Final Exam Flashcards
Explain Coronary Atherosclerosis
Include signs & symtoms, risk factors & pathology
Signs & Symptoms:
* Angina (most common)
* Weakness
* Lightheadedness
* Nausea
* Epigastric, arm, or shoulder pain
* Dyspnea (SOB)
Risk Factors:
Non-Modifiable: family history, gender, race
Modifiable: cholesterol, HTN, DM, tobacco use
Pathology:
* accumulation of lipids (as well as blood components, Ca+, carbs, & fibrous tissue) in the arteries that decreases blood flow
- affects medium & large arteries
Coronary Atherosclerosis
- What is it?
- What are the unique symptoms?
- What are the risk factors associated with it?
- What kind of vessels are impacted & what size are they?
Accumulation of plaque in arteries that decreases blood flow
- Non-Modifiable Risks: family hx, gender, race
- Modifiable Risks: cholesterol, HTN, DM, tobacco
Medium & Large ARTERIES are impacted
What is the most common symptom of coronary atherosclerosis?
Angina
weakness, light-headed, epigastric / shoulder / arm pain, SOB
What is ateriosclerosis?
Hardening / scarring of small arteries & arterioles
- due to thickening of muscle fiber & endothelial lining
What is angina?
Types, causes, pathology, & treatment
Crushing pain in the chest, neck, upper back, shoulders, arms
Types:
* Stable
* Unstable
* Intractable
Causes:
* Acute coronary syndrome
* Myocardial infarction (MI)
* Arrhythmias
* Cardiac arrest
* Heart failures
* Cardiogenic Shock
Pathology: Low blood supply to the heart (muslces don’t receive enough O2)
Treatments: stop & rest, high fiber / low fat diet
What is Coronary Atherosclerosis & what are the defining characteristics?
accumulation of plaque in arteries that decreases blood flow
Defining Characteristics:
* Angina
* Pre-MI
What is Acute Coronary Symdrome (ACS = Acute MI Onset)?
Types, Signs & Symptoms, Risk Factors, & Pathology
Sudden, reduced blood flow to the heart
Types:
* Unstable angina
* STEMI (ST-elevated myocardial infarction)
* NSTEMI (non-ST elevated myocardial infarction)
Signs & Symptoms:
* Sudden chest pain (not aleviated w/ rest or meds)
* Dyspnea (SOB)
* Indigestion / nausea
* Anxiety
* Pale, cool skin
* Increased HR / RR / BP
* New murmur
* S3 & S4
* Arrhythmia
Risk Factors:
* Smoking
* Hypertension
* Diabetes
* Hyperlipidemia
* Being male
* Physical inactivity
* Diet / Exercise
What is Acute Coronary Syndrome & what are defining characteristics?
Acute loss of blood to the heart
- Sudden Chest Pain
- New Murmur
Types = unstable angina, STEMI, & NSTEMI
What is Heart Failure? What is the difference in systolic & diastolic heart failure? What is one of the main causes?
Risk Factors, R & L sided HF symptoms, Treatments
Heart can’t pump enough blood to meet metabolic demands
R-Sided HF:
* Visceral & peripheral congestion
* JVD
* Dependent edema
* Hepatomegaly
* Ascites
* Weight Gain
L-Sided HF:
* Pulmonary congestion
* Crackles
* S3
* Dyspnea
* Low O2
* Dry cough
* Oliguria
Risk Factors: smoking, obesity, diabetes, metabolic syndrome
- Systolic HF: problems with heart contraction
- Diastolic HF: problems with hear filling
- Main Causes = atherosclerosis in coronary arteries
Treatment: ACE inhibitors
Key Differences in R-sided & L-sided Heart Failure
R-Sided: weight gain, JVD, edema, hepatomegaly, ascites, visceral & peripheral congestion
L-Sided: pulmonary congestion, crackles, S3, dyspnea, low O2, dry cough, oliguria
What is the difference in systolic & diastolic heart failure?
Systolic = issue with heart contraction
Diastolic = issue with heart fillling
What is one of the main causes of heart failure?
Atherosclerosis in coronary arteries
What do ace inhibitors do to help with heart failure?
Vasodilation = decreases afterload
important for systolic HF
Explain each part of the EKG
- P = Atrial Depolarization (atria contract)
- QRS = Ventricular Depolarization (ventricular contraction)
- T = Ventricular Repolarization (ventricular contraction)
Explain the electrical conduction pathway through the heart
- SA Node - main pacemaker
- AV Node - back up pacemaker
- His Budnle - (Bundle of His)
- Bundle Branches
- Purkinje Fibers
Sweet Apples Have A Big Price
What is the difference in ST elevation & ST depression?
- ST Elevation = NO O2
- ST Depression = LOW O2
Describe the following types of infections:
- Nosicomial
- Iatrogenic
Nosicomial = hospital acquired infection
* Catheter-associated UTI (CAUTI)
* Surgical site infection (SSI)
* Methicillin-resistant Staph aureus (MRSA)
* C. diff infection (CDI)
* Central line-associated bloodstream infection (CLABSI)
Iatrogenic = infection acquired after a procedure or treatment
Explain the stages of sleep. How long is a sleep cycle & how many sleep cycles does a person have in one night?
Non-REM Sleep: Stage I –> Stage II –> Stage III –> Stage IV –> Stage III –> Stage II –> REM –> Stage II –> ETC.
1 Cycle = 90 minutes
- Person has about 6 cycles per night
Explain the nursing process.
- Assess
- Diagnose
- Plan
- Implement
- Evaluate
What step of ADPIE are SMART goals used & what are SMART goals?
Used in planning phase
- Specific
- Measurable
- Attainable
- Realistic
- Timely
What are the four phases of the nursing interview?
1.) Preparatory -
2.) Introduction -
3.) Working - longest phase
4.) Termination -
Per Book: (1.) Orientation; (2.) Work; (3.) Termination
What is ISBAR?
- Introduction
- Situation
- Background
- Assessment
- Recommendations
What are Maslow’s Hierarchy of Human Needs?
highest to lowest priority
1.) Physiological needs
2.) Safety needs
3.) Love & belonging
4.) Self-esteem needs
5.) Self-actualization needs
What is the difference in Nociceptive & Neuropathic Pain?
- Nociceptive = aching, throbbing
Neuropathic = tingling, burning, shooting, pins & needles
What are the 5 Rights of Delegation?
Right:
- Task
- Circumstances
- Person
- Directions / communication
- Supervision / evaluation
Explain primary, secondary, & tertiary prevention in nursing
- Primary: Prevention & education
- Secondary: Screening
- Tertiary: Patient already has diagnosis, how do you prevent it from coming back / treatment
What is the difference in a contusion, abrasion, laceration, & avulsion?
- Contusion: bruising
- Abrasion: rubbing or scraping of epidermal layers / some tissue is removed
- Laceration: cut / tearing of skin
- Avulsion: structures are removed from normal anatomical position
What is the difference in dehisence & evisceration?
**Dehisence = ** wound pulls apart at the edges
Evisceration: intraabdominal contents protrudes from the wound
Describe the stages of pressure injuries
Stage I: non-blanchable, erythema, skin is intact
Stage II: partial-thickness skin loss with exposed epidermis; errosion
Stage III: full-thickness skin loss; visible adipose tissue (no underlying tissue seen)
Stage IV: bone, muscle, tendon, etc. (other underlying structures) are visible
Unstageable: obscured view (usually obscured by eschar
Deep Pressure Injury: nonblancable; red, purple, or maroon color
Explain the different types of wound drainage: serous, sanguineous, serosanguineous, purulent.
Serous: mainly clear & thin (hint of yellow)
Sanguineous: bright red & slightly thick
Serosanguineous: pink
Purulent: thick, viscous pus, yellow or green
What is tidaling in terms of a chest tube?
Fluid level in the chamber moves up & down with the patients respirations
What does it mean if there is continuous bubbling in a water seal chamber?
leak in chest tube
Bubbling is expected in suction control chamber
Which Oxygen Delivery Device provides the most precise amount of oxygen to be delivered to a patient?
Venturi Mask
What does peak flow meter measure?
Forced expiration / highest airflow during forced expiraiton
What signs & symptoms are the primary indicators of an asthma diagnosis?
- Cough
- Chest tightness
- Wheezing
- Dyspnea
What is the difference in cardioversion & defibrillation?
Cardioversion is synchronized delivery of energy
Defibrillation is asynchronous delivery of energy
Explain Pulmonary Edema (caused by HF)
Include risk factors, s&s, & pathology
Signs & Symptoms:
* Severe hypoxemia
* Restlessness / anxiety
* Tachypnea
* Dyspnea
* Cool, clammy skin
* Cyanosis
* weak / rapid pulse
* Cough (moist / noisy respirations)
* Increased pink frothy sputum (blood-tinge)
* Fluid overload
* S3 (blood rushing into L ventricle)
* Wheezes / Crackles
Risk Factors: Heart failure, specifically L ventricle failure
Pathology: blood backs up, pushes with pressure through vessels into alveoli
What are the unique signs & symptoms of Pulmonary Edema (from HF)?
- Weak / rapid pulse
- Pink, frothy sputum (blood-tinged)
- Crackles / Wheezes
What kind of oxygen should be given to a patient with Pulmonary Edema from heart failure? What prescriptions can be used & waht should be monitored?
Use a Non-Rebreather Mask (100% O2 concentration)
Rx: diuretics & vasodilators
Monitor: I/O & weight
Explain Hypertension
S&S, Risk factors, & pathology
Signs & Symptoms:
* Absent or weak pulses (esp. distal)
* S3 or S4 heart sounds
* Reginal hemorrhages
* JVD
* Renal artery bruit
Risk Factors: African American Men, older age, smoking, obesity, sedentary, dyslipidemia, DM, family hx, microalbuminuria or GFR < 60
Pathology:
* increased cardiac output (hypervolemia), peripheral resistance, or both
* Dysfunction of ANS (increased RAAS)
* Insulin resistance
* Activates immune system
* 95% of cases have no known cause
What are unique defining characteristics of Hypertension?
S&S, risk factors, & pathology
Signs & Symptoms: Retinal Hemorrages, Renal artery bruit
Risk Factors: African American Men
95% of HTN has no known cause
In HTN, you must protect vital organs including the brain, heart, & kidneys
Explain Cardiogenic Shock
S&S, Risk Factors, & Pathology
Signs & Symptoms:
* Tachypnea
* Dyspnea
* Tachycardia
* Weak pulse
* Diaphoresis
* Pale skin
* Hypotension
Risk Factors: pericardial effusion, cardiac tamponade, MI, PE, End stage HF, cardiomyopathy, arrhythmia
Patho: Heart can’t pump as much blood as the body needs, decreased CO
What is Cardiogenic Shock & what are signs / symptoms?
Heart can’t pump enough blood throughout the body; decreased CO
Signs & Symptoms:
* Tachycardia
* Hypotension
What is Virchow’s Triad and what disease does it deal with?
- Intravascular vessel wall damage
- Stasis of flow
- Presence of a hypercoagulable state
Deals with Thromboembolism
What are signs & symptoms of DVT / Thromboembolism?
- Leg Pain
- Swelling
- Erythema
- Warmth
Explain a thromboembolism
S&S, RF, & Patho
Signs & Symptoms: (DVT)
* Leg pain
* Swelling
* Arrythmia
* Warmth
Risk Factors: cardiovascular disorder, decreased mobility
Patho:
* Virchow’s Triad: intravascular vessel wall damage, stasis of flow, & presence of a hypercoagulable state
Explain Pericardial Effusion
S&S, RF, Patho
Signs & Symptoms:
* Elevated pressure in all chambers
* Dyspnea
* Discomfort breathing when lying down
* Chest pain
* Lightheadedness
Risk Factors:
* Heart Failure
* Pericarditis
* Metastatic Carcinoma
* Cardiac Surgery
Trauma
Patho: Increase in fluid in the pericardial sac
* may occur over time or suddenly
What is a pericardial effusion & what are unique characteristics?
Increase in fluid in pericardial sac that can occur suddenly or over time
- Discomfort when lying down
What is Pulsus Paradoxus?
BP decreases with inhalation
Explain Cardiac Tamponade
S&S, RF, Patho
Signs & Symptoms:
* Chest pain
* Pulsus paradoxus (BP decreases with inhalation)
* Tachypnea
* Dyspnea
* Tachycardia
* JVD
* Hypotension
* Muted Heart Sounds
Risk Factors: Heart surgery, injury to the heart, tumors in the heart, MI, HF
Patho: compression of heart by accumulated fluid in the pericardial sac
- related to PE & Cardiogenic shock
What is Cardiac Tamponade & what is unique about it?
Commpression of heart by fluid in pericardial sac
- Related to PE & Cardiogenic Shock
- Muted heart sounds
Explain Cardiomyopathy
S&S, RF, Patho
Signs & Symptoms:
* Dyspnea
* Fatigue
* Dizziness
* Arrhythmias
* Murmurs
* Pulsus paradoxus
* Weight changes
* JVD
* Edema
* S3 / S4 heart sounds
* Crackles in lungs
Risk Factors: Family history, HF, long-term HTN, prior MI, CAD, heart infection, obesity
Patho: Series of progressive events that lead to impaired cardiac output
Na+ is major electrolyte involved
What is cardiomyopathy & waht is unique about it?
Damage to the heart muscle that causes impaired cardiac output
S&S: murmur, pulsus paradoxus, weight changes, S3 / S4, crackles
Risk Factors: Long-term HTN
Sodium = major electrolyte involved
What is the main electrolyte involved in cardiomyopathy?
Sodium
Explain Infectious Diseases of the Heart
S&S, RF, Patho
Signs & Symptoms:
* Fever
* New heart murmur
* Olser nodes (fingers/toes, painful)
* Janeway lesions (palms/soles, no pain)
* Roth spots (eyes)
* Cardiomegaly
* HF
* Tachycardia
* Splenomegaly
* Fatigue
* Dyspnea
* Syncope
* Palpitations
Risk Factors: bacteria & viruses
Named for layer of heart that’s affected:
List the layers of the heart from outside to inside
- Pericardial Sac
- Epicardium
- Myocardium
- Endocardium
What is rheumatic endocarditis?
S&S, who gets it, & what’s the cause?
Bacterial Endocarditis
- Most common in School aged kids
Cause = Group A beta-hemolytic strep
Unique S/S: hemolytic nail beds
What are common complications of pericarditis?
Pericardial effusion: fluid filling sac around the heart
Cardiac tamponade: pressure from fluid build-up
What is the cause of Infective Endocarditis? What are common reasons for getting it / associated with?
Caused by Bacteria
Associated with: prosthetic heart valve or structural cardiac defects, IV drug abuse, catheters, prolonged IV therapy
What is the common cause of myocarditis?
Virus
What is the difference in these valve disorders:
- Regurgitation
- Stenosis
- Prolapse
- Regurgitation = Backflow
- Stenosis = Narrowing
- Prolapse = Relaxes into atrium
Explain Aneurysms
S&S, RF, Patho
Signs & Symptoms:
* Nausea / Vomiting
* Stiff neck
* Blurred vision
* Sensitivity to light
* Seizures
* Drooping eyelid
* LOC
Risk Factors:
* Triple A: atherosclerosis in aorta
* Congenital
* Infection
* Inflammation
* Pregnancy-related
* Trauma
Patho: Abnormal Dilation of Blood Vessels
What is the difference in Saccular & Fusiform aneurysms? What are unique signs & symptoms?
S&S:
* Stiff Neck
* Seizures
Saccular: balloon on ONE side
Fusiform: balloon on BOTH sides
What is the difference in a STEMI & NSTEMI myocardial infarction?
STEMI: total occlusion (Serious)
NSTEMI: partial occlusion (blood flow is restricted, not stopped)
Explain Reynaud’s Phenomenon
Intermittent arterial vasoocclusion of fingers & toes (vasospasm)
- color changes in fingers & toes
- numbness, tingling, burning
Explain Peripheral Artery Disease (PAD)
S&S, RF, Patho
Signs & Symptoms:
* Intermittent Claudication - aching, cramping, inducing fatigue or weakness with exercise of distal occlusion; relief with rest
* rest pain is due to ischemia
* Elevation increases pain
* Unequal pulses in limbs
Risk Factors: Atherosclerosis
Patho:Mainly caused by buildup of fatty plaque in arteries (atherosclerosis)
Extremities are cold / numb
Round, punched-out wound ulcer
Explain Venous Stasis
Stasis = blood stays in legs
Signs & Symptoms:
* Tan legs
* Ulcers with clean edges, but odorous
* Higher risk for DVT
What is the difference in Lymphagitis, Lymphadenitis, & Lymphedema?
- Lymphagitis - inflammation or infection of lymph channels
- Lymphadenitis - inflammation or infection of lymph nodes
- Lymphedema - swelling related to obstruction of lymphatic flow
What is the main function of the following electrolytes?
- Potassium
- Sodium
- Calcium
- Magnesium
- Phosphate
- K+ = Heart
-
Na+ = dehydration (Cl+ = same as Na+)
- maintain BP, blood volume, & pH
- Ca+ = bones, blood, (clotting factors** & beats** (heart beats)
-
Mg+ = muscles
* torsades de pointe - P+ = bone & teeth formation; regulates Ca+
P+ & Ca+ are inverse
What occurs with hyperkalemia & hypokalemia?
Hyper = irregular heartbeat, hypotension, bradycardia, muscle & GI contraction
Hypo =
* Low & slow GI & muscles
What occurs with hypernatremia & hyponatremia?
Hypernatremia = red skin, edema, low grade fever, polydipsia(excessive thirst)
Hyponatremia
* seizures & coma
* tachycardia & weak, thready pulses
* respiratory arrest
Late Hyper Sings = N/V, swollen dry tongue, increased muscle tone
What occurs with hypermagnesemia & hypomagnesemia?
Hyermagnesemia = CALM & QUIET
* bradycardia, hypotension, hyporeflexia, depressed / shallow respirations, hypoactive bowel sounds
Hypomagnesemia
* tachycardia, V-fib, torsades de pointe
* hyporeflexia (increased DTR)
* abnormal eye movements
* diarrhea
What occurs with hypercalcemia & hypocalcemia??
Hypercalcemia = swollen & slow (moans, groans, & stones)
* constipation
* bone pains
* kidney stones
* decreased dtr
Hypocalcemia
* Trousseau’s signs
* Chvostek’s sign (cheek)
* diarrhea
* tingling around mouth
* weak bones
* risk for bleeding
* cardiac dysrhythmias
