Exam 2 Flashcards

Question

Pre-hypertension

Answer 1

SBP: 120-129 AND DBP: <80 treatment = lifestyle changes

Answer 2

SBP: 130-139 OR DBP: 80-89 treatment = lifestyle changes and meds

Answer 3

SBP: 140-179 OR DBP: 90-119 treatment = lifestyle changes and 2+ meds

Answer 4

SBP >=180 and/or DBP> 120 treatment = IV meds

Answer 5

Hydrochlorothiazide Diuretic; used for HTN Prevents tubular reabsorption of sodium, promoting sodium and water excretion and reducing blood volume. Spironolactone may be used to treat ascites Monitor for hypokalemia, vital signs for hypotension, dizziness, headache. monitor fluid status for dehydration (daily weight) Monitor electrolyte status

Answer 6

"LOLs" Metoprolol/Lopressor Atenolol/Tenormin Labetalol / Trandate Used for HTN and for post MI. Used when HR/BP is too fast, like in hyperthyroidism/ Grave's disease Used to treat esophageal varices or gastric varices. Contraindicated for COPD patients and patients with Printzmetal Angina. Reduces BP by preventing beta receptor stimulation in the heart, resulting in decreased HR and CO Monitor for hypotension. HR less than 60, BP less than 90/60 unless otherwise indicated in the orders. Monitor for orthostatic hypotension, bronchospasm, fatigue, heart block, worsening HF.

Answer 7

Lisinopril/Zestril Captopril/Capoten Enalapril/Vasotec Used for HTN Blocks Angiotensin 1 from converting to Angiotensin 2. Prevents vasoconstriction and sodium/water retention. Monitor for syncope, persistent cough Monitor for angioedema. Less effective for African Americans, who are also more likely to develop angioedema.

Answer 8

Nifedipine/Procardia Verapamil/Calan Used for HTN Potentiates other meds, so there will be bigger side effects. Don't drink grapefruit juice. Inhibits calcium transport into myocardial and vascular smooth muscle cells, resulting in inhibition of excitation - contraction. Blocks calcium channels causing vasodilation. Assess for headache, edema, hypotension.

Answer 9

Losartan Candesartan Eprosartan Used for HTN Blocking vasoconstriction and aldosterone-secretion effects, lowering BP Monitor closely if the client is on a diuretic. May cause additive hypotension. Assess renal function and potassium level. Monitor apical pulse and BP regularly.

Answer 10

Hardening of arteries

Answer 11

Calcification of arterial walls

Answer 12

Peripheral blood supply is impaired in the lower extremities due to atherosclerosis or arteriosclerosis

Answer 13

Age: 60-70 years old African American men Smoking HTN High cholesterol Family history of PVD Overweight Physical Inactivity

Answer 14

CHECK PULSES --> if you can't find it, use the doppler, then call the provider. Assess and evaluate cardiovascular risk status, family history, lifestyle Encourage and teach healthy lifestyle changes Encourage patient to take prescribed meds Assess pulses for strength Assess for pain, discoloration Assess to detect changes and report changes to the provider Position to avoid constriction - don't bend knees Change position hourly

Answer 15

Severe headaches, especially to the back of the head Confusion Motor or sensory deficits

Answer 16

Stop smoking Lose weight, low fat diet Do not cross legs while sitting Elevate feet at rest Avoid sitting or standing for long periods of time Avoid walking barefoot Notify provider of any changes in color, sensation, temperature, or pulses

Answer 17

Used for PVD Antiplatelet Prevents clot formation Monitor for bleeding

Answer 18

Used for PVD Antiplatelet Prevents clot formation Monitor for bleeding May take with ASA following revascularization

Answer 19

Used for PVD Antiplatelet and Vasodilator Inhibit platelet aggregation, but mostly thins out the blood. Increases blood flow to the extremity, improving claudication Decreases blood viscosity and increases RBC flexibility

Answer 20

Revascularization Angioplasty -- a stent in the vein to increase perfusion to the lower extremity.

Answer 21

Insufficient venous return - O2 and nutrients don't really get to the extremity so the cells begin to die Vein blockage or valve leakage Blood pools in the vein, causing stasis - discoloration, ulcers around the ankle DVT linked to a higher risk for CVI Little to no oxygen and nutrients

Answer 22

Obesity Occupations with no movement or lots of standing in place Thrombophlebitis

Answer 23

Assess discomfort Assess long periods of sitting/standing Assess edema of lower legs Assess skin for ulcers, especially around the ankle area. Bedrest with legs elevated above the heart level Elastic support or compression hose Do not wear tight, restrictive pants/socks/boots. Avoid girdles and garters that restrict circulation in upper leg.

Answer 24

Intermittent claudication causes throbbing pain, usually in the calf area - then travels to the thighs and the buttocks. Predictable pain linked to activity. Resting pain can occur, feels like burning Legs might be cool to touch due to lack of blood flow Sensation loss Peripheral pulses absent/decreased --> LET PROVIDER KNOW!! Bruit Skin is thin, shiny, hairless, discolored Toenails/nails are really thick

Answer 25

Aching pain Mild compared to arterial ulcer; it increases with standing due to insufficient venous return. Normal temp to the touch Edema Brown discoloration Legs may be thin/shiny -- it's a bit like atrophied skin. Hard to move or spread for an IM shot. Lower extremity skin becomes thicker, harder. May experience recurrent ulcerations, especially in the medial or anterior ankle.

Answer 26

Doppler ultrasound studies to look for vesicles Angiography = a balloon is inserted to push the constricting plaque or thickened inner tissue back. Can place a stent in the lower extremity.

Answer 27

garlic supplements encourage regular exercise, which improves circulation and perfusion to the lower extremies Blood thinning meds like clopidogrel/Plavix, Cilastozal/Pletal (both inhibits platelet aggregation and improves claudication), Pentoxifyline/Trental (decreases blood viscosity and RBC flexibility)

Answer 28

Revascularization - put in a good vein bridge Endarterectomy - go in and clean the vessel out Bypass graft - reroutes blood flow around occlusion Angioplasty is a non-surgical procedure to place a stent in a lower extremity

Answer 29

Classic for males is crushing, constant pain - like an elephant sitting on their chest Atypical pain Reduced sensation of pain SOB, pulmonary edema Cold, clammy skin, pallor, diaphoresis Indigestion/fullness Nausea/vomiting Dizziness, anxiety Rapid, irregular HR Palpiations BP, cardiac output --> if the patient gets worse, they will develop left ventricular failure which results in hypotension

Answer 30

predictable chest pain, usually with activity. The patient can generally say what causes the pain, and the pain goes away when they stop doing that activity. most common type of chest pain. Usually relieved by rest and nitrates

Answer 31

unpredictable, more severe chest pain. Usually has to be treated in the hospital with an IV nitrate drip. Still occurs at rest and continues even after the patient takes their nitroglycerine. Generally will develop into an MI

Answer 32

Mostly related to smoking The chest pain is cyclic at a time of day, like maybe just before going to bed. Usually due to vasospasms

Answer 33

Heart Sounds (S4 is an indication that the patient has had some kind of cardiac event) Murmurs *report all abnormal blood sounds to provider* HR = initially high, then drops as the body tires out BP Pulse assessment Chest pain Dependent edema Neurologic/psychological disturbances

Answer 34

CK = Creatine Kinase CK-MB (also called MB Bands) Cardiac Troponins, also called cardiac specific troponin HDL LDL Triglycerides

Answer 35

One of the labs for MI; can't be used to diagnose on it's own Indicates brain, skeletal, or cardiac injury. The greater the damage to the cardiac muscle, the higher this number will be. 55-170 for men 30-135 for women

Answer 36

System indicator of an IM. Rises in response to an MI. If >6% for both males and females, the patient has had an MI

Answer 37

Usually look at troponin I. This is the best indicator of an MI A higher level is released during an MI due to necrosis of the cardiac muscle. Happens within 3 hours of muscle injury. >0.5ng/mL is an MI

Answer 38

High Density Lipoproteins highly desirable! Want them to be >40, but >60 actually provides the most protective effect. HDLs clean up the vessel and transport cholesterol to the liver for excretion.

Answer 39

Low Density Lipoproteins Not desirable! They deposit cholesterol on the vessel wall. 100-129 is fine; prefer <100

Answer 40

cardiac catheterization Angiography Echocardiogram Transesophageal echocardiogram (TEE) Electrocardiogram (ECG)

Answer 41

Priority med for hyperlipidemia (The meds end in "statin") Lipitor (atorvastatin) Zocor (Simvastatin) etc. Statins lower cholesterol and inhibit enzymes to reduce LDL synthesis. Monitor the patient's liver enzymes, as it may cause elevated liver enzymes Frequently cause muscle pain, tenderness, weakness so it's usually given at night to reduce the experience of this pain.

Answer 42

Priority Hyperlipidemia Med Cholestyramin/Questran Colestipol/Colestid Colesevalem/Welchol (have a "col" or "chol") Lowers LDL levels Reduces reabsorption and cholesterol production in the liver Biggest side effect is GI upset and constipation, so recommend to take with additional fluids Can also cause GI tract obstruction, vitamin deficiences due to poor absorption.

Answer 43

HTN cholesterol levels (LDL/HDL) obesity (BMI>30) sedentary lifestyle smoking (promotes platelet aggregation), diabetes chronic stress high fat/high sodium diet

Answer 44

age genetics (HTN, hyperlipidemia, obesity can be genetic) males have a higher risk females after menopause b/c estrogen has a protective effect African Americans

Answer 45

less detrimental than a STEMI AMI. Associated with a partial blockage of the coronary artery. ST Depression due to partial thickness injury to the heart muscle.

Answer 46

indicates a complete blockage of the coronary artery. ST segment elevation MI Full thickness injury

Answer 47

heart monitor bed rest Beta blockers to preserve the heart's energy, although might also use ACE inhibitors or digoxin Antiarrhythmic meds to prevent ventricular tachycardia Prepare for cath lab procedure, such as angioplasty Possible preparation for coronary artery bypass graft TPA (Tissue plasminogen activator) or other fibrolytic. TPA is a clot-buster. MONA cocktail

Answer 48

Aspirin first! Chew the 325 mg Nitroglycerin sublingual. 1 tablet every 5 minutes; max of 3 tablets. It's a vasodilator. headaches are a common side effect. Assess vitals between each dose. If the patient is male, cialis / viagra are contraindicated. Oxygen 2-4L to keep a good O2 saturation Morphine for pain; 2-4mg IV push. Assess RR, BP, HR before giving morphine!

Answer 49

Breaks up clots Examples are reteplace, TPA, Alteplace, Streptokinase, Urokinase Used during an MI, usually if the patient isn't going to the cath lab and no contraindications such as a recent blood/already taking blood thinners, BP> 180/120. Monitor for neurologic problems, as the clot could go to the brain. Consider strongly if the patient has to go to surgery or has a high BP (b/c this could cause the patient to bleed out faster)

Answer 50

Lifestyle modification is the most important!! Risk of reinfarction Pharmacological prescribed meds Weight reduction Diet

Answer 51

Graves' disease is an immune system disorder that results in the overproduction of thyroid hormones (hyperthyroidism). Too much iodine = too much thyroid hormone Too many meds like levothyroxine (which increases thyroid hormone) Increase release of T3 and T4 Thyroid cancer Excess TSH Pituitary tumor Thyroiditis Side effects of certain drugs (especially those that are used to treat hypothyroidism) Fatigue due to extended hyper-activity Affects cardiovascular, GI, neuromuscular systems

Answer 52

Anterior = plays a major role in producing and secreting hormones Posterior = ADH (stimulates kidneys to reabsorb water), plays a role in childbirth and the release of oxytocin, regulates fluid balance

Answer 53

Determines the rate of cellular metabolism

Answer 54

secretes PTH to regulate calcium levels

Answer 55

regulates blood glucose levels alpha cells = break down stored fat, carbs raise blood glucose level beta cells = responsible for insulin, which transfers glucose across cell membranes and lowers blood glucose levels

Answer 56

adrenal cortex plays a vital role for survival and affects metabolism Glucocorticoids stimulate most cells to increase the rate of glucose synthesis Mineralocorticoids stimulate kidneys to reabsorb sodium and water adrenal medula responds to physical and psychological stress; increases metabolism and blood glucose levels

Answer 57

responsible for sexual characteristics and reproduction

Answer 58

1a. hypothalamus releases TRH (Thrytotropin releasing hormone) 1b. Anterior pituitary releases TSH (Thyroid Stimulating Hormone). TSH is always the opposite of T3 & T4. TSH tries to slow the hyper and amp up the hypo. Hypo = low T3/T4 Hyperthyroidism = high T3/T4 Calcitonin = puts Ca2+ "in" to the bones, which means in takes it out of the blood.

Answer 59

Grape eyes (exopthalamos) Golf balls in the throat High BP (HTN crisis = 180/100) High HR (Tachycardia = 100+) Heart palpitations High temp hot & sweaty skin High GI Weight is low

Answer 60

Grave's Disease is the most common Thyroiditis (viral / postpartum) Excess iodine intake Thyroid cancer Toxic nodular goiter Secondary to pituitary tumor

Answer 61

Grape eyes (exopthalamos) Golf balls in the throat High BP (HTN crisis = 180/100) High HR (Tachycardia = 100+) Heart palpitations High temp hot & sweaty skin High GI Weight is low

Answer 62

All symptoms are exacerbated and the patient might go into severe cardiac distress/arrest Extremely elevated T3/T4 Tachycardia, lethal cardiac rhythms Elevated temps >102 HTN Agitation, tremors, confusion, possible seizures GI distress older adults increased risk for HF / cardiac arrest

Answer 63

Vital signs – tachycardic, hypertensive, elevated temp Cardiac Rhythms – ventricular tachycardia, angina Appetite Weight loss Heat intolerance Thinning hair / hair loss Goiter due to hyperactivity of the thyroid gland Bulging eyes Increased bowel elimination (diarrhea) Problems/changes with their menstrual period, although women age 60+ have a higher change of developing hyper-thyroidism Neurological effects Possible fluid volume deficit

Answer 64

Priority lab is *T4* Lab Tests: Blood TSH, Free T 4 Total T 3, Thyroid stimulating immunoglobulins, Thyrotropin receptor antibodies.

Answer 65

Ultrasound Electrocardiogram Thyroid scan clarifies the size and function of the thyroid gland New screening programs implemented by many healthcare facilities include screening for T4 and thyroid-stimulating hormone (TSH) in the newborn. Most newborns with congenital hyperthyroidism have few, if any, clinical manifestations of thyroid hormone deficiency.

Answer 66

Radioactive Therapy Antithyroid medications as prescribed, such as propylthiouracil (PTU) and Tapazole. PTU blocks the synthesis of T3 and T4 and blocks synthesis of iodine Thyroidectomy - usually in cases of thyroid cancer If no cancer, might do a sub-total so that the patient still has some ability to create T3/T4 and doesn’t develop hypothyroidism Ablation therapy – burn away sections of the thyroid gland to reduce the effect

Answer 67

Assess for VS, symptoms, thyroid storm Medications such as PTU Encourage rest, calm, cool environment. Monitor daily weights, pulse rates, BP Monitor nutrition status. Increased carbohydrate diet. Calories 4000-5000/ day.

Answer 68

Semi-fowlers, support head & neck with pillows, monitor/record hemorrhage, assess back of the neck, dressing, pulse, cardiac rhythm, respiratory distress (rate, rhythm, depth), have suction equipment set up at the bedside to suction their mouth and keep the airway clear O2 as needed Have a tracheostomy set at the bedside for immediate placement as needed Have suction equipment set up Laryngeal nerve damage – monitor the patient’s ability to speak (monitor for hoarseness) Could accidentally remove the parathyroid gland b mistake, so monitor for hypocalcemia (tingling of the toes, tetany, tingling of the fingertips, positive for Chvostek and Trousseau) *If positive, administer IV Ca2+ to replace the calcium Assess for symptoms of thyroid storm, such as extreme tachycardia and HTN and fever, extreme GI upset Total Thyroidectomy is not the main intervention; usually only in cancer cases

Answer 69

Hyperthyroid med NOT baby safe Stops the thyroid from making T3 & T4

Answer 70

hyperthyroid med "Puts thyroid underground" Baby safe Report fever/sort throat Stops the thyroid from making T3 & T4

Answer 71

Destroys the thyroid in one dose. Very toxic and makes the patient radioactive. Takes 6-8 weeks to be effective. Before giving, always assure a pregnancy test is negative Remove neck jewelry and dentures 5-7 days before, hold anti-thyroid meds Awake – no anesthesia or conscious sedation NPO 2-4 hrs before and 1-2 hrs after (NOT 12 hrs) AVOID everyone!! For up to 7 days!! * No pregnant people * No crowds * Not the same restroom (flush 3 times) * Separate laundry baskets

Answer 72

"Low and Slow" Intolerant to cold, extreme fatigue, weight gain (although can develop anorexia), dull blank expression, thick tongue – slow speech insufficient secretion of TH by the thyroid gland, caused by a decreased metabolic rate

Answer 73

Autoimmune disorder - Hashimoto Thyroiditis destroys thyroid tissue. Deficiency of thyroid hormone causes slowing of the metabolic rate. Myxedema is a complication of longstanding hypothyroidism: > unconsciousness > mental sluggishness > collapse of the cardiac system > metabolic acidosis, lactic acidosis

Answer 74

= accounts for 99% of all cases: the tissue is destroyed/ atrophy of the thyroid gland  Could be iodine deficiency  Idiopathic (cause is unknown)

Answer 75

caused by insufficient excretion of thyroid stimulating hormone, which results from a disease o Patients may develop a goiter = thyroid gland is over-stimulated, which causes the goiter to form  If the goiter is present, it causes respiratory or neck difficulties and they may elect to do a thyroidectomy

Answer 76

Goiter = Hashimoto's Super depressed, fat, and lethargic Myxedema coma: *Low RR – respiratory failure *Priority: place tracheostomy kit by the beside *Key word: endotracheal intubation set up *Low BP & HR “hypotension” ‘bradycardia” *Low temp – cold intolerance oNO ELECTRIC BLANKETS Risk factors o Post thyroidectomy o Abrupt stop of levothyroxine

Answer 77

Low energy – fatigue, weakness, muscle pains, aches Low metabolism = weight and water gain, edema in the legs and eyes Low digestion (constipation) hair loss = alopecia Low mental status (forgetfulness, altered LOC) Low modd-depression – apathy/confusion Low libido – low sex drive Slow dry skin turgor Low and slow menstruation *Amenorrhea = no period *Slow heavy period = hypermenorrhea Diet = low calories, low cholesterol

Answer 78

Encourage exercise Administer medications as prescribed (such as Synthroid) Administer thyroid hormone Monitor body temperature Provide cardiac monitoring Soybeans in large quantities are goitrogenic

Answer 79

Increases blood levels of TH, raising the metabolic rate. Give 1 hour before meals or 2 hours after meals Report a pulse >100 May potentiate the effects of digoxin and anticoagulants Also monitor blood glucose levels Be cautious for older adults, as these adults have higher risk of cardiac arrest and other cardiac effects. Report elevated HR and BP promptly L = lifelong drive, long/slow onset (3-4 weeks until relief) E = early morning & empty stomach: once per day, in the morning 60 minutes before breakfast V = very hyper: report agitation / confusion!! These are the early signs of a thyroid storm O = Oh, the baby’s fine. Pregnancy safe No food, not a cure, no double doses, never abruptly stop meds (leads to myxedema coma) Avoid narcotics / opioids Avoid benzos like sedatives

Answer 80

functioning liver tissue is destroyed and gradually replaced by fibrous scar tissue. Irreversible Treat symptoms: keep patient comfortable and oxygenated.

Answer 81

Chronic end-stage liver disease Irreversible destruction and degeneration of liver cells Functional liver tissue is replaced with fibrous scar tissue Complications: Portal HTN, jaundice, bleeding esophageal varices, defects in coagulation, encephalopathy

Answer 82

Infection with Hep B, C, D Injection drug use Excessive alcohol use

Answer 83

SOB Itching skin due to more bile salts Anorexia Nausea/vomiting Diarrhea to get rid of ammonia thru stool Jaundice Brown/dark urine secondary to bile obstruction Tan/gray stool when there's jaundice Peritoneal ascites Dilated vessels Lungs can't expand as they should, so respiratory difficulties Encephalopathy / confusion b/c the liver can't detoxify or get rid of waste (neurological effects) High risk of bleeding / bleeding varices Vomiting blood Skin effects

Answer 84

Monitor for clinical manifestations Measure abdominal girth Assess nutritional status, muscle wasting Assess color of urine Assess respiratory status Assess for bleeding varices Weigh daily Monitor I/O High Calorie Diet IV Fluids

Answer 85

Success = increased/improved coagulation studies; stable liver function tests. Transjugular intrahepatic portosystemic Shunt (TIPS) relieves portal HTN and reduces the onset of esophageal varices and ascietes. Sengstaken-Blakemore and Minnesota Tubes (also called balloon tamponades) are used for bleeding varices. can also use a beta blocker. Paracentesis is done to relieve severe ascites that doesn't respond to diuretic therapy. Liver transplantation Anticholelithic is given to promote bile flow Diuretic (spironolactone) to treat ascites

Answer 86

Stop drinking alcohol!!!!! Low sodium diet (<2g/day) Fluids restricted to 1500 mL/Day Veggie proteins provided with restricted red meat consumption Parenteral nutrition as needed Vitamin supplements that include Vitamin B complex, A, D, and E. Carefully consider meds: NSAIDs may induce bleeding and talk with provider/pharmacist before taking OTC meds.

Answer 87

Cirrhosis medication Intravascular volume replacer

Answer 88

Cirrhosis medication Used to treat hepatic encephalopathy

Answer 89

CBC LFT: enzymes may be elevated due to release from inflamed cells Liver biopsy Esophagogastroduodenoscopy (EGD scope)

Answer 90

Autoimmune disorder in which antibodies are developed against the pancreas B cells or insulin. 2Ps: Polyuria, Polydipsia, Polyphagia Exogenous insulin required for life Formerly known as Juvenile Diabetes or Insulin Dependent Diabetes.

Answer 91

Deficiency in insulin: cells become fatigued Insulin resistance: body tissues don't respond to insulin's action due to unresponsive or insufficient numbers of insulin receptors Gradual onset Risk factors: runs in families, obesity, fat cells are resistant to insulin, 40+ years old, certain ethnicities, cardiac history, elevated cardiac lab values

Answer 92

Weight loss fatigue Recurrent infections 3Ps: Polyuria, Polydipsia, Polyphagia

Answer 93

Monitor blood glucose Ask about clinical manifestations Neurological assessment Nursing Priority is *Patient Education*

Answer 94

A1C --> 5.7-6.4% is prediabetes; 6.5%+ is diabetes Fasting glucose >126mg/dL 2 hr Plasma >200 mg/dL with classic symptoms of hyperglycemia

Answer 95

Medication: insulin Consult RD and CDCES

Answer 96

T2D oral med Metformin Decreases the production of glucose in the liver and enhances transport of glucose into the cells.

Answer 97

T2D oral med glipizide Increases the production of insulin by the pancreas.

Answer 98

Monitor blood glucose Adhere to exercise and meal plan Insulin: proper storage, administration, and injection sites Insulin pump, pump care Signs and symptoms of hypoglycemia Follow up with provider

Answer 99

Monitor blood glucose Adhere to exercise and meal plan S/S of Hyper and Hypoglycemia Proper administration of insulin, injections sites if applicable Proper foot care Importance of eye exams Follow up with provider

Answer 100

Associated with Type 1 DM Very little to no insulin production leads to increased glucose levels, which then leads to fat breakdown, Positive ketones

Answer 101

Adequate ventilation IV regular insulin administration Isotonic solution (0.9% NS) --> this should change to 0.45 NS later, may add dextrose to prevent hypoglycemia NGT if comatose Electrolyte replacements if needed Sodium Bicarbonate Monitor cardiac rhythm

Answer 102

Hyperosmolar Hyperglycemic State (HHS) ASsociated with Type 2 Diabetes Insufficient amount of insulin Major fluid loss Precipitated by infection, acute illnesses, chronic illnesses Elevated plasma osmolarity Normal urine ketones

Answer 103

Adequate ventilation Maintain fluid volume; isotonic IV fluid solution Correct shock IV regular insulin administration NGT if comatose Electrolyte replacements if needed Monitor cardiac rhythm

Answer 104

maintenance dose Given around the clock--> ordered every so many hours and ordered for the same amount

Answer 105

Pre-prandial dose: given before the patient eats. Post-prandial dose: given after the patient easts Most often, it will be a set dose or a sliding scale dose.

Answer 106

usually given on a sliding scale.Take the glucose level every so many hours and insulin is given based on the glucose level. Might be given along with the basal dose.

Answer 107

arms, but, thigh, stomach. Make sure to punch and insert at a 45-90 degree angle. Want to hit the subQ fatty tissue, not muscle