Exam 2 Flashcards
Cardiac output is
What affects stroke volume
Heart rate x stroke volume
Preload - amount of blood return to right side
Afterload - force of resistance to pump blood
Contractility - ability of LV to contract
Causes of secondary HTN
What is normal glomerular filtration rate
Renal - fluid overload, RAAS
Adrenal/endocrine - regulates HR
Contraceptives, pregnancy, alcohol/drugs
Dyslipidemia - high cholesterol (plaq)
125ml/min. < 60 is risk for HTN
Chronic HTN can lead to
How to treat HTN
Retinal damage, renal damage, MI, cardiac hypertrophy, stroke
ACE inhibitors (-pril) & ARBs block angiotensin & protect kidneys
Diuretics (furosemide/spironolact)
Calcium channel block (amlodipine/diltiazem)
Deep vein thrombosis typically occur
Biggest problem of DVT
Virchows triad for etiology includes
-In lower extremities where blood flow is slow
-Thrombus dislodges & travels to heart resulting in pulmonary embolus
-Hypercoagulability, vascular damage, circulatory stasis
Management of DVT w/
What to monitor & (antidote)
Pharmacological therapy
-Anticoag therapy : heparin (SQ - prophylaxis / IV - existing problem)
-Monitor platelets, PTT (protamine sulf)
-Coumadin (initiate w heparin/ monitor PT INR/ vit K antidote)
Thrombolytic therapy to break clots (alteplase)
Varicose veins are due to
Diagnose with
Treatment options
-Prolonged standing, obesity, chronic disease (valve damage)
-Trendelenburg test (symptoms subside when patient laid back)
- sclerotherapy (inject solution to obliterate vein lumen)
Stripping (pull out vein)
Clinical manifestations of venous ulcers
Management
- Shape & border irregular, typically at ankle, very wet (exudate), surrounding skin is brownish
- promote mobility, debridement, wound dressing, VAC, hyperbaric O2
Most common causes of Peripheral vascular disease
Clinical manifestations
Diagnostic findings
- obese, smokers, Hyperlipidemia
- claudication (leg pain w activity), pain at rest (severe stage), dry skin, no hair on extremities
- ankle brachial index (0.5-.95 lower = more severe)
Clinical manifestations if arterial ulcers
Can lead to
- Borders are defined & circular, ulcer use dry, deep & looks necrotic
- possible amputation
Care for amputation
Elevate stump for first 24hrs (prevent swelling)
Bandage distal to proximal & dont occlude circulation
Compress dressing
Encourage use of prosthesis when getting up
Discourage semi-Fowler for above knee
Buergers disease
Treatment
Raynauds disease
- Inflammation in arteries in veins, only occurs in smokers
- smoking cessation, calcium channel blockers, Thrombolytic, amputation
- Vasospasms in arteries of fingers & toes; due to stress, tobacco, caffeine, cold
Aneurysms are
Types include
AAA is
TAA is
Management
-Outpouching or dilation of artery
-Saccular, berry, fusiform, dissecting
- abdominal aortic aneurysm (abdominal or back pain)
- thoracic aortic aneurysm (chest wall pain)
- control BP, surgical intervention
Heart muscles possess following properties
Automaticity
Excitability
Conductivity
Contractility
- pacemaker ability; beats on its own
- responds to electrical stimulus
- each cells conducts impulses to next
- ability to contract
PQRST complex
EKG strip small square & big square
P-R interval
QRS complex
- P (atrial depo) QRS (ventricle depo, atrial repo) T (ventricle repo)
- small is .04 sec / big is 0.20 sec
- should be 3-5 small squares (0.12-0.20) prolonged can be due to AV block or digitalis
- should be 1-3 small squares (0.06-0.12) if widened can be due to premature ventricular contraction PVC
How to Calculate HR using 300 method
If R-R interval is 2 boxes apart
How to know if rhythm is regular or irregular
Only if rhythm is regular
- Divide 300 by number of big boxes between each peak (R-R interval)
- 300/2 HR is 150
- if R-R interval isn’t the same then rhythm is irregular
Normal sinus rhythm includes
Sinus bradycardia is
Sinus tachycardia is
P for every QRS, Regular rhythm (R-R), PR interval < .20, QRS < .12, HR 60-100
- HR < 60 everything else normal
- HR > 100 (CO & SV are decreased)
Pericarditis is
Causes include
Clinical manifestations
Management
- Inflammation of pericardium
- Cancer, chest trauma
- Pain on inspiration or laying down (relieved by leaning forward) , tamponade (muffled heart sounds)
- pericardiocentesis (drain excess fluid in pericardium)
Infective endocarditis is
Causes
Manifestations
Management
- Infection of heart valves
- IV drug use, strep/ staph, rheumatic heart disease
- abnormal heart sounds (new murmur), oslers nodes (PAINFUL at tip of toes or fingers), janeway lesions (NON-PAINFUL on palm & soles)
- antibiotics, rest, valve repair
Alzheimer’s disease risk factors
Management
Age (higher incidence age >65)
Safety, orientation & validation, AChE inhibitor (donepezil, galantamine), SSRIs, chemical restraints (psychotropic), Ginko
Parkinson’s disease is
Pharmacological Management
Surgical management
- Loss of motor control due to dopamine
- levodopa-carbidopa (sinemet), Anticholinergic (benztropine), MAOI (selegeline ; interacts w aged foods)
- thalamotomy, pallidotomy
Multiple sclerosis is
Types of MS
- Autoimmune disease characterized by demyelination & axonal nerve damage
- relapsing remitting (unpredictable attacks followed by periods of remission)
Primary progressive (steady increase in disability without attacks)
Secondary progressive (initial relapsing remitting that declined without remission periods)
Progressive relapsing (steady decline with super imposed attacks)
Myasthenia gravis is
How to diagnose
How to differentiate between myasthenia or cholinergic crisis
Management
- Muscle weakness due to destruction of acetylcholine receptors
- Ice test (place above eyelid, if it rises it is positive)
- tensilon test used to differentiate
- mestinon therapy (ChE inhibitor), immunosuppression (steroids)
Maintain resp function for myasthenic crisis
Atropine if cholinergic crisis
Guillain barre syndrome is
Manifestations
- Destruction of myelin sheath in PNS (starts distal & moves proximal)
- symmetrical muscle weakness (decreased mobility), respiratory compromise, cardiac dysrhythmia
Management of seizures
Stop status epilepticus with lorazepam or diazepam (Benzos)
Prevent reoccurrence with phenytoin-Dilantin or tegretol-carbamazepine
