exam 1 med surg Flashcards
Physiologically, what should you avoid to not get a respiratory infection?
avoid trappage in mucocilliary and phagocytosis by alveolar macrophages
What is the only mode of transmission for a respiratory infection?
airborne transmission
What population is most likely to contract tuberculosis?
Homeless/incarcerated populations and people with HIV/AIDS
What is the mode of transmission for TB?
droplet
What are normally the clinical manifestations for someone with TB?
asymptomatic and noninfectious
What are clinical manifestations for someone who has symptomatic TB?
fatigue, weight loss, sweats, cough, bloody sputum
What are complications of TB?
bronchopleural fistula, meningitis, pleural effusions, bone disease, liver/kidney failure
What is the mode of transmission for influenza?
droplet transmission
What are the clinical manifestations of influenza?
fever, headache, sore throat, cough
What are the risk factors of pneumonia?
recent antibiotic therapy, immunosupression, chronic disease
What is pneumonia?
inflammation of the lung parenchyma from bacterial, viral, or fungal infection
What are the clinical manifestations of pneumonia?
altered mental status, >30 Resp, hypotension, >125 bpm, low/high temps, low pH, decreased Na
What are the complications of pneumonia?
empyema, sepsis, pneumothorax, respiratory failure
What are the diseases of the upper airway?
Rhinitis, obstructive sleep apnea, laryngeal trauma, rhinosinitis, laryngeal cancer
What is rhinitis?
inflammation of mucous membrane of nose in response to irritant
What are the clinical manifestations of Rhinitis?
itching, sneezing, congestion
What happens during obstructive sleep apnea?
upper airway narrows/collapses; increased resistance to airflow; hypoxemia, hypercapnia
What are risk factors for sleep apnea?
A-fib, type 2 diabetes, HF, men, obesity, smoking, alcohol, 40-65 y/o
What are the clinical manifestations of obstructive sleep apnea?
loud snoring, gasping during sleep, waking up a lot
Who is laryngeal trauma more common in?
men
How does laryngeal trauma occur?
Through injuries; ingestion/inhalation of causative agent; pressure from prolonged intubation
What is rhinosinitis?
Symptomatic inflammation of nasal/paranasal cavity; infection/inflammation of paranasal sinuses; nasal congestion, obstruction of airflow
What are the clinical manifestations of rhinosinitis?
purulent nasal drainage, facial pain, nasal obstruction
who is laryngeal cancer more common in?
men
What happens with your epithelial cells during laryngeal cancer?
Squamous cells line larynx, hypopharynx, and entrance to esophagus
What can cause cells to become more precancerous in laryngeal cancer?
irritants like alcohol and smoking
What are the clinical manifesations of laryngeal cancer?
hoarseness, change in voice, cough, sore throat, pain w/ swallowing, lump/mass in neck
What are the diseases of the lower respiratory airway?
asthma, cystic fibrosis, COPD, lung cancer
What do lower airway disease do?
negatively impact oxygenation, ventilation, and gas exchange
What is asthma?
reversible airway obstruction from inflammation
What happens to the muscles surrounding airways during asthma attacks?
they tighten
When the muscles tighten during an asthma attack what happens to those airways?
airway obstruction and hyper-responsiveness
What are the clinical manifestations of asthma?
Wheezing, dyspnea, coughing, increase in sputum, increase in respiratory rate
What is cystic fibrosis caused by?
Caused by defective gene carried by both parents
Cystic Fibrosis is a genetic disease of what glands?
exocrine glands
What is there a deficiency of with cystic fibrosis?
Protein
Because there is a deficiency in protein with cystic fibrosis, what occurs?
mucus build-up which blocks airways and GI as well as blocks pancreatic enzymes
What are the clinical manifestations of cystic fibrosis?
Cough, mucus, wheezing, lung infections, poor weight gain, blockage, constipation
What is the main issue with COPD?
airflow limitation that is progressive and not fully reversible
What is a disease that occurs in COPD?
emphysema (destruction of alveoli)
What are clinical manifestations of COPD?
increase work of breath, accessory muscle use, tripoding, skin change, cough, crackles, wheezing
What are risk factors for COPD?
smoking, occupational hazards, pollution
What is lung cancer?
Uncontrolled cell growth of abnormal cells
What are clinical manifestations of lung cancer?
cough, hemoptysis, SOB, Wheezing, hoarsness, chest pain
What is a pulmonary embolism?
blood clot in pulmonary artery
What happens with pulmonary embolisms?
high ventilation, low perfusion
What are risk factors for pulmonary embolisms?
obesity, smoking, fracture, trauma, heart disease, spinal cord injury
What are the clinical manifestations with pulmonary embolisms?
dyspnea, pleuritic chest pain, tachypnea
What are the 3 phases of acute respiratory distress syndrome?
- Exudate phase (24-48hours) inflammation of alveolar membrane
- proliferative phase
- fibrotic phase
What are the risk factors for ARDS?
sepsis, severe trauma, aspiration, smoking, bypass, overdose, PE
What are clinical manifestations of ARDS?
tachypnea, tachycardia
What are the two types of acute respiratory failure?
hypoxemic respiratory failure
hypercapnic respiratory failure
What are risk factors for ARF?
pulmonary edema, pneumonia, PE, Asthma, narcotics
What are clinical manifestations of hypoxemic respiratory failure?
Changes in respirations, change in HR, Change in BP
What are clinical manifestations of hypercapnic respiratory failure?
Headache, confusion, decrease in consciousness
What are the two types of chest trauma?
blunt force trauma, penetrating trauma
What are clinical manifestations of chest trauma?
decrease in oxygen and ventilation, impaired gas exchange
What are complications with chest trauma?
Pneumothorax, cardiac tamponade
location of AV valves
between atria and ventricles
location of semilunar valve
between ventricle and pulmonary/body
PR interval
depolarize atria
QRS interval
depolarize ventricles
QT interval
ventricles depolarizing and repolarizing
What is the order of the conduction system?
SA node
AV Node
Bundle of HIS
R and L bundle branches
Purkinje fibers
Depolarization
opening of Na channels
Repolarization
closed Na channels and K out
What are cardiac lab values that are vital in knowing?
lipid pannel (cholesterol, lipid density, trigycerides), creatinine, troponin, myoglobin, natriuretic peptide
What is cardiac output?
HR x Stroke volume
preload
blood in ventricle at the end of diastole
afterload
resistance ventricle must overcome
diastole
ventricles relaxed
systole
ventricles contract
Highest risk factor of cardiac dysrhythmias?
age
Manifestations of cardiac dysrhythmias?
hypotension, sweating, shortness of breath, syncope
sinus bradycardia
<60 bpm
causes of sinus bradycardia
hypoxia, hypothermia
Treatment for sinus bradycardia
beta blockers, Ca channel blockers
Causes of arterial fibrillation
age, cardiomypathy, HTN, Pericarditis, obesity, diabetes
treatment for Afib
control HR, cardiac abrasion, cardioversion
atrial flutter
the heart’s upper chambers (atria) beat too quickly
Causes of atrial flutter
acute MI, mitral valve disease, thyrotoxicosis, COPD
treatment for atrial flutter
beta blockers, Ca channel blockers, digoxin, cardioversion
ventricular tachycardia
the lower chamber of the heart beats too fast to pump well and the body doesn’t receive enough oxygenated blood
What are the causes of ventricular tachycardia?
hypovolemia, hypoxia, acidosis, hyper/hypokalemia, hypoglycemia
treatments for ventricular tachycardia
antiarrythmatic meds, electrolytes, cardioversion, resuscitation
atrial fibrillation
an irregular and often very rapid heart rhythm (arrhythmia) that can lead to blood clots in the heart
ventricular fibrillation
disorganized heart signals cause the lower heart chambers (ventricles) to twitch (quiver) uselessly
causes of ventricular fibrillation
hypovolemia, hypoxia, acidosis, hyper/hypokalemia, hypoglycemia, MI, PE
treatment for ventricular fibrillation
chest compressions, defibrillation
idioventricular rhythm
SA and AV nodes fail
causes of idioventricular rhythms
MI, post cardiac arrest, drug toxicity, electrolyte imbalance, myocarditis, cardiomyopathy
What would you do during asystole
start CPR
asystole
heart stops beating
heart block
delay or block in conduction
causes of heart block
acute coronary syndrome, electrolyte imbalance, med toxicities
heart block can cause what
ischemia/death
treatment for heart block
monitor, pacing, treat cause
Risk factors for atherosclerosis
vessel damage, infammatory response, hard thickened vessels, plaque formation
What causes atherosclerosis?
high cholesterol, high triglycerides (LDL)
clinical manifestations of atherosclerosis
Mi, stroke, gangrene, cardiac death
Peripheral artery disease risk factors
atherosclerosis
What is peripheral artery disease?
obstruction of blood flow through large peripheral arteries, partial or total occlusion
clinical manifestations of peripheral artery disease
diminished lower extremity pulses
treatment for peripheral artery disease
anti-platelets, statins, angioplasty, atherectomy
risk factors for aortic artery disease
men, family history
What occurs with aortic artery disease
middle layer artery is weakened, stretching of inner layer, artery widens, tension increases
clinical manifestations of aortic artery disease
asymptomatic till burst, thoracic or abdominal
treatment for aortic artery disease
by controlling hypertension and repair or graft
risk factors for hypertension
race, gender, socioeconomic status
What does Na do with hypertension?
increases
What happens to veins during hypertension?
vasoconstriction
What does aldosterone do to cause hypertension?
increase stroke volume and blood pressure
What does the SNS do during Hypertension?
promotes vasoconstriction
what are the clinical manifestations of hypertension?
headache, chest pain, vision changes
treatment for hypertension
lifestyle changes, diuretics, antihypertensives
risk factors for carotid artery disease
smoking, hypertension, obesity
What happens with carotid artery disease?
vessel wall thickening, plaque formation occluding coronary artery
clinical manifestations of carotid artery disease
impaired profusion, stroke or TIA
carotid artery disease usually does not present symptoms which means the patient is…
asymptomatic
treatment for carotid artery disease
carotid endocardectomy, stenting
risk factors for deep vein thrombosis
old age, cancer, varicose veins, pregnancy
what happens to the rate of bloodflow with DVT
decreases
deep vein thrombosis causes damage to what?
the vessel walls
DVT increases the chances of a…
blood clot
clinical manifestations of DVT
pain, swelling, redness, warmth
what kind of monitoring can a nurse perform for cardiovascular dysfunctions?
hemodynamic monitoring
what are ways to perform hemodynamic moniotring?
arterial catheter (BP), central venous catheter (R arterial pressure), pulmonary artery catheter (R heart function)
What is cardiogenic shock
heart cannot contract, decrease in cardiac output
what are the clinical manifestations of cardiogenic shock
chest pain, diaphoresis, nausea, vomiting
treatment for cardiogenic shock
increase BP and CO, intra-aortic balloon, heart transplant mechanical support
What is a myocardial infraction
destruction of heart muscle from lack of oxygenated blood supply
what are clinical manifestations of MI
chest, shoulder, and arm pain
what is a cardiomypathy?
structural changes to heart (weak, enlarged, thick or rigid), decrease in heart muscle function
clinical manifestations fo MI
chest pain, dizziness, indigestion, nausea
treatment for MI
Ace inhibitors, beta blockers, diuretics, pacemaker intervention (surgery)
modifiable risk factors of coronary artery disease
high cholesterol, HTN, diabetes, obesity, smoking, activity
non-modifiable risk factors of coronary artery disease
gender, race, heredity, age
What process occurs during CAD that forms and occludes the coronary arteries?
atherosclerosis
With CAD, what can occur if left untreated?
unstable angina, MI, sudden cardiac death
What happens to blood flow as a result of CAD?
reduced blood flow and ischemic problems
What are risk factors for myocarditis?
being a young men
What happens during myocarditis?
damage to myocardium, virus is causative agent
What are clinical manifestations of myocarditis?
heart failure, shock, angina, dyspnea, syncope
Treatments for myocarditis
manage HF, dysrhythmias, immunsupressants
What occurs with heart failure?
myocardial cell dysfunction, heart cannot meet bodys needs
What are clinical manifestations of HF?
fatigue, weight gain, tachycardia, HTN/hypotension, murmur
Complications with HF?
pulmonary edema (pink frothy sputum), renal failure
Treatment for HF
beta blockers, diuretics, ace inhibitors, Ca channel blockers, digoxin, defibrillator
What are risk factors for infective endocarditis?
age, immunodeficiency, drug use, diabetes, heart defect
What happens with infective endocarditis?
infection of endocardium affecting heart valve (usually bacterial)
Clinical manifestations of infective endocarditis
oslers nodes, janeway lesions, splinter hemorrhage, murmur, fever
treatment for infective endocarditis
IV therapy, valve replacement/repair
risk factors of pericarditis
non-ischemic chest pain, post MI
what is pericarditis
inflammation of the pericardium
clinical manifestations fo pericarditis
pleural chest pain, pericardial effusion, EKG changes, fever
treatment for pericarditis
aspirin, NSAIDs, antiinflammatories
What happens with valvular disease?
regurgitation, left or right sided heart failure
clinical manifestations of valvular disease
murmur, SOB, crackles, angina, syncope, fatigue, edema
treatment for valvular disease
ace inhibitors, diuretics, valve repair/replacement
sinus tachycardia rate
> 100 bpm
causes of sinus tachycardia
fever, anemia, hypovolemia, hypotension, PE, MI
treatment for sinus tachycardia
beta blockers, Ca channel blockers
