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Complex MedSurg > Complex MedSurg Exam 3 > Flashcards

Complex MedSurg Exam 3 Flashcards

1
Q

Atherosclerosis

A

The abnormal accumulation of fat, cholesterol, and fibrous tissue within arterial walls and lumen.

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2
Q

Coronary Athersclerosis

A

Blockages and narrowing of the coronary vessels reduce blood flow to the myocardium.

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3
Q

Manifestations of Atherosclerosis

A

Symptoms do not occur until blood flow is slowed down or blocked. Chest pain and shortness of breath is most common. Atypical symptoms are more common in women and in persons who are older, or who have a hx of heart failure or diabetes.

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4
Q

Serum Cholesterol and Triglyceride Values

A

Total Cholesterol - under 200. LDL 100-129. Triglyceride <150.

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5
Q

Myocardial Infarction

A

Myocardial injury from sudden restriction of blood supply to a portion of the heart. The main cause is buildup of athersclerotic plaque. The extent of cardiac damage is dependent upon reperfusion of the ischemic zone.

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6
Q

Manifestations of M.I

A

Substernal chest pain (crushing, severe, squeezing, tightness, burning. radiates to neck, jaw, shoulder of L arm) Shortness of breath, diaphoresis, indigestion, nausea, anxiety, cool pale moist skin.

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7
Q

CK in Myocardial Infarction

A

CK level rise rapidly with damage to the cardiac muscle. Normal Value for male 12-80. Normal for female 10-70.

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8
Q

CK-MB in Myocardial Infarction

A

Intracellular enzyme released when myocardial cell death has occured. Normal is 0-3% of total CK.

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9
Q

Troponin in Myocardial Infarction

A

The most specific in detecting myocardial damage. Can detect very small infarctions that do not cause significant CK elevation

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10
Q

Medications for MI

A

Aspirin, Nitroglycerin, Morphine (reduces preload and afterload and decreases workload of the heart), fibrinolytics (dissolve or break up clots), beta blockers (decrease the HR and oxygen demands of the heart)

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11
Q

Pump Failure

A

The risk of heart failure is greatest when large portions of the L ventricle are infarcted.

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12
Q

Manifestations of L sided Heart Failure

A

dyspnea, fatigue, weakness, and respiratory crackles

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13
Q

Manifestations of R sided Heart Failure

A

neck vein distention and peripheral edema

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14
Q

Cardiac Rehab

A

Purpose is to improve cardiac function and assist pt to return to as normal a life as possible. 3 Phases. Phase 1 is inpatient phase. Phase 2, immediate outpatient cardiac rehab begins within 3 weeks of the cardiac event. Phase 3, provide transition to independent exercise and exercise maintenance.

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15
Q

SA Node.

A

The pacemaker of the heart. 60-100 bpm

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16
Q

Conduction through the heart

A

Impulse travels from the SA node through to atria to the AV node. Electrical stimulation of the muscle cells of the atria causes them to contract. The AV node slows the electrical impulse, giving the atria time to contract and fill the ventricles with blood. The impulse travels through the bundle of His to the R and L bundle branches and Purkinje fibers located in the ventricles. The ventricles contract (systole). The cell repolarizes and then the ventricles relax (diastole)

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17
Q

P Wave

A

The first wave of the cardiac cycle. Represents atrial depolarization.

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18
Q

PR Interval

A

Time required for the sinus impulse to travel to the AV Node and into the Purkinje fibers.

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19
Q

QRS Complex

A

Represents ventricular depolarization, composed of 3 waves.

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20
Q

ST Segment

A

Beginning of ventricular repolarization.

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21
Q

T Wave

A

Represents ventricular repolarization (resting state of the heart)

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22
Q

Normal Sinus Rhythm

A

Regular rhythm, 60-100bpm. P wave is rounded and precedes each QRS Complex.

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23
Q

Sinus Tachycardia

A

Sinus node creates an impulse at a faster than normal rate >100bpm. Causes of sinus tachycardia are physical activity, hemorrhage, shock, medications, fever, anxiety and MI. Tx depends on the cause (digoxin, Calan, Inderal, O2). The goal is to decrease the workload of the heart.

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24
Q

PVCs

A

Premature Ventricular Contractions. The ventricles are irritable and fire prematurely, before the SA Node. The cause is caffeine, alcohol, anxiety and hypokalemia. S/S palpitations, lightheadedness. Does not require tx if infrequent.

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25
Q

Ventricular Tachycardia

A

Three or more PVCs in a row. Ventricles fire instead of the SA Node. Causes are myocardial irritability, MI, cardiomyopathy. S/S dyspnea, palpitations, light headedness. Can lead to ventricular fibrillation/ cardiac arrest. Tx with cardioversion and Class III antidysrhythmics (K Channel Blockers)

26
Q

Ventricular Fibrillation

A

Rapid, disorganized ventricular rhythm. Causes are hyperkalemia, hypomagnesemia, MI. S/S are loss of consciousness, no heart sounds, peripheral pulses or blood pressure. Tx is immediate defibrillation.

27
Q

Pacemakers

A

Are used to override dysrhythmias or to generate an impulse when the heart is beating too slow. Most are set at a rate between 60-72 bpm and will initiate a pulse if the HR falls below that. The pt is placed on cardiac monitoring for several hours after insertion. Assess for change in rhythm or rate, monitor dressing for bleeding, report change in vital signs or chest pain immediately. The pt will wear a sling for 24-48 hours.

28
Q

Pt Teaching on Pacemakers

A

Incision care. Method for taking a recording pulse rate. Report S/S of dizziness, fainting, irregular heartbeats, or palpitations. Wear a medical alert bracelet. Avoid lifting more than 10lbs for 2 months after surgery.

29
Q

Implantable Cardioverter-Defibrillator

A

Detects changes in the cardiac rhythm and automatically delivers an electric shock. It is used to treat arrhythmia’s that occur in the ventricles (ventricular tachycardia). Battery must be surgically replaced every 5 years. The pt will feel significant discomfort when the ICD discharges.

30
Q

Cardiac Arrest

A

Abrupt loss of heart function. Caused when the heart’s electrical system malfunctions, which may follow respiratory arrest. The most common causing arrhythmia is ventricular fibrillation. Pt will be unconscious, blood pressure and pulse will be absent, pupils will dilate. CPR will be initiated immediately.

31
Q

Cardiac Tamponade

A

A medical emergency. May result from pericardial effusion, trauma, cardiac rupture, or hemorrhage. Rapid collection of fluid in the pericardial sac interferes with ventricular filling and pumping, critically reducing cardiac output.

32
Q

Manifestations of Cardiac Tamponade

A

Paraoxical pulse (marked drop in the amplitude of the pulse during inspiration), hypotension, tachycardia, decreased urine output, muffled heart sounds, weak peripheral pulses, engorged neck veins.

33
Q

Medical Management of Cardiac Tamponade

A

Pericardiocentesis. Fluid is aspirated from pericardial sac. Monitor ECG and V/S. Have emergency resuscitation equipment available. HOB 45-60 degrees. Ultrasound imaging is used to guide placement of the needle. Pt normally feel immediate relief. Pt will be sedated but awake and conscious.

34
Q

Aneurysms

A

A dilation or sac formed on the wall of an artery. Common locations are abdominal aorta and thoracic. Classified by size and shape.

35
Q

Abdominal Aortic Aneurysm

A

The most common cause is atherosclerosis. 40% of pts have symptoms, can feel heart beating in abdomen when lying down and may feel an abdominal mass.

36
Q

Medical Management of Abdominal Aneurysm

A

If the aneurysm is stable, antihypertensive agents are used. If it is expanding or enlarging, surgical repair is done. Prognosis is poor if the aneurysm ruptures. Signs of impending rupture are severe back pain or abdominal pain.

37
Q

Shock

A

A state of circulatory collapse that results in organ damage and death without immediate treatment. Common causes are inadequate cardiac output due to heart failure or hemorrhage, a decrease in vascular resistance due to anaphylaxis, sepsis, or neurological alterations. All typtes cause a decrease in oxygenation and tissue perfusion leading to cell death and organ system failure.

38
Q

Hypovolemic Shock

A

The most common type, decrease in intravascular volume. Caused by trauma, surgery, hemorrhage, or burns.

39
Q

Cardiogenic Shock

A

Shock caused by cardiac failure.

40
Q

Circulatory Shock

A

Blood volume pools in peripheral blood vessels.

41
Q

Septic Shock

A

Caused by widespread infection

42
Q

Neurogenic Shock

A

Loss of balance between sympathetic and parasympathetic stimulation (spinal cord injury)

43
Q

Anaphylactic Shock

A

Due to severe allergic reaction

44
Q

Signs of Shock

A

An early sign is a change in the LOC. Late signs of shock are mental status changes, hypotension, and marked tachycardia.

45
Q

Superficial Burns

A

Involves only the epidermal layer. Most often results from sunburn, ultraviolet light, or mild radiation associated with cx treatment. Skin color ranges from pink to bright red. Healing time is approximately 3-6 days. No scar formation. Treated with mild analgesics and water-soluble lotion.

46
Q

Superficial Partial-Thickness Burns

A

Involves the entire dermis. Most often results from brief exposure to flash flame or dilute chemical agents. Skin color is bright red, moist with blister formation and will blanch on pressure. Pain is SEVERE. Healing time is within 21 days. Treated with analgesics

47
Q

Deep Partial-Thickness Burns

A

Involves the entire dermis. Most often results from hot liquids, flash flame, or chemical agents. Surface of the burn appears pale and waxy, may be moist or dry, large easily ruptured blisters, capillary refill is decreased. Areas of pain and decreased sensation may be present. Healing time is more than 21 days. Contractures, scaring, and functional impairment are possible. If it is a chemical burn remove clothing or it will continue to burn.

48
Q

Full-Thickness Burns

A

Involves all layers of the skin. May extend into subcutaneous fat, connective tissue, muscle and bone. Most often results from prolonged contact with flames, steam, chemicals, or high-voltage electric currents. Would will be dry, color will vary from pale white, leathery or charred. No pain! Pain and touch receptors are destroyed. Requires grafting to heal.

49
Q

Goal of Pt Care with Burns

A

Wound care, positioning, splints, exercise, prevention of contractures, nutritional therapies, prevent infection, pain management. Fever is very common up to several weeks after the burn.

50
Q

Escharotomy

A

A sterile surgical incision is made longitudinally along the extremity or the trunk to release taut skin and allow for expansion caused by edema formation.

51
Q

Nonmelanoma Skin Cancers

A

Basal cell and Squamous cell cancer. Risk factors are fair skin, freckles, blue or green eyes, blond or red hair, family hx, unprotected or excessive UV radiation, severe sunburns as a child.

52
Q

Basal Cell Cancer

A

Epithelial tumor. Most common but least aggressive.

53
Q

Nodular Basal Cx

A

Most common. Appears on face, neck, and head. Looks like a smooth pimple that doubles in size over 6-12 months. Bleeds easily from injury.

54
Q

Superficial Basal Cx

A

Second most common. Flat papule with erythema, ulcerations, and well-defined borders.

55
Q

Squamous Cell Cx

A

Squamous epithelium tumor of the skin or mucous membranes. Occurs in areas exposed to UV rays. More aggressive than basal cell. Small, firm red scaling lesions. Tx is surgical excision and Mohs’ surgery.

56
Q

Neuro Check

A

Assess LOC (response to auditory and/or tactile stimulud), obtain V/S, check pupillary response to light, assess strength of hand grip and movement of extremities bilaterally, determine ability to sense touch/pain in extremities.

57
Q

Lumbar Puncture

A

Verify informed consent, assisst with positioning (on side with knees drawn to chest and head flexed to the chest). Post procedure, lie prone or supine for 4-8hrs, encourage fluids.

58
Q

Angiogram

A

Preprocedure - verify informed consent, give clear liquid diet, insert IV needle, check BUN/CR, PT and PTT (risk of bleeding with angiogram) and administer sedation as ordered. Postprocedure - keep flat in bed 12-24 hours, monitor VS, catheter insertion site, pulses, sensation and encourage fluids.

59
Q

Manifestations of IICP

A

Change in LOC, slowing of speech, delay in response to verbal suggestions, abnormal respirations, increased BP and widening pulse pressure, slowing of pulse, pupil changes, decorticate or decerebrate posturing.

60
Q

Ischemic Stroke (aka Thrombotic Stroke)

A

Disruption of the cerebral blood flow due to obstruction of a blood vessel (from atherosclerotic plaque)

61
Q

Hemorrhagic Stroke

A

Caused by bleeding into the brain tissue, the ventricles, or the subarachnoid space.

62
Q

Risk Factors for Stroke

A

Hypertension, hyperlipidemia, diabetes, smoking, obesity, excessive alcohol consumption.

Complex MedSurg (1 decks)

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