Cardiovascular - Uworld Flashcards
Nitroprusside
Vasodilator
Used in hypertensive emergencies
Can begin to act within 1 minute and can produce a sudden drop in BP, so you must monitor BP very closely.
PAD
Arteries of extremities become atherosclerotic
Reduces tissue perfusion and causes ischemic pain in lower extremities with movement and exercise
What causes increased risk for PAD
HTN
Diabetes
Hyperlipidemia
Smoking
Normal PTT and PT levels
PTT = heparin
25-35 seconds
PT 11-16 sec
Normal platelet and hematocrit levels
PLT 150,000-400,000
Hematocrit
Female: 35-47%
Male: 41-50%
Infective endocarditis
Bacteria or infection that attaches to your heart.
Can cause life threatening complications such as stroke or Ischemia to the extremities
Ischemia
Inadequate blood supply to to an organ or part of the body
Cardiac Tamponade
S/S
Compression of the heart caused by fluid collecting in the sac surrounding the heart S/S include -Hypotension -Jugular Vein distention -Distant heart tones -Dyspnea, Tachypnea -Tachycardia
Pacemaker teaching
No MRI
Notify airport security when traveling
Do not place cell phones directly over
Carry a pacemaker identification card with you and wear medical bracelet
Take pulse daily
Do not raise arm above shoulder on pacemaker side until HCP says its okay to avoid dislodging
(Using microwaves is okay!)
Home management of PAD
Lower extremities when laying down or sitting. Promotes arterial blood flow
Engage in moderate exercise
Perform daily skin care such as lotion to prevent breakdown
Maintain mild warmth (socks and blankets, no heating pad)
Stop smoking
Avoid tight clothing and stress
Take prescribed medications
How to find MAP
(Systolic + (Diastolic x2))/ 3
Normal MAP is between 70-105
Map <60 indicates that vital organs are underperfused and can become ischemic
assessing Jugular vein distention
HOB 45 degree angle
What increases cervical cancer risk
Multiple sex partners
Previous STI’s
Smoking
HPV «< The must important risk factor
Diabetic Ketoacidosis and potassium
Insulin pushes potassium into the cell and out of the blood stream, so if someone is in ketoacidosis and receiving IV insulin, potassium will be given even if potassium levels are normal
Refeeding syndrome
When a malnourished client starts getting adequate nutrition, the body begins making more insulin and which causes electrolyte deficiencies
Rapid declines in phosphorus, potassium, and magnesium
PPN
Normal phosphorus levels
Normal magnesium levels
P: 2.4-4.4
M: 1.5-2.5
Estrogen therapy risk
Increased risk for blood clots (DVT)
Rheumatoid arthritis vs osteoarthritis vs gout vs ankylosing spondylitis
RA - Symmetrical pain and swelling usually affecting small joints of hands and feet (not spine! Just cervical spine). Morning joint stiffness lasting from 60 min to several hours
Osteoarthritis - Asymmetrical pain in weight bearing joints. Crepitus, especially in knee joints
ankylosing spondylitis - Low back pain and stiffness, worse in the morning and gets better
Gout - pain, swelling and redness of one or more extremity joints (typically the great toe)
Endovascular
“Inside the blood vessel”
Surgery where they cut small incisions to access the blood vessel with a catheter
Babinski sign
Normal is that the toes point downward
Indicates upper motor neuron lesion from damage to corticospinal tract
Kidney inflammation (Pyelonephritis) expected finding
costovertebral angle tenderness
Examination for skin cancer
ABCDE
A- Asymmetrical
B- Border irregularity
C- Color changes and variation
D- Diameter of 6mm or larger (pencil eraser)
E- Evolving (changing in shape, size, color)
Peripheral artery disease
OKAY to dangle feet over bed to relieve pain Characterized by: -hair loss -ulcers -gangrene -cool dry, shiny, skin -Intermittent claudication -decreased blood flow from atherosclerotic build up -Thick, brittle nails -Decreased wound healing
Ileal conduit
Take piece of ileum to make a stoma, used as a urinary diversion. Ureters are connected to create an external opening.
Underlying medical conditions that could lead to delirium
Medications (opioids, analgesics) Electrolyte embalances Hypoxia Acute infections (fever, positive cultures) Sleep deprivation Dehydration or Malnutrition Metabolic Disorders (hypoglycemia)
Two types of UTI’s
Cystitis (Lower UTI, bladder)
Pyelonephritis (Upper UTI, kidneys)
Cystitis
Lower UTI Characterized by -Inflammation of the bladder mucosa -burning -frequency -urgency -hematuria -suprapubic discomfort
Pyelonephritis
Upper UTI They become very ill Characterized by -nausea and vomiting -fever with chills -flank pain -Costovertebral angle tenderness -Septic if not treated
Carpal tunnel syndrome
Pain and paresthesia of the hand caused by median nerve compression
Can manage symptoms with wrist immobilization by wearing a splint
Genital herpes
- Avoid sexual contact with active lesions…. Barrier contraception is not sufficient with active lesions
- Keep the area clean and dry
- Maintain proper hand hygiene and avoid touching the lesions
- Use mild soap to clean… no perfumed soap or bubble baths
- Use sitz bath and oatmeal baths to provide comfort and relief from itching
Anaphylactic shock
Also need to administer steroid such as methylprednisolone
Cardiac tamponade
Compression of the heart caused by fluid collecting in the sac around the heart
Possible complication of acute pericarditis
LIFE THREATENING
Characterized by:
-Hypotension
-Muffled heart sounds
-Neck vein distention
Foods rich in iron
Eggs, meat, shellfish, green leafy vegetables, dried fruit, broccoli, dried beans, brown rice, oatmeal
Romberg test
Neurological exam
Pt stands with feet together. Asked to close eyes, ability to maintain balance is assessed.
If positive romberg test, pt will need assistance with ambulating
MRSA risk factors
Older adult Suppressed immunity Long history of ABX use Invasive tubes and lines Pt in ICU
Preferred IM administration site for children <7 mo
Vastus lateralis
Clozapine
Antipsychotic to treat schizophrenia
Associated with a risk of agranulocytosis (dangerously low WBC count)
-Must have periodic CBC while taking
-notify provider of fever or sore throat
Enteric Coated drugs
Barrier coating that dissolves at a slower rate
Mono
Viral infection… no ABX
Fentanyl patches
Prescribed for moderate to severe CHRONIC pain
Rash and ABX
A rash is an adverse affect of ABX use and can be a sign of an allergic reaction! NOT a normal side effect
Ace inhibitors
Side effects
Adverse effects
-Prils
Adverse effect: Angioedema (rapid swelling of tongue and lips)
Intradermal injection angle
5-15 degrees
Rhabdomyolysis
Occurs when muscle fibers are released into the bloodstream
Common symptoms: Oliguria (small amounts of urine), Dark urine, and fatigue
Kidney function is at risk… administer fluids!
Hemophilia
Inability to clot.
Children with hemophilia, you can give vaccines subcutaneously. Holy pressure for at least 5 minutes and use an ice pack after to promote vasoconstriction to decrease blood flow to the area and reduce the risk for a hematoma.
Frequent sites of bleeding are in the joints
Hypospadias
Urethral opening is on the underside of the penis
Bacterial Meningitis
Inflammation of the meninges of the brain and spinal chord Clinical manifestations in children <2 -seizures -high pitched cry -nuchal rigidity
Emergency care following a burn
Briefly soak burn in cool water
Cover area with a clean, dry cloth
Remove clothing if not stuck to burn around the burn
DO NOT apply ABX ointment
Celiac diet
Rice, corn and potatoes are gluten free.
Newborn breathing
Newborns RR is 30-60/min with periodic pauses lasting <20 seconds.
30 month old physical findings
Chest circumference larger than abdomen
Weight is 4x greater than birth weight
Head circumference increases by 1 inch in second year, 0.5 inches per year after than until age 5
What age do children obtain bladder and bowel sphincter control
24 months
Pregnancy weight gain
1-4.5 lb weight gain in first trimester is normal
1 pound per week after that is normal
Pregnancy precautions
Toxoplasmosis can be transferred to the fetus
This infection comes from cat feces, soiled fruits and vegetables (gardening), undercooked meats
Leukorrhea
Normal pregnancy finding… white, milky and thin vaginal discharge
After a miscarriage
Avoid sex or tampons for 2 weeks
Call provider for foul smelling and heavily bloody vaginal discharge or for severe pain
Avoid soaking in a tub
Take prenatal vitamins with iron
Rhogam shot
Given to all mothers who are Rh negative
Spina Bifida
Neural tube defect Manifestations: -Tuft of hair at base of spine -Hemangioma or nevus (birth mark... raised red spot) -Dimple along base of spine
NSAIDS during pregnancy
Do not use during 3rd trimester! Pregnancy category C
Magnesium toxicity
Magnesium is given for seizure prophylaxis for pregnant ladies with preeclampsia
S/S
- Absent or decreased deep tendon reflexes
- Respiratory depression
Magnesium toxicity treatment
IV calcium gluconate
Stop magnesium
Magic fever number
100.4
Pediculosis Capitis
Head Lice
Signs of down syndrome at birth
Single transverse crease extending across palm of hand Small, low set ears Flat nose bridge Protruding tongue Hypotonia Atrioventricular (AV) canal defect
Glucose levels of babe after birth
Decrease 1 hr after birth… >40 is considered normal
They rise and stabilize after 2-3 hours
Hypoglycemic neonate (<40) should be fed immediately
Tetralogy of Fallot
No ventricular septum in the heart. Birth defect
Mixing of oxygenated and deoxygenated blood resulting in hypercyanotic episodes.
Episodes occur upon waking, crying, eating, hunger, or other stressful environments or situations.
Nagele’s rule
First day of last menstrual cycle
Subtract 3 months
Add 7 days
Common sign for lupus
Butterfly rash across cheeks and bridge of nose
Pyloric stenosis
Hardening of the pyloric sphincter
Manifested by projectile vomiting, dehydration and electrolyte imbalance
Esophageal Atresia
Esophagus has a gap and is not fully connected
Heart sounds in children
S3 heart sound normal in children
Assisting blind client to ambulate
Sighted guide technique:
- Walk slightly ahead of pt
- Allow pt to hold on to your elbow
Safe oxygen use
DO NOT use vaseline (petroleum jelly) if nose is dry, it is flammable
Keep oxygen cannisters 5-10 feet from gas stoves, candles, fire places, or other sources of open flames
Do not polish nails when using
Do not use wool blankets
Dysarthria
Worsening ability to speak
Amyotrophic Lateral Sclerosis (ALS)
Progressive loss of motor neurons in the brainstem and spinal chord Characterized by: -Spasticity -Muscle weakness -Atrophy -Impaired swallowing -Impaired respiratory function
Oropharangeal airway
Do not tape to pt cheek. Could cause aspiration or choking
“ac” and “pc”
"ac" = before meals "pc" = after meals
polycythemia
High red blood cells
Pleural effusion
Fluid build up between the lungs and the pleural walls.
Orthopnea
Difficulty breathing while lying down
Common side effects of corticosteroids
Mood swings and irritability
Assessing Jugular vein distention
Semi-fowler’s position
Lower limb amputation teaching
Pt should lie prone several times a day
Pt should not sit in chair for >1 hr at a time
Eosinophils
ALLERGY! A high eosinophil count would indicate an allergic trigger for asthmatic response
Frontal lobe
Occipital lobe
Temporal lobe
Parietal lobe
Frontal lobe: Behavior
Occipital lobe: Vision
Temporal lobe: Auditory
Parietal lobe: Sensory
Vaginal examination during ruptured membrane
Use STERILE gloves
Risk factors for post partum hemorrhage
Multiple gestations
Big baby >8 lb 13 oz
Supraventricular tachycardia
HR of 150-220
Initial intervention is to ask them to bear down (perform vagal maneuvers)
Psychomotor retardation
Clinical symptoms of major depressive disorder Manifestations: -Slowed Speech -Lack of facial expression -Decreased movement -Reduced social interaction -Downcast gaze
Psychomotor agitation
Pt with major depressive disorder may show signs of psychomotor agitation Manifestations: -Increased body movement -Pacing -Hand wringing -Muscle tension -Erratic eye movement
Hypothermia after surgery
Muscle stiffness after surgery
Common in immediate post op period due to anesthesia effects
Muscle stiffness is a bad sign and indicative of malignant hyperthermia
Aspirin toxicity or overdose interventions
Activated charcoal
Histoplasmosis
Fungal infection from bat or bird droppings
Most common in clients with compromised immunity
Respiratory infection
Normal platelet count
150,000-400,000
Hematocrit levels
Female 35%-47%
Male 38-48
Moro reflex
Startle reflex in newborns
Children under 12 and honey
BAD. Children under 12 should not have honey due to risk of botulism
Risk factors for endometrial cancer
Obesity
Polycystic ovary syndrome
Infertility
