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DC HURST REVIEW

Cardiac, GI, Renal, Neuro, Respiratory, Endocrine

QuestionAnswer
What is the pathway of blood flow through the Heart? SVC/IVC, R Atrium, tricuspid, R Vent, pulmonic valve, pulmonic artery, Lungs, Pulmonic vein, L atrium, L Vent, aortic valve, aorta, body, SVC/IVC
What is the order of valves in the heart? Tricuspid, Pulmonic, Mitral, Aortic (TPMA)
What is the order of heart sounds? Aortic (R 2nd), Pulmonic (L 2nd), Tricuspid (L 4th), Mitral-Apex-Apical (L 5th)
Where are S1 and S2 heard? 4th and 5th intercostal space (easier to hear if pt is on their L side)
If pt has heart damage where can the sounds be heard best? Laterally
What is preload? The Amt of blood return to the heart (mostly R side)
What is after load? the pressure in aorta and peripheral artery that the L Vent has to pump against to get blood out of heart to body. Increased BP is added resistance that L Vent has to pump against.
If you increase the volume going back to heart (preload) what does that due to workload? Increases work load
What can Increased BP lead to in terms of the heart? CHF and PE- if you increase after load this decreases CO and wears out heart muscle.
What is the formula for CO and what affects it? SV=HRxSV -tissue perfusion -changes dep on bodes needs (if your HR inc then your SV with inc and then your CO will inc) -HR (if D or I too much CO drop) -BV (less volume less CO) -D contractibility (meds, MI, Muscle Dz)
What is SV? amt of blood pumped out of vent with each heartbeat
Left Ventricle equals... CO (cardiac output)
What happens to CO if you Increase after load? Decrease (too much pressure to pump against)
What are some complications of Decreased CO? - chest pain, wet lungs, SOB, cold/clammy skin, D UO, D peripheral P -Bradycardia (D HR) is ok if CO is still functioning well (can't have any of above sx) -NO CO = PULSELESSNESS/V-Tach/V-Fib
What is ANGINA? Decreased BF to myocardium that leads to ischemia or necrosis -Can be stable (know factors/tx) or unstable (unknown factors/tx)
What is ISCHEMIA? -Temporary pain and pressure in chest usually caused by CAD -Pain is caused by D O2 usually do to EXERTION -Tx: REST and NITRO
How does NITRO work? -Dilation of Veins and Arts (D pre/after which D workload on Heart) -Dilation of Coronary Art (I BF to heart muscle brings O2 & stops pain) -1 q 5 min x3 ( if this doesn't work go to ER) will D BP but should go back up-never leave pt until stabilized
How do BB work? -Antihypertensive - slows HR and D contractibility -D workload which D CO -Blocks Beta receptors on heart that accept catacholemines (NE, Epi)
How do CCB work? -antihypertensive -dilate Coronary Art (more O2 goes to heart muscle)
Why do ASA's help with ANGINA? prevents blood from sticking together in case they are actually having an MI (chewable is best bc it works fast) -stops clot from forming 81-325mg
What are some NSG MGT for ANGINA? -NO isometric exercises (no strenuous exercises on test!!) -NO caffeine/drugs/overeating/smoking (Increases HR) -wait 2 hrs after eating to exercise -avoid Temp extremes -NItro propholaticly (will be dizzy bc D BP, have pt sit down SAFETY)
What are 2 things to ask about before CARDIAC CATH? -allergic to SHELLFISH/IODINE -kidney problem (dye is excreted through kidney and could cause renal failure if it can't be excreted)
What med might be given if pt has kidney problems and needs cardiac cath? Mucomyst (helps protect kidneys)
What are the 2 Sx someone will feel after getting a dye injection? FLUSHING (and warmth) in face and METALLIC TASTE
What is the #1 complication of CARDIAC CATH? HEMORRHAGE (rpt pain at puncture site STAT) -always check 5 P's after -hold Metformin before and after (48 hrs) -lay flat in bed (extremity straight for 48 hrs)
ACS/MI/Unstable Angina -Decreased BF to myocardium (ischema and necrosis) -dont have to be doing anything to bring it on -usually occurs in AM while in REM sleep (I HR/BP/WL) -Rest and Nitro WONT help -crushing chest feeling
What SX do WOMEN have when having an MI? -Triad (indigestion (GI problems), fatigue, can't catch breath)
What SX do ELDERLY have when having an MI? -SOB is #1 (might just faint) -behavior change =pain
What is a SIGN and ELDERLY person is in pain? Behavioral Changes
What does CPK/MB do? -Enzymes that are heart specific -they Increase when damage to heart cells w/in 3-12 hrs after onset of sx and peaks in 24 hrs
What does TRIPONIN do? -Specific to MI damage -MOST SPECIFIC (can tell if pt delays tx) -elevates w/in 3-4 hrs and peaks at 3 weeks -ONLY present when there is MI DAMAGE
What does MYOGLOBIN do? -not specific to dx ACS/MI/Unstable Angina -GOOD to R/O ACS/MI/Unstable Angina -Increases w/in 1 hr, peaks at 12 hrs
What major ARRHYTHMIA can lead to sudden DEATH? V-Fib (No CO bc tissue is dead so it can't be perfused) -DEFIB the V-FIB
What are some TX for V-FIB? -1st DEFIB -2nd Epi (vasopressor) -3rd Amiodorone (antiarrythmic- used when resistant to tx, can be given to prevent 2nd) or Lidocaine (D irritability of heart) -TOXICITY = ANY NEURO CHANGES
Tx of MI? -Oxygen -ASA (165-325mh) -NITRO -MORPHINE (if pain not relieved by Nitro) -HOB UP -FIBRENOLYTIC (breaks up clot blocking BF to heart muscle)
What do FIBRENOLYTICS do? -break up clot causing problem (can be used for brain anysm) -Ex: Streptokinase - Admin w/in 6-8 hrs (some say 12) -Rsk: bleeding (ETOH,OD tylenol, liver dz) -NO if: IC bleeding/aortic disection
What kind of meds are PLAVIX, INTEGROLIN, REOPRO) Antiplatlet
What is a CABAG? - surgery done when L main Art is occluded (aka widow maker)
What are SX of HF? -weight gain -ankle edema -SOB -confusion
What is the heart doing when it is REpolarizing? -REsting -filling with blood
What is the heart doing when it is DEpolarizing? -DEspensing Blood -Heart muscle contracts
What is an Epicardial Pace maker? -temporary -wires attached to heart during heart surgery
What is a TRANSCUTANEOUS PACEMAKER? -Temporary -Defibrillator on skin set to pacemaker mode (emergency situations) -painful (requires analgesics)
What is TRANSVENOUS PACING? -wires are placed into heart chamber -power source is outside body (check batteries)
What should you not let you pt do after receiving a pacemaker? -Dont raise arm above shoulder level -avoid electromagnetic fields -no trama to site (no contact sports)
What are SX of R side HF? Backing up into venous system -edema/acites -weight gain Always 2nd to something else (i.e. Pulmonary HTN) -enlarged organs -JVD INCREASE WORKLOAD
What are SX of L side HF? Blood is not moving forward, backs up in lungs -pulmonary sx -crackles -restlessness -SOB at PM - Increased HR/BP -cool/pale DECREASE CO
What is the #1 cause of HF? HTN -complication that can result from heart problems (MI, HTN, endocarditis, cardiomyopathy)
What is the difference between SYSTOLIC HF and DIASTOLIC HF? Systolic- heart can't contract and eject blood Diastolic -heart can't relax and fill
What is the #1 cause of PULMONARY HTN? HYPOXEMIA -increase BP in lungs, increase WL on R side of heart (rsk for R side HF)
What is a SWAN GANZ Cath? Central line w/balloon inserted into R Atrium, R Ventrical. Pulmonary Artery -helps to determine cause of D CO, used in HF pt Complications: Air embolism and Pulmonary Infarct
What is BNP? Blood test to help determine HF (Sensitive Indicator) -BNP is a peptide that is secreted when vent volume and pressure in heart Increase -If on Neutracore (vasodilator and diuretic), will need to stop 2 hrs before test (will give false +)
What will a CXR show if you are in HF? -Enlarged Heart -Fluid in lungs
What does Digoxin/Digitalis/Lanoxin do? -Decreased HR (gives Vent more time to fill with blood) - Increases CO by squeezing down on more blood w/stronger contractions -Increases Kidney perfusion (diuresisng helps get rid of fluid)
What is the TDL of DIG? 0.5-2.0 you know it is working when CO increases Sx: anorexia, N/V (early), weird arrhythmias, vision changes (late)
What are GOOD CO SX? -Improved LOC -skin warm/dry -clear lungs -No SOB -pulses palpable -Increased UO -No Chest pain
What is the one electrolyte you really need to watch when a pt is on DIG? K (potassium), DIG TOX -any electrolyte imbalance while on Dig can cause toxicity but K gives the most problems
Anytime you DECREASE VOLUME you Decrease Pre/Afterload? Preload (decreases)
What common type of medication with DECREASE PRELOAD? DIURETICS
What does ALDACTONE Decrease? ALDOSTERONE -give in AM
If you have FLUID RETENTION what should you THINK 1st? HEART PROBLEM -Keep HOB elevated to Decrease preload bc heart can't handle more fluid or pressure in heart
What 2 meds are HF pt usually sent home on? -BB and ACE -decrease WL on heart -prevent vasoconstriction (increases CO- keeps blood moving forward)
What electrolyte does Salt substitute have in it? K (potassium)
What things have Increased Na? -canned foods -processed foods -OTC meds -fried foods
If a pt is hypoxic, restless, anxious, has a productive cough and pink sputum what would you assume is going on? PULMONARY EDEMA -usually hypoxic at night -can be caused by any person getting fluids too fast, HF, kidney problems (fluid excreted out of kidneys if not it will back up)
What are the 2 main sx of HYPOXIA? RESTLESS and ANXIOUS
How does LASIX work? Vasodilate (traps more blood in arms/legs), decreases preload and after load -give slow to prevent hypotension (D BP) and ototoxicity
What is the best position for a pt with PE? Sitting upright with legs down -helps improve CO -gravity pulls fluid away from Lungs
What is a Cardiac Tampanade? Blood/fluid/exudate leaks into pericardial sac and compresses heart from outside -CVP is increased so pressure in heart is Increased
What is the Hallmark sign of CARDIAC TAMPANADE? -Increased CVP -Decreased BP/CO ***Usually BP and CVP have a direct relationship*** -also narrow P Pressure
FVE does what to CVP and BP? -Increase CVP -Increase BP
FVd does what to CVP and BP and CO? -Decrease all
What main symptom can DECREASED CO lead to? SHOCK (blood not perfusing vital organs)
What is paradoxical BP? Different reading for inspiration and expiration
How do you determine pulse pressure? The difference between the Systolic and Diastolic pressure -normal is 40 -lower or NARROW would indicate significant blood loss (D preload/ CO) -25 or below is due to D SV as in CHF or SHOCK/Cardiac/AV stenosis
What are the main sx of Arterial disorders? sx are in lower extremities -decreTampanadease peripheral pulse (check 5 P's) -pain -sensitive to COLD Arterial blood not getting to tissue
NCLEX MOMENT IF YOU GET AN ARTERY QUESTION FIGURE OUT WHAT PART OF BODY ITS PERFUSING - MOST OF THE TIME IT WILL BE THE LOC ANSWER
What is BURGERS DZ? Inflammation of veins and arteries -vasoconstriction -usually in fingers and toes -Usually in MALES -Aterial Disorder
What is RYNODS DZ? Vasoconstricion when upset, cold, stressed Usually bilaterally in fingers (white-blue-red) -Usually in FEMALES -Arterial Disorder
What is a Venous problem? -blood can get to tissues but can't get away (stagnant) -Do NOT have O2 problem Ex: inflammation and chronic ulcers -edema, tenderness and sensitive to HEAT, + Homans sign (pain in calf dorsiflexed - indicates DVT) #1 concern is dislodging DVT leads t
What FOOD would you want to LIMIT if a pt is on COUMADIN? -green leafy veggies (high in vit K) -vit K is antidote to Coumadin
What is the main cause leading to Glomerial Nephritis? STREP (difference between GN and NS) also cathaterization - it puts holes in glomerilus and proteins/blood/sediment leaks out into urine (smokey or rust colored)
Sx of STREP? -Sore Throat -HA -Malaise (retaining toxins so makes you tired) If it goes to heart it will attack valves (bad bc valves prevent back flow)
What does retaining toxins cause? Tired/Malaise
What are Sx of Glomerial Nephritis? -Increased BUN/CRE/SG/BP -Sediment/blood/pro in UA due to holes strep caused (brown urine) -Flank pain -Facial Edema/ FVE -D UO, I SG Limit activity bc of fatigue (safety)
How do carbs work? -carbs empty stomach fast -body breaks them down for energy (increase when you don't want body to break down proteins for energy)
What are SX of RENAL FAILURE? -malaise -HA -N/V -anorexia -weight gain -Decreased UO
What is the difference between GN and NS (Nephrotic Syndrome)? NS you are VERY EDEMATOUS and MASSIVE PROTEINURIA -hypoalbumnic -hyperlipidemia -many things can cause NS unlike GN where step is usually cause
What does Albumin do? Holds on to/pulls fluid (H20 and Na) in vascular space -w/o this fluid goes to tissues (Decreased CVP) RA pathway (produces Aldosterone) and hold onto H2O and Na instead of excreting it but w/o Albumin to hold it in vascular space we get more edematous
What is the term for total body edema? Anasarca
What Dz would you assume if pt had sx of: proteinuria, hypoalbumina, edema, hyperlipidemia Nephrotic Syndrome
Why are ACE good in a pt with Nephrotic Syndrome? They block aldosterone secretion
What do Steroids do? -Decrease Inflammation Bad: Immunosupressed, Increase Blood Sugar,
What is the common rule in regards to proteins with kidney pts? Decrease Protein -except in Nephrotic Syndrome and Peritoneal Dialysis pt
What is Renal Failure? Bilateral (bc you can live with one kidney) -if blood can't get to kidneys or BP is below 90 (can take just 20 min to kill) SHOCK Causes: enlarged prost, kidney stones, ABX (mycin -nephro toxic), Diabetes, dyes, HTN, edemitous stoma
S/S of Renal Failure? -D UO, I SG -anemia -CHF, HTN (due to retained fluids) -anorexia, N/V -Increase K and Metabolic Acidosis (lethal arrhythmias) -Increase Ca (osteroporosis)
NCLEX MOMENT IN SELECT ALL THE APPLY- its NEVER all 5
Anytime you are Decreasing UO or it has stopped what electrolyte are we most worried about retaining? K (potassium) -if you are putting out a lot of Urine then you are losing a lot of K
What are the 2 phases of Renal Failure? 1. FVE (1-3 wks, Inc K, Dec UO) 2. Diuretic (sudden onset leads to shock, decreased K) Complete recovery can take up to 12 months
Hemodialysis Machine is glumerolis -3-4x/wk -given anticoag (Hep) stays in sys 4-6 hrs (no surf for this time) -unstable Heart can't do hemodialysis -HOLD (lisinopril, Nitro, ABX, vit, pepsid) -need IV access (permanent) Feel the thrill 300-800 ml/min -
Peritoneal Dialysis -fluid fills cavity, dwell time, fluid drained with toxins (should be straw colored , if cloudy=infx) -turn side to side to get all fluid out -2 types (CAPD & CCPD) #1 complication peritonitis (abd pain, cloudy, constant sweet taste)
S/S of Peritonitis -Abd pain, cloudy effluent, low back pain, D or C, anorexia, fever, N/V Peritoneum membrane lines inside of abd wall and covers organs
NCLEX MOMENT Avoid answers with Always/total/all - too specific
What is CRRT? Continious Dialysis -Done in ICU -never more than 80ml of blood out of body at one time -no drastic fluid shifts (unlike hemodyalysis) -less stress on Cardiac system -used for pt w/ acute RF and acute cardiac status
What is CAPD? Peritoneal Dialysis -manual exchange (3-4 x/day 7/days a week) -less freedom -not done at night -back pain will occur as SE Not for pt with prior back pain or colostomy
What is CCPD? Peritoneal Dialysis -pt is connected to cycler at night only -more freedom -continuous and automatic
What is the #1 complication of peritoneal dialysis? Peritonitis (inflammation of the peritoneum)
What type of fluid is used in peritoneal dialysis? Hypertonic (packed with particles) -pt will have a constant sweet taste bc of the glucose in the solution
What is the exception to diet in Dialysis Pts? -Increase protein and fiber bc of decreased peristalsis (usually you decrease protein in kidney its)
If someone were given Toradol, Diladid, Zolfran what are they trying to treat? Kidney Stones
If someone was having pain, N/V, Inc WBC, hematuria (RBC in urine) what they have? Kidney Stones
What happens when there is air/blood/exudate in the pleural space? Lung will Collapse
What is a Thoricentesis? Needle put into the pleural space to remove whatever is in there -positioning; lay on unaffected side at 45 degree or sit on edge of bed bend over chair, no coughing or deep breaths, need to be very still Rsk: FVD since fluid is being removed
What is the purpose of a CDU? To restore vacuum pressure in the pleural space by removing air/particles in a 1 way system until lung is healed.
How many mL can a CDU hold? 2,000mL -if it overflows it will block the H2O seal chamber and cause a tension pneuothorax
What is the 1st chamber of the CDU for? Drainage (can hold 2,000mL) -record q hr for the 1st 24 hours then q 8 hrs after that -rpt 100mL + in 1 hr or color change
What is the 2nd chamber of the CDU for? H2O seal chamber-INTERMIT BUBBLING=patent -Drainage stays in 1st chamber and the air goes to 2nd chamber -Fluctuation with Respiration (stops=kinks or lung re-expanded) -filled with 2cm of water -BAD: continuous bubbling (air in system, tell MD)
What is the 3rd chamber of the CDU for? Suction Control- CONTINUOUS BUBBLING -allows air to vent out -contolls Amt of suction need to pull fluid/air out -20cm of sterile H2O (max const no matter how much wall suction) -if dry suction no H2O = no bubbling
Should the CDU system be above or below the level of the chest? Below -if higher the drainage will go back into the pt -DONT DELEGATE THIS TEACHING
If MD has you clamp a chest tube can you leave them while this is clamped? NO -never leave -will only clamp for a few seconds -can lead to tension Pnemothorax
What is a Hemothorax/Pneomothorax? blood or air has accumulated in the pleural space = LUNG COLLAPSE Tx: Thoresentesis, chest tube, daily cxr
What are S/S of a Hemothorax/Pneomothorax? -SOB -Inc HR -diminished breath sounds on affected side -less movement on affected side -chest pain -cough
What is subcutaneous emphysema? -air that is trapped in sub q tissue (neck,face, chest) S/S: cracking feel to touch (usually reabsorbed by body) DX: of Hemothorax/Pneomothorax
What is Tension Pneumothorax? Pressure has built up in pleural space = COLLAPSED LUNG -pressure pushes everything to opposite side
What are some sx of Tension Pneumothorax? -absent breath sounds on affected side -asymmetry of thorax -trachia will be off center -Resp Distress -MEDICAL EMERGENCY (Dec CO)
What is an Open Pneumothorax/Sucking Chest wound? Opening into chest that is lg enough to allow air into pleural space Ex: gun shot or stabbing victim
If someone had a fracture of their ribs or sternum what S/S would you expect to see? -pain and tenderness -naturally splinting side with hand -shallow breaths to minimize pain (can lead to Resp Acid) -crepidis (bone ends are grinding together) Watch for other complications (hemo/pnemo/flail chest)
What type of medicine would you NOT want to administer for pain in a pt w/ fractured ribs or sternum? -Narcotics (it will Decrease R even more) -NO BINDER this will lead to shallow R, atalectasis and PNA
Intussusception Telescoping or going backward of bowel from proximal to distal and forms obstruction Sx: Currant jelly like stool (mucos/blood), sudden abd pain and V (infant colicky/inconsolable) Tx: BE(also Dx it) or surg -keep in hospital 12-24 bc it can reoccur
Hirschprung's Cogenital abnormality, aganglionic (no nerves) in colon =obstruction, usually sigmoid Sx: foul smelling ribbon stool, constipation (no parastalysis bc no nerves) -Neonate (absence of meconium, abd pain distention 1st 24 hrs) Tx: remove dz portion
TEF Opening between trach and espophogaus Sx: 3 C's (coughing, choking, cynosis)-especially w/drinking 1st feeding needs to be w/ sterile H2O or Breast Milk- watch closely (coughing or bubbling out of nose=Dx) -Supine w/head & shoulders elevated
GERD Regurgitation of gastric content into esophagus Tx of infants: small frequent feeding w/ thick rice cereal, H2, PPI Positioning: upright w/ feedings and at night, elevate prone to inc stomach emptying
Esophageal Estria Saliva can't make it to stomach bc espoh ends in blind pouch (closed off at bottom) Sx: no meconium bc they don't swallow amniotic fluid Tx: GT w/button
Pyloric Stenosis Sphincter at base of stomach connecting to SI Sx: PROJECTILE V after eating, irritability, hunger, abd distention Dx: olive shaped mass by umbilicus, ripple in abd (stomach trying to push content through small opening Tx: hydration and surg
Celiac Dz Genetic malabsorption disorder, intestinal intolerance to gluten Tx: NO GLUTEN (B-barley, R-Rye, O-oats, W-wheat) -GOOD (R-rice, C-corn, S-soy) and millitt
Enurisis Never have had extended periods of dryness -seen in children -will outgrow w/o treatment
Cryprochridism Both or one testes fails to decend through inguenal canal Tx: surgical correction may be necessary , no vigorous activity for 2 wks after
Episadis conginital defect -abnormal placement of urethreal office of the penis (ABOVE) (easy for bacteria to enter penis)
Hypospadias congenital defect -abnormal placement of uretheral office of penis (UNDER) Tx: Surgery -NO CIRCUMCISON bc the skin is needed for surgical repair
Where to look for JAUNDICE in CHILDREN -scleara of eyes -nail beds -generalized skin color change (not in one location like abd) -mucous membranes
Encopresis Fecal Inconstance Sx: soiled clothing and pt can be constipated
PKU Tested in all 50 states in newborns
Gastroschisis No protective membrane covering bowel -Rsk for infection
Appendicitis Sx: RLQ pain Tx: NO HEAT, Surg, NPO and IV ABX -position fetal -RLQ sudden relief = BURST
What DIET would you give a CHILD with DIARRHEA? BRAT (Bananas, Rice, Applesauce, Toast) and carrots NO DAIRY
Hepatitis SX -Hepatomegly -dark frothy urine -jaundice -RUQ pain -Stool clay colored
What are some Sx of LACTOSE INTOLERANCE? -Frothy Stools -D
What is FLAIL CHEST and S/S? Multiple Rib Fractures Sx: pain, paradoxical breathing (outward E), dyspnea, cyanosis, Increased P
What is used to treat FLAIL CHEST? -PEP (INVASIVE) -CPAP/BiPAP (NON-INVASIVE) -pt must breath on own POSITIVE INSPIRATORY PRESSURE
What is CPAP? Continuious Airway pressure -delivers constant pressure during I and E -non invasve (nasal cannula or face mask) -used for fail chest and obstructive sleep apnea
What is BiPAP? Bilevel Positive Airway Pressure -used to wean pt from ventilation and acute reps failure (COPD,sleep apnea, HF) and Flail Chest -excerts different levels of pressure along with O2 -pt must be able to breath spontaneously and co-operate w/support
What is PEP? Positive pressure that is expelled to keep avoli open -puts pressure down thorax which expands chest wall and realigns ribs
What do you need to check for anyone on PEP, BiPAP, or CPAP? Bilateral Lung sounds -q 2 hrs -you are putting pressure into thorax so you could pop a lung (pneomothorax)
Pulmonary Embolis Cause: dehydration, venous stasus (prolonged immobilization/surg), clotting disorder, heart arrythmias -cause blood to get thick and goes to lungs Sx: #1 HYPOXIA, R side heart failure and pulmonary HTN, coughing up blood, sharp chest pain Dx: VQ scan
What are some MEDS for PE? Heparin, Lovenox, Coumadin -all decrease clotting
Can you be on Hep and Coumadin at the same time? YES -as you tapper off Heparin, you increase Coumadin which you are sent home on
Steroids -Increase the breakdown of fat and protein -Decrease Cerebral Edema (decreases ICP)
What is one VS that you can look at when assessing NEURO? Pulse Pressure will widen with Increased ICP -VS changes are a late sign of problem
What is the formula for PULSE PRESSURE? Systolic-Diastolic (normally around 40, the wider the gap = Increased ICP
If a patient has a head injury and starts complaining about a HA what would you assume? Increased ICP
What is Occulosufalic Reflex? DOLLS EYES -these are good and means brain stem is functioning -can only do this with someone who is out of it Move head to the R and eyes should go L
What is Occularvestibulus Reflex? Assesses brain stem fxn -irrigates ear with 50ml of cool water -eyes move toward water then back to midline
CT Scan -can be with or w/o dye -takes pictures in layers -need to be still -no talking -can be claustrophobic
MRI -Magnetic -picks up pathology earlier -no dye/radiation -can talk and hear others when in tube
Cerebral Angiography -DYE -xray of cerebral circulation -goes through femoral art (like heart cath) Pre: Hydrated Post: BR 4-6hrs, check LOC since dye in brain, 1 side weakness/paralysis, compare baseline vs
What Sx will you get with a DYE/CONSTRAST? -WARMTH IN FACE -METALLIC TASTE
EEG Records electrical activity -helps dx SEIZURES NOT NPO this would Dec BS in brain HOLD: sedatives-D brain activity caffiene -I brain activity Enviroment must be quiet bc machine picks up stimuli
Lumbar Puncture -Done in 3rd or 4th sub arachnid space -gets CSF to analyze Post: lie flat or prone for 2 hrs to decrease pressure), give fluids Complication: most common HA, I pain when sitting up, brain herniation (know I ICP -procedure contraindicated)
S/S Menningitis -Fever -Chills + Brudinski/Kernigs -V -nuchal rigidity (STIFF NECK) -LIGHT HURTS EYES
What procedure is contraindicated if pt is known to have Increased ICP? Lumbar Puncture -puncture creates opening for pressure to release and causes brain matter to get sucked down foramen magnum -ICP BOTTOMS OUT, 99% Fatal
What is Cushing Triad and what does it indicate? Dx: INCREASED ICP -Increased SBP -Irregular Respirations -wide pulse pressure -Decreased HR
What are SX of Increased ICP? Cushing triad (I SBP, irregular R, wide pulse Pressure, Dec HR) -HA -V without N -change in LOC
What is a Concussion? Temporary loss of consciousness -only a few seconds -may just get dizzy -complete recovery
What is a Contusion? Brain is bruised -unconscious for longer than a few seconds -possible surface hemorrhage
What Electrolyte are all these foods high in and are they acidic or alkaline: Grains, Fruits, Veggies? K -Alkaline they Increase pH
Are salty foods alkaline or acidic? Acidic (decrease pH)
What do all these cause in terms of volume and pressure: Pancreatitis/bleeding/hemorrhage? Hypovolemic and Hypotensive -Less volume= less pressure
If your H/H is HIGH are you Dehydrated or Bleeding? Dehydrated
If your H/H is LOW are you Dehydrated or Bleeding? Bledding
In Pancreatitis what lab values are up? -WBC -lipase/amylase -SGOT -PTT H/H is LOW
What Electrolyte do all Proteins have? Phospates
What follows GLUCOSE? Water
What are the blood tests that are done for MI and which is the most specific? -Myoglobin -CK -Triponin (MOST SPECIFIC -can tell if pt delays tx)
What position do you want to put a pt in post THR? -No Flexion more than 45-60 -HOB no higher than 45 -Hip abduction with pillow (don't want to adduct)
What is Eclampsia? A Seizure -can occur to Decreased B/P postpartum
What happens to your BP as you get older? It Increases
What is so info on RSV? -Contact Precations (NO pregnant or contact lens RN) -Sx are like a really bad cold -Contagious -Can lead to PNA -Rsk for getting worse (less than 6 mo, heart or lung prob, older than 65, immunocompromised) -Tx: Ribovirin
What is Dumping Syndrome? Sx: dumps into small intestine, Severe D Tx: Eat reclining, lie down 20-30 min after food, restrict fluid during meals, NO Cho, Increase Fiber, eat small freq meals
Can you keep a COPD pt and a negative pressure room pt together? YES
What are Kussmal Respirations Deep Rapid Respirations
CHF patho The heart is not able to pump blood to the rest of the body at a normal rate. Lack of blood to body and a buildup of fluid. The fluid collects in Lungs (Congestive Heart Failure) Sx: Accumulation of fluid in lungs abd, legs, feet, ankles = weight gain
Created by: drcady