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NUR3220 ADULT HEALTH I > Exam 2 Study Guide > Flashcards

Exam 2 Study Guide Flashcards

1
Q

Lab Assessments - Male Reproductive: Prostate-Specific Antigen (PSA) Test

A
  • Normal <2.5ng/mL for age <50 & incrs w/ age (possibly up to 6.5ng/mL)
  • Used as a screening lab for prostate cx bc other prostate probs can incr the level
  • Some variance on the PSA & how it is affected by age
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2
Q

Lab Assessments - Male Reproductive: Early Prostate Cx Antigen (EPCA-2) & Serum Acid Phosphatase

A
  • Elevations indicative of prostate cx
  • EPCA-2 is very sensitive & can detect early
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3
Q

Lab Assessments - Male Reproductive: Alpha-Fetoprotein (AFP), Beta Human Chorionic Gonadotropin (hCG), & Lactate Dehydrogenase (LDH)

A
  • Elevations indicative of testicular cx
  • Indicative of testicular cx
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4
Q

Lab Assessments - Female Reproductive: Pap Smear

A
  • Cytologic study effective in detecting precancerous & cancerous cells from cervix
  • Annual Pap test starting at 21
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5
Q

Lab Assessments - Female Reproductive: Human Papilloma Virus (HPV)

A
  • Used to identify many high-risk types of HPV associated w/ development of cervical cx
  • Cells are collected from cervix at same time a Pap test is completed
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6
Q

Lab Assessments - Female Reproductive: Vaginal Cultures

A

Used to detect bacterial, viral, fungal, & parasitic disorders

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7
Q

Lab Assessments - Female Reproductive: Alpha Fetoprotein (AFP)

A

Elevated w/ ovarian cx

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8
Q

Lab Assessments - Female Reproductive: Cancer Antigen 125 (CA 125)

A

Elevated w/ ovarian cx

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9
Q

Assessment - Imaging: CT

A
  • Evaluate for metastasis w/ different reproductive cancers
  • Evaluate for ovarian cx
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10
Q

Assessment - Imaging: MRI

A

Evaluation for breast cx for women w/ high risk factors

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11
Q

Assessment - Imaging: Ultrasonography

A
  • Transvaginal ultrasound: ovarian & endometrial cx
  • Transrectal ultrasound: prostate cx
  • Ultrasound: evaluate for testicular masses vs fluid
  • Also used for breast cx evaluation
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12
Q

Assessment - Imaging: Hysterosalpingography

A
  • X-ray tht uses an injection of contrast medium to visualize cervix, uterus, & fallopian tubes
  • Used to evaluate tubal anatomy & potency & uterine problems such as fibrosis, tumors, & fistulas
  • Pre: assess for allergies to contrast dye
  • Post: some pelvic & referred shoulder pain
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13
Q

Endoscopic Studies: Colposcopy

A
  • Examination of cervix & vagina using a colposcope
  • Allows 3D magnification & intense illumination of epithelium w/ suspected disease
  • Locate exact site of precancerous & malignant lesions for biopsy
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14
Q

Endoscopic Studies: Laparoscopy

A
  • Direct examination of pelvic cavity through an endoscope
  • Performed under anesthesia
  • Pre: NPO
  • Post:
    > some pelvic & referred shoulder pain
    > observe incision sites for infection
  • Can also be used during surgical procedures
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15
Q

Endoscopic Studies: Hysteroscopy

A
  • Fibroptic camera tht is inserted into vagina
  • Examines the cervix & uterus
  • Performed w/ regional nerve block
  • Post: some pelvic & referred shoulder pain
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16
Q

Assessment - Imaging: Mammography

A
  • X-ray of soft tissue of breast
    > now have 3D mammograms tht allow visualization of layers of breast tissue
  • Pre: no creams, lotions, powders or deodorant on breast or under arms
  • May experience discomfort during procedure
  • Post: reinforce continued self breast exams & clinical breast exams
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17
Q

Biopsy Studies: Cervical

A
  • Cervical tissue is removed for cytologic study
  • Early in menstrual cycle so less vascular
  • Pre:
    > depends on anesthesia used
    > address anxiety
  • Post:
    > monitor for bleeding & infections
    > nothing in vagina for 2 wks
    > no heavy lifting
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18
Q

Biopsy Studies: Endometrial

A
  • Used to obtain cells directly from lining of uterus to assess for cx of endometrium
  • Assess menstrual disturbances infertility
  • Post:
    > some cramping may occur
    > monitor for bleeding & infections
    > spotting for 1-2 days
    > nothing in vagina for 1-2 days
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19
Q

Biopsy Studies: Breast

A
  • Tissue aspirated through a large bore needle or through small incision
  • Local anesthetic
  • Aspirated fluid from benign cysts may appear clear to dark green-brown
  • Bloody fluid suggests cx
  • Pre:
    > depends on anesthesia used
    > address anxiety
  • Post:
    > mild pain alleviated w/ analgesics, ice, or heat
    > monitor incision for bleeding & infection
    > numbness may occur around site
    > wear a supportive bra for 1wk
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20
Q

Biopsy Studies: Prostate

A
  • Definitive diagnostic tool for prostate cx
  • Transurethral biopsy
    > insert needle through area of skin btwn anus & scrotum
  • Transrectal biopsy
    > passing needle through wall of rectum
  • Pre:
    > discuss positioning & discomfort during procedure
    > address anxiety
  • Post:
    > educated regarding soreness & light rectal bleeding, blood in urine & stool for few days plus rust colored semen for several wks
    > monitor for signs of excessive bleeding, infection, & urinary retention
    > post biopsy antibiotic
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21
Q

Benign Prostatic Hyperplasia (BPH)

Define
Cause
Risk Factors
Prevention

A
  • Enlarged Prostate Gland
    > prostate gland enlarges & extends inward
    > causes bladder outlet obstruction
    > 50% of men >60 affected
  • Causes:
    > unclear
    > likely the result of aging and the influence of androgens (male hormones) that are present in the prostate tissue
  • Risk Factors:
    > obesity
    > testosterone & androgen supplements
  • Prevention:
    > avoid any drugs tht can cause urinary retention
    > EX: anticholinergics, antihistamines, & decongestants
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22
Q

Benign Prostatic Hyperplasia (BPH) - Assessment

A
  • Hx
  • CMs:
    > urinary frquency & urgency
    > nocturia
    > difficulty in starting (hesitancy) & continuing urination
    > sensation of incomplete bladder emptying
    > straining to begin urination
    > post-void dribbling or leaking
    > hematuria
  • Physical Assessment by provider
    > inspection, palpation, & percussion of abdomen
    > digital rectal examination (DRE): BPH is uniform, elastic non-tender enlargemnt vs hard nodule w/ prostate cx
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23
Q

Benign Prostatic Hyperplasia (BPH) - Lab Assessment

A
  • Urinalysis & Culture
    > incrd WBCs if infection present
    > microscopic hemturia
  • Prostate-Specific Antigen (PSA)
    > can be elevated in BPH but also other prostate issues
  • Other labs to rule out other causes:
    > CBC: systemic infection (elevated WBCs) & anemia (dcrd RBCs from hematuria)
    > BUN & Serum Creatinine: both elevated if leads to kidney disease
    > Culture & Sensitivity of Prostatic Fluid: could be expressed during DRE to check for prostatitis
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24
Q

Benign Prostatic Hyperplasia (BPH) - Diagnostics

A
  • Imaging
    > transabdominal ultrasound
    > trasnrectal ultrasound
    > tissue biopsy: used to rule out prostate cx
    > cystoscopy: scope used to evaluate for bladder neck obstruction
    > bladder ultrasound scan: evaluates for post void residual
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25
Q

Post Operative Care for Transurethral Resection of the Prostate (TURP)

CBI

A
  • Continuous Bladder Irrigation (CBI) in place post surgery
    > 3 way catheter in place w/ continuous irrigation
    > normal saline used to irrigate
    > maintain rate of CBI to ensure clear urine w/out clots & bleeding
  • Assess color, consistency, & amnt of urine output
    > normal for urine to be blood-tinged after surgery
  • Check drainage tube frequently
    > monitor for external obstructions (kinks)
    > monitor internal obstructions (blood clots, dcrd output, bladder spasms)
    > if becomes obstructed will have to manually irrigate w/ NS
  • After cath is removed, may experience buring on urination, urinary frequency, dribbling, leakage
    > symps are normal & will dcr
    > may also pass small clots & tissue debris for several days
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26
Q

Post Operative Care for TURP

A
  • Inct fluid intake
    > at least 2000-2500mL daily
    > will dcr dysuria & keeps urine clear
  • Monitor for infection
  • Prevent complications of immobility
  • Assess pain and VS q2-4hrs
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27
Q

Prostate Cancer

Causes
Risk Factors
Health Promotion

A
  • 2nd most common type of cancer in men, if found early has a near 100% cure rate
  • Slow growing
  • Causes: number of factors
  • Risk Factors:
    > over 65yrs
    > race: african american more often affected
    > family hx of prostate cx
  • Health Promotion & Maintenance
    > screening: consider at 50yrs old
    > healthy, balanced diet: dcr animal fats (red meats), incr fruits, veggies, & high fiber foods
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28
Q

Prostate Cancer - Assessment

cm
lab
other diagnostics

A
  • History
  • CMs:
    > EARLY: urinary retention, frquent bladder infections, difficulty starting urination
    > ADVANCED: hematuria, swollen lymph nodes (esp in groin), pain, unexpected weight loss
  • Lab:
    > Prostate Specific Antigen (PSA): think previous slide (this is a SCREENING tool)
    > Early Prostate Cx Antigent (EPCA-2): can detect changes in prostate gland early & is very sensitive
    > Elevated Serum Acid Phosphatase: w/ advanced disease
  • Other diagnostic assessment:
    > transrectal ultrasound (TRUS)
    > Biopsy
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29
Q

Prostatitis Assessment

define
acute
chronic

A
  • Inflammation of prostate gland
  • Acute bacterial postatitis
    > occurs w/ urethritis or an infection of lower urinary tract
    > organisms may reach prostate via bloodstream or urethra
    > symps: fever, chills, dysuria, urethral discharge, boggy & tender prostate
  • Chronic Bacterial Prostatitis
    > occurs in older men
    > symps less dramatic
    > symps: hesitancy, urgancy, dysuria, difficulty initiating & terminating flow of urine, dcrd strength & vol of urine, discomfort in perineum, scrotum & penis
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30
Q

Testicular Cancer Assessment

CMs
lab assessment
other diagnostics

A
  • Rare cancer, most often affecting men btwn 25-35yrs
  • Common manifestation
    > painless, hard swelling or enlargment of testicle
  • Lab Assessment
    > Alpha-fetoprotein (AFP)
    > Beta Human Chorionic Gonadotropin (hCG)
    > Lactate Dehydrogenase (LDH)
  • Other Diagnostic Assessment
    > ultrasonography: identify fluid or solid mass & benign vs malignant
    > CT & MRI: check for metastsis
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31
Q

Endometrial (Uterine) Caner

define
stages

A
  • Cancer of inner uterine lining
  • Most common gynecologic malignancy
  • Good prognosis
  • Adenocarcinoma most common type of tumor
  • Grows slowly in most cases:
    > Stage 1: confined to endometrium
    > Stage 2: also involves cervix
    > Stage 3: reaches vagina & lymph nodes
    > Stage 4: spread to bowel or bladder mucosa and/or beyond pelvis
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32
Q

Endometrial (Uterine) Cancer - Etiology/Risk Factors

A
  • Strongly associated w/ prolonged exposure to estrogen w/out protective effects of progesterone
  • Women in reproductve yrs
  • Nulliparity
  • Family hx
  • DM
  • HTN
  • Obesity
  • Uterine polyps
  • Late menopause
  • Smoking
  • Tamoxifen given for breast cx
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33
Q

Enodmetrial (Uterine) Cancer - Symptoms

A
  • Postmenopausal vaginal bleeding - main symptom; early symps of vaginal bleeding generally lead to prompt evaluation & treatment
  • Watery, bloody vaginal discharge
  • Low back or abdominal pain
  • Low pelvic pain (caused by pressure of enlarge uterus); uterus is enlarged if cx is advanced
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34
Q

Endometrial (Uterine) Cancer - Lab Assessment

A
  • CBC (may show anemia)
  • Cancer Antigen 125 (CA-125): elevated in ovarian cx
  • Alpha-Fetoprotein (AFP): elevated in ovarian cx
  • Human Chorionic Gonadotropin (hCG): elevated lvl may indicate pregnancy, pregnancy should be ruled out b4 treatment begins
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35
Q

Endometrial (Uterine) Cancer - Diagnostic Assessment

A
  • Transvaginal ultrasound
  • Endomentrial biopsy
  • Other diagnostic tests may be done to determine pt’s overall hlth status & presence of metastasis
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36
Q

Cervical Cancer

A
  • Progressive cx:
    > normal cervical cells
    > atypical (suspicious)
    > cervical intraepitheilial neoplasia (CIN)
    > carcinoma in situ (CIS)
  • Generally takes yrs for cervical cells to transform from normal to premalignant to invasive cx
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37
Q

Cervical Cancer Etiology/Risk Factors

A
  • Most cases are caused by certain types of HPV (most common typs of STD in US)
  • Multiparity
  • Smoking
  • African American
  • Oral contraceptice use
  • Hx of STI
  • Obesity
  • Family hx
  • HIV/AIDS
  • Younger than 18 at 1st intercourse
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38
Q

Cervical Cancer Health Promotion & Maintenance

A
  • Gardasil & Cervarix
    > ideally given before 1st sexual contact for girls & young women (9-26yrs)
    > also given for boys & young men to prevent genital warts, transmission & certain types of cx
    > protection against highest-risk HPV types tht are responsible for most cervical cxs
  • Periodic pelvic examinations & PAP tests at 21yrs for women
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39
Q

Cervical Cancer - Assessment

A
  • Asymptomatic in preinvasice cancer
  • CMs for invasive cancer:
    > painless vaginal bleeding (classic symp)
    > LATE: watery, blood-tinged vaginal discharge tht becomes dark & foul-smelling, leg pain (along sciatic nerve) or swelling of one leg, flank pain (symp of hydronephrosis); cx may be pressing on ureters, backing up urine into kidneys
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40
Q

Cervical Cancer - Diagnostic Assessment

A
  • HPV-typing DNA test if PAP results are abnormal
  • Colpscopy
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41
Q

Ovarian Cancer

A
  • Most ovarian cxs are epithelial tumors tht grow on surface of ovaries
  • Tumors grow rapidly, spread quickly, & are often bilateral
  • Leading cause of death from femal reproductive cxs
    > survival rates are low bc ovarian cx is often not detected until its in late stages
    > 2nd most common type
  • Incidence incrs in women older than 50yrs, & most are diagnosed after menopause
  • Teach women to “think ovarian” if they have vague abdominal & GI symps
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42
Q

Ovarian Cancer - Risk Factors

A
  • Older than 40yrs
  • Family hx of ovarian or breast cx or hereditary nonpolyposus colon cx
  • DM
  • Nulliparity
  • Older than 30yrs at 1st pregnancy
  • Breast cx
  • Colorectal cx
  • Infetility
  • BRCA 1 or BRCA 2 gene mutations
  • Early menarche/late menopause
  • Endometriosis
  • Obesity/high-fat diet
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43
Q

Ovarian Cancer - Assessment

A
  • CMs:
    > mild symptoms for several mnths but may have thought they were due to normal perimenopausal changes or stress
    > abdominal pain or swelling
    > vague GI disturbances such as dyspepsia (indigestion) & gas (“think ovarian”)
    > any enlarged ovary found after menopause should be evaluated as though it were malignant
  • Diagnostic Assessment:
    > CA-125 may be elevated in ovarian cxm but for other reasons too
    > transvaginal ultrasonosgraphy, CXR, CT
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44
Q

Breast Cancer - Assessment

A
  • History
  • Phsyical Assessment / CMs
    > Breast mass: identify location by using “face of the clock” method, describe shape, size, & consistency, mass will be hard & foxed vs mobile
    > Note any skin changes around mass: dimpling, redness, warmth
    > Nipple retraction or ulceration
    > Assess the adjacent lymph nodes for swelling
    > Pain or soreness
  • Psychosocial
  • Lab assessment:
    > biopsies: pathologic examination of tissue from breast mass, pathologic study of lymph nodes
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45
Q

Breast Cancer - Imagining Assessment

A
  • Mammography
  • Ultrasonography
  • MRI
  • Chest X-Ray
    > screen for lung metastases
  • CT scans
    > screen for bone, liver, & brain metastases
  • Breast tissue biopsy is the only definitive way to diagnose breast cx
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46
Q

Breast Cancer - Intervention

Coping strategies
Dcr risk for metastasis

A
  • Develop coping strategies
    > dcr anxiety
    > offer outside resources
    > assess need for knowledge
  • Dcr risk for metastasis
    > Nonsurgical involved
    > follow up w/ adjuvant radiation, chemotherpay, hormone therapy, or targeted therapy
    > promote comfort (palliation) for those who can’t have surgery or whose cx is too advanced
    > CAM
    > vitamins, special diets, herbal therapy, prayer, guided imagery, massage
    > 80% of women use fome form during breast cx treatment, should not be used in place of standard treatment
    > check w/ HCP before using
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47
Q

Breast Cancer - Surgical Interventions

A
  • Preoperative Care
    > relieve anxiety & provide info to incr pt knowledge
    > include spouse or partner
    > address body image issues b4 surgery
  • Operative Procedures
    > Lumpectomy: tumor & small amnt of tissue removed
    > Partial Mastectomy: part of breast & some noraml tissue around it removed
    > Total (simple) Mastectomy: removal of entire breast
    > Modified Radical Mastectomy: breast & some lymph nodes removed, part of chest wall muscle may also be removed
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48
Q

Breast Cancer - Interventions

Postop Care

A
  • Avoid using the affected arm for measuring BP, giving injections, or drawing blood
  • Observe for signs fo swelling & infection
  • Wound care
  • Drainage tube care
  • HOB elevated 30 degrees
  • Elevate arem of affected side on pillow while awake (promotes lymphatic fluid return)
  • Repositioning
  • Analgesics
  • Breast reconstruction
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49
Q

Breast Cancer - Interventions

Adjuvant Therapy

A
  • Radiation therapy
  • Drug therapy
    > chemotherapy, targeted therapy, hormonal therapy
  • Use depends on:
    > stage of disease
    > pt’s age & menopausal status
    > pt preferences
    > pathologic examination
    > hormone receptor status
    > presence of a known genetic predispostion
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50
Q

Breast Cancer Overview

A
  • Excluding skin cxs, breast cx is the most commonly diagnosed cx in women
    > 2nd only to lung cx as a cause of female cx deaths
  • Early detection is key to effective treatment & survival
  • Five-year Survival Rate
    > lower for women diagnosed w/ an advanced stage of breast cx
    > 98.6% for localized breast cx
    > 83.3% when cx has spread to regional lymph nodes
    > survival drops dramatically when breast cx is mestastatic
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51
Q

Noninvasive Breast Cancer

A
  • 20%
  • Ductal Carcinoma in Situ (DCIS)
    > Cx cells are located w/in duct & have not invaded surrounding fatty breast tissue
    > 14%-53% become invasive & spread into breast tissue surrounding ducts over a period of 10yrs if not treated
  • Lobular Carcinoma in Situ (LCIS)
    > rare
    > occurs as an abnormal cell growth in lobules (milk-producing glands)
    > treated w/ close observation only but women w/ breast cx risk factors amy consider prophlyactic treatment
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52
Q

Invasive Breast Cancer

A
  • 80%
  • Infiltrating Ductal Carcinoma
    > most common type
    > originates in mammary ducts & grows in epithelial cells lining these ducts
    > dimpling & an edematous thickening & pitting of breast skin called peau d’ orange (orange peel skin) may be seen as tumor continues to grow
  • Inflammatory Breast Cancer (IBC)
    > rare but highly aggressive
    > symptoms include swelling, skin redness, pain in breasts
    > usually diagnosed at a later stage than other types so it’s harder to treat successfully
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53
Q

Breast Cancer in Young Women

A
  • 4.6% occur in women younger than 40
  • Genetic predispostion is a stronger risk factor for younger women than older
  • Frequently present w/ more aggressive forms of disease, & the # of cases incring
  • Screening tools are less effective bc the breasts are denser
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54
Q

Breast Cancer in Men

A
  • Rare, occuring in fewer than 1% of all cases
  • Avg onset 68
  • Symptoms: hard, painless, subareolar mass
  • Gynecomastia may be present
  • Diagnosis frequently delayed
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55
Q

ECG Rhythm Analysis

1st 2 steps
P waves

A
  • Determine HR
  • Determine heart rhythm; can be regualr or irregualr
  • Analyze P waves
    > are P waves present?
    > are the P waves occuring regualry?
    > is there one Pwave for each QRS complex?
    > are the Pwaves smooth, rounded, & upright or are they inverted?
    > do all P waves looks similar?
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56
Q

ECG Rhythm Analysis

PR interval
QRS duration

A
  • Measure PR interval (normal .12-.20)
    > are PR intervals >0.20secs
    > are PR intervals <0.12secs
    > are PR intervals constant across the strip
    > measure from beginning of P wave to beginning of QRS
  • Measure QRS duration (normal .06-.12)
    > are QRS intervals < or > 0.12sec
    > are the QRS complexes similar in appearance across ECG
    > measure from beginning of QRS to end of S wave
57
Q

ECG Rhythm Analysis

ST segment

A
  • Examine ST segment
    > elevation may indicate myocardial infarction, pericarditis, hyperkalemia
    > depression is associated w/ hypokalemia, myocardial infarction, ventricular hypertrophy
  • Interpret rhythm & differentiate noraml & abnormal cardiac rhythms
58
Q

Normal Sonus Rhythm (NSR)

A
  • Rate: 60-100 bpm
  • Rhythm: atrial & ventricular rhythms are regualr
  • P waves: present, consistent configuration, one P wave b4 each QRS complex
  • PR interval: .12-.2- second & constant
  • QRS duration: .06-.12 second & constant
59
Q

Sinus Arrhythmia (SA)

A
  • Variant of NSR
  • Results from changes in intrathoracic pressure during breathing
  • Has all characteristics of NSR expect for its irregularity
  • The PP & RR intervals vary, w/ the difference btwn the shortest & the longest intervals being greater than .12 sec (3 small blocks)
60
Q

Tachydysrhythmias

A

Heart rates greater than 100 bpm

61
Q

Bradydysrhythmias

A

Heart rates less than 60 bpm

62
Q

Premature Complexes

A
  • Early rhythm complexes
  • If they become mroe frequent, esp those that are ventricular, the pt may experience symptoms of dcrd cardiac output
63
Q

Repetitive Rhythm Complexes

A
  • Bigeminy
  • Trigeminy
  • Quadrigeminy
64
Q

Dysrhythmias

A
  • Any disorder of the heartbeat
  • Etiology: may occur for amny reasons
  • Can be classified by their site of origin in heart (sinus, atrial, ventricular)
  • Managed w/ antidysrhythmic drug therapy
    > Vaughn-Williams classification used to caregorize drugs according to their effects on the action potential of cardiac cells (classes 1-4)
    > Other drugs: digoxin, atropine sulfate, adenosine
65
Q

Atrial Dysrhythmia - Premature Atrial Complexes (PAC)

A
  • Ectopic focus of atrial tissue fires an impulse b4 nect sinus impulse is due
  • Premature P wave may not always be clearly visible bc it can be hidden in preceding T wave
  • A PAC is usually followed by a pause
66
Q

Supraventricular Tachycardia (SVT)

A
  • Rapid stimulation of strial tissue occurs at rate of 100-280 bpm in adults
  • P waves may not be visible, bc they are embedded in preceding T wave
  • Paroxysmal supraventricular tachycardia (PSVT) rhythm is intermittent, initiated suddleny by a premature complex such as a PAC & terminated suddenly w/ or w/out intervention
67
Q

Atrial Fibrillation (AF)

A
  • Most common dysrhythmia
  • Associated w/ atrial fibrosis & loss of muscle mass
  • Common in heart disease such as HTN, HF, CAD
  • Many risk factors
  • Cardiac output can dcr by as much as 20%-30%
68
Q

Care for Patient with Dysrhythmias

A
  • Assess VS q4hrs
  • Montior for cardiac dysrhythmias
  • Evaluate & document pt’s response
  • Encourage pt to notify nurse if chest pain occurs
  • Assess for chest pain & respiratory difficutly
  • Assess peripheral circulation
  • Adminster med & monitor response
  • Monitor lab values
  • Monitor activity tolerance & schedule exercise/rest periods to avoid fatigue
  • Promote stress reduction
  • Offer spiritual support
69
Q

Atrial Fibrillation - Assessment

A
  • Assess for fatigue, weakness, SOB, dizziness, anxiety, syncope, palpitations, chest discomfort or pain, hypotension
  • High risk for PE, VTE, stroke
70
Q

Atrial Fibrillation - Treatment

A
  • Drug Therapy
    > Calcium channel blocker: diltiazem (Cardizem)
    > Aminodarone (Cordarone); class 3 antiarrythmic agent
    > Beta blockers: metoprolol (Toprol) & esmolol (Brevibloc); slows ventricular response
    > Digoxin (Lanoxin): for pts w/ HR & AF
    > Anticoagulants: Heparin, enocaparin (Lovenox), warfarin (coumadin)
    > Antiplatelet: aspirin, clopidogrel (Plavix)
  • Cardioversion
  • Percutaneous radiofrequency catheter ablation
  • Bi-ventricular pacing
  • Surgical maze procedure
71
Q

Ventricular Dysrhythmias

A
  • More life-threatening than atrial
  • Left ven pumps oxygenated blood throughout body to perfuse vital organs & ptehr tissues
  • Most common or life-threatening:
    > premature ventricular complexes
    > ventricular tachycardia
    > ventricular fibrillation
    > ventricualr asystole
72
Q

Premature Ventricular Complexes (PVC)

A
  • Result from incrd irritability of ventricular cells & are seen as early ventricular complexes followed by a pause
  • May occur as:
    > bigeminy (every other beat is PVC)
    > trigeminy (every 3rd beat is PVC)
    > quadrigeminy (every 4th beat is PVC)
    > couplet (2 consecutive PVCs)
    > nonsustained ventricular tachycardia or NSVT (3 or more consecutive PVCs)
  • PVCs w/ acute myocardial infarction can lead to VT or VF, if not treated
  • Common & incrs w/ age
  • Treatment depends on cause
73
Q

Ventricular Tachycardia (VT)

A
  • V tach
  • Repetitive firing of an irritable ventricular ectopic focus, usually at 140-180 bpm or more
74
Q

Stable Ventricular Tachycardia

A
  • Treatment: oxygen, amiodarone (Cordarone), lidocaine, or magnesium sulfate, elective cardioversion, radiofrequancy catheter ablation, implantable cardioverter debrillation
  • Oral antidysrhythmic agent: mexiletine (Mexitil) or sotalol (Betapace) to prevent further occurences
75
Q

Unstable Ventricular Tachycardia

A
  • Can cause cardiac arrest, unstbale VT w/out a pulse is treated the same way at ventricular fibrillation
  • Assess pt’s airway, breathing, circulation, LOC, & oxygenation lvl
76
Q

Treatment for Ventricular Fibrillation (VF)

A
  • Life threatening: no cardiac output or pulse, blood is no longer being pumped out of the heart & brain not receiving blood
  • May be the 1st manifestation of CAD
  • Pts w/ MI are at high risk
  • 1st priority: defibrillate the pt immediately
  • Continue high quality CPR, provide airway management, follow ACLS protocol
77
Q

Ventricular Fibrillation (VF)

A
  • V fib
  • Result of electrical chaos in ventricles
78
Q

Ventricular Asystole

A
  • Ventricular standstill
  • Complete absence of any ventricular rhythm
79
Q

Treatment for Ventricular Asystole

A
  • Full cardiac arrest: no cardiac output or perfusion to the rest of the body
  • Prognosis for the pt is poor
  • Manage airway
  • Administer CPR: compressions, airway, breathing
  • Do NOT befibrillate
  • Follow ACLS protocol
80
Q

Patient Teaching - Dysrhythmias

A
  • Prevention, early recognition, & management
  • Lifestyle modifications (avoid caffeinated beverages, stop smoking, drink alcohol in moderation, follow prescribed diet)
  • Drug therapy instructions
  • Teach the pt & family how to take a pulse and/or BP & report any changes
  • Provide oral & written instructions for pacemakers, ICDs, cardiac exercise programs, support groups as applicable
81
Q

Assessment Methods - Cardiovascular System

A
  • Pt hx
  • Nutrition hx
  • Family & genetic hx
  • Current health concerns
  • Functional hx
  • Phsyical assessment
82
Q

Patient History - CV System

A
  • Focus on risk factors & symptoms
  • Assess nonmodifiable risk factors
    > age, gender, ethnicity, family hx
    > EX: men & post menopausal women at higher risk for CAD
  • Assess modifiable risk factors
    > obesity, smoking, inactivity, psychological stress
  • Assess for chronic diseases
    > EX: diabetes pts at higher risk
83
Q

Nutrition & Family+Genetic History - CV System

A
  • EX: high sodium, fat, & cholesterol can incr risk for CV disease
  • Screen 1st degree relative for history of CAD, HTN, sudden cardiac death
84
Q

Current Health Concerns/Symptoms - CV System

A
  • Chest pain or discomfort
  • Dyspnea
  • Fatigue
  • Palpiations
  • Edema
  • Syncioe
  • Extremity pain
  • Functional history
85
Q

Phsyical Assessment - CV System

general appearance

A
  • General appearance
  • Skin
    > assess color & temp
    > assess nail beds, mucous membranes, & conjunctival mucosa
    > dcrd perfusion can be manifested as cool, pale, cyanotic, gray and/or moist ski
  • Extremities
    > assess for dehydration; skin turgor
    > assess for edema (location & 1+,2+,3+,4+)
    > vascular changes (paresthesia, muscle fatigue, pain, numbness, coolness, loss of hair)
86
Q

Physical Assessment - CV System

BP

A
  • HTN
    > systolic BP >140mmHg
    > diastolic BP >90mmHg
    > taking drugs to control BP
  • BP <90/60 may not be adequate for providing enough oxygen & sufficient nutrtion to body cells
  • Postural (orthostatic) hypotension
    > dcr of more than 20mmHg of the SBP or more than 10mmHg of the DBP & 10-20% incr in HR w/ changes in position
  • Pulse pressure
    > difference bttwn systolic & diastolic values, used an indirect measure of cardiac output
87
Q

Physical Assessment - CV System

venous & arterial pulses
precordium

A
  • Venous & Arterial pulses
    > venous pulsations in neck assess for jugular venous distention (JVD)
    > assess all major peripheral pulses
    > hypokinetic pulse; weak pulse
    > hyperkinetic pulse; boudning pulse
    > auscultate carotid for bruits; normally there are no sounds if the artery has uniterrupted blood flow
  • Precordium (area over heart)
    > inspection
    > auscultation
    > S1: mitral & tricuspid valve closing
    > S2: pulmonic & aortic valve closing
    > abnormal (splitting of S2; S3, S4, murmurs, pericardial friction rub)
88
Q

Lab Assessments

A

Cellular injury causes a release of enzymes & those enzyme lvls are used to diagnose Acute Coronary Syndrome (ACS)

89
Q

Troponin

A
  • Myocardial muscle protein released when there is injury to myocardial muscle
  • Normal = T<0.10ng/mL & I < 0.03ng/mL
90
Q

Creatine Kinase (CK)

A
  • Enzyme specific to cells of the brain, myocardium, & skeletal muscle
  • CK indicated tissue necrosis or injury
  • Normal = females 30-35 units/L & males 55-170 units/L
91
Q

CK-MB

A
  • Specially found in myocardial muscle
  • Normal = 0% of total CK
92
Q

Myoglobin

A
  • Protein found in cardiac & skeletal muscle
  • Normal = <90mcg/L
93
Q

Serum Lipids

A
  • Elevated lvls incr risk for CAD
  • Cholesterol: <200mg/dL
  • Triglycerides: btwn 40 & 160 mg/dL for men and btwn 35 & 135 mg/dL for women
  • HDL: >45 mg/dL for men and >55 mg/dL for women
    > considered good cholesterol
  • LDL: <130 mg/dL
  • HDL:LDL ratio
    > 3:1 ratio
94
Q

B-Type Natriuretic Peptide (BNP)

A
  • Will be elevated & used for diagnosing heart failure: >100 is diagnostic & the higher the worse the HF
  • BNP is produced & released by the ventricles when they are stretched and fluid overload
  • Natriuretic peptides are neurohormones tht promote vasodilation and diuresis through sodium loss in the renal tubules
95
Q

Coagulation Studies

A
  • Evaluates the ability of blood to clot
  • Monitor when pts on anticoagulants
96
Q

Homocysteine

A
  • Amino acid produced when proteins break down
  • Elevated lvls indicates incr the risk for cardiac disease
  • Normal: <14mmol/dL
97
Q

C-Reactive Protein (CRP)

A
  • Any inflammatory process can produce CRP in the blood
  • Normal: <1.0 mg/dL
  • > 3 mg/dL indicates high risk for heart disease
  • Elevations are also seen w/ HTN, infection, & smoking
98
Q

Microalbuminuria

A
  • Small amnts of protein in the urine
  • Indicates andothelial dysfunction
99
Q

Hypokalemia

A

Incrd electrical instability, ventricular dysrhythmias, incrd risk for digitalis toxicity

100
Q

Hyperkalemia

A

Slowed ventricular conduction, peaked T waves in the ECG, & contraction followed by asystole

101
Q

Hypocalcemia

A

Ventricular dysrhythmias, a prolonged QT interval, cardiac arrest

102
Q

Hypercalcemia

A

Shortens the QT interval & causes AV block, digitalis hypersensitivity, and cardiac arrest

103
Q

Hypemagnesemia

A

Prolongs the QT interval causing a specific type of ventricular tachycardia

104
Q

Chest X-Ray

A

Excamine size, silhouette, & position of heart

105
Q

Angiography or Arteriography

A
  • Uses contrast dye and fluroscopy to examine arterial vessels
  • Prep: screen for allergy to dye, sedation required, usually NPO
106
Q

Electrocardiogram (ECG)

A
  • Very common & valuable diagnostic
  • Examines electrical activity of heart
  • Prep: none required
107
Q

Echocardiography (Echo)

A
  • Uses ultrasound to assess cardiac structure & mobility
  • Specifically looks at valves
  • Prep: none required
108
Q

Exercise Electrocradiography (EPS)

A
  • “stress test”
  • Assesses cardiovascular response to an incrd workload
  • Pt Prep:
    > encourage rest night before procedure
    > light meal 2hrs before test (depends on physician order)
    > avoid smoking, alcohol, & caffeine-containing drinks on day of test
    > beta blockers & calcium channel blockers usually held
    > to allow HR to incr w/ stress
    > wear comfortable clothing & rubber-soled supportive shoes
109
Q

Transesophageal Echocardiography (TEE)

A
  • Examines cardiac structure & function using ultrasound that is placed behind heart in the esophagus or stomach
  • Sedation is required
  • Prep: similar to upper GI endoscopic exam
110
Q

Myocardial Nuclear Perfusion Imaging

A
  • Radioactive tracer substances used to view cardiovascular abnormalities
  • Can view myocardial blood flow & left ventricular function
  • Prep: NPO, no caffeine or smoking 4hrs prior
111
Q

Magnetic Resonance Imaging (MRI)

A
  • Magnetic & radio waves used to view cardiac wall thickness, heart chambers, valve & ventricular function, & blood movement
  • Prep: screen for metallic objects
112
Q

Cardiac Catheterization

A
  • Studies of the right or left side of the heart and the coronary arteries using fluroscopy and contrast dye
  • Prep:
    > renal protection from contrast dye
    > fluids may be given 12-24hrs before procedure for renal protection
    > administer acetylcysteine
    > CXR, CBC, coagulation screen, & ECG done
    > NPO after midnight or liquid breakfast if procedure scheduled in afternoon
    > assess pt for contrast dye allergy (antihistamine or steriod may be given)
    > sedative may be given
    > hold digitalis or diuretic prior to procedure
113
Q

Cardiac Catheterization

post procedure

A
  • Bed rest & keep insertion site extremity straight
  • monitor VS
  • assess insertion sire for drainage or hematoma
  • assess peripheral pulses, temp, & color in affected extermity
  • monitor I&O
  • maintain hydration
  • observe for complications
114
Q

Hypertension

A
  • Most common health problem seen in primary care settings
  • AHA 2017 guidlines below 130/80
    > desired BP below 150/90 (60yrs+)
    > desired BP below 140/90 (>60yrs)
    > desired BP below 130/90 (pts w/ DM & heart disease)
  • Continuous BP elevation results in damage to organs
    > causes thickening of arterioles
    > as the blood vessels thicken, perfusion dcrs & body organs are damaged
115
Q

HTN is a major risk factor for

A
  • Stroke
  • Myocardial infarction
  • Kidney failure
  • Death
116
Q

Classifications & Etiology of HTN

primary
secondary

A
  • Primary (essential)
    > most common type
    > not caused by an existing heart problem; can develop when a pt has nay one or more of the risk factors
    > family hx
    > african american
    > hyperlipidemia
    > smoking
    > older than 60 or postmenopausal
    > excessive sodium & caffeine intake
    > overweight/obesity
    > physical inactivity
    > excessive alcohol intake
    > low potassium, calcium, or magnesium intake
    > excessive & continuous stress
  • Secondary
    > results from specific disease & some drugs
    > kidney disease is one of the most common causes of secondary HTN
117
Q

Assessment of Hypertension

A
  • Phsyical assessment/CMs
    > most ppl have no symptoms
    > some pts experience headaches, facial flushing (redness), dizziness, fainting
    > BP screenings
    > take in both arms
    > 2+ readings at a visit
    > use appropriate size cuff
  • Orthostatic hypotension
    > dcr in BP w/ changes in position
    > 20mmHg for systolic and/or 10mmHg for diastolic
  • Psychosocial
    > assess for stressors tht can worsen HTN
  • Diagnostic Assessment
    > no specific lab or x-rays are diagnostic of primary HTN
    > secondary HTN can be screened w/ labs specific to underlying disease
    > EX: kidney disease
118
Q

Interventions for HTN

A
  • Lifestyle changes
    > dietary dosium restriction to >2g
    > reduce weight
    > use alcohol sparingly
    > exercise 3-4 days a week for 40mins
    > use relaxation techniques to dcr stress
    > acoid tobacco & caffeine
  • Complementary & alterbative therapies
    > biofeedback
    > meditation
  • Drug therapy
  • avoid OTC meds (NSAIDs & decongestants)
119
Q

VTE Prevention

prevention is key

A
  • Pt education
  • Leg exercises
  • early ambulation
  • adequate hydration
  • graduated compression stockings
  • intermittent pneumatic compression (SCDs)
  • venous plexus foot pump
  • avoid oral contraceptives
  • anticoagulant therapy
120
Q

Venous Thrombeembolism (VTE)

A
  • Includes both deep vein thrombosis (DVT) & pulmonary embolism (PE)
  • Risk Factors:
    > Virchow’s Triad
    > stasis of blood
    > vessel wall injury
    > altered blood coagulation
121
Q

Symptoms of DVT

A
  • May be symptomatic or asymptomatic
  • Classic s/s:
    > calf or groin tenderness & pain
    > sudden onset of unilateral swelling of leg
  • induration (hardening) along the blood vessel
  • warmth, edema, redness
  • checking a Homans’ sign is not advised bc it is an unreliable tool
  • phsyical exam findings may be adequate for diagnosis
122
Q

Diagnostic Assessments of DVT

A
  • Preferred diagnostic test:
    > venous duplex ultrasonography
    > assesses flow of blood thrpugh veins of arms & legs
  • Lab Testing:
    > negative d-dimer test can exclude a DVT
    > used for diagnosis DVT when pt has few clinical signs
123
Q

DVT Interventions

A
  • Goals:
    > prevent pulmonary emboli, further thrombus formation, or an incr in size of thrombus
  • Observe for symptoms of pulmonary emboli:
    > SOB, chest pain, acute confusion
  • Elevate legs when in bed or chair
  • Do not massage affected extremity
  • Drug therapy:
    > anticoagulants
    > heparin
    > enoxaparin (Lovenox)
    > warfarin (Coumadin)
124
Q

Unfractionated Heparin THerapy (UFH)

A
  • baseline PT, aPTT, INR, CBC w/ platelet count
  • anti-factor Xa assay 6hrs after initiation & every day once 2 consecutive results are w/in therapeutic range
  • platelet count 24hrs after initiation & then every other day
  • IV boul (based on body weight) followed by IN infusion
  • notufy provider for:
    > suspected or confirmed bleeding: hematuria, frank or occult blood in stool, exxhymosis, petechiae, altered LOC, or pain (esp abdominal pain)
    > dcr of 50% from initial platelet count anytime during therapy
    > dcr in hemoglobin of greater than 2g/dL anytime during therapy
  • Heparin-induced thrombocytopenia (HIT); life-threatening complcication of heparin therapy
  • have antidote available for excessive bleeding
    > protamine sulfate
  • to prevent DVT, unfractionated heparin may be given in low doses SQ for high-risk pts
125
Q

Low-Molecular Weight Heparin (LMWH)

A
  • Preferred for prevention & treatment of VTE
  • EX: enoxaparin (Lovenox) given SQ
  • dosed based on weight (1mg/kg)
  • monitor PT & INR (per textbook)
  • monitor anti-factor Xa assay (per St Luke’s)
  • Serum creatinine & platelet counts are also monitored
  • assess for signs of bleeding: hematuria, frank or occult blood in stool, ecchymosis, petechiae, altered LOC, or pain
  • have antidote available for excessive bleeding
    > protamine sulfate
  • if treating acte DVT or PE, may see overlap of enoxaparin & warfarin given
  • pt can self administer at home
126
Q

Warfarin

A
  • given PO
  • monitor PT, INR
    > INR is mroe reliable
    > need to adjust med based on INR to achieve desired range
  • assess for signs of bleeding: hematuria, frank or occult blood in stool, ecchymosis, petechiae, altered LOC, or pain
  • have antidote available for excessive bleeding
    > vitamin K
  • PCP specifies the desired INR lvl to obtain
  • teach pts to avoid foods w/ high concetrations of vitamin K
    > dark green leafy vegetables
    > more difficult to acheive desired lvls
127
Q

Other DVT Interventions

A
  • other meds for clot prevention:
    > Rivaroxaban (Xarelto)
    > no labd required
    > no antidote is available
  • Thrombolytics
    > tissue plasmsinogen activators (TPA)
    > administered directly into clot through a catheter
    > not used often
    > high risk for bleeding
  • Surgical Management
    > thrombectomy
    > inferior vena cava filtration
    > very common for recurrent DVT
128
Q

Atheriosclerosis

A

Thickening, or hardening, of the arterial wall tht is often associated w/ aging

129
Q

Atherosclerosis

A
  • Type of arteriosclerosis
  • involved the formation of plaque w/in arterial wall
  • leading risk factor for cardiovascular disease
130
Q

Risk Factors for Atherosclerosis

A
  • Low HDL-C (high density lipoprotein)
  • HIgh LDL-C (low density lipoprotein)
  • incrd triglycerides
  • genetic disposition
  • DM
  • obesity
  • sedentary lifestyle
  • smoking
  • stress
  • african-american or hispanic ethnicity
  • older adult
131
Q

Atherosclerosis Lab Assessments

A
  • Elevated lipids (cholesterol & triglycerides)
  • Total Serum Cholesterol
    > should be below 200 mg/dL
  • LDL (bad) cholesterol
    > incrd lvls indicated incrd risk
    > should be <130
  • HDL (good) cholesterol
    > incrd lvls, lower risk of CAD
    > should be >50
132
Q

Atherosclerosis Interventions

A
  • Lifestyle modifcation such as smoking, weight management, exercise, & nutrition
  • Drug therapy
    > statin or other lipid-lowering agents
133
Q

Statins (HMG-CoA)

A
  • Common statin EX:
    > Lovastatin (Mevacor)
    > Atorvastatin (Lipitor)
    > Simvastatin (Zocor)
    > Rosuvastatin (Crestor)
    > Pravastatin (Pravachol)
  • Reduce cholesterole synthesis in liver & incr clearance of LDL from blood
  • Contraindicated in active liver disease or during pregnancy
  • D/C if pt experiences muscle cramping or elevated liver enzyme lvls
  • avoid grapefruit juice
134
Q

Interventions for PAD

A
  • Exercise
  • Positioning
    > avoid crossing legs & weraing restrictive clothing
    > elevated legs/feet avoid raising above heart lvl
    > extreme elevation slows arterial blood flow to feet
  • Promote vasodilation
    > avoid cold exposure to affected extremity w/ warm socks & room temp modulation
    > avoid applying direct heat (heating pad, hot water) to limb
    > avoid emotional stress, caffeine, & nicotine (can cause vasoconstriction)
  • Drug Therapy
    > hemorheologic agents Pentoxifylline (Trental)
    > Antiplatelet agents ASA, Clopidogrel (Plavix)
  • Control BP
  • Invasive nonsurgical procedures
    > percutaneous transluminal angioplasty (PTA)
    > atherectomy
  • Surgical Management
    > arterial revascularization
135
Q

Acute Peripheral Arterial Occlusion

A
  • Occlusions may be sudden & dramatic
  • caused by embolus or thrombus
    > embolus is the most common cause
  • More common in lower extremities
  • most pts w/ an embolic occlusion have had a recent acute MI and/or artial fibrillation
  • CMs
    > cool or cold, pulseless, and mottled affected extremity
  • “Six P’s” of ischemia
    > pain, pallor, pulselessness, paresthesia, paralysis, poikilothermy (coolness)
136
Q

Acute Peripheral Arterial Occlusion Interventions

A
  • Prompt treatment is essentail to avoid permanent damage or loss of an extremity
  • Anticoagulant therapy (Heparin)
  • Surgical
    > embolectomy or thrombectomy
137
Q

Aneurysms

types

A
  • Permanent localized dilation of an artery, enlarges the artery to at least 2x normal diameter
  • Types:
    > abdominal aortic aneurysms (AAAs) account for most aneurysms, commonly asymptomatic, & frequently rupture
    > CMs: abdominal, flank, or back pain tht is usually steady, w/ a gnawing quality, is unaffected by movement, & may last for hrs or days; prominent pulsation in upper abdomen (do not palpate)
    > thoracic aortic aneurysms (TAAs)
  • Rupture is most frequent complication & is life threatening bc abrupt & massive hemorrhagic shock results
    > pain described as tearing, ripping, & stabbing & located in chest, back, abdomen; symps of hypovolemic shock, N/V, & apprehension
138
Q

Aneurysms

etiology
imaging
management

A
  • Etiology
    > atherosclerosis
    > HTN
    > hyperlipidemia
    > smoking
  • Imaging
    > CT scan w/ contrast is standard tool for assesing size & location
  • Size of aneurysms & presence of symps determine pt management
  • Nonsurgical Management
    > monitor growth & maintain BP at normal lvl to dcr the risk for rupture
  • Surgical Managment
    > resection or rapair (aneurysmectomy)
    > high risk
    > endovascular stent graft
    > pricedure of choice

NUR3220 ADULT HEALTH I (13 decks)

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