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NUR 360 > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

Heart Failure

A

Inability of the heart to pump sufficient blood to meet the demand of the body

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2
Q

Signs of Heart Failure

A

Exercise intolerance, very fatigued with activity, most cases are related to MI damage and chronic HTN

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3
Q

Clinical Manifestations of Heart Failure

A

Fatigue, Dyspnea, Orthopnea, PND, Tachycardia, Edema, Nocturia, Behavioral changes, chest pain, weight cahnges

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4
Q

Classifying Left Ventricular Failure

A

Left ventricle has weak pump, backs up into the left atrium and into the lungs

Causes: HTN, CAD, Vascular Disease

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5
Q

Classifying Right Ventricular Failure

A

Right ventricle weak, unable to pump into the lungs, symptoms come from back up into the systemic system, edema!

Causes: LV Failure, RV infarct, Pulmonary HTN

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6
Q

Bi-Ventricular Failure

A

Usually RV secondary to LV failure

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7
Q

Acute vs Chronic Failure

A 
Acute= immediate, usually LV, following acute MI
Chronic= Long term, less immediate
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8
Q

Systolic vs Diastolic Failure

A 
Systolic = Reduced ejection fraction
Diastolic= decreased filling
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9
Q

Low output vs High Output Failure

A 
Low= Reduced pumping, more common
High= fever, hyperthyroidism, pregnancy
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10
Q

Compensatory mechanisms for Heart Failure

A

Increased HR and Increased SV (to maintain output)
Arterial vasoconstriction (to increase perfusion and BP)
Sodium and H2O retention (non-therapeutic)
Myocardial hypertrophy

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11
Q

Diagnosing Heart Failure

A 
CXR= show cardiomegaly, fluid in lungs 
ECHO= EJ calculation
Angiography= visualize heart
PA Catheter= Evaluate pressure
EKG= conduction abnormalities
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12
Q

B-type natriuretic peptide (BNP)

A

Plasma levels may correspond to the severity of underlying cardiac dysfunction, provides prognostic information, elevated plasma BNP indicates a high risk of morbidity and mortality in patients with chronic heart failure or acute coronary syndrome. Should be <100.

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13
Q

Functional Classifications of Heart Failure

A

Class 1=No limitation
Class 2= Slight limitation
Class 3= More severe
Class 4= Inability to carry on any activity

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14
Q

ACE Inhibitors

A

Reduce workload of heart, increase renal function

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15
Q

Diuretics

A

Pulling off fluid, many will also have K+ replacements

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16
Q

Beta Blockers

A

Overall longevity, make the heart work less

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17
Q

Aldactone

A

Potassium sparing diuretic

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18
Q

Digoxin

A

No longer top drug, lowers work of the heart, can have toxic levels and nasty side effects

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19
Q

Nitrates

A

Dilate blood vessels

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20
Q

Rational Polypharmacy

A

Balancing beneficial and adverse drug effects and monitoring how such drug regimens affect each patient with heart failure

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21
Q

Focus of Heart Failure Therapy

A

Improve survival, relieve symptoms

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22
Q

Clinical Manifestations of Acute LV heart failure

A

Respiratory distress; crackles, increased HR, S3 gallop rhythm, restlessness

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23
Q

Pulmonary Edema

A

Life threatening LV failure; given IV diuretics, MSO4, NTG, Nitroprusside (dilates blood vessels), position in high fowlers, oxygen, and foley catheter

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24
Q

Rheumatic Carditis

A

Affects 40% of patients with RF, group A beta-hemolytic streptococci (basic strep throat), Impairs pumping function, muscle tissue, pericardium, and valves.

basically Inflammation of cardiac valves related to strep throat

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25
Q

Valvular Heart Disease

A

Congenital or acquired dysfunctions, valvular stenosis, insufficiency or regurg

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26
Q

Mitral Stenosis

A

Usually from rheumatic carditis, valve is thickened by fibrosis and calcification. Sx: Dyspnea with exertion, fatigue, orthopnea, neck vein distention
PE: diastolic murmur

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27
Q

Mitral Regurgitation

A

Caused by RHD, LA and LV dilate and hypertrophy, may be symptom free for decades; common complaints are anxiety, chest pain, and palpitations. Other Sx include fatigue, weakness, and dyspnea, and orthopnea
PE: holosystolic murmur

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28
Q

Mitral Valve Prolapse

A

Valvular leaflets enlarge and prolapse into the LA during systole, usually benign and asymptomatic
PE: Systolic Click
Familial occurence usually, associated with marfans syndrome- cardiac disease, visual problems, very long arm span, most common in young to middle aged thin women

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29
Q

Aortic Stenosis

A

Increased resistance to ejection during systole, leading to LV failure and eventually RV failure. Sx: dyspnea, angina, syncope. PE= systolic murmur
Most common in aging populations, majority men

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30
Q

Aortic Regurgitation

A

Creates dilation of LV, asymptomatic for many years untilc LV failure occurs, usually from non-RHD: endocarditis, congentital, HTN, marfans syndrome, men Sx: DOE, orthopnea, PND
PE= Diastolic Murmur - second intercostal space on right side

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31
Q

Cardiomyopathy

A

Enlarged cardiac muscle, decreased pumping, irreversible, often unknown etiology, could be etoh,

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32
Q

Dilated Cardiomyopathy

A

Damage myofibrils, decreased CO
Sx: fatigue, DOE, gallop rhythms
More common in men of middle age

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33
Q

Hypertrophic Cardiomyopathy

A

LVH with obstruction in LV outflow, abnormal stiffness of LV, genetic usually, often cause of sudden death in young athletes, gallop rhythms, a.fib

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34
Q

Restrictive Cardiomyopathy

A

Rarest, LV filling is restricted, Sx: dyspnea, fatigue, right sided HF, gallop rhythms

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35
Q

Infective Endocarditis

A

Infection of valves and endothelial surface of heart cause by direct invasion of bacteria, usually r/t valve replacements, structural cardiac defects, or IV drug abuse. Sources: Oral cavity, skin lesions, infections, invasive procedures.

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36
Q

Patient with the following should receive antibiotics before dental procedures

A

Prosthetic cardiac valves
Previous bacterial endocarditis
Certain congenital cardiac malformations
Cardiac transplantation

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37
Q

The following no longer require antibiotics prophylaxis

A 
Rheumatic Valve Dysfunction
Mitral valve prolapse
Previous CABG
Heart Murmurs
Cardiac Pacemakers and defibs
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38
Q

Infective Endocarditis 2

A 
pt c/o chills, fever, flu like symptoms
PE=new onset of murmur
Oslers nodes and Janeways lesions
petechiae
Splinter hemorrhages
arterial embolic complications
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39
Q

CO: SV X HR

A

4-6L/min is normal

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40
Q

HR

A

60-100 beats/min is normal

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41
Q

SV

A

73ml/contraction is normal

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42
Q

Preload

A

5-12 mmHg is normal

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43
Q

Cancer is…

A

The second leading cause of death in the US. Cancer accounts for nearly one-quarter of all deaths in the US.

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44
Q

Highest Estimated new cases in males and females

A

Prostate for males
Breast for females
Second for both is lung and bronchus

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45
Q

Highest estimated deaths related to cancer

A

Lung and bronchus cause the most deaths, followed by prostate and breast

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46
Q

Cancer disparity between african americans and whites

A

African americans are 10% -20% less likely to survive cancer, this is due to less likely to recieve cancer diagnosis at and early stage, unequal access to medical care, and tumor characteristics not related to early detection

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47
Q

Individual Actions to Prevent Cancer

A
  • Maintain healthy weight
  • Physical Activity
  • Consume healthy diet with plants
  • Limit alcohol consumption
  • Stop smoking
  • Limit sun exposure
  • Protect yourself from toxic substances
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48
Q

CAUTION

A 
Change in bowel/bladder habits
A sore
Unusual bleeding/discharge
Thickening/Lump
Indigestion or swallowing issues
Obvious change in wart or mole
Nagging cough/hoarseness
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49
Q

Unmodifiable Risk Factors for Cancer

A

Family history, Age, Gender, Impaired immunity

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50
Q

Prognostic Factors for Cancer

A

Performance status: Karnofsky Scale, ECOG Scale, Staging: TMN Classification, Grading

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51
Q

Karnofsky Scale

A

A person’s functional status, their ability to care for themselves and carry out normal activities of daily living. 100 = highest living 0= dead

52
Q

TMN Classification

A

T=The extent of the primary tumor
N= Lymph Node presence?
M= Distance Metastasis?
Subscripts: X= unknown, 0= none, 1-4 =extent of disease

53
Q

Grading

A

Looks at characteristics and behavior of cancer cells. If it looks and behaves more like normal cells they are usually less aggressive.

54
Q

Ploidy

A

Chromosome number and appearance. Normal human ploidy = 23. Cancer can cause addition or loss of a chromosome. More or less than 23= aneuploidy = more malignant

55
Q

Shock

A

A conditions in which systemic blood pressure is inadequate to deliver oxygen and nutrient to support vital organs and cellular function

56
Q

Inadequate tissue perfusion leads to…

A

if untreated cell death will happen

it can lead to anaerobic metabolism which leads to build up of lactic acid and metabolic acidosis

57
Q

3 optimally performing components needed to ensure adequate tissue perfusion:

A

Adequate cardiac pump
Effective and intact vasculature
Sufficient blood volume

58
Q

Mean Arterial Pressure

A

Average pressure at which blood moves through the circulatory system, normal = 70-110 mm Hg, need a minimum of 60 mm Hg for perfusion of coronary arteries, kidneys, and brain

59
Q

MAP

A

CO X Peripheral vascular resistance

60
Q

Calculated MAP

A

Diastolic BP + 1/3 Pulse Pressure

61
Q

Baroreceptors

A

Respond to dropping BP, stimulate SNS, epinephrine and norephinephrine released from adrenals, increase HR and vasoconstriction

62
Q

Chemoreceptors

A

Respond to changes in oxygen and carbon dioxide concentrations

63
Q

Kidneys role in RP regulation

A

Vasoconstriction, retention of sodium and water, ADH for further water retention, increased blood volume and BP, takes hours and days to respond

64
Q

Compensatory stage of Shock

A 
BP=Normal
HR= >100 bpm
RR= >20
Skin= Cold Clammy
Urinary Output= Decreased
Mentation= Confused
Acid Base Balance= Respiratory Alkalosis
65
Q

Medical Management of Compensatory stage

A

Identify and treat cause of shock, support successful physiologic adaptations, replace fluid, meds

66
Q

Nursing Management of Compensatory Stage

A 
PREVENT BP DROP!
Ongoing systematic assessment 
Urinary output
Skin
Lab Values: Sodium and blood glucose increase
67
Q

Progressive Stage of Shock

A 
BP= Systolic 150
RR= Rapid, shallow, crackles
Skin= Mottled, petechiae
Urinary Output= 0.5 ml/kg/hr
Acid Base Balance= Metabolic Acidosis
68
Q

Progressive Stage Prosnosis

A

All systems on the verge of failure: Kidneys, liver, GI, Resp, CV, Heme

69
Q

Medical Management of Progressive Stage of Shock

A

Fluids and Meds
Restore intravascular volume
Support pumping of the heart
Improve competence of vascular system

70
Q

Nursing Management of Progressive Stage of Shock

A 
Understand Shock
Significance of Changes
ASSESS
Prevent complications- aseptic technique
Promote rest and comfort
Support family
71
Q

Irreversible Stage of Shock

A 
BP= Requires support
HR= Erratic and asystole
RR= Intubation
Skin= Jaundice
Urinary Output+ Anuric, dialysis
Mentation= Unconsious
Acid Base Balance= Profound acidosis
72
Q

Irreversible Stage Diagnosis

A

Only made retrospectively, continue intervening until no response to treatment, nursing management is focus on comfort and support to patient and family

73
Q

Management Strategies of Shock

A

Fluid Replacement
Vasoactive meds- restore vasomotor tone and improve cardiac function
Nutritional support

74
Q

Fluid Replacement in Shock

A

Crystalloid Fluids- electrolytes move freely between intravascular and interstitial spaces
Colloidal Fluids- large molecule fluids
Blood components

75
Q

Crystalloid Fluid

A

Isotonic (Expand ECF volume)
0.9% Normal Saline
Lactated Ringer’s

76
Q

Colloids Fluid

A

Albumin

Dextran

77
Q

Vasoactive Meds

A

Inrease cardiac contactility, Regulate HR, Reduce myocaridla resistance, Initiate vasoconstriction

All work by stimulating alpha- and/or beta- adrenergic receptors

78
Q

Nursing Management of Vasoactive Meds

A

VS at least q15 mintues
Administer through central venous catheter
Always use IV pump and monitor closely
Titrate dosage based on patient parameters
NEVER stop abruptly

79
Q

Nutritional Support for Shock

A

Glycogen stores depleted in first 8 hours of shock, even with people with large fat stores, muscle is selectively broken down as an energy source, loss of skeletal muscle greatly prolongs recovery time, >3000 kcal/day high protein, enteral and parenteral

80
Q

Hypovolemic Shock

A

Hemorrhage, Trauma, Surgery, Dehydration, Burns

81
Q

Cardiogenic Shock

A

Coronary (MI), Non-coronary (Cardiomyopathies, valve damage, cardiac tamponade, dysrhythmias)

82
Q

Circulatory Shock

A 
Septic Shock: Sepsis and hypotension
Immunosuppression
Extremes of age
Malnourishment
Chronic Illness
Invasive procedures
83
Q

SIRS

A

Systemic Inflammatory Response Syndrome

Physiological alterations and organic dysfunctions seen with bacterial infections

84
Q

Sepsis

A

Systemic infection occurs in 1-2:100 hospitalized patients

55% in critical care units

85
Q

Circulatory Shock: Neurogenic Shock

A 
Massive Vasodilation
Spinal cord injury
Spinal anesthesia
Depressant Action of meds
Glucose deficiency
86
Q

Circulatory Shock: Anaphylactic

A 
Vasodilation and capillary leakage 
PCN sensitivity 
Transfusion reaction
Bee sting allergy
Latex Sensitivity
Food Allergies
87
Q

EKG’s

A

Graphic representations of the ELECTRICAL activity within the heart. They can tell about electrical function: Rhythm disturbances, and conduction disturbances.

88
Q

EKG’s cannot…

A

tell about mechanical function: Structural disorders and perfusion disorders

89
Q

The sodium pump: Polarization

A

Steady State, “Chillin”, K+ inside the cell, Na+ outside the cell “Ready State”

90
Q

The sodium pump: Deplorization

A

by an electrical impulse, sodium rushes into the cell, potassium rushes out, stimulates the contraction “Discharge State”

91
Q

The sodium pump: Repolarization

A

Potassium goes back in and sodium comes back out “recovery state”

92
Q

What do you need in order for the heart to function properly?

A

Good electrical system
Good blood flow system
Good muscular system

93
Q

Inherent Rates of the heart

A

Sinus Node: 60-100 beats/min
AV junction: 40-60 beats/min
Ventricles: 20-40 beats/min

94
Q

Pacemaker Rule

A

Pacemaker site with the fastest rate will generally control the heart. SA node should always trump the others paces because it should be fastest.

95
Q

“Irritability”

A

A site along the conduction pathway becomes irritable and speeds up, thus overriding higher pacemaking sites for control of the heart. Magnesium is a critical electrolyte to have stable to prevent arrhythmias.

96
Q

“Escape Mechanism”

A

The normal pacemaker slows down or fails, and a lower pacing site assumes pacemaking responsibility.

97
Q

Rule of electrical flow

A

Electricity flowing toward positive electrode produces upright pattern. Negative to positive electrode - lead two.

98
Q

Artifact

A

looks funny on the EKG strip. can be muscle tremors, patient movement, or lose electrodes on the patient’s chest, or it can be an electrical interference

99
Q

Digoxin

A

Anti-arrhythmia, increases force of contraction, increasing output and slowing heart rate

100
Q

Sudden Arrthythmic Death Syndrome (SADS)

A

Sudden death in healthy individuals, genetic (long QT syndrome, Marfans) vs. Acquired (Meds). If someone has exercise related fainting, its the best predictor. DxL Cardiac MRI Rx: Implantable defibrillators

101
Q

Ventricular Tachycardia

Life Threatening

A

Pulseless or pulse
Pulseless patients need to be defibrillated
Sustained or unsustained
Stable or unstable
Unstable: SBP 120, Chest pain, Heart failure
Meds: Amiodarone, anti-arrythmics, vasopressors

102
Q

Pulseless VT

A

DEFBRILLATE

103
Q

Stable VT

A

Amiodarone, Procainamide, CV

104
Q

Torsade de Pointe

A

Mg, BB, Amiodarone

105
Q

Ventricular Fibrillation

A

Ventricle quivering, this is the worst possible heart rhythm, completely chaotic activity, never a pulse, clinically dead, need to be defibrillated

106
Q

V Fib Treatment

A

Early Defib
Oxygen, CPR, Intubation, Epinephrine, Vasopressin
Prevent Re-Fib: Amiodarone, rocainmide, BB, Lidocaine
Adjust metabolic imbalances

107
Q

Idioventricular Rhythm

A

Slow slow slow, dying heart, sinus tach to sinus to sinus brady, to junctional to idioventriculars
atropine is used to speed up a little.

108
Q

Asystole

A

Not a healthy rhythm, harder to get out of than Vfib, Barely ANY electrical activity

109
Q

Prophylactic Surgery

A

Preventative

Example of removing both breasts if they are at risk for breast cancer

110
Q

Diagnostic Surgery

A

To see what kind of surgery to do

Example of Biopsies

111
Q

Curative Surgery

A

Removing all cancerous cells, thyroid cancer example, can use this for a lot of solid tumors

112
Q

Control Surgery

A

Clean out as much as we can, while preserving function, give chemo. Look again, take out more, reduce tumor mass so chemo will be more effective.

113
Q

Palliative Surgery

A

Diverting around the tumor, keeping patient more comfortable, and not be so sick

114
Q

“Second Look” Surgery

A

After chemo, go in and take another look, and clean out more

115
Q

Reconstructive/Rehabilitative

A

Example of breast reconstruction after mastectomy

116
Q

Communicating Cancer Diagnosis to the Patient

A

Nursing responsibilities: Be aware, be there, listen, ask questions for the patient, try to structure meeting time with physician (Family present, privacy)

117
Q

Goals of Treatment

A

Cure, Control (Goal is to slow down the growth, and keep patient more comfortable), Palliation (Bony metastasis, reduce pain, and increasing strength of the bone)

118
Q

Teletherapy

A

None invasive, position might be uncomfortable but no pokes or anything

119
Q

Brachytherapy

A

source of radiation is implanted into the tumor or area around the tumor

120
Q

Teletherapy part 2

A

External beam radiation, most common, go everyday, emitted from a source external to the body, linear accelerator, not radioactive, just like having an xray

121
Q

Brachytherapy part 2

A

Emitted form a source placed within the body or body cavity, sealed source placed within or near tumor (Wires, ribbons, tubes, needles, seeds, capsules)

122
Q

Sodium Iodide (I 131)

A 
Hyperthyroidism (Cure)
Thyroid carcinoma (Cure, control, and palliation)
123
Q

Sodium Phosphate (P 32)

A

Myeloproliferative Disorders

  • Polycythemia vera
  • thrombocytosis
  • Too many RBC
124
Q

Strontium Chloride (Sr 89)

A

Painful bony metastasis (Palliation)

125
Q

Starting cancer Therapy

A

Determining appropriateness, need tissue diagnosis, not all tumors are radiosensitive
Need to know position of the tumor in relation to other organs, don’t want to radiate the heart or other important organs.

NUR 360 (2 decks)

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