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308 Adult II > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

Cardiac output is
What affects stroke volume

A

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

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2
Q

Causes of secondary HTN

What is normal glomerular filtration rate

A

Renal - fluid overload, RAAS
Adrenal/endocrine - regulates HR
Contraceptives, pregnancy, alcohol/drugs
Dyslipidemia - high cholesterol (plaq)

125ml/min. < 60 is risk for HTN

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3
Q

Chronic HTN can lead to
How to treat HTN

A

Retinal damage, renal damage, MI, cardiac hypertrophy, stroke

ACE inhibitors (-pril) & ARBs block angiotensin & protect kidneys
Diuretics (furosemide/spironolact)
Calcium channel block (amlodipine/diltiazem)

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4
Q

Deep vein thrombosis typically occur
Biggest problem of DVT
Virchows triad for etiology includes

A

-In lower extremities where blood flow is slow
-Thrombus dislodges & travels to heart resulting in pulmonary embolus
-Hypercoagulability, vascular damage, circulatory stasis

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5
Q

Management of DVT w/
What to monitor & (antidote)
Pharmacological therapy

A

-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)

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6
Q

Varicose veins are due to
Diagnose with
Treatment options

A

-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)

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7
Q

Clinical manifestations of venous ulcers
Management

A
  • Shape & border irregular, typically at ankle, very wet (exudate), surrounding skin is brownish
  • promote mobility, debridement, wound dressing, VAC, hyperbaric O2
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8
Q

Most common causes of Peripheral vascular disease
Clinical manifestations
Diagnostic findings

A
  • 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)
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9
Q

Clinical manifestations if arterial ulcers
Can lead to

A
  • Borders are defined & circular, ulcer use dry, deep & looks necrotic
  • possible amputation
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10
Q

Care for amputation

A

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

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11
Q

Buergers disease
Treatment
Raynauds disease

A
  • 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
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12
Q

Aneurysms are
Types include
AAA is
TAA is
Management

A

-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

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13
Q

Heart muscles possess following properties
Automaticity
Excitability
Conductivity
Contractility

A
  • pacemaker ability; beats on its own
  • responds to electrical stimulus
  • each cells conducts impulses to next
  • ability to contract
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14
Q

PQRST complex
EKG strip small square & big square
P-R interval
QRS complex

A
  • 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
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15
Q

How to Calculate HR using 300 method
If R-R interval is 2 boxes apart
How to know if rhythm is regular or irregular

A

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

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16
Q

Normal sinus rhythm includes
Sinus bradycardia is
Sinus tachycardia is

A

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)

17
Q

Pericarditis is
Causes include
Clinical manifestations
Management

A
  • 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)
18
Q

Infective endocarditis is
Causes
Manifestations
Management

A
  • 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
19
Q

Alzheimer’s disease risk factors
Management

A

Age (higher incidence age >65)
Safety, orientation & validation, AChE inhibitor (donepezil, galantamine), SSRIs, chemical restraints (psychotropic), Ginko

20
Q

Parkinson’s disease is
Pharmacological Management
Surgical management

A
  • Loss of motor control due to dopamine
  • levodopa-carbidopa (sinemet), Anticholinergic (benztropine), MAOI (selegeline ; interacts w aged foods)
  • thalamotomy, pallidotomy
21
Q

Multiple sclerosis is
Types of MS

A
  • 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)
22
Q

Myasthenia gravis is
How to diagnose
How to differentiate between myasthenia or cholinergic crisis
Management

A
  • 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
23
Q

Guillain barre syndrome is
Manifestations

A
  • Destruction of myelin sheath in PNS (starts distal & moves proximal)
  • symmetrical muscle weakness (decreased mobility), respiratory compromise, cardiac dysrhythmia
24
Q

Management of seizures

A

Stop status epilepticus with lorazepam or diazepam (Benzos)
Prevent reoccurrence with phenytoin-Dilantin or tegretol-carbamazepine

25
Q

Bell’s palsy is
Management

A
  • Paralysis of cranial nerve 7 (facial)
  • steroids, antiviral (acyclovir), eye care (lubrication, taping)
26
Q

Low flow oxygen delivery systems
Nasal cannula
Simple face mask
Partial rebreather
Non-rebreather

A
  • 1-6L 24-44%, assess patency of nostrils
  • minimum 5L 40-60%, monitor for risk of aspiration
  • 6-11L 60-75% , keep reservoir bag inflated
  • highest O2 >90%, used for unstable patients requiring intubation
27
Q

High flow oxygen delivery systems
Venturi mask
T piece

Cpap is & used for

A
  • precise O2, best for chronic lung disease
  • attachment for a tracheostomy or ET tube, ensures humidification through mist
  • continuous positive airway pressure
    Opens collapsed alveoli for Atelectasis or sleep apnea
28
Q

Management of tracheostomy

A

Check cuff pressure
Prevent tube friction & movement
Air must be humidified
Maintain proper temperature
Ensure adequate hydration
Oral hygiene
Coughing & deep breathing

29
Q

Etiology of epistaxis
Management

A
  • trauma, irritation, coagulation disorders
  • ice 10-15 minutes, alpha 1 agonist, nasal packing - rapid rhino
    Patient should lean head forward & apply pressure for 5 minutes
30
Q

Management of pneumonia

A

Antibiotics within 8 hours
Oxygen therapy
Bronchodilation
Incentive spirometer & coughing
Hydration, nutrition

31
Q

Etiology of COPD
Management

A
  • Airflow obstruction from chronic bronchitis & emphysema; caused by smoking (tissue damage irreversible)
  • monitor oxygenation, maintain airway patency, maximize nutrition
    Give bronchodilator first & then corticosteroids
    Anticholinergics & mucolytics
32
Q

Steps for asthma control
1-6

A

Step 1 - SABA PRN
Step 2 - low dose ICS
Step 3 - low dose ICS + LABA or medium dose ICS
Step 4 - medium dose ICS + LABA
Step 5 - high dose ICS + LABA
Step 6 - high dose ICS + LABA + oral corticosteroid

33
Q

Medications for active TB first 2 months
Months 3-6+
Medication of latent TB 6-9 months

Vitamin B6 is added for
Isolation type for TB

A
  • Rifampin, isoniazid +B6, pyrazinamide, ethambutol
  • rifampin, isoniazid +B6
  • Isoniazid + B6
  • treatment of neuropathies
  • airborne precaution
34
Q

What is flail chest
Management

A
  • Fracture of 4 or more ribs with paradoxical chest movement (sucking in & puffing out)
  • supplemental O2, pain control, respiratory care
35
Q

What is a tension pneumothorax

A

Air leaks into pleural space & causes a mediastinal shift & JVD

36
Q

How to manage a dislodged chest tube

A

Cover opening with gauze & tape on 3 sides leaving bottom side untaped

37
Q

Chest drain collection system
Collection chamber
Water seal chamber
Suction control chamber

A
  • collects drainage, holds up to 2500 cc, DO NOT strip tubing (negative pressure & discomfort)
  • allows air or fluids to drain from patients chest, tidaling (water rises on inspiration & drops on expiration), continuous bubbling indicates a leak
  • increases drainage rate & re-expands lung
38
Q

How to identify malignant hyperthermia
Treatment

A
  • Muscle rigidity, respiratory & metabolic acidosis
  • remove cause, hyperventilate, cool, DANTROLENE

308 Adult II (3 decks)

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