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Nursing Prep2

Nursing Exam II Spring

Peripheral Vascular Disease (PVD) Any condition that disrupts blood flow to veins or arteries (peripheral) with the exception of the pulmonary or coronary arteries (central)
Peripheral Venous Impairments If there are any disturbances in the peripheral blood return, there is less blood and waste products leaving cells or tissues so they choke with wastes and excess fluids
Factors in Veneous Thrombosis 1) Venous Stasis 2) Injury to the vessel wall 3) Change in blood coagulation (You need 2 out of the 3 in order to consider that you have a thrombosis)
Venous Stasis It is caused by: 1) Immobility (decreased skeletal muscle contraction) 2) Dilated veins (prolonged standing) 3) Blood flow is retarded (heart failure, shock, obeses, pregnant)
Injury to the Vessel Wall It is caused by: 1) Blunt force (accidents)=immobility 2) IV (chemical and mechanical irritation)
Change in the Blood Coagulation This is caused by: 1) Anything that makes blood thicker (slow down flow) 2) Medication (birth control with smoking) 3) Diseases (clotting disorders) 4) Dehydration
What would increase the risk for thrombophlebitis? 1) Immobility 2) Obesity 3) General Surgery 4) Leg Trauma 5) Oral Contraceptives 6) Previous DVT 7) Pregnancy
What are the prevention methods of thrombophlebitis? 1) Stocking 2) Ambulation afeter surgery 3) teaching patient leg exercises 4) Cough and deep breathing (prevent the stasis of the blood by creating a vacuum to bring blood back from the lower extremities) 5) Medication (Heparin or Lovenox)
What is thrombophlebitis? Inflammation of the walls of the vein accompanying clot formation (emboli in the lungs is danger in early thrombophlebitis)
What are the signs and symptoms of thrombophlebitis? 1) Discomfort in the calf (tender with gentle palpation)-deep 2) Redness-superficial 3) Warmth-superficial 4) Unilateral swelling of one leg (in the calf and it can extend)
What are the diagnostic studies that can be done? 1) Vengography 2) Doppler (ultrasound) 3) MRI 4) Pletysmography 5) D-dimer 6) CT scan 7) Venous duplex scanning or ultrasonography
Vengography An invasive procedure that uses a contrast dye
Doppler (ultrasound) The primary one because it is the cheapest and the easiest one and it determines blood flow
MRI Expensive (non-invasive) and it takes direct picture of the thrombus
Plethysmography Non invasive and its done by using blood pressure cuff that are going to go in different location
Venous Duplex Scanning (ultrasonography) A step up from the doppler and it combines imagery
D-Dimer A blood test that tells the viscosity of the blood
CT Scan Invasive procedure that is also done with contrast dye
Heparin given for thrombophlebitis Given either SQ or IV and it prevents new clots from forming. Monitor lab values for APTT, handle with care and monitor for bleeding
APTT Activated Partial Thromboplastin Time- which should be 1.5 the control
What does heparin reverse with? Protamine Sulfate (if it is high)
What are complication with therapy of heparin? Heparin induced thrombocytopenia which are low platelet count
Lovenox (enoxaparin) It is given SQ to also prevent new clots from forming and nurse should monitor for bleeding but no need to check any lab values
Coumadin (warfarin) Given PO and it prevents new clots from forming. The nurse should monitor PT and INR, bleeding and handle carefully. It can be reversed with Vitamin K
Thrombolytics IV only and it dissolves clot and it should be given by infusion pump, avoid handling, and check for bleeding and the reason its not given IM is because the bleed can occur and it wont be able to be detected
Nursing Interventions for Thrombolytics 1) Bed rest 2) Apply elastic stocking 3) Warm, moist compress (dilate vessels) 4) Anagelsic 5) Elevate the leg
What is a serious complication with thrombolytics? A pulmonary embolus which can cause difficulty breathing, chest pain, cough up blood, crackles, apprehensive and respiratory can increase
What is varicose vein? Abnormally dilated , tortuous, superficial veins caused by incompetent venous valves
What is the sign and symptoms of varicose veins? 1) Seeing the dilated veins 2) Dull aches in the muscle 3) Increase in muscle fatigue 4) Muscle cramp (waste product in the vein) 5) Swelling
What is the contributing factors of varicose veins? 1) Family 2) Prevalent in women up to 70 3) Pressure (pregnancy, obesity) 4) prolonged standing 5) Anything that cause trauma to the leg
What are the prevention of varicose veins? 1) Avoid standing for a long period of time 2) Moving 3) Stocking 4) Change position frequently 5) Exercise 6) Lose weight
Sclerotherapy HCP injects sclerosing agent (eradicates veins) and apply pressure with aces. The compression is required for 3-5 weeks after so its palliative rather than curative
Vein Stripping They need to see if other veins can function. It is tie the vein at the top and bottom and then strip it off. Nurses should use ace bandage continuously, elevate the foot of the bed and make sure the patient moves but doesn't sit or stand
Laser Therapy Thermal ablation and this is non surgical, pressure is applied and short term bruising , stiffness and cramping can occur
What are assessment for chronic venous insufficiency? 1) Tissue has dematus so its dry and scaly (fragile) 2) Brown discoloration (distal part of the leg) 3) Discomfort (achy, burning, itchy)
What are the characteristic of venous ulcers? 1) Superficial 2) Uneven edges 3) Discomfort
What are the nurses goal in treating venous ulcers? 1) Try to restore the integrity of the skin 2) Improve their physical mobility 3) Prevent complications
What are treatment methods for venous ulcers? 1) Antibiotics if there is infection 2) Compression 3) Special dressing procedure 4) Skin graft 5) Surgery 6) Aquacel
Peripheral Arterial Disorder If there is a disturbance in the peripheral blood supply due to narrowing and obstruction of the arteries of the extremities, the cells and tissues receive less oxygen. This occur gradually over time.
What are the contributing factors in athesclerosis and what are the primary preventions? The contributing factors can be age and family disposition and the preventions include quit smoking, watch diet, exercise and loss weight. (PS secondary can include meds, control blood pressure, and manage diabetes)
What are the symptoms of AOD (arterial occlusive disorders) 1) Pain in lower limbs (brought by exercise, relieved at rest aka intermittent claudication) 2) Changes in the skin and temperature 3) Skin is shiny and smooth 4) Nail is thick and brittle 5) Muscle atrophy 6) Absent or diminished pulse 7) Tingling
What are diagnosis of arterial disorders? 1) Doppler 2) Duplex ultrasound 3) Angiography 4) Treadmill 5) ABI (Ankle Brachial Index) 6) Digital subtraction angiography (DSA)
Rayaund's Disease Intermittent episodes of arterial spasm of the small cutaneous tissue
What are the symptoms of Rayaund's Disease? 1) Cold 2) Numb 3) Pain 4) Pail (cyanotic even black looking) 5) Ulcers at the finger tips
What are the treatments of Rayaund's Disease? 1) Lifestyle modification which includes stop smoking, decrease stress and emotional upset and keep warm
What are the 6 P's associated with acute arterial embolism? 1) Pain 2) Pallor 3) Pulselessness 4) Paresthesia 5) Paralysis 6) Poikilothermia
What are medical treatments of Rayaund's Disease? 1) Heparin or thrombolytics 2) Embolectomy 3) Peripheral atherectomy 4) PTA 5) Endarterectomy 6) Bypass graft 7) Amputation
How many lobes does the right lung have? 3
How many lobes does the left lung have? 2
What is the function of the lungs? It brings oxygen to the body and let carbon dioxide out of the body
What does the bronchi do? It keeps foreign matter away
Bronchi It has 2 mainstem (one to the right which goes vertically down and one to the left which goes more horizontal)-then its the segmental bronchi then subsegmental bronchi
Subsegmental Bronchi It goes with the segment in the lobes surrounded by connective tissues, arteries, lymphatic and nerves
What does the bronchioles do? Produce mucus that lines the airway
What does the aveoli do? It where the actual gas exchange occur with these clusters of balls Type I-Epithelial cells that forms the wall Type II-Secretes Type III-Macrophages (clean up crew)so ingest foreign matter
What is the thoracic cavity and what is the function? Hold the lungs and organs of the chest and its air tight chamber with distensional walls line with the parietal
What is the function of the rib cage and what is the function? Its 12 pairs of ribs with 11 and 12 being floating and it is for the protection of the lungs
What is the function of the diaphragm and what is the function? This makes the floor of the thoracic cavity where its the major muscle used for ventilation
What is the function of the intercostal muscles and what is the function? This is muscle between the ribs where it aids in the expansion of thoracic cavity
What is ventilation? The movement of air into and out of the lungs
What happens when you take a deep breath? The diaphragm moves down and it expands
What are 3 examples that alter the bronchial diameter? 1) Obstruction (tumor, mucus, foreign matter) 2) Inflammation (thickening of the bronchi walls) 3) Smooth muscles going into spasm (ex. asthma)
What is compliance? It refers to the elasticity and expandibility of the lungs and thoracic structures
What is airway resistance? Resistance is determined chiefly by the radius or size of the airway through which air is flowing. It allows lung volume to increase as air flows in. It is determined by examining the volume-pressure relationship in the lungs and thorax
"stiff lungs" This is low compliance
If lungs has lost their elasticity This is high compliance
What are factors that determine lung compliance? 1) Surface tension of the aveoli 2) The connective tissue
Tidal Volume (TV or VT) This is the amount of air inhaled and exhaled with each breath. Normal value is 500 mL
Inspiratory Reserve Volume (IRV) This the amount of the maximum amount of air that can be inhaled after normal inhalation. Normal value is 3000 mL
Expiratory Reserve Volume (ERV) This the amount of the maximum amount of air that can be exhaled forcibly after normal exhalation. Normal value is 1100 mL (will decrease with restricted conditions like obesity, pregnancy, and pneumonia)
Residual Volume (RV) The volume of air remaining in the lungs after maximum exhalation. Normal value is 1200 mL (will increase with obstructive conditions like COPD)
Vital Capacity (VC) The maximum volume of air exhaled from the point on maximum inspiration and this is TV+IRV+ERV=VC which is 4600 mL (decreased in neuromuscular disease like COPD and obesity)
Inspiratory Capacity (IC) The maximum volume of air inhaled after normal expiration and this is IRV+TV=IC which is 3500 mL (decreased in restricted diseases)
Functional Residual Capacity (FRC) The volume of air remaining in the lungs after a normal expiration which is ERV+RV=FRC which is 2300 mL (increased with COPD)
Total Lung Capacity (TLC) The volume of air in the lungs after a maximum inspiration which is RV+ERV+IRV+TV=TLC which is 5800 mL (decreased with restricted disease and increased with obstructive disease
What is pulmonary perfusion? The actual blood flow through the pulmonary circulation
How are patterns of perfusion are determined by? 1) Gravity 2) Alveolar pressure 3) Pulmonary artery pressure
What is the the blood pressure of pulmonary artery? 20-30/ 5-15 mmHg
What is the V/Q ratio desired? 1:1
What are factors that cause imbalance in V/Q? 1) Inadequate ventilation 2) Inadequate perfusion 3) Both inadequate ventilation and inadequate perfusion
What are 4 possible V/Q states in the lungs? 1) Normal V/Q Ratio (good oxygenation/ventilation) 2) Low V/Q Ratio-shunt (ventilation is not good so perfusion wont happen) 3) High V/Q Ratio-dead space (ventilation is good but perfusion is not good) 4) Absence ventilation and perfusion (silent unit)
Pulmonary Function Test (PFT) Assess respiratory function and determine extent of dysfunction. This uses a spirometer with a volume collecting/time measuring device. The normal value is based on age, gender, height and weight
Arterial Blood Gas Studies (ABG) Measure blood pH, PaO2 and PaCO2. This is obtained from arterial pressure (radial, brachial or femoral)to assess the lungs and kidneys. (its painful but quick and its more accurate)
Pulse Oximetry Monitor O2 saturation of hemoglobin in a non invasive manner. The normal is 90%-100%
Cultures: Throat and Nasal This identify strep, pneumonia and influenza and this is quick but uncomfortable and in 24 hours you get pre-result and by 48-72 hours is when final results happen
Sputum Studies This identify organism and determine if malignant cells are present and within 2 hours of collection it should go to lab
Bronchoscopy Visualization of the larynx, trachea and bronchi and for collection of secretions
Thoracentesis Best performed under ultrasound guidance for obtaining fluid from pleural cavity for diagnostic and therapeutic purposes
Forced Vital Capacity (FVC) Maximally forced expiratory effort and this is reduced in COPD due to air trapping
Forced Expiratory Volume (FEV1) Volume of air exhaled in a specific time (1 second) during the performance of FVC and this indicates the severity of obstruction
Ratio of timed forced expiratory volume to forced vital capacity FEV1 is expressed as a % of the FVC which indicates presence or absence of airway obstruction
pH solutions Neutral solution is a pH of 7 Acidic solution is a pH of less than 7 (acidosis) Akaline solution is a pH of more than 7 (alkalosis)
What is normal pH for humans? 7.35-7.45
Blood pH Anything below 6.8 or higher than 7.8 is incompatible with life
pH Indicates the hydrogen ion concentration of the blood
PCO2 A measure of the CO2 tension (also called partial pressure of blood gas CO2) and normal is 35-45
HCO3 Amount of bicarbonate or alkaline substance dissolved in the blood and normal is 22-26
How CO2 effects blood gases Acid is produced daily in the body through the breakdown of carbon in foods--CO2 is the resulting product which combines with H2O to form Carbonic Acid--Carbonic Acid is a weak molecule and breaks down into bicarbonate and hydrogen
CO2 in relation to ventilation When CO2 is elevated in the arterial blood, the cerebral medulla is stimulated to increase the rate of ventilation When CO2 is decreased in the arterial blood, the cerebral medulla is stimulated to decrease the rate of ventilation
Kidneys can: 1) Alter bicarbonate retention 2) Alter hydrogen secretion
Interpretation of ABG results (3 questions) 1) Does the pH indicates acidosis or alkalosis? 2) Is the cause of pH imbalance respiratory (lungs) or metabolic (kidneys)? 3) Is there a compensation for the acid base imbalance?
What is the cause of metabolic acidosis? 1) Diarrhea 2) Renal failure 3) Shock 4) Sepsis 5) Salicylate overdose 6) Diabetic ketoacidosis
What is the cause of respiratory acidosis (hypoventilation)? 1) Drug overdose 2) Chest trauma 3) Neuromuscular disease 4) Airway obstruction 5) Pulmonary edema 6) COPD
What is the cause of metabolic alkalosis? 1) Lost of gastric secretion 2) Over use of antacids 3) Potassium-wasting diurectic
What is the cause of respiratory alkalosis (hyperventilation)? 1) Anxiety 2) High altitude 3) Pregnancy 4) Fever 5) Hypoxia 6) Excessive Tidal Volume
What symptoms would you see in acute respiratory acidosis? 1) Elevated pulse 2) Elevated respiratory rate 3) Elevated BP 4) Mental cloudiness 5) A feeling of fullness in the head
What symptoms would you see in chronic respiratory acidosis (COPD)? 1) Weakness 2) Headache
Management of Respiratory Acidosis Goal: Improved ventilation because if CO2 is reduced too quickly, the kidneys cannot eliminate the excess HCO3 fast enough to prevent alkalosis and seizures
What symptoms would you see in chronic respiratory alkalosis? 1) Seen in hepatic insifficiency and cerebral tumors (in the liver)
What symptoms would you see in acute respiratory alkalosis? 1) Light-headness 2) Decreased cerebral flow 3) Numbness/tingling 4) Tinnitus (ringing of the ear) 5) Possibly loss of conscious 6) Contractions
What are the risk factors for COPD? 1) Genetics 2) Age and gender 3) Lung growth and development 4) Exposure to particles 5) Socioeconomic status 6) Chronic bronchitis 7) Infections 8) Asthma/Bronchial hyperactivity
What are 3 primary symptoms of COPD? 1) Cough 2) Dyspnea 3) Sputum production and additional symptoms can be wheezing/chest tightness, fatigue, weight loss, barrel chest, and sign and symptom of depression and/or anxiety
Spirometry Most reproduceable and objective measurement of airflow. Used for FVC (forced vital capacity), FEV1 (amount of air in the first sec), and FEV1/FVC (ratio). This is done before and after a bronchodilator and if its less than 70% its COPD
ABG Studies Obtain a baseline for oxygenation
Alpha-1 Antitrypsin Deficiency Screening This should be done when younger than 45 and a strong family history of COPD
The 5 stages of COPD -Stage 0:Both FEV1 and FEV1/FVC is normal but have other risk factors -Stage 1 (mild): FEV1 is >80% -Stage 2(moderate): FEV1 is 80-51% -Stage 3(severe): FEV1 is 50-30% -Stage 4 (very severe): FEV1 is <30 +and the FEV1/FVC is always going to be <70%
What are the medical management of COPD? 1) Smoking cessation 2) Bronchodilators (relieve bronchospasm) 3) Corticoseteroids (improve symptoms but dont give long term) 4) Alpha 1 Anti-trypsin augmentation 5) Flu vaccine
Created by: nonelily