Acid Base, Glucose, Endocrine, Sensory, Cardiovascular Peds and Adult
Quiz yourself by thinking what should be in
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| What does a patient without an Acid-Base imbalance look like? | RR and depth, HR/rhythm WNL for patient
O2sat 95%+
Walk and talk w/o stopping for breath
No cyanosis or pallor
Oral mucous and nailbeds pink w/ rapid cap refill
Quiet breathing
I=O
Oriented
Energy level good
ABG WNL
Electrolyte values WNL
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| Which of the following is NOT essential for a client with potential acid-base imbalance? -Fall Precautions -Smoking cessation -Monitor neurological status q2h -Monitor ABG -Increase consumption of acidic/basic foods | Increase consumption of acidic/basic foods
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| What is the normal pH of the body's extracellular fluid? | 7.35-7.45
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| The __________ hydrogen ions present, the more acidic the fluid. The _________hydrogen ions present, the more alkaline the fluid. | More
Fewer
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| pH values below 7.35 indicate ___________ while pH values above 7.45 indicate ______________-. | Acidosis
Alkalosis
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| T/F: Chemical blood buffers are the second line of defense for correcting acid-base imbalances. | False: immediate way for correction
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| If a patient has respiratory acidosis, what will happen? | The kidney compensates by increasing the amount of bicarbonate produced and retained
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| A patient presents with reduced excitability of cardiovascular muscle, neurons, skeletal muscle, and GI smooth muscle AMB irregular EKG and constipation. You suspect (acidosis/alkalosis)? | Acidosis
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| A patient presents with increased excitability of cardiovascular muscle, neurons, skeletal muscle, and GI smooth muscle. You suspect (acidosis/alkalosis)? | Alkalosis
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| Which system should you assess first in a patient at risk for acidosis? Why? -Pulmonary -Cardiovascular -GI -Integumentary | Cardiovascular because acidosis can lead to cardiac arrest from hyperkalemia
Also be sure to assess the airway of a patient with acute respiratory acidosis
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| How often should you assess the heart rate and rhythm for a patient with and acid-base imbalance? | at least q2hours
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| The kidneys work to maintain acid-base balance in the body by creating and holding bicarbonate or excreting or excreting bicarbonate. This metabolic process is (slow/rapid) and (powerful/limited). | Slow but powerful
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| The lungs work to maintain acid-base balance in the body by decreasing CO2 elimination or increasing CO2 retention. This metabolic process is (slow/rapid) and (powerful/limited). | Rapid but limited
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| The arterial blood gas analyzes the gasses in arterial blood. What gasses can you analyze using the ABG? | pH
Carbon dioxide
Oxygen
Bicarbonate
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| These are the body's first attempt to balance the pH level. | Buffers
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| The body has multiple buffer systems including renal, respiratory, chemical and protein. Briefly describe each. | Renal- excretion/re-absorption of acids/bases
Respiratory- hyperventilation/hypo-ventilation
Chemical-PO4 (phosphate can pull in H+) and HCO3 (bicarbonate)
Protein- albumin and hemoglobin
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| Define compensation. | Use of buffer systems to correct an abnormal pH. ie, respiratory compensation for metabolic imbalances (lungs work hard to overcome kidney failure) or renal compensation (kidneys work hard to correct respiratory imbalances)
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| Which of the following is most appropriate for an ABG draw? -Radial artery -Femoral artery -Carotid artery -Popliteal artery | Radial, risk of bleeding high
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| You just got labs back for an ABG on your patient. What are the expected arterial values? | pH- 7.35-7.45
pCO2- 35-45 mmHG
pO2- 80-100 mmHG
HCO3- 21-28 mmHG
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| When you get the ABG back on a patient, the first thing you should look at is... | pH
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| If a patient has respiratory acidosis, their ABG values show... What does this patient look like? | pH<7.35
pCO2>45
Patient may have- respiratory depression (less than 12 breaths/min), inadequate chest expansion, airway obstruction, reduced alveolar-capillary diffusion (cap refill >3)
Can't catch breath, muscle weakness, hyperkalemia, Cyanotic,
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| If a patient has metabolic acidosis, their ABG values show... What does this patient look like? | pH < 7.35
HCO3<21
lactic acid production from anaerobic respiration, type 1 diabetes
kidney failure (can't eliminate H+
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| What are the physiologic effects of acidosis, generally? | CNS depression (difficult arousing)
Generalized weakness
Altered EKG (due to K+ influx)
Altered respiration (trying to expel CO2)
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| A patient presents with metabolic alkalosis, what does his ABG show? | pH >7.45
HCO3>28
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| A patient presents with respiratory alkalosis, what does his ABG show? | pH >7.45
CO2 <35
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| What are the physiologic effects of alkalosis? | Much worse than acidosis,
CNS irritability (delirium, seizures)
Cramping/twitching
Tachycardia
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| When would you classify a patient as hypoxemic? | pO2<60 mmHG
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| Explain briefly the concept of the oxy-hemoglobin disassociation curve. | Alkalosis -> high affininty for O2 which means O2 not freely released in tissues
Acidosis- -> lower affinity for O2 which means O2 not as readily picked up in lungs but released readily in tissues
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| What are the main causes of respiratory alkalosis? What are some symptoms of this? | Fear, anxiety, mechanical ventilation
Hyperventilation, tachycardia, seizures, confused, light headed, hypokalemia
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| What causes metabolic acidosis? What are some symptoms of this? | Kidney failure, diarrhea, shock
Headache, decreased BP, confusion, hyperkalemia, muscle twitching, compensatory hyperventilation
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| What causes metabolic alkalosis? What are some symptoms? | Vomiting, GI suctioning, decrease acid, increase base
Lethargy, tachycardia, compensatory hypoventilation, confusion, muscle cramps, hypokalemia
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| What is ROME? | Mnemonic for acid/base imbalance
Respiratory if
Opposite
Metabolic if
Equal
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| How many Americans have diabetes? | 20.8 million
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| What is Diabetes Mellitus? | Chronic condition where body is unable to use glucose in the blood because the pancreas cannot make insulin or utilize the insulin efficiently due to resistance.
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| Describe the pathophysiology of diabetes? | Food ingestion-> increase BG
No insulin=no glucose transport into cells so cells starve. glucose NOT stored as glycogen. Fat and protein are mobolized and converted to glucose because body thinks there is none available for cells. BG ^
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| What does insulin do? | Promotes uptake and storage of glucose by cells, promotes fat deposition and AA transport, inhibits protein degradation. Moves glucose out of blood and into cells, acts like a key for glucose in the cell to allow it to move freely inside
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| Describe the pathophysiology of high blood sugar in terms of fluid shift and urine output and electrolytes. | Hyperglycemia creates an osmotic gradient which pulls intracellular fluid to extracellular fluid which increases the glomerular filtrate. If the BG is >180mg/dl, renal threshold is exceeded ->> glucosuria, polyuria, and decreased K and Na
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| What are the clinical manifestations of diabetes? (choose all that apply) -Polyuria -Polydipsia -Polyphagia -Sweet urine -Decreased energy -Visual disturbances -Abdominal Pain -NVD | All except NVD
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| How many Americans have Type 1 Diabetes? What is the peak presentation? | 1.3 million Americans
Present 5-7 years and early puberty
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| The Pancreas has 3 types of cells that act to regulate blood sugar (Alpha, Beta, and Delta). Describe the function of each. | Alpha- Glucagon increases blood sugar by telling liver to release glycogen
Beta- Insulin decreases blood sugar by allowing cellular uptake of glucose
Delta- Somatostatin stops glucagon and growth hormone and decreases the blood sugar
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| What is ketoacidosis? What causes it? What are the signs and symptoms? Lab findings? | Presenting symptom children w/diabetes caused by metabolism of fats E
Lab- hyperglycemia, Glucosuria, ketonuria, metabolic acidosis/ketoacidosis
SS- Kussmaul respiration, dehydration, acetone breath, poor perfusion, dec. consciousness
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| What should you do for diabetic ketoacidosis? | Manage hyperglycemia, fluid and electrolyte balance, replace fluid loss, Educate!
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| Describe the pathophysiology of Type 2 diabetes? | Insulin production deficiency
Insulin resistance, cells not unlocked properly
Dysfunction of the liver, excess glucose released
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| Describe the incidence of Type 2 diabetes? | 90-95% of all diagnosed cases, 26 million people in US
1/10 people in adults over 20
1/4 in adults over 65
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| What are some things that put you at risk for Type 2 diabetes? | Overweight
Parent/sibling w/ diabetes
40+ years
High BP
AA, Latino, Native American
Gestational Diabetes
Stress of illness/injury
Baby 9+lbs at birth
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| Describe the signs and symptoms of Hyperglycemic-hyperosmolar state in mostly Type 2 diabetics? | Very high (600mg/dl) blood sugars
Glycouria
Polyuria then output decreases and becomes dark
Polydipsia
Severe dehydration-> seizures, coma, or death
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| What do you do for a patient with Hyperglycemic-hyperosmolar state? | Fluid replacement
IV insulin at 50-70 mg/dL per hour
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| What can you use to treat type 1 diabetes? (Basal and rapid acting insulins? | Basal- work for 24 hours- Levemir and Lantus
Rapid- meal time and correction doses- Humalog and Novolog
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| According to the ADA, what should your premeal and post meal and AIC levels look like? what is the A1c? | Premeal- 90-130 mg/dL
Postmeal- <180 mg/dL
A1C level- <7%
Reflects glycemic control for previous 3 months
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| Tell me what the A1C is made up of? | Tells you how well your blood glucose has been controlled, but the PPG (postprandal plasma glucose- 1-2 hours after eating) and FPG (fasting plasma glucose 8 hours of not eating)
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| When might a patient need urine testing for ketones? | When blood glucose is >240 mg/dL
Sick days
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| What is the body's main source of fuel? Calories/gram? These have the most direct effect on blood sugar levels.. | Carbohydrate 4 calories/gram
100% of carbs turn to blood glucose
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| What are the signs and symptoms of hypoglycemia? Treat? | Trembling
Headache/dizziness
Confusion/Seizures/Coma
Sweating/cool clammy skin
Tachycardia
Rapid Onset, treat with candy
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| What causes hypoglycemia? How do you treat hypoglycemia? | Delayed meals
Too much insulin
Too much activity
Drinking alcohol on empty stomach
Mild-moderate
3 glucose tablets or juice if BG<80 w/ symptoms
Treat BG<60 regardless of symptoms
Severe-unresponsive
Glucagon emergency kit
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| What are the signs and symptoms of hyperglycemia? Treatment? | Polyuria
lethargy/weakness
Ketonuria
NV
Gradual onset
Warm and dry-sugars high
Treat insulin adjustment, increase fluid, dietary changes, medical care if ketoacidosis
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| What are some complications of diabetes? | Amputation
Renal failure
Blindness
Nerve damage
Cardiovascular complication
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| What is diabetic retinopathy? What do you do about it? | damage to the blood vessels in the back of the eye (retina) caused by poorly controlled blood glucose
Recommend professional dilated eye exam once a year
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| Patients with diabetes are at a (higher/lower) risk for MI. How should you manage this? | Higher risk, aggressive management of hyperglycemia, hypertension, and hyperlipidemia.
Education on died, exercise, and medication mgmt
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| What is the cornerstone of diabetic nephropathy? | microalbuminuria (protein in the urine testing is recommended for Type 1 diabetics who have had for last 5 years, all patients with type 2
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| What does the hypothalamus do? | link between the CNS and endocrine system, controls pituitary gland
negative-feedback system
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| What hormones are controlled by the anterior pituitary? The posterior? | Posterior- ADH and Oxytocin
Anterior- ACTH, GH, Prolactin, TSH, LH, FSH
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| T/F- hormones made in the hypothalamus are released by the anterior pituitary gland/ | False- hormones made in the hypothalamus ADH and oxytocin are stored in the posterior pituitary and released by that
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| Primary pituitary dysfunction is caused by the ____________ while secondary pituitary dysfunction is caused by the ____. | Primary- pituitary gland
Secondary- hypothalamus
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| What is hypopituitarism? Panhypopituitarism? Cause? What is the most concerning? | Deficiency in one or more anterior pituitary hormones resulting in metabolic problems and sexual dysfunction
Pan- decreased production of all anterior pituitary hormones
Brain surgery, radiation, tumor
Life-threatening deficiencies of ACTH and THS
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| What does THS do? | Thyroid stimulating hormone is responsible for metabolism
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| Your patient is a very small 5 year old and you know they have hypopituitarism. You guess that they have a deficiency of what hormone? Why? | Growth hormone which stimulates Somatomedins which are responsible for bone and cartilage maintenance.
Deficiency can result in small children and osteoporosis in adults.
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| Your patient is a 50 year old man who has just been diagnosed with hypopituitarism of Luteinizing Hormone or follicle stimulating hormone. You expect what symptoms? | Decreased facial and body hair
Decreased libido
Impotence
Fine wrinkles
Reduced muscle mass
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| Your patient is a 30 year old woman who has just been diagnosed with hypopituitarism of LH and FSH. You tell them that what symptoms are likely due to the hypopituitarism? | Amenorrhea
Anovulation
Breast atrophy
Decreased libido
Loss of bone density
Decreased axillary and pubic hair
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| Somatotropin is a synthetic hormone given to some patients. Why would a patient receive this? What is the MOA and drug class. What is the indication? What is the route? | Growth stimulating peptide hormone that binds to GH receptors in tissue and skeletal cells. Recombinant Human Growth Hormone for growth failure in children secondary to pituitary GH deficiency. Give daily SQ injections
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| Your patient is prescribed cosyntropin. What is this? MOA? Drug class? Route? Why? | Synthetic corticotropin (ACTH) that stimulates the adrenal cortex to produce/secrete adrenocortical (cortisol and sex hormones) hormones via IM injection.
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| Your patient tells you that there is a history of hypopituitarism in their family related to Thyroid-Stimulating Hormone (thyrotropin). What are the clinical mainfestations of this? | Decreased thyroid hormone levels (T3 and T4)
Weight gain
Hirsutism
Menstrual abnormalities
Decreased libido
Slowed cognition
Lethargy
Cold intolerance
Alopecia
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| What is the function of T3 and T4, thyroid hormones? | Controls metabolism and produces heat
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| Your patient has a history of hypopituitarism related to adrenocorticotropic hormone (ACTH). The signs and symptoms of this are... | Decreased serum cortisol
Pale, sallow complexion
Malaise and lethargy
Anorexia
Postural hypotension
Headache
Hypoglycemia
Hyponatremia
Decreased axillary and pubic hair
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| Your patient had a head trauma which crushed their posterior pituitary gland. You explain to them that they should expect what... | Increased urine output
Very unconcentrated urine
Hypotension
Dehydration
Increased thirst
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| What most often causes hyperpituitarism? | pituitary adenoma, a benign tumor frequently treated with medication or surgical resection of tumor
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| What is Gigantism? What does it have to do with diabetes? | onset of growth hormone hypersecretion before puberty
GH is an antagonist to insulin so these children tend to have diabetes
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| What is acromegaly? | Growth hormone hypersecretion after puberty.
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| What are the physical manifestations of hyperpituitarism related to growth hormone? | Organomegaly (heart and liver size increases)
Hypertension
Dysphagia-large tongue
Deeper voice due to hypertrophy of larnyx
Joint pain
Enlarged hands, feet, lips, head
Hyperglycemia
Sleep apnea
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| Bromocriptine mesylate is a drug that might be prescribed to someone with a hormone imbalance. WHat does this drug do? Indication? Drug class? Side effects? | Prevents release of GH and Prolactin
Dopamine agonist
For hyperprolactinemia, acromegaly, and Parkinson's
Given PO once daily may cause GI, dry mouth, orthostatic hypotension, hallucinations
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| A patient just returned from surgery for a tumor resection from the anterior pituitary gland. What should your post op care include? | Monitor neuro
Asess postnasal drip/nasal drain (If glucose in drip, CSF)
Elevate HOB
Avoid coughing, bend, strain
Assess meningitis (stiff neck, vomiting, headach)
Hormone replacement
Avoid toothbrushing
Incisional numb
Nutrition
Vasopressin
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| What is diabetes insipidus? | ADH deficiency causes dehydration, Polydipsia and Polyuria, low specific gravity of urine (<1.005)
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| What can be done for a patient with Diabetes Insipidus? | Desmopressin acetate (works 5-21 hours SQ)
manage hydration
Teach to monitor daily weights
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| What is SIADH? Causes? | A disorder where too much ADH is secreted from the posterior pituitary, feedback mechanisms not functioning, water retained resulting in hyponatremia (confusion and seizures)
Head Trauma, CVD, TB, Cancer, Drug use, decrease sodium levels
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| What can you do for a person with SIADH? | Significant fluid restriction (1000-1500 mL/d)
Diuretics (demeclocycline)
Hypertonic saline
Monitor for fluid overload (edema and crackles)
Safe environment
Neuro assessment
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| What is demeclocycline? | A drug that inhibits ADH induced water reabsorption in renal distal tubules, give PO 3-4xday
Monitor Na+ levels
Discontinued in US
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| What is Addison's disease? What causes it? | A chronic disease which results in the decreased production of corticosteriods and epinephrine due to the 90% destruction of the adrenal glands.
In use, often idiopathic cause
In 3rd world, usually TB
Sometimes related to cancer metasteses from lung
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| What is an Addisonian Crisis? | A life-threatening event in response to a stressful event (surgery) where there is not enough cortisol to manage the stress >>hypotension, hypoglycemia, and fluid and electrolyte imbalances, especially hyperkalemia, and hyponatremia/hypovolemia
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| What are the signs and symptoms of Addison's disease? (Reduced Cortisol (RC) Reduced Aldosterone (RA)) | RC-\/ glucogenesis >>hypoglycemia
-\/ GFR and Gastric acid >>weight loss elevated BUN and creatinine
-Weakness
\/ RA-
-Hyperkalemia(arrythmias/confusion)->metabolic acidosis (H+ reab)
Hyponatremia, hypovolemia, hypotension
hyperpigmentation
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| You suspect your patient has Addison's, what test do you want to order? Why? | ACTH stimulation test
Give ACTH, check cortisol response
If no elevation, likely due to damaged adrenal gland
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| Your patient appears to be in an Addisonian Crisis. What do you do? | Administer large amounts of saline to correct hypovolemia and severe hypotension
Large doses of glucocorticoid to replace those not being made by adrenal glands
Manage hypoglycemia (glucose) and hyperkalemia (loop/thiazide diuretics)
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| You need to educate a patient on the long term management of their Addison's disease. You tell them to take what meds? | Hydorcortisone 20-30 mg in divided doses
Fludrocortisone 0.1 mg qday or every other day depending on BP and symptoms
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| If a patient has Addison's disease and is being treated with hydrocortisone, what is the indication, rout, class, and dosage? | Oral corticosteroid for chronic adrenal insufficiency
Dosed 25-30 mg/d in 3 doses
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| What is the class, indication, route, and dosage of fludrocortisone used in Addison's disease mgmt? | Oral corticosteroid to treat orthostatic hypotension caused by adrenal insufficiency
Dosed 0.1-.02 mg PO
Cancels out the effects of diuretics
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| What is Cushing's syndrome? What causes it? | Adrenal gland hyperfunction or over production of cortisol of by adrenal cortex due to a pituitary or adrenal tumor or self-administered Cortisol as in body builders
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| What causes adrenal gland hyperfunction? | Hyperstimulation of the adrenal medulla by a tumor
leads to hyperaldosteronism when excessive mineralcorticoid/androgen produced
Cushings when hypercortisol
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| What are the clinical manifestations of Cushing's? | Redistribution of fat onto back, centralized obesity, moon face
Increased protein breakdown> decreased muscle mass and strength, thin skin, petech., decreased immune due2 decreased lymphocytes, Hypertension, hyperpigmentation, Hyperglycemia, Hypokalemia
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| What is the difference between adrenal and pituitary Cushing's disease and Cushing's syndrome? | Adrenal Cushing's- benign tumor on adrenal cortex causes excess
Pituitary Cushing's- Anterior pituitary oversecretes ACTH which causes hyperplasia of adrenal cortes and excess secretion
Cushing's syndrome- caused by drug therapy of glucocorticoud excess
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| A patient asks about their treatment options of Cushings disease. you tell them... | Safety and symptom management
Medications (Ketoconazole, Mitotane, Metyrapone)
Nutrition
Monitoring
Surgery
Hypophysectomy (pituitary)
Adrenalectomy (adrenal gland)
requires corticosteroid replacement therapy
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| What is Conn's syndrome? Treatment? | Primary hyperaldosteronism, too much aldosterone is secreted by adrenal glands which results in mineralocorticoid excess
Treat with Spironolactone or Glucocorticoids or Adrenalectomy (requires meds for rest of life)
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| What is spironolactone? Class? Indication? Route? Dosage? | A potassium sparing diuretic to manage potassium levels which are depleted in patients Conn's syndrome (hyperaldosteronism). Admininster 100-400 mg PO daily
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| What is Pheocromocytoma? What are the signs and symptoms? | A tumor of the adrenal glands that causes excess release of epinephrine and norepinephrine which causes headaches, palpitations, flushing, apprehension, sense of impending doom, chest/abdominal pain, very high heart rate and high BP (210/120)
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| How do you treat pheocromocytoma? What are the nursing interventions? | Surgery with pre and post opt interventions
Ensure adequate hydration pre-op
treated with anti-hypertensives which can lead to hypotension after surgery- monitor
DO NOT PALPATE ABDOMEN- could lead to severe hypertension
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| What doe thyroid hormone do? | Affects all metabolic processes in all body organs, increased thyroid hormone -> increased metabolism
Increase heart rate and stroke volume-> increased CO, bp and blood flow
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| What is the most common manifestation of hyperthyroidism? | Most common- Graves Disease
autoimmune disorder resulting from autoantibodies that attach to the THS receptors resulting in an enlarged thyroid gland
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| What are the signs and symptoms of hyperthyroidism (Graves disease)? | SS
exophthalmia (bulging eyes)
heat intolerant
Tachycardia
Dysrhythmias Short of breath, weight loss, diarrhea, increased appetite
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| What are the minor and major side effects of antithyroid drugs? | Minor- itching, rash, hives, joint pain
Major- agranulocytosis- decreased production of white blood cells
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| How can you treat hyperthyroidism? | Medication (methimazole to lower T4 levels before RAI therapy, can cause birth defects)
Propylthiouracil (for pregnant women, potential
for liver damage in first 3 months of treatment)
Radioactive Iodine Therapy (RAI- oral dose destroys some cells)
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| What are some dangers to a thyroidectomy to treat hyperthyroidism? | Used for Graves' disease or when hyperthyroidism doesn't respond to medicine, can damage laryngeal nerve anc cause hoarseness/vocal weakness
Hypoparathyroidism if parathyroid is damaged->hypocalcemia->Tetany (sustained throat contraction can cause asphyx
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| As a nurse, what do you need to do for post-operative care for a thyroidectomy? | Monitor temperature increase, tachycardia, and systolic hypertension as these may indicate a thyroid storm,
notify RRT if stridor, dyspnea, or other obstructive respiratory symptoms appear
Monitor vital signs q 15 minutes, assess voice q 2 hours
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| What is the main cause of hypothyroidism in the US? Who is at risk? What are the symptoms? | Main cause is thyroid surgery and radioactive iodine treatment for hyperthyroidism, most common in women 30-60 (7-10 x more than men)
slows metabolism significantly
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| What are the signs and symptoms of hypothyroidism? | Hypoventilation, bradycardia, dysrythmias, enlarged heart, hypotension, muscle aches and pains, apathy/depression, weight gain, constipation, amenorrhea, impotence, periorbital edema, goiter, anemia, easy bruising
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| Your patient had a thyroid function test every 6-12 months to determine the best treatment. What is the normal range for thyroid stimulating hormone? Their results show an elevated (4.5) level of TSH. This indicates... | Normal 0.5-4.0
Elevated=hypothyroidism because pituitary gland is making extra TSH to try and stimulate the non-responsive thyroid gland
Low=hyperthyroidism because pituitary is making less because wants to reduce thyroid stimulation
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| What is levothyroxine? MOA? Indication? Route? Dose? Caution? | a synthetic preparation of T4, converts to T3 in the body so there is enough T3 and T4 hormone, Variable PO dose, 100 mcg/day in elderly max
Caution- thyrotoxicosis (too much thyroid hormone)
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| What causes a myxedema coma? What are the SS? | Sever hypothyroidism leading to hypothermia, stupor or coma, hypoventilation and respiratory failure
Heart failure, hyponatremia, hypotension, seizures, hypoglycemia
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| How many parathyroid glands? Location? Function? Normal function? | 4 parathyroid glands on the posterior surface of the thyroid function to produce parathyroid hormone which controls the amount of calcium in the blood and bones
Normally, low serum Ca>increase PTH>increase Ca leached from bone>normal serum level>PTH slow
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| If a patient has hyperparathyroidism, what is happening? | Bone resorption
Hypercalcemia
Hypercaluria
Decreased neuromuscular irritability
Decreased Phosphate levels
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| If a patient has hypoparathyroidism, what is happening? | Decreased bone resorption
Decreased Ca serum levels
Elevated Phosphate
Increased neuromuscular activity can lead to tetany (muscle spasms such as chvostek and trousseau)
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| HOw do you manage hyperparathyroidism? | diuretics and fluid therapy
medications
surgery
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| How do you treat hypoparathyroidism? | Correct hypocalcemia and vitamin D deficiency
Avoid phosphorous (milk, yogurt, processed cheeses)
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|
||||
| What is conjunctivitis? Causes? Signs and Symptoms? | inflammation or infection of the conjunctiva caused by allergies, bacteria or virus
Irritation but not painful, pink/redness and edema of the conjunctiva (thin clear tissue over sclera)
Drainage (clear with allergic/viral--yellow/green with bacterial)
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|
||||
| A patient has conjunctivitis and yellow/green drainage. You suspect the cause is... | Bacterial conjunctivitis
🗑
|
||||
| What can you do for conjunctivitis? | Cold compress, cultures, antibiotic/steroid eye drops
Prevent cross contamination
🗑
|
||||
| What is the major progressive risk of a corneal abrasion? What is the most common cause of this? | painful scratch most often from contact lens, can progress to ulceration and vision loss
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|
||||
| What is corneal degeration? Potential treatment? | changes in corneal structure (responsible for 70% of focusing) can result in scarring and impaired vision. May require cornea transplant
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|
||||
| What are the pharmacological interventions for corneal disorders? | Antibiotics
Antifungals
Antivirals
Steroids
Eye drops q2 hours (even in night)
be sure to apply pressure to lacrimal duct to avoid systemic absorption
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|
||||
| What is a cataract? Cause? Treatment? | Lens density increases resulting in opacity often age related. Treat with surgical emulsification and intraocular lens placement
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|
||||
| There are three types of retinal (converts light signals to neuro for brain) detachments (sudden and painless, vision loss depends on degree of detachment). Name them and describe each. | Rhegmatogenous- retinal tear, hole or break allows vitreous fluid to move behind retina causing lift
Exudative- leakage of fluid from under retina
Traction- fibrous of vascular tissue w/in vitreous cavity pulls retina
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|
||||
| You can surgically treat retinal detachment with scleral buckling, vitrectomy and pneumatic retinopexy. Describe each. | SB-silicone placed on the outside of the sclera buckles sclera towards middle of eye, relieving pressure from retina and allows retinal tear to settle against wall of eye
V- removal of vitreous fluid to access retina
PR-gas bubble seals retinal det.
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|
||||
| When caring for a client undergoing surgical interventions for eye disorders, you should teach them to... and to notify you if... | Use eye protection
adhere to med regim
avoid activities that Increase IOP (bending, lying flat, straining, lifting 10+lbs, blowing nose, coughing, sex)
Notify-Pain, changes in vision, vomiting, eye drainage (signs of increased IOP)
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|
||||
| T/F: A patient who just had a Pneumatic retinopexy can lie flat on his back safely. | False: need to lie w/HOB elevated after eye surgery and cannot lie on back or gas bubble with press against lens instead of retina
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|
||||
| What is diabetic retinopathy? What does it cause? | One of leading causes of blindness in western world, caused by chronic hyperglycemia
causes formation of new fragile blood vessels in front of retina which easily bleed and obstruct vision, causes macular edema and fibrous changes
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|
||||
| What are the interventions for diabetic retinopathy? | Glucose regulation
Laser treatment to diminsh excess fluid for macular edema
Photocoagulation to shrink vessels for neovascularization
Vitrectomy to remove vitreous gel/repair if non-resolving hemorrhage or retinal detachment
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|
||||
| Intraocular pressure is normally balanced between the rate of secretion and the rate of outflow. However, glaucoma occurs when there is a problem with IOP. What are the 2 types of glaucoma? What differentiates them? | Open angle glaucoma- aqueous fluid cannot drain through meshwork to the vein because meshwork is defective
Angle closure- Iris is pushed over meshwork so fluid cannot drain
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|
||||
| Describe the onset, manifestation, and symptoms of openangle glaucoma.(most common glaucoma in US) | Slow insidious onset of Bilateral glaucoma due to inability of fluid to drain through meshwork. Often asymptomatic resulting in progressive damage to optic nerve/vision loss
SS- vision loss, peripheral vision loss, dull eye pain, altered color, night
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|
||||
| Describe the onset, manifestation, and symptoms of angle closure glaucoma | Acute unilateral onset resulting from sudden occlusion of anterior chamber angel resulting in sudden increased IOP. Symptoms are severe pain, unilateral headache, blurred vision, cloroed halos around lights, NV
This is an opthalmic EMERGENCY
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|
||||
| T/F- open angle glaucoma is acute and an emergency. | False- angle closure is the acute emergency
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|
||||
| Prostoglandins can be used to treat glaucoma. Describe how they work. MOA, side effects, prototype. | Latanoprast decreases IOP by increasing outflow of aqueous humor.
SE- hyperpigmentation of iris, darkening eyelid, increased eyelash growth, irritation
Systemic absorption> vasodilation, decreased platelet aggregation, anti-inflammation
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|
||||
| Beta blockers can also be used to treat glaucoma. Describe how they work. MOA, side effects. | Timilol blocks sympathetic sites and decreases production of aquous humor
Serious systemic effects- decreased HR, bronchiolconstriction
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|
||||
| Alpha adrenergic agonists can be used to treat glaucoma. Describe how they work. MOA, side effects. | Apraclonidine decreases the production of aqueous humor by activation the sympathetic nervous system
Systemic effects include increased HR and BP
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|
||||
| Cholinergic agonists can be used to treat glaucoma. Describe how they work. MOA, side effects. | Pilocarpine causes miosis (pulling meshwork and greater outflow of aqueous humor via pupil constriction)
Systemic effects include decreased HR and bronchiolconstriction by activating parasympathetic
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|
||||
| Non-selective sympathomimetics can be used to treat glaucoma. Describe how they work. MOA, side effects. | Dipiverin mimics the sympathetic nervous system and causes mydriasis (dilation of pupil) which increases flow of aqueous humor
Can cause irregular heart beat
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|
||||
| Carbonic anhydrase inhibitors can be used for... MOA, adverse reactions? | Dorzolamide is adjunctive treatment of glaucoma by decreasing production of aqueous humor.
Can cause changes in mental status, diuresis, dehydration, electrolyte imbalances, GI disturbances
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|
||||
| If a patient presents to the ED for emergency treatment of acute closed angle glaucoma you might give them this.. MOA, Side effects? | Mannitol (an osmotic diuretic) that rapidly reduces IOP via reduction of plasma volume
SE- hypotension, flushing, electrolyte imbalances, severe headache
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|
||||
| If hearing loss is conductive, this means? Example? | anything that interferes with transmission of sound from outer to inner ear such as blockage, fluid, middle ear infection, ear drum damage, otosclerosis
🗑
|
||||
| If hearing loss is sensorineural, this means? Example? | caused by damage to sound impulse pathways from hair cells of inner ear to auditory nerve and brain from aging, trauma, medications, or disease processes
🗑
|
||||
| What is adult otitis media? Cause? Assessment? Priority nursing diagnoses? | Inflammation of the middle ear from blockage of Eustatian tube, assessment reveals increased auricle lymph nodes indicate worsening condition
Alteration in comfort; pain (suddenly disappears if tympanic membrane ruptures)
Vertigo,
Nausea
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|
||||
| What is Meniere's Disease? Cause? Symptoms? Crisis? | Swelling of the entire inner ear causing fluid back up, pain, balance distortion, vertigo, NV, Tinnitus for no known reason (virus, head injury, allergy or genetics)
Crisis lasts 2-4 hours, lie down, Exhaustion and visual stimuli sensitive
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|
||||
| Your patient has Meniere's Disease. You teach them about nutrition... | Evenly distribute food and fluids
Avoid aspirin and NSAIDS (tinnitis)
avoid caffeine(trigger attacks)
Limit alcohol
Avoid cigarettes
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|
||||
| Your patient has Meniere's Disease. You teach them to ________- when they have an attack. | Lie down, stay still with eyes fixed on one spot, do not drink until the vertigo passes, get up slowly
If unable to take fluids for 24+ hours, contact provider for nausea meds and dehydration protocol
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|
||||
| Prenatally, which side of the heart has higher pressure? Why? | Right side because lungs have high resistance due to contracted arterioles b/c lung not inflated which requires the pulmonary arteries to have high pressure which must come from the right ventricle and ultimately from the highly pressurized right atrium
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|
||||
| What prenatal blood flow adaptations are due to the high pressure in the right atrium? | High pressure in R atrium sends some blood to the right ventricle to be pumped to the lungs, but most of the blood is pumped to the left atrium via the Foramen Ovale which then combines with some blood from the pulmonary A down to the L Ventricle to Aorta
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|
||||
| What is the function of the Ductus Arteriosus? | Allows blood to go from the pulmonary artery (from R. Ventricle) to the Aorta instead of the lungs due to high resistance in the lungs which explains why very little blood comes through pulmonary veins
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|
||||
| What is true about children and cardiac distress? What causes most cardiac distress in children? | Children do not have primary cardiac distress unless they have a cardiac defect. Most cardiac distress is caused by respiratory distress
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|
||||
| What puts a baby at risk for a cardiac defect? | Mom with chronic health condition (diabetes)
Maternal medications (anticonvulsants)
Drug/alcohol use
Exposure to infections
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|
||||
| What is the appropriate placement for cardiac monitoring for a 3 and 5 lead? | 3 lead- (left) Smoke over fire, white to the right
5 lead- (left) Smoke over fire, (right) snow over grass, brown ground
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|
||||
| How many leads for an EKG? What does this test do? | 12 leads, looks at electrical pathways
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|
||||
| What is an echocardiogram? How does it work? | A non invasive ultrasound that uses sound-waves to produce images of the heart
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|
||||
| What is cardiac catheterization? How does it work? | A diagnostic test or intervention by which a catheter is run though a large blood vessel to the heart to assess blood flow and possibly insert a stent to open up a blockage
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|
||||
| What are the risks of a cardiac catheterization? What do you as the bedside nurse need to include in your treatment? | High risk for infection, hemorrhage at procedure site (apply pressure dressing over insertion site), need to assess CVS and PVS (pulses, temp, cap refill) system, Vitals q 15 until stable
Client lie flat for 4-8 hours to decrease risk of hemorrhage
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|
||||
| What is congestive heart failure? What causes it? In children, what is the major cause of CHF? | Heart can't pump enough blood to meet body's needs due to :
Volume or Pressure overload
Decreased contractility
Increased output demands
In children, due to congenital cardiac defect
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|
||||
| What does right sided congestive heart failure look like? | Right ventricle not pumping enough, blood backs up to R atrium increases venous pressure >systemic venous engorgement which>edema,
not enough blood to lungs
Fatigue (dec. O2)
Palpitations
edema feet/legs
JVD
Weight+
+night urine
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|
||||
| What does left sided congestive heart failure look like? SS? | Left ventricle suboptimal so blood backs up to L atrium, puts pressure on Pulmonary veins> pulmonary congestion, can lead to increased pulmonary pressure and pulmonary edema
Tired (not enough O2)
Decreased urine
Palpitations
SOB
Pink sputum
Weight +
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|
||||
| As blood flows through the heart, in what order does it pass through the chambers and valves? | Superior/Inferior Venacava>Right atrium>Tricuspid valve>Right ventricle>, Pulmonary valve> pulmonary arteries>lungs>pulmonary veins>Left atrium>, Mitral valve> Left Ventricle>, Aortic
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|
||||
| What are some signs and symptoms of the Congestive heart failure (impaired myocardial function, pulmonary congestion, systemic venous congestion)? | IMC=Tachycardia, fatigue, exercise intolerance, dec. perfusion (cold extremeties, weak pulses, dec cap refill, Low BP, mottled skin)
PC=Tachypnea, Hypoxemia, feeding intolerance r/t Tachypnea
SVC- weight+ edema, JVD, dependent edema
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|
||||
| Which side of congestive heart failure would lead to increased urine production at night? Decreased urine? | Increased- right sided b/c of systemic edema causing fluid to reenter circulation at night when lying flat
Decreased-Left b/c not enough blood being pumped out to body, fluid build up in lungs
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|
||||
| What are the cornerstone signs of CHF in infants? | Poor weight gain due to feeding intolerance due to fatigue, activity intolerance, Developmental delay (gross motor, motor and cognitive delays r/t chronic hypoxemia due to delayed brain growth_
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|
||||
| How can you manage CHF? | Meds to increase cardiac function
Remove excess fluid
Decrease cardiac demand
Increase tissue O2 by decreasing demand and O2 supplementation
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|
||||
| Your infant patient has CHF and you know you need to decrease the cardiac demand to help them out. How can you do this? | Warm room- prevent shivering which is a lot of Energy
Treat/Prevent infections- increased BMR
Maximize chest expansion by elevating HOB 45
Provide scheduled periods of uninterrupted rest
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|
||||
| What medication is a positive inotrope (increases force of contractility of heart) and is safe for use in infants and children in CHF? | Digoxin, need 2 nurses to sign off on dose
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|
||||
| This diuretic can be used to remove excessive fluid in infants and children. Be sure to take daily weights and record I&O. What restrictions might a CHF baby be on? | Furosemide (Lasix) (loop diuretic), possible fluid restriction, let the family help monitor I+O
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|
||||
| You know that growing babies need adequate nutrition. What can you do for a baby in CHF? | Increase the calories per ounce, decrease feeding work by making larger hole, feed as soon as they look hungry, limit feeding time to 30 minutes, provide rest before, during and after feeds
Hold oral feeds (use NG/G tube) for fatigue or tachypnea
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|
||||
| Congenital heart defects can be classified by blood flow pattern. Which are characterized by acyanotic appearance and increased pulmonary blood flow? Which are characterized by cyanotic appearance and decreased pulmonary blood flow? | Acyanotic-Patent Ductus Arteriosis, Ventricular Septal Defect, Atrial Septal Defect
Cyanotic- Tetralogy of Fallot
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|
||||
| Which congenital heart defects are considered obstructive to blood flow? Which are considered to have mixed blood flow? | Obstructive- Coarctation of the Aorta, Aortic/Pulmonic Stenosis
Mixed- Pransposition of great vessels/arteries, Hypoplastic Left heart syndrome
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|
||||
| What is Patent Ductus Arteriosis? | PDA occurs when the pulmonary artery link, the ductus arteriosis, does not close between the aorta and the pulmonary artery after birth so blood is recirculated from aortic to pulmonary artery to lungs which increases workload of L heart
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|
||||
| What are the signs and symptoms of PDA (Patent ductus arteriosis)? | Asymptomatc or CHF?
Acyanotic (blood is oxygenated)
Machinery type murmur
Widened pulse pressure
Bounding pulses
Risk for bacterial endocarditis
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|
||||
| How do you treat PDA? What is the prognosis? | Indomethicin is a prostaglandin inhibitor that can close a PDA
Surgical Ligation closes the PDA to prevent return of O2 blood to lungs
Excellent prognossis! 1% mortality
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|
||||
| What is VSD (ventricular septal defect)? What does this do to blood flow? | An opening between L&R ventricles that causes blood to flow from the Left Ventricle (high pressure) to the Right ventricle (low pressure) which increase blood flow to the lungs and increases pressure in the R heart which leads to right sided hypertrophy
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|
||||
| What are the physical manifestations of VSD? What are the treatments? Prognosis? | Acyanotic
Holosystolic murmur
CHF
Risk for bacterial endocarditis
Treat- Pulmonary banding to decrease P blood flow
Surgical repair, cardiac cath closure
Prognosis <2% mortality
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|
||||
| What is tetralogy of fallot? | 4 Heart defects:
Large VSD (ventricular septal defect)
Pulmonic stenosis (thick pulmonic valve not working)
Overriding aortic arch (aorta right over VSD so blood from both L&R ventricle enter aorta)
Right ventricular hypertrophy (enlarged ventricle)
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|
||||
| What are the manifestations of Tetralogy of Fallot? What do you do about it? | murmur
Tet spells (acute episodes of cyanosis and hypoxia)
O2 requirements exceed blood supply d/t obstructed pulmonary blood flow
Place child in knee-chest position to \/ venous return & ^ systemic vascular, shunting more blood to pulmonary artery
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|
||||
| T/F- A child with tetralogy of fallot will have tet spells and, if old enough, will assume the knee chest position to get more blood through the pulmonary artery to increase O2 supply. | True
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|
||||
| T/F- children with PDA are at risk for emboli, poor growth, clubbing, Loss of consciousness due to hypoxia and sudden death. | False- that's indicative of Tetralogy of Fallot due to tet spells
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|
||||
| How can you manage tetralogy of fallot? What is the prognosis? | Insert a pallative shunt to increase blood flow to pulmonary artery
Surgical repair to close VSD, correct stenosis, and insert pericardial patch to enlarge R ventricle
Prognosis: <3% mortality
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|
||||
| If a patient has coarctation of the aorta, what does this mean? How does this manifest? | This localized narrowing of the aorta obstructs the blood flow (usually past aortic arch) leading to increased pressure proximal to defect (head/neck) and decreased pressure distal to defect (body and Lower extremities)
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|
||||
| T/F- a patient with coarctation of the aorta will have high BP and bounding pulses in lower extremeties and weak or absent pulses and cool skin and lower BP in the upper extremeties. | False- High BP and bounding pulses in upper extremeties
Low BP, weak/absent femoral pulses, and cool lower extremeties due to position of the coarctation
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|
||||
| How can you manage coarctation of the aorta? What is the prognosis? | Surgical repair of the defect before age 2 to prevent hypertension
Balloon angioplasty
Prognosis: <5% mortality with isolated defect
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|
||||
| What is transposition of the great vessels? | A congenital heart defect where the pulmonary artery exits from the left ventricle, instead of the right, and the aorta exits from the right ventricle instead of the left so there is no communication between the R& L side so no oxygenated blood to body
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|
||||
| How can someone with a transposition of the great vessels survive? | Must have a septal defect to survive so that oxygenated and deoxygenated blood can mix so some oxygen gets to the body
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|
||||
| How do you treat transposition of the great arteries? Prognosis? | Prostaglandine to keep PDA (patent ductus arteriosis) open
Surgically switch pulmonary and aortic arteries in first few weeks of life
Prognosis: <2% mortality
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|
||||
| What is hypoplastic left heart syndrome? How do you treat it? Prognosis? | The Left heart is underdeveloped (LV small, mitral valve, aortic valve and ascending aorta) requiring 3 surgical procedures to correct and possibly a heart transplant. Fatal w/o intervention
🗑
|
||||
| What are the 3 acquired cardiovascular disorders in children? | Endocarditis
Rheumatic Fever
Kawasaki Disease
🗑
|
||||
| What is bacterial endocarditis? Who is at high risk? | An infection of the valves/inner lining of the heart
Children with cardiac defects at high risk
Bacteria enters from dental procedure, UTI post catheterization, blood from long term catheters
🗑
|
||||
| How do you manage bacterial endocarditis? | High doses IV antibiotics 2-8 weeks
Prevention in highly susceptible children (education and care with cardiac surgery/defects)
🗑
|
||||
| In terms of cardiac effects, why is it important to treat strep throat? | TO prevent rheumatic heart disease
🗑
|
||||
| What is rheumatic heart disease? Cause? | Damage to the heart (especially carditis of the mitral valve causing mitral regurgitation) after rheumatic fever.
May lead to CHF and need for valve repair/replacement
🗑
|
||||
| What is Kawasaki disease? Cuase? Symptoms? | Acute fever affecting children under 5 for no apparent reason, causes acute systemic vasculitis including inflammation of coronary artery
resolves on own 6-8 weeks,
without treatment, 25-50% cardiac sequela (MI)
Fever, red eyes, hands mouth and tongue
🗑
|
||||
| How do you manage Kawasaki disease to prevent long term cardiac complications? | High doses of IV immunoglobulin, High doses of aspiring (antiinflammatory and blood thinner)
Great prognosis with treatment
🗑
|
||||
| What is atherosclerosis? | Hardening of arteries causes narrowing as it gets clogged, leads to decreased perfusion and depletion of O2 and nutrients to tissues on other side, can lead to tissue damage or death
🗑
|
||||
| What is an Angina Pectoris or Stable angina? | Chest pain caused by inadequate blood supply to heart muscle, pain relieved by rest or medication, usually indicative of fibrous plaque (atherosclerotic plaque)
🗑
|
||||
| What is an unstable Angina? | a blood clot has blocked the artery and blood flow to the heart, not relieved by rest/meds. Can occur at rest feels like crushing chest pain not related to activity
🗑
|
||||
| What is Prnzmetal's angina? | Falls under category of unstable angina, coronary spasms that occur at rest not related to a blood clot but highly associated with cocaine use and it's stimulant effects
🗑
|
||||
| When a patient tells you they are experiencing chest pain, what should you do next? | Ask follow up questions about the:
Location,
Timing
Quality
Quantity
Alleviating
Aggravating
Associated factors of the pain
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|
||||
| What would you expect to be the 7 associated findings surround chest pain for an unstable angina in a man? | Timing-sudden
Location- left side
Quality-crushing pressure
Quantity- 0-10 bad
Aggravating- physical activity
Alleviating- nothing
Associated- Nausea, SoB, diaphoresis, dizzy, activity limitation
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|
||||
| What is an Acute Myocardial Infarction? | Prolonged imbalance between the supply and demand of the heart, tissue starts to die when supply is less than demand
🗑
|
||||
| What is the difference between a STEMI and NSTEMI? | STEMI is ST elevating MI, big heart attack that goes completely through wall of heart
NSTEMI is a non ST elevating MI, partial thickness heart attack, doesn't go through entire wall
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|
||||
| If you had to have a heart attack, would it be better to have a STEMI or NSTEMI? | NSTEMI because this is a partial thickness heart attack so there is still viable tissue around the dead tissue so heart can still beat
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|
||||
| Which type of MI involves a depressed ST segment and upside-down T wave? | NSTEMI
🗑
|
||||
| Which type of MI involves an elevate ST segment? | STEMI- tissue starts to die
🗑
|
||||
| Which cardiac biomarker is heart specific with a very long duration that allows us to look back within the last 5-14 days to see if they had a heart attack recently. | Troponin
🗑
|
||||
| Which cardiac biomarker elevates the quickest but is not specific to cardiac cells? | Creatine kinase
Creatine kinase MB is more heart specific but slower
🗑
|
||||
| What are some common symptoms of MI in women? | Fatigue, heart burn, tired, hot, jaw pain, dizzy, altered mental status, GI, arm pain, sweating, Unusual complaints, confused, high stress, back cramps
🗑
|
||||
| Is heart disease more fatal in men or women? | Women because the symptoms of MI are not often noticed quickly.
🗑
|
||||
| 15% of people experience a silent MI or one with no apparent symptoms. Who is likely to fit in this category? | Elderly
Diabetic
Women
🗑
|
||||
| What is the difference between the goal for managing an Angina and a MI? | Angina- decrease heart workload, increase O2 supply and decrease O2 demand
AMI- Re-establish oxygen supply to myocardium
🗑
|
||||
| Explain MONA and the changing evidence surrounding it. | When someone is having an AMI, the practice has been to give:
Morphine- for pain and vasodilation, stress
Oxygen
Nitrates- vasodilation
Aspirin- anticoagulant
However, the body is smart and giving lots of O2 causes vasoconstriction> decreased O2
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|
||||
| When should you give O2 to a person having an AMI? | only when their O2 sats are very low
🗑
|
||||
| When someone is having an AMI or has an angina, you might treat them with what medications and surgeries? | Meds-
antiplatelets, anticoagulants, thrombolytics
Surgeries- Cardiovascular lab (angiogram/stent) and coronary artery bypass surgery
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|
||||
| What is an angioplasty indicated for? What does it do? | Angioplasty is used to open up blocked arteries by threading a catheter through an artery to the coronary arteries, inflating a balloon at the obstructed artery site and possibly inserting a stent to hold artery open
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|
||||
| A patient comes to your floor from the cardiovascular lab procedure. What do you need to do? | Assess the femoral artery site
Bedrest with flat straight leg to avoid hemorrhage
Educate patient to report pain or MI SS
Assess the 5 p's
Pulseless
Pain
Palor
Paresthesia (numb)
Paralysis
🗑
|
||||
| What are the 5 P's for Post Cardiovascular lab patient care? | Assess:
Pulseless
Pain
Pallor
Paresthesia (numb)
Paralysis
🗑
|
||||
| T/F- you do not always have to stop the heart to do a coronary artery bypass. | True- there are off-pump bypass surgeries where you slow the heart significantly and sew directly onto heart while it beats
🗑
|
||||
| T/F- valve replacement surgery can be due to an acute or chronic event. | True- although most valve replacements are due to chronic disease process, valve rupture does haooen sometimes
🗑
|
||||
| What are the benefits/risks to using a human or porcine valve verses a mechanical valve for a valve replacement surgery? | Biological valves do not require anticoagulant therapy but the valves will likely need to be replaced.
Mechanical valves require anticoagulant therapy but will last longer than biological valves
🗑
|
||||
| A patient comes to your floor after a CAB or valver replacement surgery. What are your nursing goils and treatment plans? | Incision care to avoid infection
Neurologic assessment to check for hypoxia or stroke
Dysrhythmias, EKG monitoring
Assess for Chest pain (sign of MI)
Get your patient moving so heart/lungs can work
Educate on med/diet compliance
🗑
|
||||
| What are the 4 indications for an internal pacemaker? | Symptomatic bradycardia
Heart blocks (electrical impulse is getting stopped and not traveling through whole heart)
Cardiac resynchronization (heart beats irregularly)
Overdrive pacing for tachyarrhythmias (want to slow the heart down)
🗑
|
||||
| What are the indications for ICD (internal cardiac defibrillator)? | Prevent sudden cardiac death due to ventricular tachycardia or ventricular fibrilation
Class 1 or 2 heart failure
🗑
|
||||
| On an X-ray, how can you tell if your patient has an ICD or a pacemaker? | ICD has high gauge wire areas in two spaces (shows up brighter sections)
🗑
|
||||
| How do you care for a patient who just had a pacemaker or ICD surgically implanted? | Perform incision care
Don't let lift left arm above shoulder for 6 weeks so wire isn't pulled (no driving, ADLs)
Manage pain
Educate about Pacemaker/ICD ID card, avoiding electrical/magnetic fields, notify provider if feel electric shocks w pacemaker
🗑
|
||||
| T/F- all Internal Coronary Defibrilators are Pacemakers. | True
🗑
|
||||
| T/F- all Pacemakers are Internal Coronary Defibrilators. | False, ICD's have additional programs, high gauge wires for fibrilation, and a larger battery
🗑
|
||||
| What is the difference between Defibrillation and Cardioversion? | Defibrillation =non-synchronized delivery of energy during any phase of the cardiac cycle, used in patients with no heart beat or with lethal dysrhythmias
Cardioversion delivers shock to patient w/ organized by fast rhythm on top of R wave to reorganize
🗑
|
||||
| Which procedure is considered elective, done while the patient is sedated, synchronized with QRS complex, delivers 50-200 Joules and has a consent form? (cardioversion/defibrillation) | Cardioversion
🗑
|
||||
| Which procedure is done in an emergency situation where the patient is in V-Fib/V-tachycardia with no cardiac output, delivers 200-360 Joules to an unconscious client? (cardioversion/defibrillation) | Defibrillation
🗑
|
||||
| What is the goal for ablation therapy of the heart? | Insert wires into heart to track rhythm, burn parts of heart that are causing irregular heartbeat to redirect electrical impulses
🗑
|
||||
| Who might need Ablation therapy? | Patients with atrioventricular reentrant tachycardia,
Atrial tachycardia
Idiopathic ventricular tachycardia
Atrial flutter/A-fib
🗑
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| If a patient is in systolic heart failure, what is happening? What is their ejection fraction like? | The ventricles can't contract as strongly as they need to, the heart muscle becomes thin and weak, blood backs up into the organs, especially the lungs.
Ejection fraction: <40%
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| What is a normal ejection fraction for the heart? | 55-70%
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| If a patient is in diastolic heart failure, what is happening? What is their ejection fraction like? | The ventricles cannot relax and fill appropriately, the heart muscle is thick and stiff
Ejection fraction: >60% because the ventricle can still eject the blood, but the CO is bad because the amount of blood available to pump is less than it should be
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| What is left sided heart failure? What causes it? | Blood is not ejected through the aorta due to high afterload with HTN, Valvular disease (aortic/mitral valve fail), CAD where there is an MI on the L ventricle so heart dies
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| What does a patient with left sided heart failure look like? | Pulmonary congestion (cough, crackles, wheezes, tachypnea)
Fatigue, cyanosis
Tachycardia b/c heart tries to compensate
SOB at night
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| What should you do for a patient in left sided heart failure? | Elevate HOB
Diuretics
Provide Oxygen
Encourage rest, cluster care
Give inotropes (digoxen) to increase force of contractility
Discourage salt intake
Encourage airway clearance w/ incentive spirometry
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| What is right sided heart failure? What causes it? | Right side of the heart is not pumping blood to the lungs as it should due to Coronary disease, Left-sided heart failure (pulmonary congestion >pulmonary HTN so afterload is too high for Right side to push)
Pulmonary Hypertension (afterload is too high)
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| What does a patient with right sided heart failure look like? | Fatigue
Increased Peripheral venous pressure
Ascites
Enlarged liver/spleen
Distended Jugular Veins
Anorexia/GI distress
Weight gain
Dependent edema
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| You suspect your patient to be in heart failure because he has very distended JVD, Ascites, fatigue, and notable weight gain and edema in the legs and feet. What type of heart failure is this likely? | Right sided heart failure
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| You suspect your patient may be in heart failure. He is having a hard time breathing, is tachypnic and tachycardic, easily fatigued and cyanotic. What type of heart failure is this likely? | Left sided heart failure
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| What can you do for a patient with right sided heart failure? | Elevate HOB so abdomen dosen't squish lungs
Diuretics
Incentive Spirometry
Small meals (anorexia)
Monitor skin integrity b/c of decreased nutrition and edema
Nutritional support
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| Which type of heart failure will your patient likely be considered a fall risk? | Right sided because causes dependent edema and ascites so they are carrying a lot of extra weight
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| Your patient is in heart failure. They are confused, restless, tachycardic, have cool extremeties, pulmonary congestion and complain of oliguria during the day and nocturia at night. This is likely | Left-sided heart failure
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| Your patient is in heart failures. They complain of anorexia and nausea, swollen hands, fingers, polyuria at night and weight gain. This is likely | Right sided heart failure
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| This laboratory assessment is used for diagnosing Heart failure, especially diastolic heart failure in patients with acute dyspnea. | BNP- low levels (100)= not heart failure or well controlled
Some chronically ill heart patients have chronically stretched ventricles so closer to 1000
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| What are the different classifications of heart failure? Briefly describe. | Class 1-5
1- might get winded when doing activities
3- comfortable at rest, any physical exertion causes SoB
5- SoB at rest
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| When educating your client on their diagnosis of heart failure, you should teach them about... | Increased edema
need to report Increased SoB
Increased activity intolerance
Large change in daily weights
Dyspnea
Anorexia
Persistent cough
Nocturia might occur
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| When discharging a patient with heart failure, you teach them to... | Do daily weights
Cluster activities
Restrict salt intake
Medication compliance (diuretics, antihypertensives, digoxin)
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| Which valves do you expect to fail in a patient's heart? Why? | Mitral and aortic valve (left heart valves) because higher pressure
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| T/F- A valve replacement surgery can be done on or off pump. | False- must be done on pump because heart is cut open
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| What is mitral stenosis? Cause? | Often caused by Rheumatic fever, leads to mitral valve thickening (fibrotic or calcified) that cannot open so the left atrium is backed up, pressure rises, LA dilates, pulmonary congestion and right ventricle hypertrophy, right-sided HF then CO falls
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| What is mitral regurgitation? Cause? | Often caused by Endocarditis, fibrotic/calcified valve prevents mitral valve from closing in systole so blood backs up into L atrium, during diastole blood reenters LV>^blood volume in next systole>LA&LV hypertrophy
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| What is mitral prolapse? Cause? | Mitral valve is enlarged as in Marfan syndrome, and leaflets don't come together well
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| What is aortic stenosis? Cause? | fibrotic/calcified valve obstructs outflow of blood during systole so LV hypertrophies, CO becomes fixed and can't increase to meet needs of body>LV failure>pulmonary congestion
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| What is the most common cardiac valve dysfunction in the US? | Aortic stenosis (disease of "wear and tear")
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| What is aortic regurgitation? Cause? | Endocarditis or Congenital defect cause Aortic valve leaflets don't close properly during diastole, blood flows back from aorta to LV which hypertrophies to accommodate
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| List the Blood Pressure readings for Normal, Pre-Hypertension, Stage 1, and Stage 1 HTN. | Normal<120/<80
Pre-Hypertension 120-139/80-89
Stage 1- 140-159/90-99
Stage 2- >160/>100
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| What are some causes of Hypertension? | Hyperthyroidism
Hyperaldosteronism (retention of fluid)
Cushing's syndrome (cortisol increase BP)
Pheochromocytoma (hormone releasing tumor)
Renal disease (RAAS upregulates to increase blood flow through kidneys)
Pheoch
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| There are 4 stages of PAD (peripheral artery disease). Explain them briefly. | Stage 1- No symptoms
Stage 2- Claudication (pain w/ activity)
Stage 3- Rest Pain
Stage 4- Gangrene/Necrosis
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| If a patient has PAD, what should you watch for? | Decreased pulses
Pain, Pallor, Pulselessness, Paresthesia
Decreased cap refill
Cool/Pale Skin
Cyanosis
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| What are the appropriate non-surgical interventions for a patient with PAD? Surgical? | Minimize exposure to extreme temp (unable to feel)
Minimize vasoconstriction
Maintain warmth
Angioplasty, Stent, Atherectomy, Vascular Bypass
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| What is an arterial aneurysm? Where can it occur? | Weakening of vascular wall, can occur in any artery, often occurs in Aorta or Cerebral arteries (near a bifurcation)
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| There are many types of aneurysm. Explain the differences between a True and False aneurysm and a dissection. | True- entire vessel wall bulges
False-not entire vessel wall, just outer layers bulge
DIssection- layers of the artery separate
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| When a patient comes in and you're assessing for an aneurysm, what are the presentations? | Pulsatile mass (abdomen maybe?)
Aching pain
Tearing feeling
Bruit
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| How can you non-surgically manage an aneurysm? Surgical? | Monitor the aneurysm, manage BP and stress
Endograft- replace part of artery with synthetic substance
Clipping/Coiling to keep blood from flowing into aneurysm
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| What is the appropriate post-procedural care for a patient being surgically treated for an aneurysm? | Monitor for bleeding/infection
Monitor Neuromuscular function
Monitor for graft occlusion and educate client
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| What is Peripheral Venous disease? | Mostly seen in the arms and legs blockage in the peripheral veins blocks blood return fro the periphery to the heart, can be caused by DVT, Phlebitis or Thrombophlebitis
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| How can you treat/prevent Peripheral Venous Disease? Surgical interventions? | Antiplatelets, anticoagulants and thrombolytic
Elevate extremety
Apply SCDs to prevent DVT
Thrombectomy (clot retrieval)
IVC filter/Greenfield filter
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| Why does the electrical conduction slow down when it reaches the AV node from the SA node? | To allow atrium to squeeze blood into ventricles
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| How should you attach the 5 leads on an EKG? | White (right)
Green (RL)
Black (LA)
Red (LL)
Brown (4ICS, right side)
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| In an ECG, the P wave is indicative of? | Atrial depolarizaton
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| In an ECG, the QRS complex is indicative of? | ventricular depolarization
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| In an ECG, the T wave is indicative of? | Repolarization of myocardium
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| In an ECG, the PR segment is indicative of? | Electrical impulse being held in AV node (atria contracting)
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| In an ECG, the ST segment is indicative of? | Electrically silent because impulse is dissipating as ventricles are contracting
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| When measuring an ECG with calipers, you know that each Tic mark is ____ seconds, Each small box is _______ seconds and ______ mV and each Large box is _______ seconds and _____mV | Tic mark= 3 seconds
Small box=0.04 seconds and 0.1 mV
Big box= 0.2 seconds and 0.5 mV
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| When interpreting an EKG, what are the 6 steps? | Heart rate
Rhythm
P-Wave presence
P-R interval
QRS duration
Determine rhythm
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