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adult health 1 > AH 1 exam 2 > Flashcards

AH 1 exam 2 Flashcards

1
Q

What is the accurate assessment when taking BP?

A 
● 2-3 readings spaced out
● sitting - feet flat - NO talking 
● correct size CUFF
➢ too BIG = LOW reading
➢ too SMALL = HIGH reading
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2
Q

What can interaction with BP?

A 
● interactions
➢ STRESS - pn, anxiety 
➢ temp changes
➢ barometric pressure 
➢ smoking, ETOH
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3
Q

HTN risk factors?

A 
Modifiable
● CKD - chronic kidney disease 
● Diabetes
● HIGH cholesterol 
● Poor DIET
● obesity
● stress
● SEDENTARY lifestyle, sleep apnea 
● tobacco use
Non-Modifiable
● age ➢ vasculature stiffens
● ethnicity/race ➢ African American
● gender ➢ men ➢ women (> 65) 
● family hx/genetics
● (social determinants of health)
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4
Q

HTN lifestyle modifications

A 
● weight loss
➢ ↓↓ demand on body
➢ ↓↓ cholesterol = have to work against atherosclerosis
● diet ➢ DASH diet ➢ ↑ K+/ ↓ Na+/↓ fat
● exercise
➢ HR = more efficient
➢ ↓↓ weight & cholesterol
● ETOH ➢ leads to DEHYDRATION
● smoking ➢ clogs arteries → ATHEROSCLEROSIS
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5
Q

HTN medications, AE, pt ed

A 
FIRST line:
➢ ACE, ARBs, Ca channel blockers, thiazide diuretic
● HOLD meds:
➢ HR<60bpm
➢ SYSTOLIC < 90 mmHg 
● start LOW & go SLOW

SECONDARY line:
➢ loop diuretics, beta blockers, K+ sparing

AE - orthostatic hypotension, hypotension

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6
Q

Effects of Long-Term HTN

Target organ Damage

A 
Retina/eye changes
renal damage 
myocardial infraction 
cardiac hypertrophy 
heart failure
 stroke
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7
Q

What are the effects of HTN on EYES?

A

● microaneurysms in the eye, papilledema
● cotton wool spots
● ↑ intraocular pressure = damages vessels

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8
Q

What are the effects of HTN on Kidneys?

A

● renal damage
● affected by ↑ in pressure
● proteinuria, Dec. urine output
● ↑↑ BUN/creatinine

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9
Q

What are the effects of HTN on the heart?

A

● angina/palpitations, MI, cardiac hypertrophy
● peripheral pulse = bounding
● dyspnea

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10
Q

What are the effects of HTN on neuro?

A

● neuro deficits - motor speech, stroke
● headaches/dizziness
● falls, weakness, gait changes

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11
Q

Hypertensive emergency

A 
signs & symptoms
● chest pain
● neuro changes
● ha
● ↑↑ BP = target organ damage

cause
abrupt in ↑↑ BP
SBP >180 or DBP >120

treatment
● in ICU
● IV anti-HTN meds
● SLOWLY lower BP
● tx target organ damage (Encephalopathy, Ischemic stroke, MI, Heart failure, Dissecting aortic aneurysm, Renal failure
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12
Q

HYPERTENSIVE URGENCY

A

signs & symptoms
more stable
→ NO target organ damage

Cause
SBP >180 or DBP >120

treatment
● usually w. oral meds
● get to the ROOT of WHY they
aren’t adherent

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13
Q

HTN primary vs secondary

A

Primary unknown

Secondary: related to another disease 
Cushing's
Hyperaldosteronism
Aortic coarctation
Pheochromocytoma
Stenosis of renal arteries.
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14
Q

Cardiovascular modifiable vs. non-modifiable risk factors

A

modifiable
Smoking, HTN, cholesterol, activity level, diet, stress, obesity, diabetes

non-modifiable
Age, gender, race, Family history

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15
Q

cardiovascular - considerations for older adults?

A 
Hypertrophy
Changes in the cardiac structure and function
Conduction system
Vasculature
thickening of rigidity of AV valves
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16
Q

Cardiovascular older adult consideration

hypertrophy

A

thickening of heart walls

➢ ↓↓ VOLUME of blood into the chamber ➢ ↓↓ STRENGTH of contraction

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17
Q

Cardiovascular older adult consideration

● ↓↓ cardiac output

A

➢ fatigue, exercise intolerance, HF, VENTRICULAR arrhythmias

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18
Q

Cardiovascular older adult consideration

thickened AV valves

A

➢ doesnt close properly → leads to BACKFLOW
○ hear murmur
(why they are so common in older adults)

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19
Q

Cardiovascular older adult consideration

conduction system

A

➢ SA node = pacemaker
➢ CONNECTIVE tissue develops in SA/AV node, and bundle branches = less tissue that can conduct electricity
○ s/s = bradycardia, blocks, ECG changes

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20
Q

Cardiovascular older adult consideration

stiffened vasculature/loses elasticity

A

➢ must work harder to pump against it
➢ leads to → ventricular hypertrophy
○ ↑↑ systolic BP
(why older adults have high BP)

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21
Q

Cardiovascular older adult consideration

↑↑ size of left atrium

A

➢ atrial arrhythmias

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22
Q

Cardiovascular older adult consideration

↓↓ sympathetic nervous system

A

➢ doesn’t react to demand of O2 → intolerance to EXERCISE

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23
Q

Cardiovascular older adult consideration

↓↓ sensitivity in BARORECEPTORS

A

➢ in CAROTID artery and AORTA

➢ unregulated response to HR/vascular changes → orthostatic hypotension

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24
Q

Cardiovascular older adult consideration

falls

A

➢ fx, head injuries

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25
Q

BUN Lab

A

8 - 20 mg/dL

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26
Q

Creatinine lab

A
  1. 6 - 1.2 mg/dL (male)

0. 4 - 1 mg/dL (female)

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27
Q

Calcium lab

A

8.8 - 10.4 mg/dL

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28
Q

Magnesium Lab

A

1.8 - 2.6 mg/dL

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29
Q

Potassium lab

A

3.5 - 5 mEq/L

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30
Q

Sodium lab

A

135 - 145 mEq/L

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31
Q

RBC lab

A
  1. 2 mil - 5.4 mil/ mm3 (male)

3. 6 mil - 5.0 mil/ mm3 (female)

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32
Q

Hemoglobin/ Hematocrit labs

A

14 - 17.4 g/dL 42 - 52% (male)

12 - 16 g/dL 36 - 48% (female)

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33
Q

Platelets lab

A

140,000 - 400,000/mm3

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34
Q

WBC lab

A

140,000 - 400,000/mm3

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35
Q

aPTT lab

A

21 - 35 sec (use w. heparin)

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36
Q

PT lab

A

11 - 13 sec (use w. warfarin)

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37
Q

INR lab

A

0.8 - 1.2 (use w. warfarin)

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38
Q

Lipid Tests:

A

● HIGH LDL/triglycerides = ↑↑ risk of heart disease
● HIGH CRP = indicates INFLAMMATION
● B-type = related to HEART FAILURE
● HOMOCYSTEINE = ↑↑ risk of disease and stroke

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39
Q

electrocardiogram (ECG)

A

= tests CONDUCTION in the heart

● normal sinus or dysrhythmias

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40
Q

exercise stress test

A

= how well pt tolerates ↑↑ HR and BP
● on treadmill with tele
● for: chest pn/CAD/big changes in HR and BP

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41
Q

pharmacologic stress test

A

for people who can’t tolerate being on the treadmill

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42
Q

echocardiogram

A

= STRUCTURE of the heart

● valves, silhouette of heart, measuring chamber SIZE

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43
Q

cardiac test - chest x-ray

A

= SIZE of heart

● just a silhouette of heart

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44
Q

fluoroscopy

A 
= see CLOT/NARROWING of arteries 
● like a moving x ray
● in cath lab
● w. contrast dye
→ takes pictures of where is GOES and STOPS
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45
Q

CARDIAC CATHETERIZATION
= for CORONARY & PERIPHERAL arteries

pre - op

A

● baseline coag studies (INR,PT,PTT)
➢ compare labs - before and after
➢ on HEPARIN
● electrolyte panel and CBC for baseline
● ↑↑ risk
➢ KIDNEY issue: CKD, renal insufficiency, diabetic patients ○ check renal fxn before (BUN/creatinine)
➢ HF
➢ dehydration
➢ other nephrotoxic med (metformin) ➢ older adults

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46
Q

cardiac Catheterization is and can cause

A

● iodinated contrast dye
➢ iodine allergy or shellfish allergy!
➢ pretreat with benadryl or steroids

47
Q

CARDIAC CATHETERIZATION Post - op

A

● bleeding
➢ usually in FEMORAL artery (maybe radial)
➢ must be SUPINE for several hours
➢ constantly monitor for signs of bleeding
➢ usually a clear dressing over insertion site
➢ hematoma development
➢ changes in vitals - ↓↓ bp ↑↑ hr = BLEEDING
○ back pain = retroperitoneal bleeding
● peripheral neurovascular assessment
➢ compare bilaterally
➢ lose pulse/cold = clot/dec blood flow to limb (need to go back to cath lab)
➢ temp/color/cap refill
● on tele
➢ ↑↑ risk of DYSRHYTHMIAS
● edu:
➢ supine 2-6 hrs
➢ report chest pain/bleeding

48
Q

Normal duration of the QRS complex is

A

< 0.12 seconds

49
Q

Duration of normal PR interval is

A

0.12-0.2 seconds.

50
Q

Arteriosclerosis

A

hardening of of arteries

Muscle fibers/endothelial lining become thickened (small arteries/arterioles)

51
Q

Atherosclerosis

A

(narrowing)
• Large/medium sized arteries
• Accumulation of fats, calcium, blood components, carbs, fibrous
tissues
● Forms plaques - atheroma ➢ stable & unstable

52
Q

Path to MI

A 
● arteriosclerosis (hardening) or atherosclerosis (narrowing)
● ↓ blood flow to myocardium = ↓ o2
● angina (ischemia)
● plaque ruptures
● causes thrombus
● complete obstruction = MI
53
Q

ANGINA

A

ISCHEMIA of blood flow to heart muscle → painful

54
Q

ACUTE CORONARY SYNDROME (ACS)

A

Unstable - no biomarker changes
NSTEMI - less tissue damage, transient occlusive - increased biomarkers
STEMI - ST elevation + biomarkers - emergency - complete/prolonged occlusion

55
Q

MI is

A

= complete occlusion
● ↓ O2 supply and ↑ O2. demand
● causes: blood loss, rapid HR, drug use, thyroid storm

56
Q

stable angina relieved by

A

REST & NITRO

57
Q

unstable angina

A

= ↑ severity/freq of symptoms; NOT relieved by REST & NITRO

58
Q

intractable/refractory angina

A

= severe pain

59
Q

variant angina

A

= pain at REST - caused by

VASOSPASM

60
Q

silent angina

A

no pain - ECG changes & ischemia are present

61
Q

CORONARY ARTERY DISEASE (CAD) lab values

A 
total cholesterol < 200 mg/dL 
LDL cholesterol < 100 mg/dL 
HDL cholesterol
> 40 mg/dL (males)
 > 50 mg/dL (females)
triglycerides < 150 mg/dL
62
Q 
ACS & MI cardiac enzymes lab values 
Troponin?****
creatine phosphokinase (CPK)?
CKMB?
myoglobin?
A 
troponin < 0.35 ng/mL 
creatine phosphokinase (CPK)
 50 - 325 mU/mL (males)
 50 - 250 mU/mL (females)
CKMB 0-5ng/mL 
myoglobin 0 mcg/mL
63
Q

STEMI VS NSTEMI ECG changes

A

STEMI - ST eleveted

NSTEMI - ST depression

64
Q

CAD Clinical manifest.

A 
depends on LOCATION and amnt of NARROWING
● epigastric distress/indigestion 
● angina
● weakness/lightheaded/nausea 
● shoulder pain
● SOB
65
Q

Angina Clinical manifest.

A 
● chest pain
● indigestion
● choking/heavy sensation 
● feeling of impending doom 
● radiating pain (shoulder)
● pallor
● N/V/lightheaded
66
Q

ACS & MI Clinical Manifest.

A 
● similar to unstable angina
● DIFFERENCE = biomarkers
➢ MI = biomarkers
● cool, pale, moist skin
● elevated HR & RR
● chest pain
● indigestion
67
Q

CAD risk factors and managment

A

Risk factors - smoking, obesity, stress, sedentary lifestyle, high fat diet (saturated fats)

● diet - eat more plants (fiber - omega3 fatty acids)
● physical activity
● medications 
● tobacco cessation 
● HTN management 
● diabetes control

CHOLESTEROL = statins
BLOOD PRESSURE = ACE’s, ARB’s, beta blockers, Ca channel blockers, thiazide diuretics

68
Q

Angina managment

A 
● medications
➢ stable - nitro, beta blocker, Ca channel blocker, anticoags
➢ unstable - heparin 
● oxygen therapy
➢ ↓ demand on heart
● PCIs/CABG

PCIs - balloon-tipped catheter is inserted into a coronary artery to open the artery; stents are put in place

CABG - 1. borrowed piece of blood vessel used to bypass a blocked artery in the heart
2. Traditional, alternative, endoscopic

69
Q

ACS and MI managment

A

GET PT TO CATH LAB ASAP
● pain management ➢ oxygen & morphine
● bed rest - elevates HOB
● manage fluid volume ➢ risk of HF
● adequate tissue perfusion
● anxiety ➢ ↓ workload on heart
● prevent complications
➢ ↓ cardiac output (↓BP, cool ext, ↓ pulses)
➢ fluid/electrolyte imbalances (labs, dysrhythmias)
➢ impaired cerebral circ (LOC, neuro symp)
● serial cardiac enzyme levels

70
Q

ACS/MI MEDS

A

● nitroglycerin
● analgesics - pain and ↓ O2 demand
● anticoagulants - aspirin, heparin

71
Q

PERIPHERAL ARTERY DISEASE

eti/patho

A

atherosclerosis in LE

arteriosclerosis

72
Q

CHRONIC VENOUS INSUFFICIENCY

eti/patho

A

● blood NOT returning to heart

● ↑↑ venous pressure → distended veins → causes BACKFLOW = venous stasis

73
Q

PAD Clincial manifest.

A 
● limb cool or numb
● pale skin
● absent pulses
● intermittent claudication - ↓ blood supply to the tissue causes pain 
● ARTERIAL ulcers
➢ small, round, dry, black sores
➢ on TOES and FEET
74
Q

Chronic venous insufficiency Clincial manifest.

A 
● dull, achy pain 
● ruddy skin
● VENOUS ulcers
➢ bigger, red sores 
➢ wet & weeping 
➢ on MEDIAL & LATERAL malleolus
75
Q

PAD management

A 
● #1 nicotine cessation 
● medication
➢ anti-platelet (aspirin, clopidogrel)
➢ direct vasodilator - for intermittent
claudication
● maintain circulation ➢ legs BELOW heart
● promote vasodilation
➢ warm temperatures 
➢ avoid cold and trauma
● good nutrition
● meticulous hygiene
76
Q

Chronic venous insufficiency

pt edu and managment

A 
● monitor skin - keep clean & dry 
● DONT:
➢ dangle or cross legs
➢ wear constrictive clothing 
● elevate legs at rest
● apply:
➢ compression stockings
➢ SCD’s
● encourage exercise 
● good nutrition
77
Q

DVT PREVENTION:

A

● early ambulation
● prophylaxis meds ➢heparin, lovenox
● SCDs/ted hose
● ankle exercises

78
Q

PE PREVENTION:

A

● bed rest until anticoag therapy
● no exercise → can throw clot to the lungs
● IV heparin
● initiate anti-coag therapy ➢ lovenox, heparin IV (therapeutic levels - draw aPTT)

79
Q

DVT and PE DIAGNOSIS:

A

● chest x ray, arterial blood gasses, D-dimer (inflx)

● GOLD STANDARD = CT scan w contrast

80
Q

DVT and PE NURSE MANAGEMENT

A

● anticoagulation meds
● endovascular intervention = remove clot
● thrombolytics = clot busters (Alteplase)
● reduce discomfort/manage pain
● relieve anxiety
● mange O2 therapy/ encourage exercise

81
Q

Lymphangitis

A

inflammation, acute influx of lymph channels (red streaks that outline lymph vessels as they drain)

82
Q

Lymphadenitis

A

involves lymph node; become larger, red, and tender

caused by strep or staph

83
Q

Lymphedema

A

tissue swelling due to inc lymph and
obstruction of the lymphatic vessels;
begins soft/pitting, then hard/non pitting

84
Q

Cellulitis Clinical manifest.

A

● strep or staph usually

● acute onset of redness, swelling, tenderness

85
Q

Cellulitis Nurse management

A

● outline to monitor progression
● cool, moist packs until influx goes does
● don’t use heat
● often recurs - edu about foot care, inspecting between toes ➢ keep clean and dry
Ankle Brachial Index (ABI)

86
Q

muscleskeletal and aging

A
  • Loss of height due to osteoporosis
  • Kyphosis – forward curvature of the thoracic spine
  • Thinned intervertebral discs, compressed vertebral bodies
  • Flexion of knees and hips
  • Menopausal withdrawal of estrogen contributes to osteoporosis
  • Loss of muscle strength
  • Collagen structures less able to absorb energy

***Many effects of aging can be slowed if the body is kept healthy and active

87
Q

Neurovascular assessment

A 
6's P's 
• Pain - ask
• Paresthesia - ask for numbness
• Pulse - palpate, if none use doppler
• Pallor - inspect - temperature
• Pressure - can they tell the difference between pressures
• Paralysis - too far gone
88
Q

muscleskeletal - Diagnostic evaluation

A
  • X-ray - “go to” check for texture, breaks, density, bone heal - serial x-ray
  • Bone Densitometry - DEXA - bone mineral density - used to diagnose osteoporosis
  • Bone Scan - Used to detect tumors, osteomyelitis, and breaks. Requires education, uses radioactive isotope, sits and waits, then gets scanned. Isotope causes a warm flushed sensation, needs an empty bladder.

Arthroscopy - Scope used therapeutically and diagnostically in joints

Arthrocentesis - Aspirate joint synovial fluid - thera. and diagn.

Electromyography (EMG) - test to look at nerve conduction - carpal tunnel - used to determine if its a muscle or nerve issue

89
Q

osteoarthritis (OA) Risk Factors

A

older adult, female, post-menopausal, Hispanic and African American, obesity, previous joint injuries

90
Q

osteoarthritis (OA) diagnosis

A

X-ray

91
Q

osteoarthritis (OA) treatment

A

decrease pain and stiffness - weight loss, incorporate exercise - NSAIDS, Tylenol, steroids, physical therapy, assistive devices,

lastly invasive - surgery

92
Q

osteoarthritis (OA) CM’s

A
  • Insidious, progressing over multiple years
  • Pain – aggravated by movement, relieved at rest
  • Stiffness – especially in the morning
  • Functional Impairment – decreased ROM
  • Joint enlargement
  • Crepitus
93
Q

Total Joint Arthroplasty/Replacement

A

Surgical removal of unhealthy joint surfaces and replacement with metal artificial surfaces

94
Q

Total Joint Arthroplasty/Replacement

Nursing Interventions (Post-op)

A
  • Preventing DVT - pain, swelling, change in color, tenderness, warmth - compression devices, ambulation, ankle ROM, anticoagulation meds
  • Preventing Infection - fever, high WBC’s, purulent drainage, pain, CHG baths, prophylactic antibiotics
  • Managing Pain - ICE, pharm, non-pharm, promote ambulation
  • Promoting Ambulation
  • Monitoring Wound Drainage
  • Preventing Dislocation (THA) HIP - affected extremity will be shorter and external rotation, pain, unable to bear weight, adduction
    • Clinical Manifestations of Joint Dislocation
    • Hip Precautions - bending over at 90 degree angle, do not cross legs, hips cannot be lower than knee, turn on non-operated side, no internal/external rotation
95
Q

Osteoporosis

A

Degenerative disease of the bone characterized by reduced mass, deterioration of matrix, and diminished architectural strength 🡪 Leads to bone fractures

96
Q

Osteoporosis * Risk factors *

A

women, post-menopause, small Frame women, Asian and caucasian, calcium and vit D insufficiency, corticosteroid use

97
Q

Osteoporosis diagnosis

A

DEXA

98
Q

Osteoporosis prevention

A

identify people at risk, exercise, no smoking

99
Q

Osteoporosis * Foods high in calcium and vitamin D?*

A

dairy, eggs, almonds, OJ, steamed broccoli

100
Q

Osteoporosis - education regarding calcium/vitamin D supp and bisphosphonate?

A

avoid carbonated soft drinks… ?

101
Q

Osteoporosis nursing interventions

A
  • Promoting Understanding of Regimen
  • Relieving Pain - heat
  • Preventing Injury ** - fall precautions
  • Improving Bowel Elimination (r/t immobility and medication) - w/fiber & fluids
102
Q

Osteomalacia

A

Metabolic bone disease characterized by inadequate mineralization of bone - weak, soft bones w/deformities

103
Q

Osteomalacia treatment & Clinical Manifestations:

A 
Skeletal softness and weakness
Skeletal deformities
Pain
Bowing of bones and spinal kyphosis
Pathologic fractures

treatment?

104
Q

Osteomyelitis - infection of the bone

Causes?

A

blood-borne infection, contamination during surgery, vascular insufficiency

105
Q

Osteomyelitis Risk Factors?

A

malnourished, obesity, long-term steroid use, IV drug use, older adults, chronic illness

106
Q

Osteomyelitis Treatment? **

A

long-term antibiotics, PICC

line then oral

107
Q

Osteomyelitis diagnosis

A

Arthrocentesis

108
Q

Osteomyelitis CM’s ***

A

Pain
Swelling
Extreme tenderness

109
Q

Osteomyelitis Nursing Interventions:

A

Relieving Pain
Improving Physical Mobility at comfort level
Controlling the Infectious Process - lots of assessing, antibiotics, lab draws

110
Q

Low Back Pain Nursing Interventions: **

A

Relief of Pain
Improved Physical Mobility
Use of Back-Conserving Tech. of Body Mechanics
Weight Reduction

111
Q

Low back pain causes

A

improper lifting during activity, weak muscles, comorbidities - depression, stress, obesity, smoking

112
Q

Low back pain diagnosis

A

x-ray, CT, MRI

113
Q

Low back pain CMs **

A

Pain
Acute (less than 3 months) vs Chronic

Muscle spasms

Radiculopathy(nerve involvement w/pain) shooting, sharp, electric, burning pain/Sciatica(shooting feeling down the leg)

adult health 1 (1 decks)

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