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ADULT HEALTH 1 > Exam 3: Neuro & Cardiac > Flashcards

Exam 3: Neuro & Cardiac Flashcards

1
Q

DVT

A

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

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2
Q

virchow’s triad

A

3 causes for DVT:
venous stasis
vessel damage
hypercoagulability

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3
Q

anticoagulant

A

heparin, lovenox (LMWH), warfarin
monitor PTT and UHV and INR
if on Heparin drip, monitor PTT !!!
warfarin antidote= vit K

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4
Q

thrombolytic

A

tpa

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5
Q

antiplatelet

A

aspirin, plavix

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6
Q

Myocarditis

A

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

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7
Q

pericarditis

A

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.

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8
Q

pulsus paradoxus

A

on inspiration, systolic BP drops
assessed by arterial line montioring

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9
Q

infective endocarditis

A

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,

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10
Q

to draw blood cultures

A

draw from 2 separate sites before antibiotics are started

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11
Q

valvular disease

A

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

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12
Q

left sided heart failure

A

patho: pushes blood back into pulmonary
signs: orthopnea, hypoxia, crackles, pulmonary edema, dyspnea, S3

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13
Q

right sided heart failure

A

signs: peripheral edema, ascites, JVD, hepatomegaly

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14
Q

cranial nerve I

A

olfactory nerve
smell

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15
Q

cranial nerve II

A

optic nerve
visual acuity

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16
Q

cranial nerve III

A

oculomotor nerve
eye movement

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17
Q

cranial nerve IV

A

trochlear nerve
eye movement

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18
Q

cranial nerve V

A

trigeminal nerve
chewing and face sensation, jaw

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19
Q

cranial nerve VI

A

abducens nerve
eye movement

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20
Q

cranial nerve VII

A

facial nerve
facial expression

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21
Q

cranial nerve VIII

A

vestibulocochlear nerve
balance and hearing

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22
Q

cranial nerve IX

A

glossopharyngeal nerve
swallowing and taste

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23
Q

cranial nerve X

A

vagus nerve
parasympathetic nervous system

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24
Q

cranial nerve XI

A

spinal accessory nerve
shoulder shrug

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25
Q

cranial nerve XII

A

hypoglossal nerve
tongue movement

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26
Q

hypertension

A

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

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27
Q

peripheral arterial disease

A

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

28
Q

carotid artery disease

A

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

29
Q

how to position pt w hypotension

A

lay down flat

30
Q

how to position pt w hypertension

A

elevate head of bed

31
Q

aortic artery disease

A

aneurysm
patho: media of artery is weakened, stretching intima, widening artery and increasing tension
RN interv: admin statins

32
Q

arterial lines

A

displays a constant systemic blood pressure
used to obtain ABGs

33
Q

central line

A

often connected to arterial line
ensure no bubbles
remove w one exhale to prevent air embolism

34
Q

central venous monitoring

A

allows CVP monitoring, including RAP
normal RAP: 5-10
high RAP: hypervolemic
low RAP: hypovolemic

35
Q

PA catheter “Swan”

A

through right side of heart into pulmonary artery

36
Q

myocardial infarction

A

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

37
Q

post coronary artery bypass grafting assessment

A

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)

38
Q

post CABG interventions

A

control bp
admin fluids
admin sedation
rewarm pt slowly
pulmonary hygiene
sternal precautions
monitor for infection

39
Q

cardiogenic shock

A

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

40
Q

pt w mechanical valve…

A

will need to be on anticoagulant for whole life

41
Q

CSF should..

A

be clear, colorless
have no bacteria
have no RBCs
WILL contain glucose

42
Q

lumbar punctures

A

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

43
Q

cerebrovascular accident (stroke)

A

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

44
Q

acute care for ischemic stroke

A

establish IV for CT
possibly admin thrombolytic therapy (tPa) depending on last known well time
NPO
HOB at 30
keep systolic 160+
seizure precautions

45
Q

acute care for hemorrhagic stroke

A

keep systolic below 160 degree
seizure prophylaxis meds
clips and coils may be needed

46
Q

core measures

A

hospital regulated
pts in afib need to be on anticoagulants
need to be on bp meds at discharge
documented stroke education

47
Q

tension headache

A

stress headache
bilateral pressing, tightening
tylenol or NSAIDs can be used
assess alcohol consumption

48
Q

migraine

A

recurring, unilateral throbbing
try NSAIDs, triptans

49
Q

cluster headaches

A

repeated, primarily men
sharp, stabbing, pulsing pain
use triptans and provide oxygen

50
Q

seizure

A

transient, uncontrolled electric discharge of neurons
four phases:
-prodromal
-aural (seizure occurs after)
-ictal
-postictal

51
Q

focal seizure

A

one side of brain
alert/simple focal=sensing things that are not there
altered/complex focal=unaware of consciousness, dangerous

52
Q

generalized seizures

A

both sides of brain
either probable altered or brief altered

53
Q

probable altered consciousness

A

tonic clonic- falling, body jerk movements
absence- in kids, daydreaming

54
Q

brief or possible altered consciousness

A

myoclonic- sudden excessive muscle jerking
atonic- loss of muscle tone, falling
tonic- very stiff, usually in sleep
clonic- jerking rhythmic movement

55
Q

status epilepticus

A

continuous seizure activity that lasts longer than 5 minutes
pt unconscious
admin IV loraz and diaz
lay on left side

56
Q

multiple sclerosis

A

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)

57
Q

myasthenia gravis

A

patho: autoimmune, antibodies attack Ach receptors
signs: facial drooping, oxygenation issues, risk for aspiration
treat: steroids or thymectomy

58
Q

guillan barre syndrome

A

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

59
Q

trigeminal neuralgia

A

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

60
Q

MAP calculation

A

(2x DBP) + SBP / 3

61
Q

ACEI meds

A

end in -pril
decrease afterload

62
Q

beta blockers

A

increase contractility and therefore decrease workload of heart

63
Q

dobutamine and milrinone

A

inotropic meds that increase contraction of heart

64
Q

nitrates and diuretics

A

decrease preload

65
Q

cardiomyopathy

A

dilated- ventricles enlarge
hypertrophic- ventricle wall thickens
restrictive- walls become stiff
often treated w LVAD or pacemaker

66
Q

Glascow coma scale

A

verbal response
eye response
motor response

67
Q

normal pulmonary arterial pressure

A

ADULT HEALTH 1 (2 decks)

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