Exam 3: Neuro & Cardiac Flashcards
DVT
patho: clot formed in large vein
etiology: virchow’s triad
signs: warmth, tenderness, swelling, pain
diagnostics: D dimer & venous duplex ultrasound
RN interv: greatest risk for PE, monitor O2, admin meds (heparin, tpa, coumadin, lovenox), monitor for bleeding, monitor PTT
virchow’s triad
3 causes for DVT:
venous stasis
vessel damage
hypercoagulability
anticoagulant
heparin, lovenox (LMWH), warfarin
monitor PTT and UHV and INR
if on Heparin drip, monitor PTT !!!
warfarin antidote= vit K
thrombolytic
tpa
antiplatelet
aspirin, plavix
Myocarditis
patho: damage to myocardium by virus
etiology: men & kids most
signs: heart failure, chest pain, carcinogenic shock, hypotension, tachycardia, tachyons, dysthymias, low O2
diagnostic: CRP and sed rate, troponin, echo, MRI, myocardial biopsy
RN interv: treat dysthymia’s and symptoms, admin steroids or immunosuppressants
pericarditis
patho: inflammation of pericardium
etiology: often post MI
diagnostic: EKG, CXR, echo, cardiac CT, MRI
signs: pleuritic chest pain, fever, ST elevation and PR depression, hypotension, tachycardia, tachypnea, pericardial friction rub, pulsus paradoxus
RN interv: alleviate pain by NSAIDs, anti inflammatories, aspirin.
pulsus paradoxus
on inspiration, systolic BP drops
assessed by arterial line montioring
infective endocarditis
patho: infection of mitral or aortic valves
etiology: age, immunodeficiency!!, IV drug use
diagnostics: blood cultures, echo, elevated WBC
signs: osler’s node (painful), janeway lesions(nonpainful), splinter hemorrhage, hypotension, tachycardia, murmur, fever, fatigue, confusion, weak peripheral pulses, pale cold extremeties
RN interv: IV antibiotic therapy via PICC for 4-6weeks, maintain IV access, provide social support, educate on oral hygiene and completing antibiotic regimen
complications: embolic event(leads to stroke), TIA(risk for strokes), sepsis,
to draw blood cultures
draw from 2 separate sites before antibiotics are started
valvular disease
patho: regurgitation or valvular stenosis.
diagnosis: echo, CXR, cardiac cath
signs: murmur, SOB, crackles, angina, weight gain, weak pulses
RN interv: ACEI (vasodilate to decrease BP), diuretics, valve replacement, restrict sodium and fluids, educate on med regimen, consider prophylactic antimicrobial
left sided heart failure
patho: pushes blood back into pulmonary
signs: orthopnea, hypoxia, crackles, pulmonary edema, dyspnea, S3
right sided heart failure
signs: peripheral edema, ascites, JVD, hepatomegaly
cranial nerve I
olfactory nerve
smell
cranial nerve II
optic nerve
visual acuity
cranial nerve III
oculomotor nerve
eye movement
cranial nerve IV
trochlear nerve
eye movement
cranial nerve V
trigeminal nerve
chewing and face sensation, jaw
cranial nerve VI
abducens nerve
eye movement
cranial nerve VII
facial nerve
facial expression
cranial nerve VIII
vestibulocochlear nerve
balance and hearing
cranial nerve IX
glossopharyngeal nerve
swallowing and taste
cranial nerve X
vagus nerve
parasympathetic nervous system
cranial nerve XI
spinal accessory nerve
shoulder shrug
cranial nerve XII
hypoglossal nerve
tongue movement
hypertension
etiology: increased salt= increased water retention= increased CO= increased BP
signs: chest pain, SOB, fatigue, renal dysfunction
diagnosis: 2 or more high blood pressure readings in 2 or more office visits
RN interv: meds (statins, diuretics, ACEI, beta blockers, Ca channel blockers), educate lifestyle changes
peripheral arterial disease
patho: progressive chronic condition w obstruction of blood flow through peripheral arteries
diagnostics: ABI below 0.9
signs: claudication, cool extremities, loss of hair and thickening toe nails
RN interv: monitor ABI, palpate bilateral pulses, assess bilateral muscle tone, assess pain, keep limb dependent, no crossing limbs, at risk for becoming limb ischemia
carotid artery disease
patho: vessel wall thickening, plaque formation, occluding blood in carotid artery
diagnosis: carotid duplex scan, CT angiography, carotid angiography
signs: carotid bruit, slurred speech, facial droop, weakness, dizziness,
RN interv: assess cranial nerves VII, X, XI, XII post CEA, admin antihypertensives and antiplatelets
how to position pt w hypotension
lay down flat
how to position pt w hypertension
elevate head of bed
aortic artery disease
aneurysm
patho: media of artery is weakened, stretching intima, widening artery and increasing tension
RN interv: admin statins
arterial lines
displays a constant systemic blood pressure
used to obtain ABGs
central line
often connected to arterial line
ensure no bubbles
remove w one exhale to prevent air embolism
central venous monitoring
allows CVP monitoring, including RAP
normal RAP: 5-10
high RAP: hypervolemic
low RAP: hypovolemic
PA catheter “Swan”
through right side of heart into pulmonary artery
myocardial infarction
patho: dead heart muscle r/t lack of oxygen
diagnosis: increased troponin, CK-MB, myoglobin
NSTEMI- non ST elevation, partial occlusion
STEMI- ST elevation, full occlusion, damage occuring
RN interv: MONA (morphine, oxygen, nitro, aspirin) give 4 baby aspirin
post coronary artery bypass grafting assessment
hemodynamic monitoring (PAP, CVP)
continuous tele
heart sounds
continuous pulse ox
core temp (foley cath)
assess I+O
assess neuro
monitor chest tube (should be less than 100cc per hr)
post CABG interventions
control bp
admin fluids
admin sedation
rewarm pt slowly
pulmonary hygiene
sternal precautions
monitor for infection
cardiogenic shock
patho: heart unable to pump for adequate tissue perfusion
signs: tachycardia, hypotension, narrowed pulse pressure, decreased pulses, cool extremities
RN interv: meds to increase bp, admin oxygen, anticipate intubation
pt w mechanical valve…
will need to be on anticoagulant for whole life
CSF should..
be clear, colorless
have no bacteria
have no RBCs
WILL contain glucose
lumbar punctures
performed in pt w neuro changes and high WBC
place pt in fetal position on side
have pt lay flat for at least 1 hr after
major SE: spinal headaches
cerebrovascular accident (stroke)
three types:
-TIA: symptoms come and go, stroke precursor
-ischemic: no blood flow to brain (if right sided stroke=manifestations on left side)
-hemorrhagic: brain bleed (weakness + falls)
CT scan is 1st line diagnostic test if suspected stroke
acute care for ischemic stroke
establish IV for CT
possibly admin thrombolytic therapy (tPa) depending on last known well time
NPO
HOB at 30
keep systolic 160+
seizure precautions
acute care for hemorrhagic stroke
keep systolic below 160 degree
seizure prophylaxis meds
clips and coils may be needed
core measures
hospital regulated
pts in afib need to be on anticoagulants
need to be on bp meds at discharge
documented stroke education
tension headache
stress headache
bilateral pressing, tightening
tylenol or NSAIDs can be used
assess alcohol consumption
migraine
recurring, unilateral throbbing
try NSAIDs, triptans
cluster headaches
repeated, primarily men
sharp, stabbing, pulsing pain
use triptans and provide oxygen
seizure
transient, uncontrolled electric discharge of neurons
four phases:
-prodromal
-aural (seizure occurs after)
-ictal
-postictal
focal seizure
one side of brain
alert/simple focal=sensing things that are not there
altered/complex focal=unaware of consciousness, dangerous
generalized seizures
both sides of brain
either probable altered or brief altered
probable altered consciousness
tonic clonic- falling, body jerk movements
absence- in kids, daydreaming
brief or possible altered consciousness
myoclonic- sudden excessive muscle jerking
atonic- loss of muscle tone, falling
tonic- very stiff, usually in sleep
clonic- jerking rhythmic movement
status epilepticus
continuous seizure activity that lasts longer than 5 minutes
pt unconscious
admin IV loraz and diaz
lay on left side
multiple sclerosis
patho: chronic, progressive, autoimmune degenerative disease of myelin sheath
diagnosis: increased protein and WBC in CSF, MRI shows plaques on brain
signs: bowel/bladder dysfunction, ataxia, slowed movements, diplopia, fatigue
RN interv: meds for best QOL (baclofen, steroids, immunosupressents)
myasthenia gravis
patho: autoimmune, antibodies attack Ach receptors
signs: facial drooping, oxygenation issues, risk for aspiration
treat: steroids or thymectomy
guillan barre syndrome
patho: rapidly progressing flaccid paralysis to lower extremities
etiology: usually post infection
diagnosis: EMG (shows decreased nerve conduction velocity)
RN interv: plasmapheresis, IVIG, high risk for DVTs, admin enteral feedings
trigeminal neuralgia
cranial nerve V disorder
sudden unilateral stabbing pain in jaw
treat w AED(carbamezapine and gabapentin, and muscle relaxant (baclofen)
beware of tremors w high doses of gabapentin
MAP calculation
(2x DBP) + SBP / 3
ACEI meds
end in -pril
decrease afterload
beta blockers
increase contractility and therefore decrease workload of heart
dobutamine and milrinone
inotropic meds that increase contraction of heart
nitrates and diuretics
decrease preload
cardiomyopathy
dilated- ventricles enlarge
hypertrophic- ventricle wall thickens
restrictive- walls become stiff
often treated w LVAD or pacemaker
Glascow coma scale
verbal response
eye response
motor response
normal pulmonary arterial pressure
