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
2
Q
cations
A
positively charged electrolytes
3
Q
what are the major cations
A
sodium, potassium, calcium, and magnesium
4
Q
anions
A
negatively charged electrolytes
5
Q
major anions in body’s fluid
A
chloride, phosphate, sulfate, and bicarbonate
6
Q
sodium is the major electrolyte in the…
A
extracellular fluid w/ potassium being present at much lower concentrations
7
Q
potassium is the major electrolyte in…
A
intracellular fluid with sodium found in lesser concentrations
8
Q
metabolic alkalosis happens when
A
vomiting & NGT suction
9
Q
metabolic acidosis happens when
A
diarrhea, renal failure, diabetic acidosis
10
Q
hyponatremia
A
low serum sodium
11
Q
hyponatremia is caused by
A
excessive sweating, diarrhea, vomiting, NG suction
12
Q
symptoms of hyponatremia
A
dizziness, confusion, weakness, low BP, shock
13
Q
hypernatremia
A
happens when sodium blood levels become too high because of excessive water loss or sodium ingestion
14
Q
hypernatremia symptoms
A
extreme thirst, agitation, dry swollen tongue, restlessness
15
Q
potassium creates much of the … & is essential for
A
osmotic pressure in intracellular fluid & neurons & muscle cells
16
Q
an imbalance in potassium can produce
A
hypokalemia or hyperkalemia
17
Q
hypokalemia
A
blood levels of potassium becomes too low & usually a consequence of vomiting, diarrhea, or kidney disease
18
Q
symptoms hypokalemia
A
fatigue, confusion, possible cardiac arrest
19
Q
hyperkalemia & what is the cause
A
blood levels of potassium becoming too high
cause = consequence of Addison’s disease
20
Q
symptoms hyperkalemia
A
weakness, abnormal sensations, cardiac arrhymias, possible cardiac arrest
21
Q
calcium maintains…
A
normal excitability of neurons and muscle cells & is essential for clotting
22
Q
an imbalance of calcium causes
A
hypocalcemia / hypercalcemia
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
24
Q
symptoms hypocalcemia
A
muscle spasms leading to tetany (continuous spasm)
25
hypercalcemia
parathyroid over functions
26
symptoms of hypercalcemia
muscle weakness, bone fragility, and possible kidney stones
27
where is phosphate most abundant
bones and teeth
28
phosphate functions as an
intracellular anion and is part of the nucleic acids (DNA, RNA)
phospholipids and the phosphate buffer system
29
bicarbonate
part of buffer system
helps regulate blood pH
30
hypovolemia
decreased volume of circulating blood
31
causes of hypovolemia
loss of blood, loss of plasma, loss of body sodium and consequent intravascular water (diarrhea)
32
excessive sweating is not a cause of hypovolemia, because the body eliminates significantly more water than sodium t/f
TRUE
33
signs and symptoms of hypovolemia
sweating & moist skim, anxiety/agitation, cool clammy skin, confusion, decreased or no urine output, general weakness, pale skin, rapid breathing
34
nursing interventions for hypovolemia
measure daily weight
assess LOC
measure intake & output
35
causes of hypervolemia
excessive water intake
excessive intake of sodium from food
IV solutions and blood transfusions
medications
36
symptoms of hypervolemia
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
37
nursing interventions for hypervolemia
admin diuretics
limit fluid intake
limit sodium
38
acid-base balance
mechanisms that keep fluids close to neutral pH
39
homeostasis
chemical reactions that sustain life depend on a delicate balanceof fluids, electrolytes, acids and bases
40
acid base balance is the regulation of
hydrogen ions
41
normal range of blood
7.35 to 7.45 (slightly alkaline)
42
3 regulatory systems maintaining AB balance
chemical buffers, respiratory system, kidneys
43
chemical buffers
neutralize the offending acid or base imbalance
44
respiratory system for AB balance
regulates the retention or exhalation of acids
45
kidneys for AB balance
excrete or retain acids as needed
46
role of the lungs
release CO2
CO2 gets excreted into blood, blood carries CO2 to lungs where its exhaled
47
as CO2 accumulates in blood, the pH of blood ....
decreases (acidity increases)
48
role of kidneys in AB balance
excreting excess acids or bases
adjustments are slower than lungs, compensation takes multiple days
49
acidosis
excessive acid (not enough base) in blood
decrease in blood pH
50
alkalosis
excessive base (not enough acid)
increase blood pH
51
metabolic acidosis
accumulation of hydrogen (acids) or a loss of bicarbonate (base) in extracellular fluid-blood
52
metabolic acidosis can occur from
overproduction of ketones
diabetes
cardiac failure
starvation
severe infection with fever
impaired kidney function
diarrhea
K+ sparing diuretic
53
signs and symptoms metabolic acidosis
hyperventilation to compensate for excess acid
drowsiness, disorientation, coma, death
tachycardia, decreased output, decreased BP, warm flushed skin
nausea, vomiting, diarrhea
54
treatment metabolic acidosis
sodium bicarbonate IV to neutralize acidity
maintain IV
dialysis
ventilation
assess LOC
55
metabolic alkalosis
loss of acid and a gain of bicarbonate
56
causes metabolic alkalosis
loss of acid from vomiting or NG suctioning
overactive adrenal gland (crushing syndrome)
use of diuretics
kidney disease
57
symptom of metabolic alkalosis
dizziness, irritability, confusion
tachycardia due to hypokalemia from compensation
tremor, muscle cramps, tingling in fingers/toes
anorexia, nausea, vomiting
58
assessment of metabolic alkalosis
monitor vitals
watch for muscle weakness
assess LOC
O2 if hypoxic
59
respiratory acidosis occurs when
excess of CO2 due to hypoventilation
60
hypoventilation
unable to blow off enough CO2
61
in acute respiratory acidosis, the pH _____ & the ____ try to compensate by _______
decreases, kidneys, retaining bicarbonate
62
causes of respiratory acidosis
- hypoventilation
- depression of respiratory centre (OD, brain injury)
- problems with neuromuscular functioning, lung disease or airway obstruction
- mechanical hypoventilation
63
symptoms of respiratory acidosis
neurological: headache, disorientation, confusion, seizures, coma, death
cardiovascular: tachycardia, decreased blood pressure, warm flushed skin (r/t peripheral vasodilation)
64
treatment for respiratory acidosis
- 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
65
respiratory alkalosis
rapid, deep breathing (hyperventilation) causes too much CO2 to be expelled from bloodstream
66
most common cause of respiratory alkalosis & other causes
hyperventilation from anxiety
aspirin overdose, fever, low levels of oxygen in blood, pain
67
symptoms of respiratory alkalosis
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
68
treatment of respiratory alkalosis
treat cause = O2 if hypoxic, anti-anxiety meds PRN, controlled breathing exercises
69
hyperventilation can be treated by….
having the pt breath into paper bag, which forces the pt to rebreathe exhaled CO2, thereby raising CO2 level
70
asthma
inflammatory disorder of airways
inflammation causes varying degrees of obstruction in airways leading to recurrent episodes of wheezing, breathlessness, chest tightness, and cough
71
when asthma most common
at night and early in the morning
72
pathophysiology of asthma
** 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
73
cells lining the bronchi have microscopic structures called receptors such as
beta-adrenergic
cholinergic
74
receptors in bronchi regulate airflow by
sensing presence of specific substances & stimulate underlying muscles to contract & relax
75
causes of asthma
- abnormal sensitivity of cholinergic receptors (muscles of airways contract when they shouldn’t)
- mast cells responsible for initiating response
76
mast cells throughout bronchi release substances such as histamines & leukotrienes which….
cause smooth muscle to contract, mucus secretion to increase, and certain white blood cells to migrate to area
77
eosinophils (white blood cell found in airways of people with asthma)
release additional substances, contributing to airway narrowing
78
during an asthma attack
- 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
79
what can provoke asthma attacks
cigarette smoke, cold air, viral infection, certain foods (RARE, like shellfish or peanut butter)
stress and anxiety
exercising can cause bronchoconstriction
80
symptoms of asthma
vary in frequency & severity
some symptom-free, occasional brief mild SOB
cough & wheeze more serious
crying/laughing can bring on symptoms
81
asthma attacks occur most often in
early morning hours when the effects of protective drugs wear off and the body is least able to prevent bronchoconstriction
82
coughing may be the only symptoms in some people with asthma
TRUE
83
an asthma attack may begin suddenly with
wheezing, coughing, and SOB
people first notice SOB, coughing or chest tightness
attack may last minutes, hours, or days
84
wheezing is particularly noticeable when the person ….
breathes out
85
what happens when SOB becomes more severe in asthma
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
86
confusion, lethargy, and cyanosis are signs that person’s O2 supply is severely limited & ……. is needed
emergency treatment
87
most severe form of asthma
status asthmaticus
88
in status asthmaticus the lungs are
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
89
status asthmaticus requires…
artificial airway (intubation) & mechanical ventilator
90
diagnosis of asthma
subjective report
confirm by pulmonary function test
91
pulmonary function test done by
before & after giving inhaled drug (beta-adrenergic agonist) = reverses bronchoconstriction
if results are sig better after person gets drug, asthma is present
92
treatment of asthma
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
what should people know regarding asthma
- what can stimulate an attack
- what helps to prevent an attack
- how to use drugs properly
- when to seek medical care
94
what is COPD
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
what is chronic bronchitis
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
when chronic bronchitis involves airflow obstruction…
it qualifies as chronic obstructive bronchitis
97
emphysema is defined as
widespread & irreversible destruction of the alveolar walls (cells support lung alveoli) & enlargement of many alveoli
98
in emphysema, destruction of alveolar wall attachments results in
collapse of bronchioles, which causes permanent airflow obstruction
99
inflammation of the bronchioles develops & causes
smooth muscle to spasm (contract), further obstructing airflow
inflammation also causes airflow to be blocked by secretions
100
airflow obstruction of COPD —>
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
causes of COPD
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
symptoms of COPD
- 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
acute exacerbation of symptoms (flare-up) of COPD
worsening of symptoms, usually cough, increased sputum, & SOB
sputum colour often changes to yellow/green & fever & body aches common
SOB at rest
104
during severe flare-ups, people may develop life-threatening condition called (COPD) & symptoms are
acute respiratory failure & severe SOB (likened to being drowned), severe anxiety, cyanosis, confusion
105
chronic bronchitis is diagnosed by
he of prolonged productive cough
106
ppl with chronic obstructive bronchitis diagnosis
chronic bronchitis & evidence of airflow obstruction on pulmonary function tests
107
emphysema is diagnosed by
basis of findings observed during a physical examination & pulmonary function test results
108
chest movement in COPD
diminishes during breathing & use of accessory muscles
109
how is COPD diagnosed
chest x-ray which shows over-inflation of lungs
110
treatment for COPD
- 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
treatment of COPD symptoms
- 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
pulmonary rehab programs for COPD
help people improve lung function, programs provide education about disease, exercise, nutritional & psychological counselling
113
single lung transplant may be used in certain people who are usually younger than 60 & have severe airflow obstruction
TRUE
114
lung volume reduction surgery can be done in people with severe emphysema in the upper portion of lungs
TRUE
115
complications of COPD
- O2 levels in blood may decrease, but CO2 levels remain normal (early stages)
- later stages, CO2 levels increase, O2 levels fall
116
polycythemia
decreased O2 levels in blood stimulates the bone marrow to send more red blood cells into blood stream
117
does the decrease in O2 levels in blood also increase the pressure in the pulmonary artery?
YES
118
pneumonia
inflammatory process in lung parenchyma (functional tissue) thats usually associated with a marked increase in interstitial and alveolar fluid
119
causes of pneumonia
bacteria, viruses, mycoplasmas, fungi, protozoa, aspiration of food fluids or vomit, inhaled toxic chemicals smoke dusts or gases
120
different types of pneumonia
community-acquired pneumonia, hospital acquired pneumonia, fungal pneumonia, aspiration pneumonia, opportunistic pneumonia
121
aspiration pneumonia
abnormal entry of secretions or substances into the lower airway
usually aspiration of material from mouth or stomach
122
opportunistic pneumonia
people with an altered immune response are susceptible to respiratory infections
123
risk factors of pneumonia
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
additional risk factors for pneumonia
dysphagia (difficulty swallowing)
exposure to air pollution
altered LOC (alcohol, anesthesia, seizures)
inhalation of a noxious substance
aspiration
125
symptoms of pneumonia
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
diagnostic tests for pneumonia
hx & physical exam
chest x-ray
sputum culture & sensitivity
complete blood count & differential
SpO2 levels
blood & urine cultures
127
baby blues
mood swings after delivery, feeling joyful one minute and depressed the next
go away within 10-14 days of delivery
128
perinatal depression
depression that begins in the period from conception to after pregnancy
129
symptoms of perinatal depression
- 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
causes of perinatal depression
- hormonal changes
- physical changes
- stress
131
explain hormonal changes r/t the cause of perinatal depression
after childbirth there is a drop in estrogen & progesterone levels
thyroid levels can also drop leading to fatigue & depression
132
explain physical changes r/t cause of perinatal depression
childbirth causes numerous physical & emotional changes e.g. physical pain form the delivery, difficulty losing the baby weight causing insecurity, appearance & sexual attractiveness
133
explain stress r/t perinatal depression
stress caring for a newborn, sleep deprivation, feeling overwhelmed and anxious, ability to care for a baby especially for a first time mom
134
perinatal depression can interfere with a mother’s ability to care for herself & her child
TRUE
135
other factors that increase risk of perinatal depression
medical complications for mother or baby
relationship difficulties
lack of support from family or friends
136
perinatal depression & attachment
- 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
impact of peripartum depression on children
- 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
perinatal depression disrupts the…
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
education for new moms
- 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
professional treatment for perinatal depression
responds to the same treatments as regular depression
support groups
individual therapy
marriage counselling
antidepressant medications
ECT
141
perinatal psychosis
rare but very serious disorder that can develop after childbirth
characterized by loss of contact with reality
142
perinatal psychosis should be..
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
symptoms of perinatal psychosis
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
depressive disorder diagnosis must include
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
behavioural findings in depression
- 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
depression risk factors
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
initial insomnia
difficulty falling asleep
148
middle insomnia
waking up during the night and having difficulty returning to sleep
149
terminal insomnia
waking too early and being unable to return to sleep
150
treatment for depression
cognitive therapy (thought stopping & positive self-talk)
behaviour therapy
interpersonal therapy
family & marital therapy
group therapy
ECT
151
common medications for depression
tricyclic
SSRI
SNRI
SARI
NaSSA
NDRI
152
side effects of medications for depression
nausea, vomiting, diarrhea, changes in appetite or weight, dry mouth, yawning, dizziness, headache, anxiety, tremors, tired, sleep problems
153
ECT
general anesthesia & small electric currents are passed through the brain, intentionally triggering a brief seizure
154
ECT causes
changes in brain chemistry that can quickly reverse symptoms of certain mental health conditions
155
risks and side effects of ECT
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
what is pain
- complex experience
- personal and subjective
- influenced by factors (age, economic, ethnicity, gender)
157
pain results from
a series of complex electrical and chemical changes involving your peripheral nerves, spinal cord, and brain
158
nociceptive pain
damage to somatic or visceral tissue
159
nociceptors
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
spinal cord in pain
specialized nerve cells filter and prioritize messages from the peripheral nerves
pain messages travel to the brain
161
brain pain pathway
sends back messages that promote the healing process: signals ANS to send increased WBCs & platelets for tissue repair, release pain-suppressing chemicals
162
somatic pain
musculoskeletal pain: skin, muscle, joints, bones & ligaments
characterized as sharp localized pain in specific area
swelling, cramping, & bleeding may exist
163
somatic pain responds to a variety of
medications: non-opioids, opioids, nonsteroidal anti-inflammatory drugs
164
visceral pain
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
what is the most effective pain medication for visceral pain
opioids because it feels like a deep ache with cramping
166
visceral pain may ___ to other locations in the back and chest
radiate
167
neuropathic pain
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
neuropathic pain often described as
burning, freezing, numbing or tingling
pins and needles sensation
169
a common form of neuropathic pain occurs when …
diabetes damages the small nerves in the hands and feet, producing a painful burning sensation
170
sympathetic pain
source is due to possible over-activity of sympathetic nervous system and C/PNS mechanisms
171
causes of sympathetic pain
after fractures & soft tissue injuries of arms and legs
172
receptors activated in sympathetic pain
like nerve pain, there are no specific pain receptors
173
characteristics of sympathetic pain
- 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
referred pain
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
acute pain
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
acute pain responses/signs & symptoms
increased heart rate
diaphoresis
increased respiratory rate
increased blood sugar
elevated blood pressure
decreased gastric acid secretion
pallor or flushing
dilated pupils
nausea
177
chronic/persistent pain
discomfort that lasts beyond normal healing period
affect persons life dramatically (make simple things difficult, hopelessness, depression)
often unknown causes
178
control gate theory
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
pain assessment
pattern, area, intensity, nature
180
nursing interventions for pain
- 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
TIA
- 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
symptoms of TIA
motor
sensory
speech/language
vision
cerebellar disturbances
183
stroke
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
types of strokes
ischemic (clot stops blood supply to an area of brain) 83% of strokes
hemorrhage (blood leaks into brain tissue) 17% of strokes
185
stroke pathophysiology
- loss of blood supply: loss of O2 and glucose & cell death and permanent changes within minutes
186
ischemic stroke
blockage of blood supply caused by a thrombus or embolism (blood clot)
187
hemorrhage stroke
bleeding into the brain tissue or subarachnoid space
188
how does the brian control movement
one side of the brain controls the opposite side of the body
left brain = controls right side
right brain = controls left side
189
functionally, the left brain controls….. & the right brain controls …..
logic & creativity
190
right side of the brain common tasks
creativity, imagination, facial recognition, emotion, music & arts
191
left side of the brain common tasks
logic, analysis, sequencing, math, language, critical thinking, reasoning, thinking in words
192
at pt with left-side stroke may suffer from
aphasia = inability to understand or express language (left brain task)
193
a pt with right-side stroke may suffer from
emotional lability = which includes involuntary outbursts of emotion (right-brained task)
194
risk factors for stroke
- 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
identifying a stroke
FACE
196
symptoms of stroke
- parenthesia (numbness, tingling, burning)
- weakness or paralysis of limbs
- aphasia
- confusion
- visual disturbances
- dizziness
- loss of balance and coordination
- headache
197
treatment of stroke
TIA = antiplatelet agents reduces risk of stroke
tissue plasminogen activator: ischemic stroke — should be administered within 4.5 hours
198
medical interventions for stroke
- early diagnosis
- maintain cerebral oxygen
- restore cerebral flow
- prevent complications (bleeding, edema)
- prevention of second stroke
- rehab
- pt & family teaching
199
important to note for stroke!!!!
- pt have impaired swallowing & high risk for aspiration
- monitor VS & know BP
- prevent edema = elevate limbs
- promote self care
200
nursing interventions for stroke
HOB at 30 degrees
initiate DVT prophylaxis
ensure OT ordered
fall prevention measures
201
UTI
infection that affects urinary system
urine is unsterile due to infectious agents present
infection anywhere along the urinary tract
202
causes of UTI
through lower end of the urinary tract, urethra —> infection ascends the urethra to the bladder
infection enters through bloodstream
203
cystitis
infection of bladder usually caused by bacteria
204
symptoms of UTI
- 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
risks of UTI
bacteria, STI, poor hygiene, voiding problems, spermicides, indwelling catheters, honeymoon cystitis (not peeing after sex)
206
if UTI travels up to kidneys, it may…
cause pyelonephritis causing renal scarring and occasionally renal failure
207
pyelonephritis
kidney infection
bacterial infection of one or both kidneys
more common in women
antibiotics given to treat infection
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symptoms of kidney infection
chills, fever, back pain, nausea, vomiting
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causes of kidney infection
e. coli
physical obstruction
increase risk during pregnancy
infections ascend from genital area
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chronic pyelonephritis
longstanding infection
underlying abnormalities (obstructed urinary tract)
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glomerular disease
attack tiny blood vessels within the kidney
first sign is proteinuria or hematuria
diagnosed by biopsy
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treatment of glmerular disease
immunosuppressive drugs and steroids to reduce inflammation
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polycystic kidney disease
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
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acute kidney disease
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
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chronic kidney disease
gradual loss of kidney function
may develop permanent kidney failure - higher risk of death from stroke or heart attack
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end stage renal disease
total or nearly total and permanent kidney failure
must undergo dialysis or transplantation to stay alive
kidneys are no longer adequately filter blood
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signs of chronic kidney disease
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
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3 tests to screen for kidney disease
blood pressure, urine test for protein & albumin, calcification of glomerular filtration rate (GFR) based on serum creatinine measurement
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medical tests for kidney disease
measuring urea in blood
kidney imaging
biopsy
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difference between fast and slow fibres related to pain
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.
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Explain nociceptors and provide example
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.
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Hemiparesis hemiplegia aphasia dysarthria apraxia homonymous hemianopia horner syndrome agnosia
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
