Exam 2 Flashcards
What is prostate cancer?
Common cancer in the prostate gland, higher risk for men 50 or older
What is the cause of prostate cancer?
Unclear cause but can increase due to:
Age
Heavy Metal Exposure
Smoking
Hx of STDs/STIs
What are some assessment findings you might see of a patient who has prostate cancer?
Hard, Pea sized nodule
Painless hematuria
Weight Loss
Urinary obstruction
Bone pain
What are some nonsurgical interventions for prostate cancer?
Hormone Therapy
Luteinizing Hormone
Pain meds
Radiation and Chemotherapy
Corticosteroids
Bisphosphonates
What surgical interventions for prostate cancer?
Orchiectomy (Limits production of testosterone)
Prostatectomy
Cryosurgical Ablation
What is TURP?
Transurethral Resection of the prostate
The procedure involves insertion of a scope into the urethra to remove prostatic tissue
What is the most common post op complication of TURP?
Bleeding
What may be needed after a TURP procedure?
Continuous Bladder Irrigation (CBI)
What may be prescribed post TURP?
Antispasmodics for bladder spasms
What are the risk factors for bladder cancer?
smoking
exposure to chemical
exposure to radiation
What are some assessment findings you might see with bladder cancer?
Painless hematuria
Frequency or Dysuria
Clot induced obstruction
What are non surgical treatments for bladder cancer?
Radiation
Chemotherapy
What are surgical inventions for bladder cancer?
Removal of bladder tumor
Partial cystectomy
cystectomy/ Urinary diversion
When a urinary diversion is preformed what types of appliances will be implanted?
ileostomy (bag worn over stoma to collect urine)
Nephrostomy tubes
What is normal sinus rhythm?
A rhythm that originates from the SA node
What are the rates for normal sinus rhythm?
60-100 bpm
What are the rates for sinus bradycardia?
less than 60 bpm
When might treatment be necessary for a bradycardia patient?
If patient is symptomatic, showing signs of decreased cardiac output
Who may bradycardia?
Athletes and some healthy individuals
What medication is given to increase the heart rate?
Atropine Sulfate, do not give additional doses may induce tachycardia
What are other interventions for bradycardia?
Hold medications that may cause bradycardia
Give oxygen
Monitor for Hypotension (give fluid if indicated)
What may be necessary if bradycardia is not fixed with atropine?
Applying a Transcutaneous pacemaker or possibly a permanent pacer
What are the rates for tachycardia?
100-180 bpm
How do you treat sinus tachycardia?
Decrease the heart rate via:
medication (LOLs, CCB, Adenosine)
comfort measures (to relieve stress, anxiety, pain)
vagal manuever
What are premature ventricular contractions?
Early contractions in the ventricles due to increased irritability of the ventricles
What causes PVCs?
Stimulants
Electrolyte Imbalance (hyperkalemia/ hypo)
Hypoxia
Heart Disease
What is more than 3 PVCs in a row considered?
Run of V-Tach
How do you treat PVCs?
correct underlying cause (meds, electrolytes)
Beta Blockers (Lols)
Amiodarone
Lidocaine
Oxygen to fix hypoxia if necessary
What are other ways we can manage arrhythmia’s if they are not responsive to other interventions?
Carotid Sinus Massage
Cardioversion
Defibrillate if pulseless VT or VF
What is a synchronous (demand) pacemaker do?
only paces if the clients rhythm falls below set rate, pacer will start stimulating depolarization
What is an asynchronous (Fixed rate) pacemaker do?
Paces at a preset rate regardless of clients normal rhythm, used most commonly when patient is asystolic or severely bradycardic
What is overdrive pacing?
suppresses the underlying rhythm so that SA node will regain control of the heart
What type of pacemaker would be given to a severely bradycardic patient or asystolic patient?
A temporary pacer, the transcutaneous pacing until invasive pacing can be initiated
What do you educate to a client with a pacemaker?
Keep pacemaker identification card
Avoid contact sports
How to take their own pulse
What is coronary artery disease?
narrowing of one or more arteries as a result of atherosclerosis
What does atheroscleosis cause?
decreased perfusion and inadequate o2 supply
What are complications of atherosclerosis?
HTN
HF
MI
Dysrhythmias
Angina
What is collateral circulation?
More than 1 artery supplying a muscle with blood, usually occurs in older people
What are some assessment findings of CAD?
Chest pain
Syncope
Palpitations
Fatigue
How is CAD diagnosed?
ECG
Cardiac Cath
Blood Lipid levels elevated
What are some ways to manage or reduce risk of CAD?
Cholesterol lowering meds
low calorie, fat, salt, cholesterol diet
What resources should be given to a patient with CAD?
community resources to exercise, smoking cessation, and stress reduction
What is important to stress to a client with CAD?
Dietary changes must be incorporated for the rest of their life
What medications treat CAD?
Nitrates
Calcium Channel Blockers (PINE, MIL)
Cholesterol Lowering meds (Statins)
Beta Blockers to reduce BP
What is the drug alert for Nitrates?
Keep in the dark
do not combine w/ erectile dysfunction meds
Patient should have 10-14 hour free period of nitrates
What is angina?
Chest pain caused by imbalance between oxygen supply and demand
What is stable angina?
Occurs with activities that involve exertion, emotional stress
How is stable angina relieved?
rest or nitroglycerin
What is unstable angina?
Occurs with an unpredictable degree of exertion, or emotional stress
How long does unstable angina last?
15 minutes or longer
How is unstable angina treated?
MONA
How do you diagnose angina?
ECG
Stress testing
Troponin and cardiac enzymes will be normal
Cardiac cath
What should the client do if nitro does not relieve pain?
Chew aspirin
How should the client be positioned during angina?
Bedrest in semi fowlers position, Stay with the client
What is a myocardial infarction?
Occurs when myocardial tissue is abruptly deprived of oxygen
What are symptoms of MI?
SOB
Pulmonary Edema
AMS
Dizziness
Pain radiate to the jaw, back, and left arm
Unrelieved by nitro or rest
Pain last 30 minutes or longer
What are risk factors for MI?
Atherosclerosis
CAD
Smoking
HTN
Obesity
Stress
Sedentary lifestyle
How is an MI diagnosed?
Troponin level
Total CK level
Myoglobin
WBC
ECG
Cardiac Cath
Thallium Scans
Stress test
What is treatment for MI?
MONA
Thrombolytic therapy
Beta Blockers
What does cool diaphoretic skin and diminished or absent pulses indicate?
Poor cardiac output
What is recommended for a patient after an MI?
Cardiac Rehab
What is heart failure?
inability for heart to maintain cardiac output to meet bodies needs
What is left sided heart failure?
Fluid backs up to lungs can develop pulmonary edema
What is right sided heart failure?
Fluid trapped in other areas of the body usually lower than the heart
What are some characteristics of Left sided heart failure?
Dyspnea
Tachypnea
Crackles in lungs
HTN or hypotension
What are some characteristics of right sided heart failure?
Edema in legs
JVD
Hepatomegaly
Splenomegaly
Weight gain
HTN
What medications will the client take for HF?
Digoxin
Diuretics
Ace Inhibitors (Prils)
Low dose beta blockers
vasodilators (nitrates)
What should heart failure patient avoid?
Large amounts of caffeine, coffee, tea, cocoa, chocolate, acidic fruits and carbonated drinks
What type of diet should a patient with HF be on?
low sodium, low fat, low cholesterol diet
Give a list of potassium rich foods
Possible fluid restriction
What is important for a HF patient do daily?
Daily weight, must record and report to HCP if 3 pounds or more is gained
What are the signs and symptoms of pulmonary edema?
Severe dyspnea
tachycardia
Tachypnea
Wheezing and crackles in lung
Large amount thick frothy sputum
cold and clammy
What nursing interventions should be done for pulmonary edema?
High Fowlers position
Administer oxygen
Auscultate lungs
Give diuretics if ordered
What is pericarditis?
acute or chronic inflammation of the pericardium that results in loss of pericardial elasticity
What may pericarditis cause?
Heart failure
cardiac tamponade
What are some assessment findings you might encounter with pericarditis?
Pain is aggravated by coughing, breathing, swallowing
Pericardial friction rub (high pitched sound when auscultating heart
How might pain be relieved for pericarditis?
sitting edge of bed leaning forward or leaning forward in bed
What medications are given for pericarditis?
NSAIDs (aspirin, ibuprofen)
Corticosteroids
Antibiotics for bacterial infections
Diuretics
Digoxin
What is endocarditis?
Inflammation of the inner lining of the heart and valves
Who is at risk for endocarditis?
IV drug users
Valve replacements/prosthetic materials
structural cardiac defects
What are signs and symptoms of endocarditis?
weight loss
murmurs
petechiae
splinter hemorrhages in nail beds
Clubbing of fingers
osler nodes (red lesions on pads of hands, fingers, and toes
janeway lesions (nontender lesions on fingers, toes, nose, ears)
What is used to treat endocarditis?
Antibiotics
When you discharge a patient home who has endocarditis, what is important to educate?
Record daily temperatures
Good oral hygiene, brushing twice a day
avoid using floss or oral irrigation to avoid bactermia
What is cardiac tamponade?
Restricts ventricles from filling and cardiac output drops
What places a client at risk for cardiac tamponade?
Pericardial Effusion
What are signs and symptoms of cardiac tamponade?
Pulsus paradoxus (blood pressure drops when inhaling)
Increased CVP
JVD
Muffled heart sounds
If a client continues to have reoccurring episodes what are the client’s options?
a portion or all of the pericardium will be removed (pericardiectomy)
May need a pericardiocentesis if pericardial effusion occurred (drain fluid off heart)
What are diagnostic test used to diagnose cardiac tamponade?
Chest xray
Echocardiogram
What is valvular heart disease?
develops when the heart cannot fully open (stenosis) or close completely (regurgitation), does not provide efficient blood through the heart.
What is mitral valve stenosis?
Valvular tissue thickens and narrows valve opening, preventing blood from flowing from the left atrium to the left ventricle
What is mitral regurgitation?
Valve is incompetent, preventing complete valve closure during systole
What is mitral valve prolapse?
Valve leaflets protrude into the left atrium during systole
What are ways to fix these valve issues?
Valve replacement procedures (Mechanical or biologic valves)
Open heart surgery
What is the difference between Mechanical Valve repairs and Biologic Valves?
Mechanical valves are more durable but clot formation is high
Biologic valves are less durable but clot formation is small
The patient receives a mechanical valve, what is important to educate?
Anticoagulants must be taken lifelong
What is an Acute Kidney injury (AKI)?
Rapid loss of kidney function, can be reversible
What is prerenal caused by?
Volume depletion caused by blood loss, trauma, surgery, dehydration, decreased CO
What is intrarenal caused by?
Tubular necrosis, infection, obstruction, nephrotoxicity
What is postrenal caused by?
Bladder obstruction, bladder cancer, infection
What is Chronic Kidney Disease?
Irreversible loss of kidney function
What causes chronic kidney disease?
Diabetes
HTN
Chronic urinary obstruction
Autoimmune disorders
What type of diet should a CKD patient be on?
Moderate protein, High carb, low potassium, low phosphorus
What it important to educate to CKD patients?
Keep up good oral care to prevent stomatis
What it important to educate to CKD patients?
Keep up good oral care to prevent stomatitis.
Daily weight
What are the signs and symptoms of a UTI?
Frequency
Urgency
inability to void
cloudy dark urine
hematuria
What is BPH?
enlargement of the prostate gland that compresses the urethra resulting in partial or complete obstruction
What medications are used for BPH?
Alpha blockers (osin)
5a- alpha reductase inhibitors (asterides)
What is normal cardiac output?
4-6liters per minute
How is cardiac output calculated?
CO=SVxHR
