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final Flashcards

1
Q

electrolytes

A

chemical substances that separate into electrically charged particles (ions) when dissolved in fluids

can conduct electric currents vital for function of nerves and muscles

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2
Q

cations

A

positively charged electrolytes

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3
Q

what are the major cations

A

sodium, potassium, calcium, and magnesium

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4
Q

anions

A

negatively charged electrolytes

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5
Q

major anions in body’s fluid

A

chloride, phosphate, sulfate, and bicarbonate

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6
Q

sodium is the major electrolyte in the…

A

extracellular fluid w/ potassium being present at much lower concentrations

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7
Q

potassium is the major electrolyte in…

A

intracellular fluid with sodium found in lesser concentrations

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8
Q

metabolic alkalosis happens when

A

vomiting & NGT suction

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9
Q

metabolic acidosis happens when

A

diarrhea, renal failure, diabetic acidosis

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10
Q

hyponatremia

A

low serum sodium

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11
Q

hyponatremia is caused by

A

excessive sweating, diarrhea, vomiting, NG suction

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12
Q

symptoms of hyponatremia

A

dizziness, confusion, weakness, low BP, shock

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13
Q

hypernatremia

A

happens when sodium blood levels become too high because of excessive water loss or sodium ingestion

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14
Q

hypernatremia symptoms

A

extreme thirst, agitation, dry swollen tongue, restlessness

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15
Q

potassium creates much of the … & is essential for

A

osmotic pressure in intracellular fluid & neurons & muscle cells

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16
Q

an imbalance in potassium can produce

A

hypokalemia or hyperkalemia

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17
Q

hypokalemia

A

blood levels of potassium becomes too low & usually a consequence of vomiting, diarrhea, or kidney disease

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18
Q

symptoms hypokalemia

A

fatigue, confusion, possible cardiac arrest

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19
Q

hyperkalemia & what is the cause

A

blood levels of potassium becoming too high

cause = consequence of Addison’s disease

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20
Q

symptoms hyperkalemia

A

weakness, abnormal sensations, cardiac arrhymias, possible cardiac arrest

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21
Q

calcium maintains…

A

normal excitability of neurons and muscle cells & is essential for clotting

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22
Q

an imbalance of calcium causes

A

hypocalcemia / hypercalcemia

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23
Q

hypocalcemia

A

blood levels of calcium become too low usually because of a decreased function of the parathyroid gland or a decreased calcium intake

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24
Q

symptoms hypocalcemia

A

muscle spasms leading to tetany (continuous spasm)

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25
Q

hypercalcemia

A

parathyroid over functions

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26
Q

symptoms of hypercalcemia

A

muscle weakness, bone fragility, and possible kidney stones

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27
Q

where is phosphate most abundant

A

bones and teeth

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28
Q

phosphate functions as an

A

intracellular anion and is part of the nucleic acids (DNA, RNA)

phospholipids and the phosphate buffer system

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29
Q

bicarbonate

A

part of buffer system

helps regulate blood pH

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30
Q

hypovolemia

A

decreased volume of circulating blood

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31
Q

causes of hypovolemia

A

loss of blood, loss of plasma, loss of body sodium and consequent intravascular water (diarrhea)

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32
Q

excessive sweating is not a cause of hypovolemia, because the body eliminates significantly more water than sodium t/f

A

TRUE

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33
Q

signs and symptoms of hypovolemia

A

sweating & moist skim, anxiety/agitation, cool clammy skin, confusion, decreased or no urine output, general weakness, pale skin, rapid breathing

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34
Q

nursing interventions for hypovolemia

A

measure daily weight

assess LOC

measure intake & output

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35
Q

causes of hypervolemia

A

excessive water intake

excessive intake of sodium from food

IV solutions and blood transfusions

medications

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36
Q

symptoms of hypervolemia

A

edema

headache

stomach bloating

high BP caused by excess fluid in bloodstream

shortness of breath caused by extra fluid entering lungs and reduce ability to breathe

heart problems, because excess fluid can speed up or slow your heart rate

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37
Q

nursing interventions for hypervolemia

A

admin diuretics

limit fluid intake

limit sodium

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38
Q

acid-base balance

A

mechanisms that keep fluids close to neutral pH

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39
Q

homeostasis

A

chemical reactions that sustain life depend on a delicate balanceof fluids, electrolytes, acids and bases

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40
Q

acid base balance is the regulation of

A

hydrogen ions

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41
Q

normal range of blood

A

7.35 to 7.45 (slightly alkaline)

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42
Q

3 regulatory systems maintaining AB balance

A

chemical buffers, respiratory system, kidneys

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43
Q

chemical buffers

A

neutralize the offending acid or base imbalance

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44
Q

respiratory system for AB balance

A

regulates the retention or exhalation of acids

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45
Q

kidneys for AB balance

A

excrete or retain acids as needed

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46
Q

role of the lungs

A

release CO2

CO2 gets excreted into blood, blood carries CO2 to lungs where its exhaled

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47
Q

as CO2 accumulates in blood, the pH of blood ….

A

decreases (acidity increases)

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48
Q

role of kidneys in AB balance

A

excreting excess acids or bases

adjustments are slower than lungs, compensation takes multiple days

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49
Q

acidosis

A

excessive acid (not enough base) in blood

decrease in blood pH

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50
Q

alkalosis

A

excessive base (not enough acid)

increase blood pH

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51
Q

metabolic acidosis

A

accumulation of hydrogen (acids) or a loss of bicarbonate (base) in extracellular fluid-blood

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52
Q

metabolic acidosis can occur from

A

overproduction of ketones

diabetes

cardiac failure

starvation

severe infection with fever

impaired kidney function

diarrhea

K+ sparing diuretic

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53
Q

signs and symptoms metabolic acidosis

A

hyperventilation to compensate for excess acid

drowsiness, disorientation, coma, death

tachycardia, decreased output, decreased BP, warm flushed skin

nausea, vomiting, diarrhea

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54
Q

treatment metabolic acidosis

A

sodium bicarbonate IV to neutralize acidity

maintain IV

dialysis

ventilation

assess LOC

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55
Q

metabolic alkalosis

A

loss of acid and a gain of bicarbonate

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56
Q

causes metabolic alkalosis

A

loss of acid from vomiting or NG suctioning

overactive adrenal gland (crushing syndrome)

use of diuretics

kidney disease

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57
Q

symptom of metabolic alkalosis

A

dizziness, irritability, confusion

tachycardia due to hypokalemia from compensation

tremor, muscle cramps, tingling in fingers/toes

anorexia, nausea, vomiting

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58
Q

assessment of metabolic alkalosis

A

monitor vitals

watch for muscle weakness

assess LOC

O2 if hypoxic

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59
Q

respiratory acidosis occurs when

A

excess of CO2 due to hypoventilation

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60
Q

hypoventilation

A

unable to blow off enough CO2

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61
Q

in acute respiratory acidosis, the pH _____ & the ____ try to compensate by _______

A

decreases, kidneys, retaining bicarbonate

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62
Q

causes of respiratory acidosis

A
  • hypoventilation
  • depression of respiratory centre (OD, brain injury)
  • problems with neuromuscular functioning, lung disease or airway obstruction
  • mechanical hypoventilation
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63
Q

symptoms of respiratory acidosis

A

neurological: headache, disorientation, confusion, seizures, coma, death
cardiovascular: tachycardia, decreased blood pressure, warm flushed skin (r/t peripheral vasodilation)

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64
Q

treatment for respiratory acidosis

A
  • focus: improving ventilation
  • monitor vital signs & neurological status
  • maintain patent airway
  • O2 therapy (if ordered)
  • provide adequate humidification to moisten secretions
  • chest auscultation (good air entry to bases, no crackles or wheezes)
  • deep breathing exercises
  • careful with sedatives
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65
Q

respiratory alkalosis

A

rapid, deep breathing (hyperventilation) causes too much CO2 to be expelled from bloodstream

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66
Q

most common cause of respiratory alkalosis & other causes

A

hyperventilation from anxiety

aspirin overdose, fever, low levels of oxygen in blood, pain

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67
Q

symptoms of respiratory alkalosis

A

neurological: lethargy, light-headedness, confusion
cardiovascular: tachycardia, dysrhythmias (r/t to hypokalemia from compensation)
GI: nausea, vomiting, epigastric pain
neuromuscular: numbness, tingling of extremities, seizures

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68
Q

treatment of respiratory alkalosis

A

treat cause = O2 if hypoxic, anti-anxiety meds PRN, controlled breathing exercises

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69
Q

hyperventilation can be treated by….

A

having the pt breath into paper bag, which forces the pt to rebreathe exhaled CO2, thereby raising CO2 level

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70
Q

asthma

A

inflammatory disorder of airways

inflammation causes varying degrees of obstruction in airways leading to recurrent episodes of wheezing, breathlessness, chest tightness, and cough

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71
Q

when asthma most common

A

at night and early in the morning

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72
Q

pathophysiology of asthma

A

** reversible narrowing of the airways**

bronchi narrow in response to stimuli that usually do not affect normal lungs — triggering allergens: pollens, dust, feathers

ALLERGENS + ANTIBODY = asthma-causing chemicals released (allergens combined with immunoglobulin e on surface of mast cells) trigger allergic asthma

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73
Q

cells lining the bronchi have microscopic structures called receptors such as

A

beta-adrenergic

cholinergic

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74
Q

receptors in bronchi regulate airflow by

A

sensing presence of specific substances & stimulate underlying muscles to contract & relax

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75
Q

causes of asthma

A
  • abnormal sensitivity of cholinergic receptors (muscles of airways contract when they shouldn’t)
  • mast cells responsible for initiating response
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76
Q

mast cells throughout bronchi release substances such as histamines & leukotrienes which….

A

cause smooth muscle to contract, mucus secretion to increase, and certain white blood cells to migrate to area

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77
Q

eosinophils (white blood cell found in airways of people with asthma)

A

release additional substances, contributing to airway narrowing

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78
Q

during an asthma attack

A
  • smooth muscle layer goes into spasm, narrowing airway
  • middle layer swells b/c of inflammation, & more mucus is produced
  • some segments of airway, mucus forms plugs that nearly or completely block the airway
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79
Q

what can provoke asthma attacks

A

cigarette smoke, cold air, viral infection, certain foods (RARE, like shellfish or peanut butter)

stress and anxiety

exercising can cause bronchoconstriction

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80
Q

symptoms of asthma

A

vary in frequency & severity

some symptom-free, occasional brief mild SOB

cough & wheeze more serious

crying/laughing can bring on symptoms

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81
Q

asthma attacks occur most often in

A

early morning hours when the effects of protective drugs wear off and the body is least able to prevent bronchoconstriction

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82
Q

coughing may be the only symptoms in some people with asthma

A

TRUE

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83
Q

an asthma attack may begin suddenly with

A

wheezing, coughing, and SOB

people first notice SOB, coughing or chest tightness

attack may last minutes, hours, or days

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84
Q

wheezing is particularly noticeable when the person ….

A

breathes out

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85
Q

what happens when SOB becomes more severe in asthma

A

creating feeling of severe anxiety

person instinctively sits upright & leans forward, utilizing neck & chest muscles to help breathing but still struggles to inhale enough air

diaphoresis common symptoms due to the increased effort to breath

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86
Q

confusion, lethargy, and cyanosis are signs that person’s O2 supply is severely limited & ……. is needed

A

emergency treatment

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87
Q

most severe form of asthma

A

status asthmaticus

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88
Q

in status asthmaticus the lungs are

A

no longer able to provide the body with adequate O2 or adequately remove CO2

without O2, organs begin to malfunction

build up leads to acidosis

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89
Q

status asthmaticus requires…

A

artificial airway (intubation) & mechanical ventilator

90
Q

diagnosis of asthma

A

subjective report

confirm by pulmonary function test

91
Q

pulmonary function test done by

A

before & after giving inhaled drug (beta-adrenergic agonist) = reverses bronchoconstriction

if results are sig better after person gets drug, asthma is present

92
Q

treatment of asthma

A

anti-inflammatory drugs: suppress inflammation that narrows the airways (ex: flovent, corticosteroids)

bronchodilators: relax & dilate airways (ventolin, beta-adrenergic agonists)

education: how to prevent & treat asthma attacks beneficial for people who have asthma, also educate family

93
Q

what should people know regarding asthma

A
  • what can stimulate an attack
  • what helps to prevent an attack
  • how to use drugs properly
  • when to seek medical care
94
Q

what is COPD

A

persistent obstruction of the airways that occurs with emphysema, chronic bronchitis, or both

leads to chronic airflow obstruction which is a persistent decrease in the rate of airflow from the lungs when the person exhales

95
Q

what is chronic bronchitis

A

presence of chronic productive cough for 3 months in 2 successive yrs

glands lining the bronchi (larger airways) of the lungs enlarge & increase their secretion of mucus

96
Q

when chronic bronchitis involves airflow obstruction…

A

it qualifies as chronic obstructive bronchitis

97
Q

emphysema is defined as

A

widespread & irreversible destruction of the alveolar walls (cells support lung alveoli) & enlargement of many alveoli

98
Q

in emphysema, destruction of alveolar wall attachments results in

A

collapse of bronchioles, which causes permanent airflow obstruction

99
Q

inflammation of the bronchioles develops & causes

A

smooth muscle to spasm (contract), further obstructing airflow

inflammation also causes airflow to be blocked by secretions

100
Q

airflow obstruction of COPD —>

A

air becomes trapped in lungs after full exhalation —> increases effort required to breathe —> # of capillaries in the walls of the alveoli also decreases —> O2 & CO2 exchange impairment between alveoli & blood

101
Q

causes of COPD

A

cigarette smoking main cause

pipe & cigar smokers develop COPD more often than non smokers but not as often cig

lung function improves only alittle if people stop smoking

genetics

working in environment with polluted chemicals, fumes, dust

102
Q

symptoms of COPD

A
  • mild cough that produces clear sputum
  • cough usually occurs when person gets out of bed in morning
  • SOBOE
  • sputum colour changes from clear to yellow/green
  • pneumonia & other infections occur more often
  • severe weight loss
  • coughing up blood (due to bronchi inflammation)
  • morning headaches
  • pursed lips breathing
  • barrel chest over time
  • low O2 levels in blood = cyanosis
103
Q

acute exacerbation of symptoms (flare-up) of COPD

A

worsening of symptoms, usually cough, increased sputum, & SOB

sputum colour often changes to yellow/green & fever & body aches common

SOB at rest

104
Q

during severe flare-ups, people may develop life-threatening condition called (COPD) & symptoms are

A

acute respiratory failure & severe SOB (likened to being drowned), severe anxiety, cyanosis, confusion

105
Q

chronic bronchitis is diagnosed by

A

he of prolonged productive cough

106
Q

ppl with chronic obstructive bronchitis diagnosis

A

chronic bronchitis & evidence of airflow obstruction on pulmonary function tests

107
Q

emphysema is diagnosed by

A

basis of findings observed during a physical examination & pulmonary function test results

108
Q

chest movement in COPD

A

diminishes during breathing & use of accessory muscles

109
Q

how is COPD diagnosed

A

chest x-ray which shows over-inflation of lungs

110
Q

treatment for COPD

A
  • quit smoking
  • trying multiple strategies at once most likely to be effective
  • group counselling
  • support sessions
  • NRT
  • champix & zyban
  • avoid exposure to airborne irritants
  • avoid influenza or pneumonia
111
Q

treatment of COPD symptoms

A
  • inhaled bronchodilators w/ device that allows user to spray specific & consistent dose of drug into airways via mouth/throat (anti cholinergic & beta-adrenergic agonist drugs)
  • nebulizers
  • corticosteroids
112
Q

pulmonary rehab programs for COPD

A

help people improve lung function, programs provide education about disease, exercise, nutritional & psychological counselling

113
Q

single lung transplant may be used in certain people who are usually younger than 60 & have severe airflow obstruction

A

TRUE

114
Q

lung volume reduction surgery can be done in people with severe emphysema in the upper portion of lungs

A

TRUE

115
Q

complications of COPD

A
  • O2 levels in blood may decrease, but CO2 levels remain normal (early stages)
  • later stages, CO2 levels increase, O2 levels fall
116
Q

polycythemia

A

decreased O2 levels in blood stimulates the bone marrow to send more red blood cells into blood stream

117
Q

does the decrease in O2 levels in blood also increase the pressure in the pulmonary artery?

A

YES

118
Q

pneumonia

A

inflammatory process in lung parenchyma (functional tissue) thats usually associated with a marked increase in interstitial and alveolar fluid

119
Q

causes of pneumonia

A

bacteria, viruses, mycoplasmas, fungi, protozoa, aspiration of food fluids or vomit, inhaled toxic chemicals smoke dusts or gases

120
Q

different types of pneumonia

A

community-acquired pneumonia, hospital acquired pneumonia, fungal pneumonia, aspiration pneumonia, opportunistic pneumonia

121
Q

aspiration pneumonia

A

abnormal entry of secretions or substances into the lower airway

usually aspiration of material from mouth or stomach

122
Q

opportunistic pneumonia

A

people with an altered immune response are susceptible to respiratory infections

123
Q

risk factors of pneumonia

A

advanced age
hx of smoking
upper respiratory tract infection
tracheal intubation
prolonged immobility
immunosuppressive therapy
nonfunctional immune system
malnutrition
dehydration
homelessness
chronic disease state

124
Q

additional risk factors for pneumonia

A

dysphagia (difficulty swallowing)

exposure to air pollution

altered LOC (alcohol, anesthesia, seizures)

inhalation of a noxious substance

aspiration

125
Q

symptoms of pneumonia

A

fever
chills
sweats
fatigue
cough
producing sputum
dyspnea
hemoptysis
pleuritic chest pain (sharp pain when breathing caused by inflamed pleura rubbing together)
headache
older adults = delirium
crackles

126
Q

diagnostic tests for pneumonia

A

hx & physical exam

chest x-ray

sputum culture & sensitivity

complete blood count & differential

SpO2 levels

blood & urine cultures

127
Q

baby blues

A

mood swings after delivery, feeling joyful one minute and depressed the next

go away within 10-14 days of delivery

128
Q

perinatal depression

A

depression that begins in the period from conception to after pregnancy

129
Q

symptoms of perinatal depression

A
  • lack of interest in baby
  • negative feelings towards baby
  • worry about hurting the baby
  • mother lacks concern for herself
  • lack of energy & motivation
  • feelings of worthlessness & guilt
  • changes in appetite
  • sleeping more or less than usual
  • recurrent thoughts of death or suicide
  • loss of pleasure
130
Q

causes of perinatal depression

A
  • hormonal changes
  • physical changes
  • stress
131
Q

explain hormonal changes r/t the cause of perinatal depression

A

after childbirth there is a drop in estrogen & progesterone levels

thyroid levels can also drop leading to fatigue & depression

132
Q

explain physical changes r/t cause of perinatal depression

A

childbirth causes numerous physical & emotional changes e.g. physical pain form the delivery, difficulty losing the baby weight causing insecurity, appearance & sexual attractiveness

133
Q

explain stress r/t perinatal depression

A

stress caring for a newborn, sleep deprivation, feeling overwhelmed and anxious, ability to care for a baby especially for a first time mom

134
Q

perinatal depression can interfere with a mother’s ability to care for herself & her child

A

TRUE

135
Q

other factors that increase risk of perinatal depression

A

medical complications for mother or baby

relationship difficulties

lack of support from family or friends

136
Q

perinatal depression & attachment

A
  • depressed mothers interact less with babies
  • are less likely to breastfeed, play with or read to their children
  • may be inconsistent providing care to their newborn
    -may be loving & attentive or may react negatively or not at all
137
Q

impact of peripartum depression on children

A
  • behavioural problems (sleep problems, temper tantrums, aggression, & hyperactivity)
  • delays in cognitive development (may learn to walk & talk later than other children, may have learning difficulties & problems in school)
  • social problems (may have difficulty establishing secure relationships, have trouble making friends, be socially withdrawn or act out in destructive ways)

developing major depression early in life
emotional problems like low self esteem, more anxious & fearful, more passive, less independent

138
Q

perinatal depression disrupts the…

A

bonding process (attachment = most important task of infancy)

a child insecurely attached is at risk for multiple developmental difficulties & delays, including behavioural, emotional & social problems

139
Q

education for new moms

A
  • relationships are priority = stay connected to family
  • let loved ones know what you need
  • don’t keep feelings to yourself
  • get practical help & emotional support
  • share what you are experiencing
  • join a group for new moms
  • find people to help with childcare, housework, and errands
  • make time for yourself
  • give yourself credit for things you accomplish
140
Q

professional treatment for perinatal depression

A

responds to the same treatments as regular depression

support groups
individual therapy
marriage counselling
antidepressant medications
ECT

141
Q

perinatal psychosis

A

rare but very serious disorder that can develop after childbirth

characterized by loss of contact with reality

142
Q

perinatal psychosis should be..

A

considered a medical emergency because of the high risk of suicide or infanticide, hospitalization is usually required to keep the mother and baby safe

143
Q

symptoms of perinatal psychosis

A

hallucinations, delusions, rapid mood swings, bizarre behaviour, refusal to eat, extreme agitation & anxiety, suicidal thoughts, confusions & disorientation, thoughts of harming or killing their baby

144
Q

depressive disorder diagnosis must include

A

one or more major depressive episodes

either depressed mood or a loss of interest or pleasure in nearly all activities must be present for at least 2 weeks

145
Q

behavioural findings in depression

A
  • tearfulness, irritability
  • anxiety, phobias, excessive worry over health
  • complaints of pain
  • possible panic attacks
  • difficulty with intimate relationships
  • difficulties with sexual functioning
  • marital problems
  • occupational problems
  • substance abuse
  • higher mortality rate
  • increased pain or physical illness
  • decreased physical, social, role functioning
146
Q

depression risk factors

A

childhood emotional, physical, and sexual abuse & subsequent life experiences of depression

  • prior episode of depression
  • family hx of depressive disorder
  • lack of social support
  • stressful life event
  • current substance use
  • medical comorbidity
  • economic difficulties
147
Q

initial insomnia

A

difficulty falling asleep

148
Q

middle insomnia

A

waking up during the night and having difficulty returning to sleep

149
Q

terminal insomnia

A

waking too early and being unable to return to sleep

150
Q

treatment for depression

A

cognitive therapy (thought stopping & positive self-talk)
behaviour therapy
interpersonal therapy
family & marital therapy
group therapy
ECT

151
Q

common medications for depression

A

tricyclic
SSRI
SNRI
SARI
NaSSA
NDRI

152
Q

side effects of medications for depression

A

nausea, vomiting, diarrhea, changes in appetite or weight, dry mouth, yawning, dizziness, headache, anxiety, tremors, tired, sleep problems

153
Q

ECT

A

general anesthesia & small electric currents are passed through the brain, intentionally triggering a brief seizure

154
Q

ECT causes

A

changes in brain chemistry that can quickly reverse symptoms of certain mental health conditions

155
Q

risks and side effects of ECT

A

confusion (immediately after treatment to several hours)

memory loss (some people have trouble remembering events that occurred right before treatment or in the weeks or months before treatment)

physical side effects (nausea, headache, jaw pain, muscle ache

156
Q

what is pain

A
  • complex experience
  • personal and subjective
  • influenced by factors (age, economic, ethnicity, gender)
157
Q

pain results from

A

a series of complex electrical and chemical changes involving your peripheral nerves, spinal cord, and brain

158
Q

nociceptive pain

A

damage to somatic or visceral tissue

159
Q

nociceptors

A

millions of peripheral nerve fibres sense harmful stimuli —> relay pain messages via electric impulses —> pain messages travel along a peripheral nerve to spinal cord

160
Q

spinal cord in pain

A

specialized nerve cells filter and prioritize messages from the peripheral nerves

pain messages travel to the brain

161
Q

brain pain pathway

A

sends back messages that promote the healing process: signals ANS to send increased WBCs & platelets for tissue repair, release pain-suppressing chemicals

162
Q

somatic pain

A

musculoskeletal pain: skin, muscle, joints, bones & ligaments

characterized as sharp localized pain in specific area

swelling, cramping, & bleeding may exist

163
Q

somatic pain responds to a variety of

A

medications: non-opioids, opioids, nonsteroidal anti-inflammatory drugs

164
Q

visceral pain

A

nociceptive pain located within the main body cavity due to injury or illness to an INTERNAL ORGAN within in: thorax, abdomen, pelvis

the pain receptors in the visceral cavities respond to stretching, swelling, oxygen deprivation

165
Q

what is the most effective pain medication for visceral pain

A

opioids because it feels like a deep ache with cramping

166
Q

visceral pain may ___ to other locations in the back and chest

A

radiate

167
Q

neuropathic pain

A

abnormal processing of sensory input because of injury to the peripheral or central nervous system’

caused by damage to the nerve cells or changes in spinal cord processing

168
Q

neuropathic pain often described as

A

burning, freezing, numbing or tingling

pins and needles sensation

169
Q

a common form of neuropathic pain occurs when …

A

diabetes damages the small nerves in the hands and feet, producing a painful burning sensation

170
Q

sympathetic pain

A

source is due to possible over-activity of sympathetic nervous system and C/PNS mechanisms

171
Q

causes of sympathetic pain

A

after fractures & soft tissue injuries of arms and legs

172
Q

receptors activated in sympathetic pain

A

like nerve pain, there are no specific pain receptors

173
Q

characteristics of sympathetic pain

A
  • extreme hypersensitivity in skin around injury & peripherally in the limb
  • associated with abnormalities of sweating & temperature control in area
  • limb usually so painful, that the sufferer refuses to use it, causing secondary problems after time: muscle wasting, joint contractures, osteoporosis
174
Q

referred pain

A

reason for “referral” of visceral pain is lack of dedicated sensory pathway in brain for info concerning internal organs

often useful tool to diagnose diseases of internal organs

175
Q

acute pain

A

sudden injury that causes trauma to body tissue

somatic and visceral pain may be perceived

the body responds to the most intense pain primarily

176
Q

acute pain responses/signs & symptoms

A

increased heart rate
diaphoresis
increased respiratory rate
increased blood sugar
elevated blood pressure
decreased gastric acid secretion
pallor or flushing
dilated pupils
nausea

177
Q

chronic/persistent pain

A

discomfort that lasts beyond normal healing period

affect persons life dramatically (make simple things difficult, hopelessness, depression)

often unknown causes

178
Q

control gate theory

A

spinal cord contains a neurological “gate” that either blocks pain signals or allows them to continue onto the brain

explain phantom and chronic pain

179
Q

pain assessment

A

pattern, area, intensity, nature

180
Q

nursing interventions for pain

A
  • therapeutic relationship,
  • routine assessments,
  • discuss goals of pain management,
  • explore previous pain management strategies and coping skills,
  • non-pharm treatments
  • pharm treatment
  • interprofessional care planning
  • pt family education
181
Q

TIA

A
  • temporary focal loss of neurological function
  • ischemia causes loss in one of the vascular territories of the brain
  • last 15mins-24hrs
  • clinical symptoms last minutes to 1 hr
182
Q

symptoms of TIA

A

motor
sensory
speech/language
vision
cerebellar disturbances

183
Q

stroke

A

death of brain cells occurs when there’s either ischemia to part of the brain or hemorrhage into the brain

symptoms of stroke like TIA but not TEMPORARY

184
Q

types of strokes

A

ischemic (clot stops blood supply to an area of brain) 83% of strokes

hemorrhage (blood leaks into brain tissue) 17% of strokes

185
Q

stroke pathophysiology

A
  • loss of blood supply: loss of O2 and glucose & cell death and permanent changes within minutes
186
Q

ischemic stroke

A

blockage of blood supply caused by a thrombus or embolism (blood clot)

187
Q

hemorrhage stroke

A

bleeding into the brain tissue or subarachnoid space

188
Q

how does the brian control movement

A

one side of the brain controls the opposite side of the body

left brain = controls right side
right brain = controls left side

189
Q

functionally, the left brain controls….. & the right brain controls …..

A

logic & creativity

190
Q

right side of the brain common tasks

A

creativity, imagination, facial recognition, emotion, music & arts

191
Q

left side of the brain common tasks

A

logic, analysis, sequencing, math, language, critical thinking, reasoning, thinking in words

192
Q

at pt with left-side stroke may suffer from

A

aphasia = inability to understand or express language (left brain task)

193
Q

a pt with right-side stroke may suffer from

A

emotional lability = which includes involuntary outbursts of emotion (right-brained task)

194
Q

risk factors for stroke

A
  • hx of TIA
  • prior stroke
  • older age
  • family hx of stroke
  • alcoholism
  • hypertension
  • cig smoking
  • hypercholesterolemia
  • diabetes
  • obesity
  • sex (male)
  • inactivity
  • oral contraceptives
  • use of certain drugs (cocaine)
195
Q

identifying a stroke

A

FACE

196
Q

symptoms of stroke

A
  • parenthesia (numbness, tingling, burning)
  • weakness or paralysis of limbs
  • aphasia
  • confusion
  • visual disturbances
  • dizziness
  • loss of balance and coordination
  • headache
197
Q

treatment of stroke

A

TIA = antiplatelet agents reduces risk of stroke

tissue plasminogen activator: ischemic stroke — should be administered within 4.5 hours

198
Q

medical interventions for stroke

A
  • early diagnosis
  • maintain cerebral oxygen
  • restore cerebral flow
  • prevent complications (bleeding, edema)
  • prevention of second stroke
  • rehab
  • pt & family teaching
199
Q

important to note for stroke!!!!

A
  • pt have impaired swallowing & high risk for aspiration
  • monitor VS & know BP
  • prevent edema = elevate limbs
  • promote self care
200
Q

nursing interventions for stroke

A

HOB at 30 degrees
initiate DVT prophylaxis
ensure OT ordered
fall prevention measures

201
Q

UTI

A

infection that affects urinary system

urine is unsterile due to infectious agents present

infection anywhere along the urinary tract

202
Q

causes of UTI

A

through lower end of the urinary tract, urethra —> infection ascends the urethra to the bladder

infection enters through bloodstream

203
Q

cystitis

A

infection of bladder usually caused by bacteria

204
Q

symptoms of UTI

A
  • changes in void patterns
  • frequency
  • dysuria (pain)
  • urgency
  • suprapubic pain
  • lower back pain
  • hematuria
  • cloudy, strong or foul urine
  • fatigue
  • abdominal distension
  • nausea, diarrhea
  • fever
205
Q

risks of UTI

A

bacteria, STI, poor hygiene, voiding problems, spermicides, indwelling catheters, honeymoon cystitis (not peeing after sex)

206
Q

if UTI travels up to kidneys, it may…

A

cause pyelonephritis causing renal scarring and occasionally renal failure

207
Q

pyelonephritis

A

kidney infection

bacterial infection of one or both kidneys

more common in women

antibiotics given to treat infection

208
Q

symptoms of kidney infection

A

chills, fever, back pain, nausea, vomiting

209
Q

causes of kidney infection

A

e. coli

physical obstruction

increase risk during pregnancy

infections ascend from genital area

210
Q

chronic pyelonephritis

A

longstanding infection

underlying abnormalities (obstructed urinary tract)

211
Q

glomerular disease

A

attack tiny blood vessels within the kidney

first sign is proteinuria or hematuria

diagnosed by biopsy

212
Q

treatment of glmerular disease

A

immunosuppressive drugs and steroids to reduce inflammation

213
Q

polycystic kidney disease

A

genetic disorder where many cysts grow within the kidneys

cysts slowly replace much of the mass of the kidneys, reducing kidney function and leading to kidney failure

214
Q

acute kidney disease

A

can happen by: traumatic injury to kidneys, losing a lot of blood, some drugs

may lead to permanent loss of kidney function but can be REVERSED

215
Q

chronic kidney disease

A

gradual loss of kidney function

may develop permanent kidney failure - higher risk of death from stroke or heart attack

216
Q

end stage renal disease

A

total or nearly total and permanent kidney failure

must undergo dialysis or transplantation to stay alive

kidneys are no longer adequately filter blood

217
Q

signs of chronic kidney disease

A

don’t usually feel sick
- need to urinate more or less often
- feel tired
- lose their appetite or experience nausea and vomiting
- edema in hands and feet
- feel itchy or numb
- drowsy or difficulty concentrating
- have darkened skin
- muscle cramps

218
Q

3 tests to screen for kidney disease

A

blood pressure, urine test for protein & albumin, calcification of glomerular filtration rate (GFR) based on serum creatinine measurement

219
Q

medical tests for kidney disease

A

measuring urea in blood

kidney imaging

biopsy

220
Q

difference between fast and slow fibres related to pain

A

The fast pathway records sharp, localized pain (such as that caused by cutting your skin) and transmits this information to the cortex in less than a second. The slow pathway travels through the limbic system, a detour that delays arrival at the cortex by seconds.

221
Q

Explain nociceptors and provide example

A

sensory receptors that detect signals from damaged tissue or the threat of damage and indirectly also respond to chemicals released from the damaged tissue

External nociceptors are found in tissue such as the skin (cutaneous nociceptors), the corneas, and the mucosa. Internal nociceptors are found in a variety of organs, such as the muscles, the joints, the bladder, the visceral organs, and the digestive tract.

222
Q

Hemiparesis hemiplegia aphasia dysarthria apraxia homonymous hemianopia horner syndrome agnosia

A
  1. Hemiparesis- is weakness of one entire side of the body
  2. Hemiplegia- complete paralysis of half of the body
  3. Aphasia- is an impairment of language, affecting the production or comprehension of speech and the ability to read or write
  4. Dysarthria- difficult or unclear articulation of speech. It results from impaired movement of the muscles used for speech production, including the lips, tongue, vocal folds, and/or diaphragm.
  5. Dysphagia- difficulty or discomfort in swallowing
  6. Apraxia- is a motor disorder where the patient has difficulty with the motor planning to perform tasks or movements despite intact motor function.
  7. Homonymous hemianopia- is a condition in which a person sees only one side―right or left
  8. Horner Syndrome- caused by the disruption of a nerve pathway from the brain to the face and eye on one side of the body. Normally, patients with Horner syndrome have the following- decreased pupil size, a drooping eyelid and decreased perspiring on the affected side of the face.
  9. Agnosia- inability to interpret sensations and hence to recognize things
  10. Unilateral neglect- is failure to report or respond to stimuli presented from the contralateral space, including visual, somatosensory, auditory, and kinesthetic sources

concepts 2 (3 decks)

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