Common Diagnosis Flashcards
Answer the following about Congestive Heart Failure (CHF)
- Pathology
- Risk Factors
- Diagnostics
- Patient Education
Pathology
- Cardiac disorder that impairs the ability of the ventricles to fill or eject properly
- Heart cant pump enough blood to meet the needs of the body
Risk factors
- uncontrolled hypertension
- congenital heart disease
- Arrhythmias
- Coronary artery disease
- faulty heart valves
- damage or inflammation of the heart muscle
Diagnostics
- Increase B-Type natriuretic peptides (BNP)
- chest x-ray (will show an enlarged heart and pulmonary infiltrate)
- ECG (measures ejection fraction)
- Cardiac stress test
Patient education
- Report signs and symptoms of fluid retention (oedema or weight gain)
- Elevate head of bed
- Balance of activity and rest
- Daily weigh
- Diet modifications (fluid restrictions, reduced sodium, reduced fats, reduced cholesterol)
Explain Left-sided heart failure
Left Side = Lungs
- Systolic HF - weakened heart muscle (reduced ejection fraction)
- Diastolic HF - stiff and non-compliant heart muscle (normal ejection fraction)
- fluid builds up in the lungs
Symptoms
- Trouble breathing
- Trouble breathing when lying down
- SOB while sleeping
- Rales (Crackles) in lungs
- Constant cough - frothy blood-tinged sputum
Explain right-sided heart failure
Right Side = rest of body
- Occurs due to left sided heart failure
- left ventricle fails and pressure builds up and causes backflow of fluids into the right side of the heart
- fluids back up into the venous system
- swelling of hands and feet
- Weight gain
- Pitting oedema
- Large jugular veins
- Increased abdominal girth
- Enlarged liver from build up of fluid
Answer the following about Coronary Artery Disease (CAD)
- Pathology
- Signs and symptoms
- Risk factors
- Diagnostics
- Treatment
- Patient education
Pathology
- Damage to the coronary arteries due to atherosclerosis = plaque build up over time on blood vessel walls causing narrowing and limiting blood supply
Signs and Symptoms
- Asymptomatic
- chest pain (angina)
Risk factors
- age, gender, race, family history
- modifiable risks - diabetes, smoking, hypertension, obesity, inactivity, high cholesterol, metabolic syndrome
Diagnostics
- Blood tests (LDL, total cholesterol, triglycerides, HDL
- ECG - access for changes in the ST segment
- stress test
- cardiac catheterization
Treatment
- Percutaneous coronary intervention (PCI) (stents)
Patient education
- Heart healthy diet (reduced saturated fats and increased fibre)
- Preventable measures - check cholesterol levels, control hypertension and diabetes, stop smoking, loose weight, increase physical activity
Answer the following about Angina
- Pathophysiology
- types
- Signs and symptoms
- interventions
Pathophysiology
- Chest pain associated with ischemia due to narrowing of at least one major coronary artery
Types
- Stable - predictable - occurs with exertion
- Unstable - Preinfarction - occurs at rest
- Prinzmetals variant - coronary artery vasospasms, pain at rest with reversible ST elevation
Signs and symptoms
- Chest pain relieved by rest and nitroglycerin
Interventions
- The goal is to reduce oxygen demand
- Reperfusion procedures
- CABG - Coronary Artery Bypass Graft
- Percutaneous coronary intervention (PCI) (catheter, balloon or stent)
Answer the following about Myocardial Infarction (MI) (Heart Attack)
- Pathology
- Signs and symptoms
- Diagnosis
- Treatment
- Prevention
Pathology
Complete blockage in one or more arteries of the heart due to
- Myocardial Infarction - Plaque ruptures and becomes a blood clot that blocks arteries of the heart
Signs and symptoms
- Sudden crushing chest pain
- pain that continues despite rest and medications
- SOB
- Nausea and vomiting
- Sweating
- Pale and dusky skin
- Rain radiating to: left arm, shoulder, jaw, back, epigastric area (heartburn)
Diagnosis
- Blood test for Troponin
- Stress test (chemical and exercise)
- ECG - access the ST segment
- STEMI - ST Elevation, complete block
- NonSTEMI - non-ST elevation MI, ST Segment NOT elevated, ST depression or T inversion
Treatment
Immediate
- Morphine to reduce work of the heart as well as pain
- Oxygen to increase O2 to the heart
- Nitroglycerin - opens up the vessels
- Antithrombotic medication
- aspirin (stops platelets sticking together)
- Heparin (anticoagulant)
- Thrombolytics (bust apart clots ie. Ateplase)
- Surgery - Stents or Graft
- Prevention and rest
What is Peripheral Venous Disease (PVD)?
- Causes
- Diagnosis
- Treatment
- Deoxygenated blood cant get back to the heart
- Oxygenated blood pools on extremities
- Dull, constant, achy pain
- pulse may not be palpable due to oedema
- oedema in legs due to blood pooling
- warm legs
- brown/yellow skin
- venous ulcers - shallow irregular shaped wounds
Causes
- Smoking, diabetes, hypertension, high cholesterol
Diagnosis
- Doppler ultrasound
- ankle-brachial index (ABI)
Treatment
- Elevate legs
- Medication (aspirin or clopidogrel or statins)
- surgery - angioplasty or bypass
What is Peripheral Arterial Disease (PAD)?
- Causes
- Diagnosis
- Treatment
- Narrow arteries (atherosclerosis) prevent oxygenated blood from getting to the distal extremities (hands and feet)
- Ischemia and necrosis of extremities
- Sharp pain that gets worse at night
- Pulse is poor or nearly absent
- No oedema
- cold extremities
- Skin is pale, hairless, dry, scaly and thin
- red sores with a punched-out appearance
- gangrene/tissue death
Causes
- Smoking, diabetes, high cholesterol, hypertension
Diagnosis
- Doppler ultrasound
- ankle-brachial index
Treatments
- Dangle arms and legs
- Daily skin care using moisturisers
- stop smoking
- avoid tight clothing
- avoid heating pads
- medications (vasodilators, antiplatelets)
Answer the following about Hypertension (HTN)
- BP Values
- Risk factors of primary HTN
- Risk factors of secondary HTN
- Signs and symptoms
- Patient education
HIGH BP
Hypotension <100/60
Normal 120/80
Pre HTN 120-129/<80
Stage 1 HTN 130-139/80-89
Stage 2 HTN 140-179/90-119
HTN Crisis >180/>120
Primary HTN = cause unknown, not curable only controllable
Risks factors = Race, Intake of ETOH, Smoking, Low K+ and Vit D, Family history, Age, High cholesterol, Caffeine, Obesity, Inactivity, sleep apnea
Secondary HTN = a direct cause / pre-existing condition
- Chronic Kidney disease (CKD)
- Diabetes
- Hypo/Hypertension
- Cushing’s disease
- Pregnancy
- Drugs - oral contraceptives
Signs and symptoms
- Usually asymptomatic
- known as the silent killer
If symptomatic
- blurred vision
- headaches
- nosebleeds
- chest pain
Patient Education
- Limit sodium intake
- limit alcohol intake
- stop smoking
- measure BP and keep records
- exercise and weight loss
Answer the following about Ventricular Tachycardia (VT)
- Pathology
- Causes
- signs and symptoms
- treatment
Pathology
- Wave forms are irregular, coarse and of different shapes
- ventricles are quivering
- no contraction or cardiac output
- can be fatal
Causes
- myocardial infarction/ischemia
- electrolyte imbalances
- digoxin toxicity
- stimulants - caffeine, methamphetamine
Signs and Symptoms
- Usually patient is awake (unlike V-Fib)
- Chest pain
- lethargy
- anxiety
- syncope
- palpitations
Treatment
Stable patient with a pulse
- Oxygen
- antiarrhythmics to stabilize (amiodarone)
- synchronised cardioversion (shock (not defib) in sync to QRS Wave)
Unstable patient without a pulse
- CPR
- ACLS - protocol for defib - shock
- Possible intubation
- drug therapy
Answer the following about Atrial Fibrillation (A-Fib)
- Pathology
- causes
- signs and symptoms
- Treatment
Heart rate usually >100bpm
- Uncoordinated electrical activity in the atria that causes rapid and disorganised ‘fibbing’ of the muscles in the atria
Causes
- Open heart surgery
- heart failure
- COPD
- Hypertension
- Ischemic heart disease
Signs and symptoms
- Most commonly asymptomatic
- fatigue
- malaise
- dizziness
- SOB
- Tachycardia
- anxiety
- palpitations
*all due to low O2
Treatment
Stable patient
- Oxygen
- Drug therapy
Unstable patient
- Oxygen
- Cardioversion - synchronised shock in sync with QRS wave (Not DeFib)
Answer the following about Atrial Flutter
- Pathology
- Causes
- Signs and symptoms
- Treatment
Pathology
- Rate 75-150bpm
- similar to A-Fib, but the heart electrical signals spread through the atria which are beating too quickly
Causes
- coronary artery disease (CAD)
- hypertension
- heart failure
- valvular disease
- cardiomyopathy
- hyperthyroidism
- chronic lung disease
- pulmonary embolism
Signs and symptoms
- May be asymptomatic
- fatigue/syncope
- chest pain
- SOB
- Low BP
- Palpitations
- Dizziness
Treatment
Stable patient
- Drug therapy
- calcium channel blockers
- antiarrhythmias
- anticoagulants
Unstable patient
- Cardioversion - syncronised shock with QRS wave (not DeFib)
Answer the following about Ventricular Fibrillation (V-Fib)
- Pathology
- Causes
- Signs and symptoms
- Treatment
Pathology
- Heart rate unknown, chaotic and irregular
- rapid, disorganised pattern of electrical activity in the ventricles
causes
- cardiac injury
-medication toxicity
- electrolyte imbalances
- untreated ventricular tachycardia
Signs and symptoms
- loss of consciousness
- may not have a pulse or BP
- respirations may stop
- Cardiac arrest
Treatment
- CPR
- Oxygen
- Defibrillation
- Possible intubation
- drug therapy
Answer the following about T1DM
- Pathology
- Onset
- Risk factors
- signs and symptoms
- treatment
Pathology
- produces no insulin
- caused by an autoimmune response
- cells are starved of glucose
- cells breakdown protein and fat into energy causing ketones to build up = acidosis
Onset
Abrupt - usually in childhood
Risk factors
- Genetics and family history
Signs and symptoms
- polyphagia
- Polydipsia
- Polyuria
Treatment
- Insulin dependent for life
Answer the following about T2DM
- Pathology
- Onset
- Risk factors
- signs and symptoms
- Treatment
Pathology
- pancreas does not produce enough insulin or produces bad insulin that does not work properly
- caused by insulin resistance
- insulin receptors are worn out and not working properly
Onset
- Gradual - usually in adulthood
Risk Factors
- High blood sugars, hypertension, obesity, inactivity, high cholesterol, family history, smoking
Signs and symptoms
- Polyphagia
- Polydipsia
- Polyuria
Treatment
- diet and exercise
- oral hypoglycemic agents
- possibly insulin
What complications occur to the following due to Diabetes
- Kidneys
- Nerves
- Eyes
- Heart
- Brain
Kidneys
Neuropathy - excessive blood glucose can damage the tiny blood vessels in the glomeruli which may cause kidney failure and even end-stage kidney disease
Nerves
Peripheral Neuropathy - excessive blood glucose can damage the nerves, outside the brain and in the spinal cord. Complications
- tingling, numbness, and eventually loss of sensation
- Foot nerve damage can cause major infections in cuts and blisters
- delayed wound healing
Eyes
Diabetic Retinopathy - Can damage the blood vessels of the retina which may lead to blindness, cataracts or glaucoma
Heart
Cardiovascular disease - damage to the heart and major coronary arteries and nerves controlling the heart leading to coronary artery disease, hypertension,n and atherosclerosis
Brain
Stroke - damage to blood vessels may make them stiff and cause build-up of fatty deposits which may cause a blood clot to travel to the brain causing a stroke
Answer the following about Rheumatoid Arthritis (RA)
- Pathology (and stages)
- Signs and symptoms
- Risk factors
- Treatment
Pathology
- chronic inflammatory type of arthritis classified as an autoimmune disease
- Stage 1 - Synovitis - synovium inflammation and synovial membrane thickens
- Stage 2 - pannus formation - vascular fibrous tissue forms
- Stage 3 - fibrous ankylosis - the joint is invaded by fibrous connective tissue
Stage 4 - Bony ankylosis - bones fuse together
Signs and symptoms
- rapid onset
- pain - symmetrical, redness and swelling - both parts on the opposite side of body affected
- stiffness in the morning
- affects small joints of hands and feet
- can affect heart, lungs and skin
- deformity of fingers
Risk factors
- Environmental (pollution)
- bacterial or viral illness
- smoking
- family history
Treatment
- Surgery - synovectomy: removal of synovium
- joint replacement
- arthrodesis - joint fusion
- heat for stiffness
- cold for pain/inflammation
Answer the following about Osteoarthritis (OA)
- Pathology
- Signs and symptoms
- risk factors
- treatment
Pathology
- Not autoimmune or inflammatory
- joint disorder caused by breakdown of articular cartilage between joints from wear and tear
Signs and symptoms
- Slow onset
- asymmetrical - affects one joint
- Pain/stiffness after weight-bearing activities
- affects weight-bearing joints - knees, hips, spine
- bony enlargements in hands
risk factors
- obesity
- older age
- female
- genetics
- wear and tear
- occupational risks ie. lifting, kneeling
treatment
- weight loss
- walking aids
- orthotic devices (splints, knee brace)
- aerobic exercise and strength training
- injection of gel-like substance into the affected joint
- Surgery - arthroplasty - replacement or reconstruction of joint
Answer the following about Osteoporosis
- pathology
- Diagnostic
- signs and symptoms
- risk factors
- patient education
Pathology
- Porus bones - the rate of bone reabsorption is greater than the rate of bone formation
- decreased total bone mass
Diagnostic
- Bone density test
- Dexa - dual-energy x-ray absorptionmetry (measures calcium and other minerals in bones)
Signs and symptoms
- maybe asymptomatic prior to a fracture
- pathological fractures - hips, spine, wrists
- low back, neck, hip pain
- rounded back (hunchback) causing height loss
Risk factors
- Low intake of calcium and vitamin D
- longterm use of corticosteroids levothyroxine or proton pump inhibitors
- women after menopause (lower estrogen = increased bone reabsorption)
- Lifestyle - smoking, excessive alcohol, sedentary lifestyle, immobility
- caucasian or asian women
- malabsorption disorders
- being overweight
- Advanced age - over 75 years
Patient education
- Diet - Increase calcium and vitamin D
- medications - bisphosphonates
- Prevention - weight-bearing exercises, limit alcohol and caffeine, stop smoking
- Prevent falls - avoid area rugs, watch out for pets, keep glasses handy, keep rooms well lit, non-slip socks, clutter-free environment, ask for help
Answer the following about GOUT
- Pathology
- Signs and symptoms
- causes
- patient education
Pathology
- form of arthritis characterized by increased uric acid levels
- deposits of uric acid cause crystal deposits in joints
- Uric acid = purine breakdown during digestion, produced by the liver and excreted by the kidneys
Signs and symptoms
- Acute gout arthritis - severe pain, swelling, warmth at site, bone deformity, joint damage, tophi (build-up of crystals in joints), renal calculi
Causes
- Diet high in purines ie. seafood, bacon
- certain meds - diuretics (cause dehydration), aspirin, cyclosporine
- disorder of purine metabolism
- kidney problem (lack of uric acid excretion)
Patient education
- Avoid food high in purine
- avoid certain meds
- avoid alcohol
- stay hydrated (fluid prevents kidney stones)
- weight loss
Answer the following about Seizures
- What is a seizure
- what is epilepsy
- stages of a seizure
- Causes
Seizure
- abnormal and sudden electrical activity in the brain
Epilepsy
- Chronic disease - recurrent and unprovoked
Stages
Prodromal - symptoms before a seizure
Aura - warning signs right before a seizure (weird smell or taste, altered vision, dizziness)
ICTUS - seizure activity
Post-ICTUS - Recovery post-seizure (headache, confusion, extreme tiredness, possible injury)
Causes
- Increased fever (febrile seizure in a child)
- CNS infection
- drug or alcohol withdrawal
- ABG Imbalance
- Hypoxia
- Brain tumor
- hypoglycemia
- Head injury
- hypertension
What are the following types of seizures
- Generalised
- Tonic Clonic
- Myoclonic
- Absent
- Atonic
- Partial (focal)
- Simple partial
- Complex partial
Generalised is when the entire brain is affected.
Tonic Clonic - or Grand Mal, may begin with an aura, stiffening (tonic) and/or rigidity (clinic) of muscles
Myoclonic - sudden jerking or stiffening of extremities (arms or legs)
Absent - Blank stare, often goes unnoticed
ATonic - sudden loss of muscle tone, may lead to sudden falls or dropping things
Partial (focal) - one area of the brain is affected
Simple partial - sensory symptoms with motor symptoms and continued awareness. May be preceded by an aura
Complex partial - altered behaviouf/awareness and loss of consciousness for a few seconds
What are the DO’s and DO NOT’s of a seizure
DO’s:
- note the time and duration of the seizure
- provide privacy
- turn to the side ( lying position immediately post-seizure) to prevent aspiration
- Place bed in lowest position
- move furniture or edges and corners away from the patient
- use padded side rails (or use pillows)
- loosen clothing around neck to protect airway
- place pillow under patients head
- maintain patent airway - have O2 and suction available
DO NOT:
- Restrain the patient
- move the patient unless they are in immediate danger
- force the jaw open
- place anything in the mouth
- leave patient unattended
What are the three types of Cerebrovascular Accident (CVA) stroke? Explain.
Ischaemic Stroke
- sudden interruption of blood supply to the brain
- blockage from a thrombus (blood clot on an artery wall) or embolism (blood clot, air or fat travels to the brain and gets stuck)
Transient Ischemic Attacks (TIAs)
- mini strokes
- no cerebral infarction or death occurs in TIA
- It is a warning sign of an impending stroke
Hemorrhagic Stroke
- A collection of blood in the brain that leads to ischemia and increased ICP
- caused by a ruptured artery, aneurysm or uncontrolled hypertension
- classic symptom is a sudden severe headache
