Final Flashcards
Orthostatic intolerance
Plasma volume loss and pooling in LE when upright -> exaggerated HR and decreased diastolic filling
Cardiac output
Stroke volume x HR
Stroke volume
Volume of blood ejected during each heartbeat
Cardiovascular effects of bed rest
Reduced cardiac output due to reduced volume, increased venous compliance, orthostatic intolerance, increased resting HR
DVT Virchows triad
Venous stasis (pooling), vessel trauma, hypercoagulability
Pulmonary Embolism
Peripheral clot that dislodges and goes to lungs. Symptoms are dyspnea, chest pain, coughing
Pulmonary effects of prolonged bedrest
Decreased strength and endurance of ventilatory muscles, increased RR and work of breathing, pneumonia risk due to pooling of mucus
Gastrointestinal effects of prolonged bedrest
Decreased appetite and fluid intake, constipation due to decreased motility of small intestine in supine
Urinary effects of prolonged bedrest
Excretion of sodium in urine causing decreased blood volume, increased risk of UTI, trouble voiding
95% of pressure injuries occur where?
Heels, sacrum, ischial tuberosities, back of head,
Delirium
Can be Due to prolonged bedrest, meds, anesthesia. Can be hyperactive, hypoactive, or a mix
Blood pressure normal vs not
120/80. Stage 1 hypertension 140/90, stage 2 160/100
Hypervolemia
Fluid imbalance causing fatigue and SOB
Hypovolemia
Fatigue and elevated HR
Sodium
Fluid balance and muscle contractions
Hypernatremia
Too much sodium. Irritable, tachycardia, seizure, coma
Hold at >150
Hyponatremia
Too little sodium. Lethargy, seizure, coma.
Hold at <125
Potassium
Skeletal and cardiac muscle contractions
Hyperkalemia
Weakness, bradycardia, cardiac arrest, numbness/tingling, paralysis
Hold at >5.1
Hypokalemia
Weakness, cramps, cardiac arrest, arrhythmias
Hold at <3.2
Calcium
Bone and cell growth
Hypercalcemia
Arrhythmia, weakness, poor tolerance
Hypocalcemia
Anxiety, confusion, cramps
Hold at <6.0
Chloride
Associated with sodium for fluid balance
Hyperchloremia
Lethargy, tachycardia, weakness
Hypochloremia
Irritability, cramping, twitching
CO2
Elevated= acidosis and elevated pH: lethargy
Decreased= alkalosis and decreased pH: confusion and dizziness
Platelets
<5000= bed rest
Hemoglobin
Binds and transports O2 in RBCs
High= clogging
Low= heart failure
Hematocrit
Percentage of red blood cells in total blood
Assesses blood loss and fluid balance
Tracheal
Over trachea, high pitched, 1:1
Bronchial
Over manubrium, 1:2
Bronchovesicular
Between scapulae, 1:1
Vesicular
Most commonly heard, mostly hear inhale
3:1
Stage 1
Skin intact, nonblanchable redness
Stage 2
Pink, painful, partial. Through to dermis with no slough
Stage 3
Through to subcutaneous, crater with or without undermining/tunneling, slough
Stage 4
Through to bone, muscle, tendons. Includes slough or eschar
Deep tissue
Discolored intact skin, mushy or boggy feel
Unstageable
Full thickness loss covered by slough or eschar, tan green black brown
Symptoms of arterial insufficiency
Ur or of dependency, elevations of pallor, weak or absent pulse, cool, hairless, shiny, intermittent claudication
Tests for arterial insufficiency
Elevation- between 25- 60 sec. No pallor is is normal
Rubor- in 15-30 turns bright red
Pulses- 0-4. 0= absent, 2= normal
Cap refill- takes longer than 3 sec
Claudication- scale 0-4. Exercise should cease at 2
Venous insufficiency symptoms
Peripheral edema, hemosideran staining, venous stasis ulcers (moist and irregular)
Venous testing
Pitting edema- scale 0-4. 1 = 0-15 sec. 4 = >60 sec
Calf girth measurement
Venous fill time
DVT presentation
Swelling and pain
Redness and warmth
Low fever
Dull ache
Wells CPR for DVT
Cancer
Bedridden
Paralysis
Swelling of leg
Localized tenderness
Calf swelling
Pitting edema
Hip precautions
No flexion past 90
No IR
No adduction
All for 3 months, but avoid combo for life
Causes dislocation
Spine
No bending or twisting
No lifting more than 10 lbs
2-6 weeks
Fractures
No precautions other than WB
A lot of the time is WBAT for bone regrowth
Compartment syndrome
Swelling leads to occlusion of blood flow in compartment
Can lead to necrosis within 4-12 hours
General anesthesia
Fully under and ventilated, complications are nausea and sore throat
Requires more monitoring
Regional anesthesia
Spinal and epidural (stays in place) and nerve block
Numbed from waist down typically
Abdominal surgery precautions
Log roll
Avoid extension/flexion
No lifting more than 10 lbs
Complications for cardio thoracic surgery
Pulmonary: atelectasis, lung collapse, pneumonia
Bleeding, hemorrhaging, infection
Interventions after thoracic or abdominal surgery
Coughing, breathing, splinting, ROM, positioning, mobility
Sternal precautions
No pushing/pulling
Lifting >10 lbs
No full abduction arm
No full extension arm
No driving for 4 weeks
12 weeks for bony callus
Palliative care
Holistic and life sustaining
See pt though to end of life or to transition to hospice
Hospice
Focused on comfort
>6 months and signed into transition
Full code
All life saving/sustaining measures
DNI (limited code)
Do everything one can except for intubation
DNR (no code)
No life saving or sustaining measures
Advanced directive
Living will
States what pt wants at end of life
What kind of code? Etc
Health care proxy
Designated person that will make healthcare decisions for you once you are unable to
If no one is designated then next of kin or court appointed guardian takes over
