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Med Surg 1 > Exam 4 > Flashcards

Exam 4 Flashcards

1
Q

Bronchoscopy

A

Direct visualization of bronchi with a fiber optic bronchoscope, Need: informed consent NPO status vital signs Assess labs Remove dentures Prepare suction equipment Begin IV/administer sedative Emergency equipment available

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2
Q

Lung biopsy

A 
purpose to obtain tissue, cells, or secretions for evaluation
Transbronchial approach
Percutaneous or Transthoracic needle
Video-assisted thoracic surgery (VATS) 
Open lung biopsy (surgery)
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3
Q

Transbronchial Approach or Transbronchial Needle Aspiration

A

Obtain consent, NPO, Sensation of pressure may be felt during needle insertion and aspiration
Monitor VS
Apply dressing and monitor for drainage or bleeding
Monitor for signs of respiratory distress/notify MD
Monitor for signs of pneumothorax/notify MD

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4
Q

Thoracentesis

A

Used to obtain pleural fluid for diagnosis, remove pleural fluid, or instill medication

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5
Q

Epistaxis

A

Nose bleed pinch nose and lean slightly forward
Causes:
Trauma Foreign bodies topical corticosteroid use Nasal spray abuse Street drug use Anatomic malformations Allergic rhinitis tumors
Any condition that prolongs bleeding time or alters platelet counts
If it does not stop pack it or get nasal sling

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6
Q

Acute Pharyngitis

A

Acute inflammation of pharyngeal walls which may include the tonsils, palate, and uvula.
Can be caused by Bacteria Virus Fungus

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7
Q

Acute Bronchitis

A

Most common symptom- cough (10-20 days) Clear mucus Headache Malaise shortness of breath on exertion sometimes low-grade fever Chest discomfort
Diagnosis: chest xray or history

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8
Q

Acute bronchitis treatment

A

Usually self-limiting
Treatment supportive: fluids Rest Anti-inflammatory agents
Cough suppressants & bronchodilators for nocturnal cough or wheezing Humidifier or steam in bathroom
Antibiotics only if prolonged infection associated with systemic symptoms
Antiviral drugs (oseltamivir-Tamiflu) if started within 48 hours of onset of infection

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9
Q

Pneumonia

A

Acute Inflammation of one or both lungs caused by microorganisms
Pneumonia results when the defense mechanism become incompetent or overwhelmed by the virulence or quantity of infectious agents
Can reach lungs by aspiration inhalation of microbes from air or hematogenous spread from other place in the body

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10
Q

Clinical manifestations of pneumonia

A 
Fever, chills, or sweats
Respiratory rate greater than 20
Heart rate greater than 100
Crackles heard on auscultation; dullness with percussion
Chest discomfort
Dyspnea
Rusty colored sputum
Cough
Fatigue, muscle aches, headache, nausea
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11
Q

Atypical pneumonia

A

Pneumonia that manifests with a more gradual onset, a dry cough, and extrapulmonary manifestations (fever, headache, sore throat, nausea, vomiting, and diarrhea

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12
Q

Labs and diagnosis of pneumonia

A 
Chest x-ray
Sputum gram stain and culture
CBC
ABG
Blood cultures
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13
Q

More H+ =

A

decrease PH- acid

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14
Q

Less H+ =

A

Increased PH - base

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15
Q

normal arterial blood PH

A

7.35-7.45

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16
Q

PH lower than 6.8 and higher than 7.8 are

A

fatal

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17
Q

pCO2 normal level

A

35-45, controlled by the lungs

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18
Q

pCO2 higher than normal is ____ lower is _____

A

acidosis, alkalosis

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19
Q

HCO3 normal level

A

22-26, controlled by the kidney

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20
Q

HCO3 higher than normal _____ lower is _____

A

alkalosis, acidosis

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21
Q

buffer system

A

acts immediately, acts chemically to change strong acids into weaker acids or to bind acids to neutralize their effect, first line of defense at the cellular level to buffer excess acid or base

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22
Q

decrease PH Increased acid= ____ K

A

increase

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23
Q

increase PH increase alkaline = ____ K

A

decrease

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24
Q

hold pressure for ___ minutes after ABG

A

5

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25
Q

ROME

A

respiratory opposite metabolic equal

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26
Q

If uncompensated or partially compensated

A

the pH remains outside the normal range

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27
Q

If fully compensated

A

the pH has returned to within the normal range (the other values may still be abnormal)

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28
Q

Complications of hypertension

A

Blindness stroke mi heart failure kidney failure

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29
Q

Cultural diffderences for hypertension

A

Hypertension is increased in African Americans
Hypertension affects African American females more than African American males
Hypertension in Whites and Hispanics is more prevalent in males than in females
African Americans acquire hypertension at a younger age and are more at risk for hypertensive kidney disease.
The highest rate of hypertension in the United States occurs among African Americans living in the southeastern states

30
Q

How to prevent and control hypertension

A 
Healthy weight
Reduce sodium intake
Increase physical exercise
Limit alcohol
Monitor B/P and know what is normal
Take medication as directed
31
Q

For bp to rise

A

CO or SVR must increase

32
Q

Primary hypertension

A

90-95% of all cases, unknown cause

33
Q

Risk factors for primary hypertension

A

Age alcohol cigarette use diabetes excess sodium or fat diet elevated lipids gender family history obesity ethnicity sedentary lifestyle socioeconomic status stress

34
Q

Secondary hypertension

A

Elevated BP with a cause that can be identified and corrected, people over 50 that suddenly have high BP

35
Q

Causes of secondary hypertension

A

Cirrosis , congenital narrowing of the aorta , endocrine disorders medications, pregnancy induced, renal disease, sleep apnea

36
Q

Clinical manifestations of hypertension

A

Often called silent killer (asymptomatic)
Patient with severe hypertension may experience symptoms secondary to: effects on blood vessels in various organs, increased workload of heart
Symptoms may include: Fatigue, reduced activity tolerance, Dizziness, Palpitations, Angina, Dyspnea, Headache

37
Q

Complications of hypertension

A

Heart Disease (Coronary Artery Disease Heart failure)
Cerebrovascular Disease
Peripheral Vascular Disease
Retinal damage

38
Q

Diagnostic studies of hypertension

A

Because most HTN is primary, testing for secondary causes is not routinely done
Basic lab studies are performed to: identify or rule out causes of secondary HTN, evaluate target organ disease, determine overall cardiovascular risk, establish baseline levels before initiating therapy
U/A, BUN, creatinine, serum electrolytes
Lipid profiles

39
Q

DASH diet

A

Dietary approaches to stop hypertension,Rich in grains, fruits, vegetables and low fat dairy products
Limits fat, saturated fat, cholesterol, and salt

40
Q

Dietary sodium reduction

A

A low sodium food should contain less than 140 mg/serving or less than 5% of daily allowance of sodium
Foods with more than 400 mg of sodium/serving should be avoided
Read labels for sodium content
It takes 2-3 months for the taste buds to adapt to changes in salt intake

41
Q

Drug therapy for hypertension

A

Diuretics, Beta-blockers, ACE inhibitors, ARBs, Calcium channel blockers
Two main actions:
decrease volume of circulating blood
Decreases systemic vascular resistance

42
Q

Orthostatic hypotension

A

Orthostatic hypotension (if any of the following occur from supine to standing position)
A decrease of 20 mmHg or more in SBP
A decrease of 10 mmHg or more in DBP
Increase in heart rate of greater than or equal to 20 beats/min
Causes
Intravascular volume loss
Inadequate vasoconstrictor mechanisms related to disease or medications

43
Q

Hypertensive crisis

A

Severe and abrupt elevation in systolic and/or diastolic B/P.
Occurs most commonly in patients: with a history of HTN who have failed to comply with their meds, those who have been under medicated
Also cocaine or crack amphetamines phencyclidine (PCP), and lysergic acid diethylamide (LSD)
Less damaging (hypertensive urgency) no evidence of organ damage developed over days to weeks

44
Q

Hypertensive emergency

A

More damaging, Classified by the degree of organ damage and the rapidity with which the B/P must be lowered, develops over hours to days, is a situation in which a patient’s B/P is severely elevated (systolic greater than 180 & diastolic greater than 120) with evidence of: acute target organ damage, Stroke, Change in level of consciousness, Heart attack, Eye or kidney damage, Angina, Pulmonary embolism

45
Q

Serious manifestations of CAD

A 
Unstable angina (UA) ,myocardial infarction (MI), and SCD (sudden cardiac death) are more serious manifestations of CAD 
termed acute coronary syndrome (ACS)
46
Q

Coronary artery disease

A

A type of blood vessel disorder that is included in the general category of atherosclerosis
Begins as soft deposits of fat that harden with age
Referred to as “hardening of arteries”

47
Q

Modifiable risk factors of CAD

A

Hyperlipidemia, Hypertension, Tobacco use, Physical inactivity, Obesity
Contributing factors: Metabolic syndrome, Psychological state, Homocysteine level, Diabetes Mellitus, Periodontal disease, Sleep apnea

48
Q

Risk factors in women for CAD

A

Premature menopause birth control pills hormone replacement therapy

49
Q

Therapy for CAD

A

Cholesterol-lowering drug therapy, Antiplatelet therapy, Low dose aspirin (81 mg.)

Garlic, Niacin, Psyllium, Omega 3 Fatty acids, Plant sterols, Red yeast rice, Soy, Stress management

50
Q

Chronic stable angina

A

Angina pectoris (chest pain) is the clinical manifestation of reversible myocardial ischemia, Primary reason for insufficient blood flow is narrowing of coronary arteries, For ischemia to occur the artery is usually obstructed 75% or more

51
Q

Therapy for chronic stable angina

A

Drug therapy (NRS 255): Antiplatelet therapy, Cholesterol lowering drugs, Nitrates (NTG), Beta blockers, Calcium channel blockers, Reduction of risk factors

52
Q

Precipitating factors of angina

A

Physical exertion, Temperature extremes, Strong emotions, Consumption of a heavy meal, Tobacco use, Sexual activity, Stimulants, Circadian rhythm patterns

53
Q

Acute intervention for anginal shock

A

Administration of supplemental oxygen & upright position unless contraindicated, Assess vital signs, 12-lead ECG, Prompt pain relief first with a nitrate followed by an opioid analgesic if needed, Auscultation of heart sounds

54
Q

Diagnostic studies of stable angina

A

Health history/physical examination, Laboratory studies, CK-MB, Cardiac troponin, Myoglobin, Lipid panel, CBC, Chest x-ray, Exercise stress test, holter monitoring (recordes electrical activity), echocardiogram (ultrasound waves), coronary angiography, PTCA

55
Q

PTCA percutaneous transluminal coronary angioplasty

A

Can be done with a balloon or stent, opens area occluded by plaque

56
Q

Heart failure

A

An abnormal condition involving impaired cardiac pumping and/or filling, Heart is unable to produce an adequate cardiac output (CO) to meet metabolic needs

57
Q

Heart failure risk factors

A

Primary risk factors: Coronary artery disease (CAD), Advancing age
Contributing risk factors: Hypertension, Diabetes, Tobacco use, Obesity, High serum cholesterol, African American descent

58
Q

Systolic heart failure

A

characterized as a weakened heart muscle

59
Q

Diastolic heart failure

A

stiff heart muscle making ventricular filling difficult

60
Q

The heart attempts to compensate for its inability to pump efficiently by

A

Increasing the rate of contractions
Increasing the size and strength of the ventricular muscle (hypertrophy)
Increasing the capacity of the ventricle (dilation)

61
Q

Left-sided HF

A

(most common) from left ventricular dysfunction

Backup of blood into the left atrium and pulmonary veins Pulmonary congestion Pulmonary edema

62
Q

Right-sided HF

A 
Backup of blood into the right atrium  and venous systemic circulation
Jugular venous distention
Hepatomegaly, splenomegaly
Vascular congestion of the GI tract
Peripheral edema
63
Q

Treating CHF: UNLOAD FAST

A

Up right, Nitrates, Lasix, Oxygen, Ace inhibitors, Digoxin, Fluid decrease, After load decrease, Sodium restriction, Test like Dig ABG potassium

64
Q

HF diagnostic studies

A 
Primary goal is to determine underlying cause: History and physical examination, Chest x-ray, 12 lead ECG, Lab studies (e.g., cardiac enzymes,  BNP- B-type natriuretic peptide; liver function studies), ABG, liver enzymes
Endomyocardial biopsy (EMB), Hemodynamic assessment, Echocardiogram, Nuclear stress testing, Cardiac catheterization, Ejection fraction (EF)
65
Q

Drug therapy for HF

A

Diuretics (hydrochlorothiazide; HydroDIURIL), ACE inhibitors, ARBs, Vasodilators, Beta adrenergic blockers, Positive Inotropes (digoxin), Digitalis toxicity-anorexia, nausea, vomiting, visual disturbances (yellow vision)
Digoxin immune Fab (Digibind)

66
Q

Acute Decompensated Heart FailureClinical Manifestations

A

Pulmonary edema (lung alveoli become filled with fluid) often life-threatening
Early: Increase in the respiratory rate Decrease in PaO2
Later: Tachypnea, Worsening blood gas values

67
Q

Acute Decompensated Heart FailureClinical Manifestations of Pulmonary Edema

A

Anxious, pale, possibly cyanotic Cool, clammy skin
Orthopnea, Dyspnea, tachypnea, Use of accessory muscles; distended jugular veins, Cough with frothy, blood-tinged sputum, Breath sounds: Crackles, wheezes, rhonchi, Tachycardia, Hypotension or hypertension

68
Q

MAD DOG pulmonary edema treatment

A

Morphine, Aminophylline, Digitalis, Diuretics, Oxygen, blood Gases

69
Q

Ultrafiltration (UF)

A

removes extracellular and intravascular fluid volume

70
Q

Chronic HF FACES

A 
Heart Failure Society of America (HFSA)
F—fatigue
A—limitation of activities
C—chest congestion/cough
E—edema
S—shortness of breath

Med Surg 1 (4 decks)

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