein, vit. A and C, and Zinc
    Venous stasis ulcers
  136. involves progessive narrowing and degeneration of arteries of neck, abdomen, and extremities
    -atherosclerosis is the leading cause
    peripheral arterial disease
  137. S/S of peripheral arterial disease include:
    -diminished or absent pedal, popliteal or femoral pulses
    • -ischemic muscle ache or pain
    • -paresthesia
    • -shooting or burning pain, present near ulcerated areas
    • -thin, shiny, taught skin, pallor
  138. Tx for PAD include:
    antiplatelet and ACE inhib
  139. drugs prescribed for Tx of intermittent claudication are:
    • Tental
    • -^erythrocyte flex
    • -lowered blood viscosity
    • Pletal
    • -^vasodilation
    • -^walking distance
  140. the affinity of hemoglobin for oxygen
    oxygen-hemoglobin dissociation surve
  141. a receptor that responds to a change in the chemical composition of the fluid around it
  142. respond to changes in the H+ ion concentration
    central chemoreceptors (in medulla)
  143. respond to decreases in PaO2 and pH and to increases in PaCo2
    peripheral chemoreceptors (in carotid bodies)
  144. what diagnostics studies are used with the respiratory system
    Hb,Hct, AGBs, Oximetry, Sputum studies
  145. what allergy stops people from having CT scans?
  146. if a chest tube is placed high in the chest it is used to release _____, if it is placed low it is used to release _____
    • air
    • fluid
  147. septum is bent from one side, altering air passage
    -S/S; obstruct. breathing, nasal edema, dryness,
    deviated septum
  148. what should be withheld 2 weeks prior to septoplasty
  149. what position should i person be placed in when they are experiencing epistaxis
    leaning forward or high fowlers
  150. the reaction of the nasal mucosa to an allergen such as pet saliva, dust mites, mold, pollen, etc
    Allergic Rhinitis
  151. spread by airborne droplets, can survive on inanimate objects for 3 days
    -common cold or coryza
    Acute Viral Rhinitis
  152. what complications can result from acute viral rhinitis
    • pharyngitis
    • sinusitis
    • otitis media
    • tonsillitis
    • lung infections
  153. cause significant morbidity and mortality
    symptoms typically subside in 7 days
  154. what is one major complication of the flu
  155. when ostia from the sinuses are narrowed or blocked by inflamm. or swelling
  156. what are the main Tx's for sinusitis
    • Decongestants (2nd generation only!)
    • antihistimines, corticosteroids
  157. benign mucous masses that form slowly in response to repeated inflamm. of the sinus or nasal mucosa
    -appear bluish and glossy
  158. acute inflamm.; may include the tonsils, palate, and uvula
    -can be caused by viral, bacterial, or fungal infection
    acute pharyngitis
  159. what are the complications of Strept
    rheumatic heart disease or glomerulonephritis
  160. this is often caused by inhaled corticosteroids
    candida (yeast)
  161. inflamm. of the lower respiratory tract, most ofter ciral but could also be bacterial; often follows a URI
    Acute Bronchitis
  162. the treatment for acute bronchitis includes ^ fluids, rest,.........
    • anti-inflamm.
    • cough suppresants
    • bronchodilatos
  163. acute inflamm. of lung caused by microbial organism
    -decreased cough and epiglottal reflexes may allow aspiration
  164. what are the three ways organisms can reach the lungs causing pneumonia
    • aspiration
    • inhalation of microbes
    • hematogenous spread from primary infection
  165. onset outside hospital or during first 2 days of hopitalization; ^ midwinter
    community acquired pneumonia
  166. occuring 48 hours or longer after admission and not incubating at time of hospitialization
    hospital acquired pneumonia
  167. the second most common nosocomial infection
  168. occurs from abnormal entry of secretions into lower airway; usually with hx of LOC; tube feeding is risk factor
    aspriation pneumonia
  169. pts at risk for this disease include;
    severe protein-calorie malnutrition, immune deficiencies, chemotherapy/radiation,
    transplant pts
    opportunistic pneumonia
  170. this phase of pneumonia causes massive dilation of capillaries, causing lungs to appear red and granular
    red hepatization
  171. Pneumonia:
    leukocyte and fibrin concolidate in affected part of the lung
    -Decreased blood flow
    gray hepatization
  172. unpon physical examination of this disease you will find; dullness on percussion, ^ fremitus, bronchial breath sounds, crackles
  173. collapsed alveoli
  174. pts with pneumonia should have fluid intake of atleast ___L per day and a caloric intake at least _____ per day
    • 3L
    • 1500
  175. what are the risk factors for Buergers disease
    • smoking
    • <40
    • male
  176. a mugascan looks at what
    blood flow in the heart