Exam 4 Flashcards
Cardiogenic Shock
This will inadequately perfuse primary organs: decreased urine output, confusion, chest pain, dyspnea; NO FLUIDS
Beta blockers
Decrease chronotropy; decrease HR, BP, and contractility
Metoprolol (Lopressor) Carvedilol (Coreg)
Diuretics
Decrease preload and decrease sodium and water retention
Nitrates
decreases SVR afterload, decreases myocardial oxygen demands
Natriuretic factors
decreases filling pressure (wedge, CVP), reduces vascular resistance, increaed urine output; Nesiritide, Natrecor
causes smooth muscle dilation and decreases workload of the heart by decreaing preload and afterload, decreasing BP by dilating arteries and veins
Inotropes
augment cardiac output by increasing contractility and enhancing contractility and enhancing tissue perfusion; digoxin- cardiac glycoside; sympathomimetics- epiniphrine
NATRECOR
Non inotropic drug used in CHF; a recombinant form of human B-type natriuretic peptide (h BNP) a naturally occurring hormone secreted by the ventricles; causes smooth muscle dilation
The nurse is conducting a staff in-service on congenital heart defects. Which structural defect constitutes tetralogy of Fallot?
Pulmonic stenosis, ventricular septal defect, overriding aorta, right ventricular hypertrophy
A nurse is teaching nursing students the physiology of congenital heart defects. Which defect results in decreased pulmonary blood flow?
Tetralogy of Fallot
Nitro
sensitive to light, do not keep for longer than a year; IV- glass bottles with special tubing
TPA
within 4 hours of the MI; can make a patient go into arrhythmias which is ok, need to shock; contraindications- recent surgery, anything in spine (epidural), active bleeding
If MI is in left main artery (widow maker)
Coronary artery bypass graft (CABG)
Unstable angina
“strangling of the chest”; limited ischemia that doesn’t result in permanent damage to myocardium; proressively worse, preinfarction, unpredictable; if you are questioning it, don’t do a stress test! Chest pain occurs with rest or minimal exertion; poorly relieved by nitro; treatment of pain and increased perfusion is priority
Peripheral vascular disease
disorders with altered flow of blood through the arteries and/or veins of the peripheral circulation; causes- HTN, DB, aging; intermittent claudication
Arterial PAD
Acute
cold, pale limb; decrease or loss of sensory/motor function; absent pulses; veins collapsed; no edema
Chronic
intermittent claudication, delayed healing, atrophy of skin with loss of hair
Venous PVD
Acute
elephant legs; elevate legs;moderate steady pain; skin warm
Chronic
aching, heavy sensation, ankle ulcers, increased pigmentation and edema of lower leg, scaling and thickening of skin
What to do during an acute anginal attack?
Oxygen, vitals, 12 lead EKG, pain relief (nitrate then narcotic), physical assessment of the chest, position comfortably
Complications of coronary artery disease
Hypoxic cells get irritable and “fire off”, left ventricle needs more O2, hurts worse without O2; get arrhythmias, PVC’s because of ischemia and irritability; 80% are silent MIs
Hypertensive Crisis
If it’s greater than 180/120 (either number); classified by organ damage; BP is unresponsive to oral antihypertensive medications; can occur from drug abuse, peeclampsia, head injury, IICP, undermedicating
Aortic
Severe “tearing” or “ripping” pain; may feel heart beat in the belly or have a pulsing mass, “blue toe” syndrome
Thoracic Aortic
Most common site for dissecting aneurysm; sudden, tearing chest pain radiating to shoulders, neck and back; cough hoarseness, resulting from pressure against recurrent laryngeal nerve; pt is bleeding if heart sounds are muffled
Abdominal aortic aneurysm (AAA)
most common; pulsation in abdomen, dull abdomen or low back pain (impending rupture), N/V (pressure against duodenum), severe, sharp, sudden pain (rupture), syncope
Aortic dissection
Acute severe and instantaneous chest pain, radiating to back, neck or jaw; “Ripping,” “tearing” sensation
Differentiated from AMI by its instantaneous, severe onset and absence of central pulses
Neurologic symptoms (15%) – syncope, presyncope, paralysis, numbness, aphasia
Cholesterol levels
Normal: 100-240, want under 200; Triglycerides: 50-160; LDL: 50-160; HDL: 35-45
MUGA Multigated
Blood pool imaging, ejection fraction study; normal EF: 55%-65%; crippling: under 35%; to evaluate cardiac function after an MI; used to diagnose cardiac abnormalities involving left ventricle and myocardial wall abnormalities by imaging the blood within the cardiac chamber rather than myocardium
Cardiac Catheterization
procedure can dislodge the plaque; assess for s/s of clots, pneomothorax (breath sounds, know baseline O2), aspiration (pts arent always honest about eating), hemorrhage (look behind them), sedation (put them on their sides so tongues don’t fall back)
Rheumatic fever
inflammatory disease that is usually self-limiting; usually preceded by group A beta- strep infection; inflammatory hemorrhagic lesions, called Ashoff bodies -> alteration of connective tissue in heart, joints, skin, CNS
Treatment of Rheumatic Fever
Monthly administration of penicillin over extended period of time; Penicillin: 1.2 mega units IM; salicylates to control inflammatory process (aspirin 75-100 mg/kg for 6-8 weeks); prophylactic treatment
Kawasaki Disease
high fever, conjunctiva, red cracked lips and strawberry tongue, rash, cervical lymphadenopathy
Tetrology of fallot
knee to chest position, give morphine, give oxygen, beta blocker and general anesthesia
Patent Ductus Arteriosus
connection between aorta and pulmonary artery
usually closees in the first 2 weeks of life
symptoms: if large, can cause CHF 6-8 weeks
signs: systolic murmur in a newborn and a continous “train in a tunnel”
large PDA causes left atrium and ventricle enlargement
Coarctition of the Aorta (CoA)
gets narrow and squeezes off aorta; severe -> shock moderate -> CHF mild -> heacaches, leg claudication
Treatment: for an infant in shock PGE1 (prostaglandin E1) immediately or surgical vx. transcatheter repair
BP lower in lower limbs
Diagnostic: echo
Which is the most common causative agent of bacterial endocarditis?
Streptococcus viridans
Which painful, tender, pea-sized nodules may appear on the pads of the fingers or toes in bacterial endocarditis?
Osler nodes
The primary nursing intervention to prevent bacterial endocarditis is to:
counsel parents of high-risk children about prophylactic antibiotics.
Asthma
Peak flow meter- green, do nothing; yellow-
Cystic fibrosis
earliest sign is they don’t pass meconium in 24 hours; excretion of undigested food in stool; sweat chloride test: normal less than 40 mEq/L (40-60 mEq/L indicates CF)
Pilocarpine
high protein and high calories
Acute laryngotracheobronchitis (LTB)
most common croup syndrome; generally affects children younger than 5; inspiratory stridor, barking cough, can progress to respiratory acidosis, respiratory failure, and death
Otitis media
malfunction of eustachian tube; an inflammation of the middle ear without pathogenesis
bronchitis
persistent dry hacking cough, worse at night
Acute otitis media
An inflammation of the middle ear space with a rapid onset of the signs and symptoms of acute infection—namely, fever and otalgia (ear pain)
Otitis media with effusion (OME)
Fluid in the middle ear space without symptoms of acute infection
Which is an important nursing consideration when chest tubes will be removed from a child?
administer analgesics before procedure
A nurse is caring for a school-age child with left unilateral pneumonia and pleural effusion. A chest tube has been inserted to promote continuous closed chest drainage. Which interventions should the nurse implement when caring for this child? (Select all that apply.)
assessing chest tube and drainage device for correct settings
administering prescribed doses of analgesia
monitoring for need of supplemental oxygen
Which defect results in increased pulmonary blood flow?
atrial septal defect
A nurse is teaching nursing students the physiology of congenital heart defects. Which defect results in decreased pulmonary blood flow?
Tetralogy of Fallot
Tracheostomy
give them a way to communicate
An infant has developed staphylococcal pneumonia. Nursing care of the child with pneumonia includes which interventions? (Select all that apply.)
Cluster care to conserve energy
Administration of antibiotics
A nurse is caring for a school-age child with left unilateral pneumonia and pleural effusion. A chest tube has been inserted to promote continuous closed chest drainage. Which interventions should the nurse implement when caring for this child? (Select all that apply.)
Administering prescribed doses of analgesia
Assessing the chest tube and drainage device for correct settings
Monitoring for need of supplemental oxygen
