Exam 4 Flashcards
Bruit
Swishing sound as blood attempts to push through narrowed artery
Often carotid, aortic, popliteal or femoral artery
Murmur
Same sound as bruit but only related to heart
Sinus bradycardia
Normal for athletes or young people
<45 can cause syncope, weakness, confusion, sweating, SOB, angina
Tx for sinus bradycardia
Atropine
Transcutaneous pacing- avoid strenuous activity after placement of pacemaker until leads are healed
A fib
No discernible P waves
P rates of 300-600/min
QRS normal
High risk for developing clots
Need anticoagulants
A fib Tx
Diltiazem to reduce rate
Amiodarone
Cardioversion
V fib
“De-fib”
Squiggly lines- they’re dead- no pulse
Leading cause of cardiac arrest
Need defibrillation right away - 3-5 min
Administer antidysrrhythmic (Amiodarone)
V-Tach
Life threatening- ventricles take over as pacemaker
If pulse and no change in LOC- need synchronized Cardioversion
If no pulse, defibrillate
Asystole
Not a shockable rhythm
Dx of CHF
BNP(B-type natriuretic peptide) lvl high
Causes of left sided HF
HTN, CAD, mitral or aortic valve disorders
S/S of left sided HF
Tachypnea
Muscle weakness
Weak distal pulses
Pale
Cough w/ pink frothy sputum
Crackles/rales
Right sided HF causes
Left ventricle failure
Right ventricle MI
Pulmonary HTN
COPD
ARDS
S/S of right sided HF
Edema in extremities
JVD
Organ congestion-ascites
Teaching for right sided HF
Weigh daily- 2:5 rule
Energy conservative techniques
Eat small meals with rest afterwards
Possibly may need pacemaker for severe bradycardia
CAD causes
Inflammation and lipid deposits in wall of arteries
LDL
<100
HDL
> 40
Tx of CAD
CABG
CABG (coronary artery bypass graft)
Surgery to bypass blockage in one or more of coronary arteries using saphenous veins, mammary artery or radial artery
Atherosclerosis
Plaque in arterial wall causing narrowing or blockage of artery (bruit)
If blocked, ischemia or infarction possible
Progressive- begins early in life
Arteriosclerosis
Hardening/thickening of arteries
S/S of Arteriosclerosis
Angina
Arm/leg weakness or numbness
Difficulty speaking
Loss of vision in one eye
HTN
Kidney failure
HTN
Primary- develops gradually
Secondary- caused by something- usually back to normal if problem fixed
Malignant HTN S/S
Occurs suddenly-medical emergency
“Worst headache ever”
Swelling in legs/feet
Changes in eye (blurred vision)
Abnormal heart sounds
Fluid in lungs (dyspnea)
May leak fluid or blood (nosebleed)
Teaching for malignant HTN
Wt reduction
Eliminate saturated fats
Sodium restriction <2g
PAD teaching
Potential loss of limb/life
Warm compresses
Dont elevate or cross legs
PAD S/S
Pain in lower extremity with exercise (intermittent claudication)
Loss of hair on lower calf
Dry, scaly pale skin
Rubor with dependent position
PVD causes
> 40 yrs
Surgery
Immobility
Phlebitis
Prolonged travel
Stroke
Obesity
Pregnancy
Highest risk pts for PVD
Hx of orthopedic surgery
Teaching for DVT
PTT lvl on heparin needs to be <75 (50-70)
Calf painful, swollen, red - DVT
Don’t check homans sign
Elevate legs with slight knee bend
No high impact exercises
Acute peripheral occlusion
Arteries occluded from embolism, thrombosis, trauma, Vasospasm or edema
Tx of Acute peripheral occlusion
T-PA to dissolve clots
Dx of Acute peripheral occlusion
Cholesterol lvls
Arteriography of lower extremities
Stunting of narrowed vessel
Peripheral or femoral bypass surgery
Monitor plts and coagulants
Buergers disease
Inflammatory disease of distal small and medium sized arteries and veins of extremities
Risk factors for Buergers disease
Smoking
Men
Teaching for Buergers disease
Raising arm doesn’t help
Warm foot soaks
Avoid cold, caffeine, stress, smoking
S/S of buergers disease
Pain with walking- ulcers/gangrene- amputations
Weak pulses
Rubor or cyanotic
Reynauds disease
“Red, white and blue disease”
Color changes- white, blue, then red in hands from spasms of digital arteries
Exacerbated by vasoconstriction - stress, caffeine, nicotine, cold, chocolate
Teaching for Reynauds disease
Keep hands/feet warm and dry
Keep body from cold exposure
No caffeine or tobacco
Tx for Reynauds disease
Nifedipine (calcium channel blocker) - decreases frequency, duration and intensity
Could take prophylactically 1-2 hrs before cold exposure
Venous insufficiency
Obstruction of venous valves in legs or a reflux of blood back through the valves
S/S of venous insufficiency
Edema
Altered pigmentation
Pain
Dilated superficial veins
Stasis ulcers
Teaching for venous insufficiency
Elevate legs
Compression stockings
Walking
No crossing legs avoid restrictive clothing
Protect skin from trauma
Varicose veins
Protruding veins that are dark, raised and crooked caused by weak vein valves, high venous pressure and incompetent valves
Varicose veins common in
Standing for long periods of time
Pregnant
Obese
Systemic problems
S/S of varicose veins
Aching pain in legs
Fatigue and heaviness
Stasis dermatitis
Heat in leg
Discolored skin above ankles
Nursing interventions for varicose veins
Active ROM
Elevate legs
Stop smoking
Compression stockings
Amputations teaching
Soft or rigid dressing after
Elevate stump for 24-48 hrs after ONLY
Move/turn slowly to prevent severe muscle spasms
Prone and push stump into bed to prevent contractures
No pillows under or between legs
Gabapentin to relieve phantom pain
Migraines tx
Sumatriptan - don’t take with SSRIs or St. John’s wort
NSAIDs or Tylenol are okay
Lumbar puncture
To obtain CSF sample to rule out meningitis
After procedure- monitor for nausea , LOC, respiratory status, assess sensation in legs/toes
DONT restrict fluids
Tonic clonic seizures
“Grand mal”
Not able to hear, talk or sense
Loss of consciousness, no breathing, stiffening, shaking
Tx of seizures
Lorazepam to break seizure
Midazolam if status epilepticus
Anti epileptic drugs can cause
Osteoporosis in post menopausal women
Parkinson’s s/s
Tremors at rest
Rigidity (pill rolling)
Bradykinesia
Loss of postural reflexes
Freezing movement
Mask like face
Parkinson’s tx
Carbidopa/levodopa - no protein shakes with med, can cause orthostatic hypotension
Multiple sclerosis
Affects myelin sheath of nerve
S/S of multiple sclerosis
Weakness or tingling
Vision loss
Problems with coordination
Muscle spasticity
Slurred speech
Problems with bladder control
Teaching for multiple sclerosis
Eye patch to block diplopia
Test bath water with unaffected extremity
Interferon beta subQ injection x3 a week- monitor for immunosuppression
Potholder when cooking
No heating pads
Gloves in cold weather
Drink fluids
Transient ischemic attack
Sudden S/S of stroke that lasts minutes-hrs and resolves within 24 hrs
Warning sign for full blown stroke
Placed on anti platelets (ASA plavix)
Tx of Transient ischemic attack
CT without contrast
Ischemic stroke
Blockage of vessel
Hemorrhagic stroke
Rupture of vessel
Risk for stroke
DM
Stress
Obesity
Oral contraceptives
Teaching for stroke
Vision changes - safety concern
No eating/drinking until swallow test
tPA administration
For ischemic stroke only
Monitor in ICU q1hr x 24hrs for AMS, Headache, high BP, N/V and bleeding
Keep BP < 185/110
No venipuncture
No anticoags or anti-platelets
No recent surgery or head injury
Decortication
To the core
Flexes extremities towards body
Decerebration
Posturing that extends extremities outward
Cataracts
Distorts image projected into retina causing blurry vision
Only Tx is surgery
Teaching for cataracts
Eye protection from UV light
Post op for cataract surgery
Elevate HOB 30-45
Eye drops several times a day for 3-4 weeks
Position on nonoperative side with belongings on same side
REPORT bruising, swelling or flashes of light
Clear discharge is okay
Glaucoma
Increased intraocular pressure
2nd leading cause of blindness
Central vision not affected
If not treated, can damage optic nerve resulting in blindness
Risk factors for glaucoma
HTN
DM
Cardiovascular disease
Obesity
Nursing interventions for glaucoma
Timolol can cause bronchospasms and bradycardia
Macular degeneration
Deterioration of central vision field
Lose vision faster if you smoke
S/S of macular degeneration
Mild blurring and distortions REPORT
Color perception changes/diminishes
Retinal detachment
Retina deprived of blood supply
Sudden onset
S/S of retinal detachment
Shadow or curtain being drawn over vision
Flashes of light
Floaters or black spots (sign of bleeding)
Retinal detachment Tx
Gas bubble that puts pressure on retina to keep it in place
Face down for weeks and no strain on eye for one week
Risk factors for hearing loss
Age
Family hx
Injury
Exposure to excessive noise levels
Meds that are ototoxic
Hearing aid teaching
Use at home first
Adjust to lowest volume
Turn off, remove battery and place in case when not using
Clean ear mold with soap and water, NOT alcohol
Menieres disease
Excessive fluid in ear (usually one sided)
S/S of Menieres disease
Vertigo
Tinnitus
Headache
N/V
Hearing loss
Tx of Menieres disease
Low sodium diet and diuretics
Osteoarthritis
Non symmetrical joint pain from deterioration of cartilage
Cause unknown
Triggered by aging, obesity, smoking, sports, trauma
Heberdeem and bouchards nodes
Swelling of joints found in osteoarthritis pts
Heberdeem: joint by nail
Bouchards: joint in middle of finger
Rheumatoid arthritis
Autoimmune
Ulnar deviation of fingers
Cause unknown
Symmetrical- happens on both sides of body
Hugh risk for smokers
Stiffness more in morning and relieved by moving
Osteoporosis
Loss of bone strength
Preventable
Risk factors for Osteoporosis
Corticosteroid use
Estrogen deficiency
Antiepileptic drug use
Smoking
Teaching for osteoporosis
Increase Ca and vit D (Calcitriol)
Weight bearing exercises
Reduce carbonated drinks and caffeine
Tx for osteoporosis
Biphosphonates
Osteomyelitis
Bone infection
S/S of Osteomyelitis
Tachycardia
Fever
Hx of pressure ulcer
Elevated ESR level
Constant bone pain
Tx of Osteomyelitis
Long term IV Abts that can take up to 3 months
Nursing care for fracture
Straps to hold abduction pillow
Bucks traction
Bucks traction
Realigns broken bones
Helps with severe pain
Temporary
Weight not to exceed 10 lbs
Don’t let weights rest on floor
Cast care
Check circulation - paresthesia 1st sign of compartment syndrome
Don’t allow to get soft or wet
Cold compresses to itchy areas
Fat embolism syndrome S/S
Occurs with long bones
Lethargy
Petechiae
Hypoxemia
Tachypnea
Decreased LOC and confusion
Arthroplasty
Hip and knee joints replaced
Complications- DVTs, bleeding, infection, loosening of prosthetic part
Post op: REPORT disoriented and restless
Carpal tunnel tx
Non surgical splinting
Cool packs
NSAIDS
Corticosteroids
Hand yoga
Frequent breaks
Sprains S/S
Stretching/tearing of ligaments
Pain
Swelling
Bruising
Unable to move or use joint
STrains S/S
Stretching/tearing of tendon or muscle
Pain
Muscle spasms
Weakness
Swelling
Cramping
Trouble moving muscle
Herniated disk
Common cause of disability
Place in Williams position- semi fowlers with pillow under knees
Tx of Herniated disk
Discectomy
Laminectomy
Spinal fusion
Post op: need swallow test before oral intake
