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MS 120
first exam
| Question | Answer |
|---|---|
| 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 |
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