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MS 120

first exam

QuestionAnswer
Heart Failure Diagnosis (drugs that reduce afterload) ACE-Is (e.g. prils), ARBs (e.g. Tans) suppresses the renin-angiotensin system= decreased BP & fluid retention
Heart Failure Diagnosis (drugs that reduce preload) diuretics (e.g. Furosemide) decrease fluid overload
Heart Failure Diagnosis (drugs that reduce preload) Vasodilators (e.g. nitro) decreases volume return to the heart= decrease preload
Heart Failure Diagnosis (drugs that reduce preload) positive inotropes (e.g. digoxin, dobutamine, milrinone) increase force of myocardial contaction
Heart Failure Diagnosis (drugs that reduce preload) Beta blockers (e.g. LOLs) block activiation of beta adrenergic receptors= decrease HR and force of myocardial contraction
Heart Failure Diagnosis (teaching) DIETARY MODS: restrict Na to 2-3g daily; restrict fluid to 2L daily; restrict or avoid caffeine and ETOH
Heart Failure Diagnosis (teaching) MAWDS Medications: take meds as prescribed and don't run out, know the purpose and side effects of each drug
Heart Failure Diagnosis (teaching) MAWDS Activity: stay as active as possible within limits, be able to carry on conversation while exercising.
Heart Failure Diagnosis (teaching) MAWDS Weight: weigh each day at the same time on the same scale to monitor for fluid retention
Heart Failure Diagnosis (teaching) MAWDS Diet: Limit sodium to 2-3g as prescribed and daily fluid intake to 2L
Heart Failure Diagnosis (teaching) MAWDS Symptoms: Note any new or worsening symptoms, and notify the health care provider immediately
Peripheral Arterial Disease: Buerger's Disease uncommon occlusive disease of arteries and veins in distal extremities; tissues may fibrose= scarring that binds artery, vein, and nerve.
Etiology of BUERGER'S DISEASE smoking, genetic predisposition, autoimmune factors
Manifestations of BUERGER'S DISEASE CLAUDICATION: muscle pain caused by inadequate blood supply
Manifestation of BUERGER'S DISEASE COLD SENSITIVITY: Coldness, numbness, diminished pulses in distal extremities
Diagnosis of BUERGER'S DISEASE Peripheral ischemia, ulcerations and gangrene in digits, arteriographs of occlusions
Interventions of BUERGER'S DISEASE abstinence from tobacco, avoid extreme or prolonged cold exposure, vasodilators (e.g. Nifedipine), analgesics
Peripheral Arterial Disease: SUBCLAVIAN STEAL occlusion or stenosis of subclavian artery, usually unilateral
Etiology of SUBCLAVIAN STEAL unknown, common in people with risk factors for atherosclerosis
Manifestations of SUBCLAVIAN STEAL tiredness in arm with exertion, numbness, dizziness, exercise induced pain, BP difference of 20mm Hg or greater, subclavian bruit on auscultation, affected arm may be discolored or cyanotic
Interventions for SUBCLAVIAN STEAL Endarterectomy to clean out artery, stent placement to dilate artery
Interventions for SUBCLAVIAN STEAL (post-op care) Monitor arterial flow; check distal pulses, monitor for edema, redness.
Peripheral Arterial Disease: Thoracic Outlet Syndrome: compression of subclavian artery at the thoracic outlet by muscle or bone
Etiology of Thoracic Outlet Syndrome common in women and in those whose occupations require holding their arms up or leaning over (e.g. baseball players, golfers, swimmers)
Manifestations of Thoracic Outlet Syndrome neck, shoulder, arm pain; numbness; edema; cyanosis
Interventions for Thoracic Outlet Syndrome surgery to resection compression; PT; exercises; avoid aggravating positions
Peripheral Arterial Disease: Raynaud's Phenomenon unilateral vasospasm of arteries and arterioles in extremities (Raynaud's disease; BILATERAL
Etilogy of Raynaud's Phenomenon unknown, associated with connective tissue disease such as SLE
Manifestations for Raynaud's Phenomenon Vasospasm causes constriction and blanching, followed by cyanosis= when vasospasm relieved, the tissue becomes hyperemic (reddened); numbness, coldness, pain, swelling, ulcers
Interventions for Raynaud's Phenomenon DRUGS: Vasodilators (e.g. Nifedipine) to relieve symtoms
Interventions for Raynaud's Phenomenon Surgery: lumbar sympathectomy for legs or sympathetic ganglionectomy for arms= cuts sympathetic innervations that cause VC= relieves sever symptoms
Interventions for Raynaud's Phenomenon education: minimize cold exposure, reduce caffeine intake, smoking cessation, identify and reduce stressors
Peripheral Arterial Disease: Popliteal Entrapment Compression of popliteal artery by adjacent muscles or tendons
Etiology of Popliteal Entrapment unknown, may involve abnormally developed muscles
Manifestations for Popliteal Entrapment calf claudication, chronic leg ischemia
Diagnosis of Popliteal Entrapment Ultrasound, MRI, CT, angioplasty to determine blood flow
Interventions for Popliteal Entrapment Surgery to relieve compression or resection popliteal artery
post of care for Popliteal Entrapment Monitor arterial blood flow, check distal pulses, monitor for edema, redness, etc
Peripheral Venous Disease To function properly, veins must be patent (open) with competent valves; requires assistance of skeletal muscles.
eripheral Venous Disease: Venous Thromboembolism: DVT, PE
Venous Thromboembolism: Thrombus Blood clot
Venous Thromboembolism: Embolus Blood clot that's traveled from it's site of origin
Thrombophlebitis Thrombus associated with inflammation
Etiology of Venous Thromboembolism Associated with Virchow's Triad - stasis of blood flow, endothelial injury, hyper-coagulability; surgery, ulcerative colitis, HF, cancer, oral contraceptives, immobility
manifestations for Venous Thromboembolism Calf or groin pain tenderness and pain, edema, ecchymosis
Diagnosis for Venous Thromboembolism Venous duplex ultrasonography to assess blood flow; doppler flow studies (thromboses veins produce little or no sound); D-dimer to measure products from clot breakdown
Interventions for Venous Thromboembolism (goals) prevent complications, prevent further thrombus formation, prevent increase in size of thrombus
Interventions for Venous Thromboembolism Drugs: Anticoagulants: unfractionated heparin, low-molecular weight heparin (e.g. Enoxzparin), Warfarin= prevent further thrombus formation, prevent increase in size of thrombus formation.
Drug interventions for Interventions for Venous Thromboembolism Heparin: monitor aPTT; antidote-protamine sulfate
Drug interventions for Interventions for Venous Thromboembolism Warfarin: monitor PT/INR, antidote- Vitamin K
Drug interventions for Venous Thromboembolism Thrombolytics (e.g.tPA) dissolve clots
Interventions for Venous Thromboembolism Surgery: thrombectomy to remove clots, inferior vena cava filtration to trap emoli
Teaching for Venous Thromboembolism Smoking cessation, avoid oral contraceptives; avoid potentially traumatic situations when on anticoagulant therapy
Teaching for Venous Thromboembolism How to self inject heparin; limit or omit foods high in Vit K when on warfarin; report s/s of bleeding (blood in stool, urine, nosebleeds, ecchymosis, altered mental status)
Venous Insufficiency Occurs as result of prolonged venous HTN that stretches the veins and damages the valves
Etiology of Venous Insufficiency Prolonged sitting or standing=venous HTN; obesity causes chronically distended veins= damaged the valves; thrombus, thrombophlebitis also contribute to valve damage
Manifestations of Venous Insufficiency Edema, reddish brown discoloration ( statis dermatitis), statis ulcers, heaviness, cramping
Interventions for Venous Insufficiency Goals: decrease edema, promote venous return
Interventions for Venous Insufficiency Nonsurgical: graduated compression stockings, elevation of legs, Unna boot dressing (contains Zinc Oxcide) Topical agents, debride ulcer, eliminate necrotic tissue, promote healng
Interventions for Venous Insufficiency Surgical: Debridement of ulcers
Teaching for Venous Insufficiency Elevate legs, wound care, how and when to apply SCD's, exercise program, maintain optimal weight
Varicose Veins Distended, protruding veins that appear darkened and tortuous; frequently seen in pt's with systemic problems (e.g. HF), obesity, and family Hx
Manifestations of Varicose Veins Pain, fullness, and heaviness in legs
Diagnosis of Varicose Veins Trendelenburg test= place pt in supine position with elevated legs; with varicosities, veins fill from the proximal end
Interventions for Varicose Veins Graduated compression stockings, elevate legs, sclerotherapy, surgical removal of vein
Phlebitis Inflammation of superficial Veins caused by an irritant such as peripheral IV therapy
Manifestation of Phlebitis reddend, warm area radiating up arm, pain, soreness and swelling
Interventions for Phlebitis warm, moist skin soaks to dilate vein and promote circulation, graduated compression stockings for phlebitis in legs
Vascular Trauma include punctures, lacerations, and transections
Etiology of Vascular Trauma MVA's, gunshot/knife wound, arterial puncture for arteriographic or hemodynamic studies
Manifestations of Vascular Trauma Circulatory, motor, sensory impairment
Diagnosis of Vascular Trauma Ask about mechanism of injury; arteriogrpah
Interventions for Vascular Trauma Establish patent airway, control bleeding, restore blood flow; repair vein with bypass grafting, lateral suture repair, thrombectomy, resection with end to end anastomosis, vein patch grafting.
Purpose of the lungs Oxygenate blood, eliminate co2 from blood
What does the upper respiratory tract consist of nose, mouth, pharynx, larynx
What does the lower respiratory tract consist of trachea, lungs, associated blood systems
What are the alveoli functional unit of the lungs
Diagnostic assessments of the Pulmonary System (Labs) Blood/RBC count, ABG, H&H, sputum - to identify organisms or abnormal cells, such as in cancer or an allergy
Noninvasive Test for the Pulmonary System Radiographic studies- chest x-rays: disease process, fluid in lungs, pulmonary, vasculature, infection, tumors, tube placement.
Noninvasive Test for the Pulmonary System CT scan- soft tissues, PE; V/Q scan (nuclear scan) for ventilation, perfusion, PE, advanced COPD
Noninvasive Test for the Pulmonary System Pulse ox, PFT's, exercise training=- tolerance, need for o2 therapy, skin testing -PPD for TB
Invasive tests for the pulmonary system endoscopic exams- visualization, biopsy, sputum collection, trauma, "bronch wash" to get rid of secretions, thoracentesis- removes fluid from pleural spaces.
What is the follow up care after a endoscopy? monitor pt until effects of sedation is resolved and gag reflex returned, monitor VS and assess lung sounds every 15 minutes for 2 hours. assess for infection, pneumthorax, hemorrhage
Manifestations of nose fractures? asymmetry/deviation, pain, crepitus
Interventions for a Nose Fracture Closed reduction- manipulation of bonds by palpation to reposition them in proper alignment; done within 24 hours
Interventions for a Nose Fracture Rhinoplasty: surgical reconstruction of the bone
Interventions for a Nose Fracture Observe for edema and bleeding; monitor V/S; put pt at semi-fowler's, cold compress to reduce swelling and bruising.
Interventions for a Nose Fracture drink 2.5L/day, limit valsalva maneuvers, dont blow nose, don't sneeze with mouth closed, humidifiers too keep mucosa moist
Epistaxis Nose bleed
what causes epistaxis? trauma, HTN, blood dyscrasia, inflammation, tumor, decreased humidity, nose blowing, nose picking, chronic coke use, NG suctioning
interventions for epistaxis keep pt upright leaning forward, lateral pressure, cold compress, gauze or tamponades to pack nares,
Nasal polyps bengin grape like clusters of mucus membrane and connective tissue
causes of nasal polyps irritation, allergies, infection, could obstruct airway
interventions for nasal polyps nasally inhaled steroids, polypectomy (surgery removal)
Causes of cancer of the nose and sinuses smoking, chronic exposure to dusts and radiation
Manifestations of nose and sinus cancer resembles sinusitis, persistant nasal obstruction, drainage, bloody discharge, pain, lymph nose enlargement
Interventions for nose and sinus cancer surgical removal, radiation, chemo
facial trauma blunt force breaks bone; described by specific bones and side of face involved
Le Fort I nasoethmoid fracture
Le Fort II Naseothmoid and maxillary fracture
Le Fort III Naseothmoid, maxillary, and orbital-zygoma fracture,"craniofacial disjunction
Manifestations of facial trauma airway obstruction= stridor, SOB, Dyspnea, hypoxia, hypercarbia (high Co2 in blood) bleeding, edema, asymmetry
Interventions for facial trauma maintain airway by... intubation, tracheotomy, criothyroidotomy, plates, screws, bone substitutes
define sleep apena breathing disruption during sleep that lasts at least 10secs and occurs at least 5x/hr. happens in upper airway obstruction by soft palate or tongue.
Causes of sleep apena obesity, large uvula, short neck, smoking, enlarged tonsils/adenoids, oropharyngeal edema, neurologic origin, PREVENTS DEEP SLEEP NEEDED FOR GOOD REST
manifestations of sleep apnea heavy snoring, excessive daytime sleepiness, inability to concentrate, irritability
Dx of sleep apnea polysomnogram during an overnight sleep study
Interventions for sleep apnea changing sleeping positions, weight reduction, Bipap, CPAP=delivers +airway pressure to prevent collapse. MODAFINIL to manage daytime sleepiness. surgery
what causes vocal cord paralysis injury, trauma, disease, prolonged intubation, (can affect one or both chords) may be open (risk for aspiration) or closed (airway obstruction)
Manifestations of vocal cord paralysis open= hoarseness, breathy voice, weak voice, aspiration. If it's closed= strider
Interventions for vocal cord paralysis open-- teflon injection to enlarge affected cord, TUCK CHIN WHEN EATING, high-fowler's position, THICK LIQUIDS. closed-- intubation, tracheotomy
Vocal cord nodules Enlarged, fibrous tissues caused by infection or overuse of voice
Vocal cord polyps Edematous masses caused by smoking and allergies
Vocal cord nodules & polyps manifestations Painless hoarseness
Vocal cord nodules & polyps interventions quitting smoking, voice rest, humidification, surgical removel
Laryngeal Trauma occurs with a crushing or direct blow injury, fracture, prolonged intubation
Laryngeal Trauma manifestations Dyspnea, aphonia, hoarseness, subcutaneous emphysema (air present in subcutaneous tissue), hemoptysis (bleeding from airway)
Laryngeal Trauma INTERVENTIONS maintain airway-- apply o2 and humidification, tracheotomy; surgical repair of larynx
upper airway obstruction life threatening emergency in which airflow through nose, mouth, pharynx, or larynx is interrupted
Causes of upper airway Obstruction include tongue edema, or occlusion, laryngeal edema, peritonsillar abscess, head and neck cancer, thick secretions, stroke, foreign-body aspirations, burns, anaphylaxis
Manifestations of Upper Airway Obstruction diaphoresis, tach, increased BP, hypoxia, hypercarbia (high co2 in blood), anxiety, sternal retractions, restlessness, "seesawing chest"
Interventions for Upper airway obstructions maintain airway== intubation, tracheotomy, cricothyroidotomy,
Neck trauma knives, gunshots, traumatic accidents; may involve cardiovascular, intestinal, or neurological damage
Manifestations of neck trauma bleeding== shock, pain, crepitus
Interventions for neck trauma maintain airway== intubation, tracheotomy, cricothyroidotomy.
Head and Neck Cancer usually squamous cell carcinomas, slow growing; risk factors- tobacco and ETOH use, voice abuse, chronic laryngitis, exposure to chemicals, dusts, poor oral hygiene
Head and Neck Cancer manifestations difficulty speaking, SOB, tumor bulk, pain, dysphagia (difficulty swallowing) persistant or unexplained bleeding, numbness, anorexia
Head and Neck Cancer Interventions surgery, radiation, chemo, maintain airway
COPD: Emphysema Proteases (enzymes that destroy particulars and organisms inhaled during breathing). are present in higher-than-normal amounts.
COPD: Emphysema Proteases== destroy elastin of alveoli= decreasing lung elasticity and hyperinflation of lung
COPD: Chronic Bronchitis Inflammation of bronchi and bronchioles caused by exposure to irritants; inflammation increases the number and size of mucous glands== large amounts of thick mucous produced, which thicken the bronchial wall and obstruct air flow
Etiology of COPD smoking; aplha1-antitrypsin (ATT) deficiency- ATT inhibits proteases from damaging healthy lung tissue
Complications of COPD Hypoxia and acidosis due to decreased gas exchange
Complications of COPD Respiratory infections due to increased mucus and poor oxygenation
Complications of COPD Cardiac failure, especially cor pulmonale (right-sided HF) due to increased pressure in lungs
Complications of COPD Cardiac dysrhythmias due to hypoxemia, other cardiac disease, drug effects, or acidosis
Manifestations of COPD hallow respirations, retractions, wheezes, decreased breath sounds, barrel chest, cyanosis, delayed cap refill, finger clubbing, peripheral edema
Manifestations of COPD Anorexia and weight-loss, enlarged neck muscles, orthopedic or tripod position, decreased activity tolerance, fatigue, increased RR
What Labs Help Dx COPD adnormal ABG, low O2 sat, sputum culture of infections, increased H&H (polycythemia- compensatory increased in RBC's) electrolyte imbalance
How do x-rays help Dx COPD Chest x-rays rule out other lung diseases, monitor progress of infections or chronic disease; hyperinflation in lungs; flattened diaphragm
Drug interventions for COPD Beta agonists short acting (albuterol) long acting (salmeterol) activate sympathetic NS= bronchodilation
Drug interventions for COPD Anticholinergics (ATROVENT) inhibit Parasympathetic NS== bronco-dilation
Drug interventions for COPD Corticoteroids (PREDNISONE) decrease inflammation
Drug interventions for COPD Mucolytics (MUCOMYST) break up and thin mucus secretions
Drug interventions for COPD Expectorants (MUCINEX) creat productive cough to expel secretions
Interventions for COPD Abdominal or purse-lip breathing, elevate HOB to manage dyspnea O2 therapy, exercise conditioning, suctioning, hydration, achieve and maintain WT within 10% ideal
Interventions for COPD Prevent infection-- report S/S of infections, avoid crowds, vaccinations
Interventions for COPD Lung transplant and lung reduction surgery
Functions of Renal System Filters waste, regulates electrolyte balance, regulates blood volume and blood pressure, activates Vit D (needed for Ca absorption),
Functions of Renal System Produces and secretes erythropoietin (stimulates RBC production in bone marrow)
Renal Disease Term PRE-RENAL FAILURE Kidney's healthy; problems with blood supply (e.g. anemia, HF, dehydration, trauma)
Renal Disease Term INTRINSIC RENAL FAILURE Kidney dysfunction
Renal Disease Term POST-RENAL FAILURE Kidney's healthy; problems with ureters, bladder, or urethra
URINARY Dx TESTS/PROCEDURES (renal) Blood: serum creatinine, BUN measure levels of byproducts from protein and muscle breakdown (elevated with kidney impairment)
URINARY Dx TESTS/PROCEDURES: Urine (renal) Color: concentration/dilution of urine reflect hydration status, drugs, diet
URINARY Dx TESTS/PROCEDURES (renal) Turbidity (cloudy) infection, dehydration, diet, drugs
URINARY Dx TESTS/PROCEDURES (renal) Smell: foul odor indicative od infections, dehydration, diet, drugs,
URINARY Dx TESTS/PROCEDURES (renal) pH: normal range= 4.6-8!!!!!!!!!
URINARY Dx TESTS/PROCEDURES (renal) Glucose: presence reflects hyperglycemia
URINARY Dx TESTS/PROCEDURES (renal) Ketones: presence reflects incomplete metabolism of fatty acids, as in diabetic ketoacidosis
URINARY Dx TESTS/PROCEDURES (renal) Protein: increased levels may indicate stress, infection, glomerular disorders
URINARY Dx TESTS/PROCEDURES (renal) RBC's infection, bleeding disorders, stones
URINARY Dx TESTS/PROCEDURES (renal) WBCs: infection, inflammation, fever
URINARY Dx TESTS/PROCEDURES (renal) C&S: done when manifestations of infection and bacteria in urine present
URINARY Dx TESTS/PROCEDURES (renal) 24hr collection: I&O
Renal Dx TESTS/PROCEDURES Bladder scan: post-void residual, determines need for catheterization
Renal Dx TESTS/PROCEDURES Kidney, ureter, bladder (KUB) X-ray: stones, strictures, calcifications, obstructions
Renal Dx TESTS/PROCEDURES CT SCAN: tumors, cysts, abscesses, other masses, obstructions
Renal Dx TESTS/PROCEDURES Cystogram: dye instilled into bladder via catheter, used in cases of trauma when urethral or bladder injury suspected
Renal Dx TESTS/PROCEDURES Cystoscopy: Dx or treatment, determine extent of trauma,identify causes of obstructions, remove tumors or enlarged prostate
RENAL: Cystitis Inflammation of the bladder; infections cystitis is the most common of the UTI's; interstitial cystitis has no known cause
Etiology of Cystitis (UTI's) E.coli, Klebsiella, proteus, from perineal area move into urethra as a result of irritation, trauma, caths, improper hygiene
Complications of Uti's pyelonephritis, sepsis== life-threatening
Manifestations of UTI's FREQUENCY!!!! URGENCY!!!! DYSURIA!!!! (other manifestations; hesitancy, nocturia, low back pain, suprapain, incontinence, hematuria (blood in urine), fever, chills, N/V
Dx of UTI's UA-- WBC's, nitrates, C&S, turbidity, RBC's
Radiology tests for UTI Obstructon, urinary stasis
Cystoscopy for UTI recurrent UTI's (3/years or more)
Interventions for UTI's (drug therapy) Antiseptics/antibiotics: cephalosporins (suprax)
Interventions for UTI's (drug therapy) Antiseptics/antibiotics: sulfonamides (Bactrim),
Interventions for UTI's (drug therapy) Antiseptics/antibiotics: Fluoroquinolones (levaquin),
Interventions for UTI's (drug therapy) Antiseptics/antibiotics: penicillins (amoxicillin),
Interventions for UTI's (drug therapy) Analgesics (Pyridium) Decreases pain and burning during urination (may discolor urine)
Interventions for UTI's Patient comfort: warm sitz bath
Interventions for UTI's Surgery: remove obstructions
Patient Teaching for UTI's drug therapy, proper hygiene, maintain hydration; avoid ETOH, caffeine, acidic foods, carbonated drinks
What is Urethritis? Inflammation of the urethra
Etiology of Urethritis STD's (gonorrhea, Chlamydia, Trichomonas) decreased estrogen in postmenopausal women,
Manifestations of Urethritis same as Cysitis
Interventions of Urethritis Antibiotics, estrogene creams
Urethral Strictures narrowed areas of the urethra obstruct urine flow; occur more often in men
Etiology of Urethral Strictures Complication of STD, trauma during cath insertion, procedures, childbirth
manifestations of Urethral Strictures obstruction of flow, no pain, risk for developing UTI, overflow incontinence.
Interventions of Urethral Strictures dilation, stent placement, surgical removal of stricture
What is urinary incontinence? involuntary loss of urine severe enough to cause social or hygienic problems
What is stress incontinence? loss of urine during activities; Pt cannot tighten urethra to prevent leakage; caused by weakened pelvis floor muscles,
Manifestations of Stress incontinence urine loss with exertion (cough, sneeze, exercise); usually only small amounts
What is urge incontinence? a overactive bladder; loss of urine associated with strong desire to urinate; pt cannot suppress signal from brain; unknown cause, problem neurologic dysfunction
Manifestations of Urge Incontinence abrupt and strong urge to void; may lose large amounts
Mixed incontinence Combination of stress, urge, and overflow incontinence
OVERFLOW (REFLEX) INCONTINENCE Loss of urine associated with over-distention; caused by diabetic neuropathy, side effects of meds, surgery, spinal cord injury, obstruction
Manifestations of OVERFLOW (REFLEX) INCONTINENCE bladder distention often up to umbilicus, constant dribbling of urine
FUNCTIONAL INCONTINENCE results from factors other than abnormal function of bladder and urethra; caused by loss of cognitive function in patients with dementia
Manifestations of Functional Incontinence quantity and timing of leakage will vary; patterns difficult to discern
Dx of incontinence UA to rule out infection; cystourethrogram to identify obstructions; cystourethrogram to measure filling pressure; uroflowmetry to measure rate and degree of emptying
interventions for incontinence Kegel exercises to strengthen pelvic floor muscles in stress incontinence
interventions for incontinence Wt reduction; obesity may worsen stress incontinence; avoid bladder irritants (etoh, nicotine, artificial sweeteners, citrus, caffeine); maintain hydration.
Drugs to help with Incontinence Estrogen: improves vaginal and urethral blood flow and tone
Drugs to help with Incontinence Anticholinergics/antipasmodics (TOLTERODINE): relax bladder muscle, suppress urge
Drugs to help with Incontinence Tricyclic antidepressants: some have anticholinergic effects
Interventions for Incontinence Vaginal Cones: strengthen pelvic floor muscles
Interventions for Incontinence surgery: reposition urethra and bladder, change structure of involved tissues, insert artificial device to improve function
Other Interventions for Incontinence Bladder training, habit training, condom caths, pads/diapers, intermittent caths, bladder compression
Pt teaching for Incontinence drug therapy, Wt reduction, diet modification, need for external devices/protective pads
Urolithiasis Presence of calculi (stones, usually composed of Ca oxalate/Ca phos) in the urinary tract
Urolithiasis involves three conditions 1. slow urine flow== supersaturation of urine with Ca==Ca crystallizes and later becomes stones
Urolithiasis involves three conditions 2. Damage to lining of urinary tract
Urolithiasis involves three conditions 3. Decreased amount of substances that prevent supersaturation and crystal aggregation
Etiology of Urolithiasis unknown; may involve metabolic disorders (e.g. hypercalcemia, hyperuricemia), urinary stasis or retention, immobility, dehydration
manifestations of Urolithiasis sever pain (renal colic), N/V, pallor, diaphoresis, frequency/dysuria (painful) when stone in bladder, oliguria/anuria (low output/nonpassage) when stone in bladder neck or urethra
Dx of Urolithiasis UA- RBC's, WBC's, bacteria, turbidity; KUB x-ray, urogram, or CT to visualize stone
Interventions for Urolithiasis Pain management; opioid meds or NSAIDs, breathing techs, positioning, acupuncture, avoid over-hydration, and under-hydration, lithotripsy to break up stone so it can be passed
Interventions for Urolithiasis Surgery: stenting to dilate ureter so stone can be passed; ureteroscopy, ureterolitotomy, pyeolithotomy, nephrolithotomy to remove stone
Interventions for Urolithiasis Prevent infection: broad-spectrum antibiotic until C&S complete, balanced diet, fluid intake of 2-3L/day
Interventions for Urolithiasis (drug) Prevent obstruction: drug therapy depends on cause (e.g. ALLOPURINOL for uric acid stones,
Interventions for Urolithiasis (drug) Thiazide diuretics for Ca stones
Interventions for Urolithiasis Fluid intake; nutrition therapy depends on cause; encourage walking to pass stones, monitor urine pH: strain urine to collect and analyze stone fragments
Urothelial Cancer Transitional cell carcinomas; usually low grade, have multiple points of origin, and are recurrent;
Causes of Urothelial Cancer smoking, exposure to toxins (especially chemicals)
Manifestations of Urothelial Cancer asymmetry and tenderness of abdomen, bladder distention, hematuria, dysuria, frequency, urgency
Dx for Urothelial Cancer UA for blood, cystoscopy for biopsy, CT to show tumor invasion of surrounding tissues
Interventions for Urothelial Cancer BCG installation: live virus to prevent recurrence of superficial cancers
Interventions for Urothelial Cancer Radiation, chemo
Interventions for Urothelial Cancer Surgery: cystectomy plus urinary diversion (ileal conduit, continent pouch, bladder reconstruction, ureterosigmoidostomy
Bladder Trauma May occur by stabbing, gunshot wound, other trauma, pelvic fracture
manifestations of Bladder Trauma Anuria (can't pee) hematuria (blood in urine)
Interventions for bladder trauma surgery to repair bladder (foley cath in place post-op to allow bladder to heal
FLUID BALANCE AND ELECTROLYTES Water is needed for structure of cells and organs, transportation, thermoregulation
FLUID BALANCE AND ELECTROLYTES Water makes up 60% of total weight of adults (mainly in skeletal muscle)
FLUID BALANCE AND ELECTROLYTES Average intake of 2.5L of water (65% from fluids, 35-40% from solids)
FLUID BALANCE AND ELECTROLYTES Sensible water loss: urine, feces, emesis, wounds, drainage
INTRACELLULAR FLUID (ICF) Fluid in the cells
EXTRACELLULAR FLUID (ECF) Fluid in the vasculature; "blood"
INTERSTITIAL FUILD Fluid between cells; "third space"
TRANSCELLULAR FLUID Fluid in special body spaces; includes CSF, synovial fluid; no effect on overall fluid balance.
CATIONS positively charged ions
ANIONS Negatively charged ions
FILTRATION Hydrostatic pressure in capillaries > hydrostatic pressure in interstitial space = force water out of capillaries
DIFFUSION movement of solutes (electrolytes, nutrients, etc.)
OSMOSIS Movement of solvents (water)
OSMOSIS Movement of solute and solvents between ICF and ECF needed to maintain homeostasis
POTASSIUM NORMAL RANGE 3.5-5.0mEq/L
POTASSIUM functions depolarize excitable tissue and generate action potentials
POTASSIUM functions Regulates protein synthesis
POTASSIUM Functions regulates use and storage of glucose
POTASSIUM Functions 80% removed by kidney; removal
HYPOKALEMIA Potassium >3.5 mEq/L; decreases cell excitability, so they are less responsive to stimuli
HYPOKALEMIA Potassium >3.5 mEq/L Relative cause: abnormal distribution between ICF and ECF. dilution by water
HYPOKALEMIA Potassium >3.5 mEq/L Actual Cause: excessive loss, inadequate intake
HYPOKALEMIA Potassium >3.5 mEq/L MANIFESTATIONS Shallow respiration's, skeletal muscle weakness; decreased deep tendon reflexes; thready and weak pulses; dysrhythmias
HYPOKALEMIA Potassium >3.5 mEq/L MANIFESTATIONS Orthostatic HYPOtension; altered mental status==coma; decreased or absent GI peristalsis=== constipation
HYPOKALEMIA Potassium >3.5 mEq/L TESTS Serum levels, ECG changes
HYPOKALEMIA Potassium >3.5 mEq/L Interventions Potassium supplements; increase dietary intake; potassium sparing diuretics
HYPOKALEMIA Potassium >3.5 mEq/L Interventions IV Potassium (dilute and slow drip); fall precautions
HYPOKALEMIA Potassium >3.5 mEq/L Interventions Monitor RR (rate, depth, o2 sat, cough, pallor, cyanosis, ABG's)
HYPERKALEMIA POTASSIUM >5.0 mEq/L Increases cell excitability, so they response to less intense stimuli and may fire spontaneously
HYPERKALEMIA POTASSIUM >5.0 mEq/L ACUTAL CAUSE? increase in total body potassium
HYPERKALEMIA POTASSIUM >5.0 mEq/L RELATIVE CAUSE? movement of potassium from ICF to ECF
HYPERKALEMIA POTASSIUM >5.0 mEq/L Manifestations Bradycardia; HYPOtension; ECG changes= heart block, asystole, ventricular fibrillation; muscle twitching= muscle weakness; increased GI mobility= diarrhea
HYPERKALEMIA POTASSIUM >5.0 mEq/L TESTs serum levels; dehydration= other electrolyte levels, H&H; renal failure=BUN, creatinine, decreased pH, decreased H&H
HYPERKALEMIA POTASSIUM >5.0 mEq/L INTERVENTIONS Stop Potassium-containing infusions, potassium supplements;
HYPERKALEMIA POTASSIUM >5.0 mEq/L INTERVENTIONS use potassium-excreting diuretics; KAYEXALATE (increase sodium excretion and increases potassium excretion in GI)
HYPERKALEMIA POTASSIUM >5.0 mEq/L INTERVENTIONS Dialysis; insulin (moves potassium from ECF into ICF); Cardiac Monitoring (ECG, HR, Rhythm)
SODIUM (Na) 135-145mEq/L FUNCTIONS Skeletal and Cardiac muscle contractions; nerve impulse transmission; normal osmolarity and volume of ECF (water balance)
SODIUM (Na) 135-145mEq/L FUNCTIONS Regulated by the kidney under influences of aldosterone, ADH,natriuretic peptide
HYPONATREMIA (Na) <135 mEq/L Decreases depolarizations of excitable tissue and causes cell swelling.
HYPONATREMIA (Na) <135 mEq/L Causes: Increased excretion, inadequate intake, dilution by water (e.g. excess diaphoresis, diuretics, decreased aldosterone, NPO, hyperglycemia, kidney disease)
HYPONATREMIA (Na) <135 mEq/L Manifestations changes in behavior, LOC, mental status; muscles weakness; increased GI mobility - diarrhea, nausea, cramps)
HYPONATREMIA (Na) <135 mEq/L with HYPOVOLEMIA (DECREASED BLOOD VOLUME) rapid and thready pulses, decreased BP, othrostatic hypotension
HYPONATREMIA (Na) <135 mEq/L with HYPERVOLEMIA (FLUID OVERLOAD) Full and bounding pulses; increased BP
HYPONATREMIA (Na) <135 mEq/L Interventions Avoid drugs that promote Na loss (e.g. diuretics); IV infusion of hypertonic saline solutions; increase dietary intake; restrict fluids; monitor I&O's
HYPERNATREMIA (Na) >145 mEq/L Increases depolarizations of excitable tissue (increases irritability) and causes dehydration
HYPERNATREMIA (Na) >145 mEq/L Causes increased intake, decreased excretion
HYPERNATREMIA (Na) >145 mEq/L manifestations muscle twitching= muscle weakness, decreased deep tendon reflexes
HYPERNATREMIA (Na) >145 mEq/L with Hypovolemia (decreased blood volume) decreased attention span; agitation; confusion; manic episodes; seizures; increased HR
HYPERNATREMIA (Na) >145 mEq/L with Hypovolemia (decreased blood volume) weak peripheral pulses; orthostatic hypotention
HYPERNATREMIA (Na) >145 mEq/L with Hypervolemia (fluid overload) lethargy; drowsiness; stupor; coma; bradycardia; bounding pulses; distended neck viens; increased BP
HYPERNATREMIA (Na) >145 mEq/L Interventions Drug therapy: IV infusions of hypotonic saline solutions; drugs that increase sodium excretion (e.g. diuretics)
CALCIUM (Ca) 9.0-10.5 mg/dL Functions maintain bone strength and density; activates enzymes; skeletal and cardiac muscle contractions; nerve impulse transmission; blood clotting
CALCIUM (Ca) 9.0-10.5 mg/dL Functions Absorption requires Vit D
CALCIUM (Ca) 9.0-10.5 mg/dL Functions Parathyroid hormone (PTH) increases serum calcium
CALCIUM (Ca) 9.0-10.5 mg/dL Functions Thyrocalcitonin (TCT) decreases serum calcium
HYPOCALCEMIA Ca <9.0 MG/dL increases sodium movement across excitable membranes, so depolarization occurs more realily and at inappropriate times
HYPOCALCEMIA Ca <9.0 MG/dL Causes decreased absorption, increased excretion, decreased ionized Ca, endocrine disturbances
HYPOCALCEMIA Ca <9.0 MG/dL Manifestations Painful muscle spasms ("charley horses"); paresthesias (tingling, numbness); increased or decreaed HR; weak, thready pulses;
HYPOCALCEMIA Ca <9.0 MG/dL Manifestations hypotension; prolonged ST and QT intervals; increased GI peristalsis (abdominal cramping, diarrhea); bone pain
HYPOCALCEMIA Ca <9.0 MG/dL Manifestations TROUSSEAU'S SIGN Keep BP cuff inflated on upper are 1-4 min = hand and fingers go into spasm in palmar flexion
HYPOCALCEMIA Ca <9.0 MG/dL Manifestations CHVOSTEK'S SIGN facial twitching
HYPOCALCEMIA Ca <9.0 MG/dL Interventions oral and IV replacement; aluminum hydroxide and Vit D to increase absorption; muscle relaxants; decrease environmental stimuli (quiet room, soft lighting; seizure precautions; injury/fall precautions
HYPERCALCEMIA Ca >10.5 mg/dL excitable tissues less responsive to stimuli, increased clotting times
HYPERCALCEMIA Ca >10.5 mg/dL causes: increased absorption, decreased excretion, increaed release from bone, hemoconcentration
HYPERCALCEMIA Ca >10.5 mg/dL Manifestations: increased HR,BP= decreased HR; severe muscle weakness and decreased deep tendon reflexes without numbness
HYPERCALCEMIA Ca >10.5 mg/dL Manifestations: Altered LOC; decreased peristalsis (constipation, anorexia, N/V, abdominal pain)
HYPERCALCEMIA Ca >10.5 mg/dL Interventions stop oral and IV calcium; fluid volume replacement; loop diuretics; Ca chelators (bind Ca so it can be excreted in feces);
HYPERCALCEMIA Ca >10.5 mg/dL Interventions Phosphorus and NSAIDs to decrease Ca absorption; hemodialysis; ecg monitoring
PHOSPHORUS NORMAL RANGE 3.0-4.5 mg/dL
PHOSPHORUS NORMAL RANGE 3.0-4.5 mg/dL functions: activate vitamins and enzymes; form ATP; assist in cell growth and metabolism; acid-base balance; calcium homeostasis
PHOSPHORUS NORMAL RANGE 3.0-4.5 mg/dL functions: PTH decreases serum phosphorus
PHOSPHORUS NORMAL RANGE 3.0-4.5 mg/dL functions: TCT increases serum phosphorus
HYPOPHOSPHATEMIA: phosphorus <3.0 mg/dL decreases energy metabolism, causes imbalances of other intake, increased excretion, intracellular shift
HYPOPHOSPHATEMIA: phosphorus <3.0 mg/dL Causes: insufficient intake, increased excretion, intracellular shift
HYPOPHOSPHATEMIA: phosphorus <3.0 mg/dL Manifestations decreased stroke volume= decreased cardiac output; decreased HR; skeletal muscle weakness= rhabdomyolysis; respiratory failure
HYPOPHOSPHATEMIA: phosphorus <3.0 mg/dL Manifestations decreased bone density; irritability= seiures= coma
HYPOPHOSPHATEMIA: phosphorus <3.0 mg/dL Interventions Oral and IV phosphorus replacement; stop drugs that promote phosphorus loss
HYPERPHOSPHATEMIA: phosphorus >4.5 mg/dL Related to hypocalcemia= increased membrane excitability
HYPERPHOSPHATEMIA: phosphorus >4.5 mg/dL causes increased intake, decreased excretion
HYPERPHOSPHATEMIA: phosphorus >4.5 mg/dL Manifestations hypotension; prolonged ST and QT intervals; increased GI peristalsis (abdominal cramping, diarrhea); bone pain,
HYPERPHOSPHATEMIA: phosphorus >4.5 mg/dL Manifestations Painful muscle spasms ("charley horses"); paresthesias (tingling, numbness); increased or decreaed HR; weak, thready pulses;
HYPERPHOSPHATEMIA: phosphorus >4.5 mg/dL Interventions oral and IV replacement; aluminum hydroxide and Vit D to increase absorption; muscle relaxants; decrease environmental stimuli (quiet room, soft lighting; seizure precautions; injury/fall precautions
MAGNESIUM normal range 1.7-2.1 mEq/dL
Magnesium: functions skeletal muscle contraction; carbohydrate metabolism; ATP formation; vitamin activation; cell growth; blood coagulation
HYPOMAGNESEMIA <1.7 mEq/mL excitable membranes depolarize spontaneously (occurs with hypocalcemia)
HYPOMAGNESEMIA <1.7 mEq/mL causes inadequate intake, increased excretion, intracellular movement
HYPOMAGNESEMIA <1.7 mEq/mL Manifestations hyperactive deep tendon flexes; numbness; tingling; painful muscle contractions; tetany; seizures; depression; psychosis
HYPOMAGNESEMIA <1.7 mEq/mL Manifestations confusion; decreased GI motility; (anorexia, nausea, constipation, distention)
HYPOMAGNESEMIA <1.7 mEq/mL interventions stop drugs that promote magnesium loss; IV magnesium sulfate (PO magnesium causes diarrhea, which increases magnesium loss)
HYPERMAGNESEMIA >2.1mEq/L excitable membranes less responsive to stimuli
HYPERMAGNESEMIA >2.1mEq/L CAUSES increased intake, decreased excretion
HYPERMAGNESEMIA >2.1mEq/L Manifestations bradycardia= cardiac arrest; hypotension; peripheral VD; drowsiness/lethargy= coma; decreased or absent deep tendon reflexes skeletal muscle weakness
HYPERMAGNESEMIA >2.1mEq/L Interventions Mg. free IV fluids; diuretics; Ca to reverse cardiac effects
INFUSION THERAPY delivery of meds in solution or fluids by parenteral route through a wide variety of catheter types and locations using multiple procedures
INFUSION THERAPY goals: Maintain fluid balance or correct fluid imbalance
INFUSION THERAPY goals: Maintain electrolyte/acid-base balance or correct electrolyte/acid-base imbalance
INFUSION THERAPY goals: Administer MEDS
INFUSION THERAPY goals: Replace blood/blood products
INFUSION THERAPY IVFS Colloids Solutions that contain large molecules ( proteins, starches)
INFUSION THERAPY IVFS: Crystalloids solutions that contain nonprotein molecules (minerals, salts, sugars)
INFUSION THERAPY Parenteral nutrition: When a Pt cannot use GI tract for nutrition
INFUSION THERAPY Blood/blood components packed RBC's, platelets, fresh frozen plasma, albumin, clotting factors
INFUSION THERAPY Blood 270-300 mOsm/L (determines how well diffusion and osmosis happens)
Isotonic solutions 270-300 mOsm/L (e.g. 0.9% NS)
Hypertonic Solutions >300 mOsm/L cell swelling; (3% NS)
Hypotonic solutions >270 mOsm/L "cell shrinking" (0.45%)
INFUSION THERAPY purpose for meds? 100% bioavailability= increased therapeutic effects, increased adverse effects
What should a INFUSION order consist of type of fluid, rate of admin in ml/hr, drugs and specific dose to be added to the solution
Central vs. peripheral lines osmolarity and pH of solution (peripheral lines = pH =5.9
Vascular access device (VAD) plastic tube placed in a blood vessel to deliver fluids and meds
Define Short Peripheral Catheter plastic cannula built around sharp stylet-- stylet allows for venipuncture and cannula advanced into vein
Short Peripheral Catheter: how long is it good for? 72-96hrs
Short Peripheral Catheter: can you draw blood on me? NO
Where can you place a Short Peripheral Catheter choose a distal site and make all subsequent venipunctures proximal to previous sites
Where can you place a Short Peripheral Catheter avoid a site with joint flexion
Where can you place a Short Peripheral Catheter avoid a site where vein feels hard or cordlike
Where can you place a Short Peripheral Catheter choose a vien with appropriate length and width
MIDLINE CATHETER description 3-8in long, 3-5Fr, single or double lumen; tip located in upper arm (no further than axillary vein)
How long is a Midline Cath good for? 1-4wks
Uses for Midline Cath? skin integrity or limited peripheral veins make it difficult to maintain shorter cath; fluids for hydration; antibiotics; heparin for DVT; Broncho-dilators; steroids
Restrictions for Midline Cath? vesicant meds, parenteral nutrition formulas; solutions with osmolarity > 600mOsm/L; blood draws
Define a PICC line..... long catheter inserted through vein in antecubital fossa or middle of upper arm; tip located in superior vena cava; 18-29in long; chest x-ray to confirm tip location.
How many lumens in a PICC line??? 1-3
What are the benefits of a Picc line? no limits on pH, transfusion of blood requires pump; paraplegics can't use
nontunneled percutaneous central caths... inserted by Dr. through subclavian vein or internal jugular vein; tip resides in SVC (confirmed by x-ray) 1-5 lumens
Uses for nontunneled percutaneous central cath emergent/trauma situations; Critical Care; surgery
Restrictions for nontunneled percutaneous central cath Pt's with respiratory conditions, spinal curvatures, increased ICP; trauma; surgery; or radiation in the neck
tunneled caths portion of cath lies in subcutaneous tunnel; tissue granules for over cuff, creating a mechanical barrier to microbes and securing the cath 1-3 lumens
When is a good time to use a tunneled cath when needed for infusion therapy is frequent or long-term
Implanted Ports surgically placed so no part of the catheter is visible externally; placed on upper chest or upper extremity; 1-2 lumens
Dialysis caths large lumens;tunneled (long term) nontunneled (short term)
Can you use a dialysis cath to admin fluids or meds? only in emergency situations
What is the dialysis cath flushed with? heparin or sodium citrate (must be aspirated to prevent systemic bleeding)
Benefits of a glass infusion system? doesn't react with drugs, easily sterilized, easy to measure amount of fluid left,
non-benefit of using a glass infusion system? heavy, difficult to use, requires air-vent
Benefits of using a plastic infusion system? closed system; easy to use; resists breaking
Primary administration sets infuse primary fluid by gravity or pump
Secondary administration sets "piggy-back" delivers intermittent meds; changed every 72-96 hrs
intermittent administration sets infuse multiple doses of meds through a cath that's been capped, changed every 24hrs
examples of add-on devices for administration sets short extension sets; injection caps;filters
what is the purpose of needle-less connectors lure-locks decrease accidental needle sticks; positive-pressure valves to prevent backflow of blood into cath
what are Rate controlling devices and how do they help? controllers, pumps/syringe pumps; ambulatory pumps; have free-flow protection to prevent unwanted/rapid flow of fluids
CATHETER CARE/MAINTENANCE: Pt education need for therapy; benefits/risks; infection prevention
CATHETER CARE/MAINTENANCE: how do you confirm tip location? chest x-ray
CATHETER CARE/MAINTENANCE: What does a nurse assess for? redness, swelling, hardness, drainage, assess integrity of dressing, check rate of infusion, assess for amount of fluid
CATHETER CARE/MAINTENANCE: How do you flush a IV? per facility policy; 10mLs syringes
When can you obtain a blood sample off a IV? central lines only
How to remove a PICC line? do not pull rapidly (apply warm compress, admin meds to relax vein; may venospasm
IV's with older adults; why would pain be a concern? fewer nerve endings=decreased ability to feel pain
Why would the skin of a older adult be a concern with IV's? antisepsis important because of decreased immunity; decreased lipids makes skin more fragile/easily damaged; skin integrity easily compromised by application/removal of tape/dressings
Vein distention for the old person do not apply tourniquet for long periods of time, causes blood to overfill vein; hematoma on venipuncture, ecchymosis; veins more likely to roll away from needle
What would a infusion technique be? 10-15 degree angle between skin and catheter
Alternate infusion sites: Intra-arterial used to obtain repeated arterial blood samples, to monitor hemodynamic pressures continuously, and to infuse chemo agents
Alternate infusion sites: INTRAPERITONEAL used to admin chemo agents to treat intrabdominal malignancies such as ovarian and GI tumors
Alternate infusion sites: subQ used in palliative care pts who cannot tolerate PO meds, when IM injections are too painful. most used in hospice for pain management
INTRASPINAL: EPIDURAL infusion into space between dura mater and vertebrae; used for post op and chronic pain mgnt.
INTRASPINAL: Intrathecal infusion into subarachnoid space closer to spinal cord; used for treating cancers that cross the BB barrier and involve the CNS; also to treat cerebral palsy, MS and brain injures
INTRAOSSEOUS: access to red bone marrow; used in life threatening situations. trauma, burns, cardiac arrest, diabetic ketoacidosis
Heart Failure (Pump Failure) Inability of the heart to work effectively as a pump.
Left-sided heart failure Failure of left ventricle results in decreased tissue perfusion and pulmonary congestion.
HF caused by HTN, CAD, problems with mitral or aortic valve
What is forward failure? Systolic Heart Failure
Systolic Heart Failure (systolic ventricular function) Results when the heart cannot contract forcefully enough to eject adequate amount of blood into the circulation
Preload (pressure in left ventricle at rest) Increases
Afterload (peripheral vascular resistance) increase
Ejection fraction (% of blood ejected during systole) decrease from the normal 50-70% to <40%
Diastolic Heart Failure occurs when the left ventricle cannot relax adequately during diastole
Right-sided HF Failure of the right ventricle to empty completely results in increased pressure and volume in the venous system leading to Peripheral Edema
What are the causes of Right-sided HF? Left sided HF, Right ventricular MI, Pulmonary HTN
High-output HF ventricular function and cardiac output is preserved.
Causes of High output HF Increased metabolic needs, septicemia, Hyperthyroidism, anemia, high fever.
Compensatory mechanisms of Heart Failure Sympathetic Nervous system (activated by decreased tissue perfusion)
Compensatory mechanisms of Heart Failure Beta receptors activated → Increased Heart rate and stroke volume → increased Cardiac output.
Compensatory mechanisms of Heart Failure (Smp NS) Heart rate and stroke volume are limited in their ability to compensate for decreased tissue perfusion.
Compensatory mechanisms of Heart Failure (SMP NS) Alpha receptors activated → VC→ increased BP (increased afterload, worsens HF
Compensatory mechanisms of Heart Failure RAAS Activated by decreased renal perfusion
Compensatory mechanisms of Heart Failure Angiontensin-II causes VC which increases BP
Compensatory mechanisms of Heart Failure Aldosterone causes sodium and water retention which increases blood volume and elevates BP *increased BP=increased afterload which worsens HF
Compensatory mechanisms of Heart Failure increased blood volume worsens pulmonary congestion and peripheral edema
Compensatory mechanisms of Heart Failure (chemical responses) In MI, heart muscle injury causes an immune response → ventricular repair and remodeling
Compensatory mechanisms of Heart Failure (chemical response) B-type natriuretic peptide (BNP) released when PT has fluid volume overload from HF causes VD, diuresis through Na loss in renal tubules
Compensatory mechanisms of Heart Failure (chemical responses) Posterior pituitary secretes antidiuretic hormone (ADH, vasopressin) when CO is low= Na & H2O retention= increased BP
Compensatory Mechanisms of HF Endothelin (proteins) released when myocardial fibers are stretched= VC= ↑BP
Compensatory Mechanisms of HF (chemical responses) Myocardial hypertrophy: walls of heart thicken to provide more muscle mass which increases force of contraction
Compensatory Mechanisms of HF (myocardial hypertrophy) Muscle may enlarge more rapidly than collateral circulation can provide adequate blood supply.
Compensatory Mechanisms of HF (myocardial hypertrophy) Hypertrophied heart is slightly oxygen deprived.
Heart Failure assessments & Manifestations (left sided) decreased cardiac output= fatigue, weakness, oliguria during the day, nocturia at night, angina, confusion, restlessness, dizziness, tach, palpitations, pallor, weak peripheral pulses, cool extremities.
Heart Failure assessments & Manifestations (left sided) Pulmonary congestion= hacking cough (worse at night), dyspnea, breathlessness, crackles or wheezes in lungs, tachypnea.
Heart Failure assessments & Manifestations (right sided) Systemic congestion= JVD, enlarged liver and spleen, anorexia, nausea, dependent edema, distended abdomen, swollen hands and fingers, polyuria, Wt gain, changes in BP.
Heart Failure Diagnosis (labs) Electrolyte imbalance (complication of heart rate or diuretic therapy)
Heart Failure Diagnosis (labs) Altered renel function= increased BUN, increased creatinine, decreased creatinine clearence
Heart Failure Diagnosis (labs) H&H if HF is caused by anemia (fluid overload= decreased Hct.
Heart Failure Diagnosis (labs) Increased BNP (>100)
Heart Failure Diagnosis (labs) Urinary Analysis= proteinuria, increased specific gravity >(1.030)
Heart Failure Diagnosis (labs) ABG= hypoxemia
Heart Failure Diagnosis (Radiology) Chest x-ray: enlarged heart
Heart Failure Diagnosis (radiology) Echocardiogram: valvular changes, heart enlargement, ejection fraction
Heart Failure Diagnosis (radiology) ECG: dysrhythmias,hypertrophy, ischemia, infarction
Created by: 169330