FINAL EXAM Flashcards by olivia mcnamara

depolarization of atria

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depolarization of ventricles

QRS

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repolarization of ventricles

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de and repolarization of ventricles

QR interval

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Impulse travel through AVN

PR segment

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Atrial depolarization and travel time

PR interval

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Slow repolarization of the Purkrnje fibers

U waev

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Total ventricular activity

QT interval

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occurs when the heart contracts to pump blood out

systole

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occurs when the heart relaxes after contraction

diastole

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angiotension ii is a what

vasoconstriction

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MONABATH- used for MI

Morphine
Oxygen
Nitroglycerin
ASA

Beta-blockers
ACE-I
Thrombolytics
Heparin

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treating congestive heart failure

Upright position 
Nitrates
Lasix- urinate less pressure in body 
Oxygen
Ace I
Digoxin

Fluids - decrease
Afterload- decrease
Sodium restriction
Test - ABGs

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ABG (partial blood gases)

ph 7.35-7.45
PCO2-35-45

HCO3- 22-26

PaO2- >80

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anaerobic metabolism is what

breakdown of glucose without oxygen

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what is the by product of anaerobic metabolism

lactic acid

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normal wbc count

4,000-12,000

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normal platelet range

150,000 to 350,000

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Controls the reabsorption of water by the kidneys

ADH

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synthesized by cells in the nuclei of the hypothalamus and then transported to the posterior pituitary gland, where it is stored.

adh

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adh levels are controlled by

extracellular fluid (ECF) volume and osmolality

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adh pulls the water out of the cells to give to other places so it makes the urine

concentrated

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less than 400 ml in a 24 hour period

oliguria

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Not enough ADH or kidney/tubules are not responding; Deficiency of ADH or a decreased renal response to ADH

diabetes ins

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how much urine do diabetes in excrete per day

3-20L a day

dehydration can be measured by

osmolarity and severity

one of the markers used to measure dehydration

Serum sodium marker of osmolarity

(130-150 mEq/L)

isonatremic

(< 130 mEq/L)

hyponatremic

(>150 mEq/L)

hypernatremic

sodium in the blood is = to the sodium I am losing

isotonic

more sodium than water is lost. Because the serum sodium is low, intravascular water shifts to the extravascular space, exaggerating intravascular volume depletion for a given amount of total body water loss.

hyponatremic

Relatively less sodium than water is lost. dehydration occurs when the lost fluid contains less sodium than the blood (loss of hypotonic fluid).

hypernatremic

severe hyponatremia

intractable seizures

hypernatremia dehydration

cerebral edema- more water than sodium so swelling occurs

holding onto fluid

SI ADH - concentrated

Urine osmolarity will be concentrated because its not mixing Serum osmolarity be diluted because its mixing-hyponatremic

SI ADH

which occurs because of a defect in the synthesis or release of ADH Inflammatory, autoimmune, vascular disease

neurogenic DI

kidneys do not respond to ADH

nephrogenic DI

Complaints of intense thirst Craving for ice water Polyuria

treatment for DI

DDAVP

The syndrome of inappropriate ADH (SIADH) results from a failure of the negative feedback system that regulates the release and inhibition of ADH.

SIADH

``` INCREASE ADH DECREASE URINE HYPERTENSION INCREASE HR DILUTIONAL HYPONATREMIA URINE OSMOLARITY HIGH SERUM OSMOLARITY LOW ```

SIADH

``` INCREASE URINE DECREASE ADH HYPOTENSION DECREASE HR DECREASE OSMOLARITY DILUTIONAL HYPERNATREMIA SERUM OSMOLARITY HIGH URINE OSMOLARITY LOW ```

DI ADH

``` Lung tumors Chest lesions CNS disorders Tumors, particularly bronchogenic carcinomas and cancers of the lymphoid tissue, prostate, and pancreas Positive-pressure ventilation ```

SI ADH

treatment for SIADH

give them fluids | diuretic-lasix

Break of a bone in the base of the skull

basilar skull fracture

bruising behind the ears bruising around the eyes blood behind the ear drum.

basilar skull fracture

how to test for cerebral spinal fluid

halo test | check for glucose -csf has glucose in it

what should you not do if your patient has a basilar skull fracture

insert a nasogastric tube; tube can go through the skull and go up to the brain

170-171

look at

The greater the concentration of the substance dissolved

the higher the osmolality

acute failure of the circulatory system to supply the peripheral tissues and organs of the body with an adequate blood supply, resulting in cellular hypoxia

circulatory shock; not enough oxygen/nutritents; inflammatory mechanism

hypotension and hypoperfusion are present

shock

why is anaerobic not good for a patient experiencing shock

lactic acid is produced and there is not oxygen in the cells;

lactic acid level greater than WHAT is not good

sodium potassium pump

NA outside the cell | K inside the cell

when the na/k pump isn't working properly, the sodium ends up inside the cell. what follows sodium?

water; edema.. lots of fluid

compensatory mechanisms for shock

``` raas system (LOOK UPP) sympathetic nervous system ```

receptor that works with epiphinerphine and norephinerphine

adrenergic receptors

(vasoconstriction)located arteries

alpha cells in adrenergic

Increase HR and myocardial contraction

B1 cells

Vasodilatation skeletal muscle

B2 cells

why do you not want to give a beta blocker to a person with asthma

beta blocker vasoconstricts so it constricts the airways

20-1

look over

internal hemorrhage | third-space losses

hypovolemic shock

the passage of black, tarry stools. Hematochezia is the passage of fresh blood per anus, usually in or with stools.

melena

black tarry stool indicative of

high gi bleed; a low GI bleed it'll be red

biggest shock states we see in burns

hypovolemia

adult- not good it means heart failure | child-normal

Necrosis of >40% of the left ventricle

cardiogenic shock

3 I's of a myocardial infarction

inverted T wave- ischemia ST elevation- injury abnormal Q- infarction

blood ejected with each beat

stroke volume

amount of blood thats ejected from heart in 1 minute

cardiac output

``` Tachycardia Hypotension- bum left ventricle SBP < 90 or 30mm Hg less than the baseline UA output < 30mL/hr Cold, clammy skin, PPP Agitation, restlessness, or confusion- LOC Pulmonary congestion Tachypnea Continuing chest discomfort ```

cardiogenic shock

amount of stretch on ventricle at the end of diastole / filling

preload

what would you give to treat a patient in cardiogenic shock

lasix and nitroglycerin (vasodilation)

most frequent cause of obstructive struck whats the second

pulmonary embolism ; cardiac tamponde

blood clot in the lungs

pulmonary embolism

a pressure on the heart that keeps it from filling which decreases blood pressure

cardiac tamponde

total collapsed lung

tension pneumothorax

partial collapsed lung

atelectasis

#1 cause of thrombus formation

DVT in lower extremities

cardiac tamponade becks triad

JVD Hypotension Muffled heart sounds

someone who is in septic shock you will see what

SIRS- Systemic Inflammatory Response Syndrome

– Temperature >38⁰C (100.4⁰F) or <36⁰C (96.8⁰F) – Heart Rate >90 – Respiratory Rate >20 or PaCO2 – White Blood Cell (WBC) Count >12,000 or <4,000 or >10% bands

SIRS requirement

treatment for SIRS

steroid; can mask their symptoms

what sepsis

2 characteristics of SIRS and the infection

what is severe sepsis

sepsis and hypotension

when do you know your patient is in septic shock

severe sepsis and MODS (blood pressure doesn't respond to fluid anymore)

treatment for septic shock

vasopressor- levafed

what does qSOFA measure (SEPSIS)

respiratory rate altered mental status low blood pressure

heart rate

60-100 beats per minute

respiratory breaths

12-20

legal pulmonary injury; white lungs

Acute Lung Injury/Acute Respiratory Distress Syndrome (ALI/ARDS)

test for ARDS

ground glass - stiff lungs

the amount of gas reaching the alveoli

ventilation

the blood flow reaching the alveoli

perfusion

what is the initial problem in DIC | Disseminated Intravascular Coagulation

clotting- give heparin (break down clots from occurring)

complicated condition that can occur when someone has severe sepsis or septic shock.

DIC | Disseminated Intravascular Coagulation

what test is for a DVT ?

D dimer; Deep vein thrombosis (DVT) Pulmonary embolism (PE)

inability to achieve and maintain an erection sufficient to permit satisfactory sexual intercourse

erectile dysfunction

What symptom will the patient exhibit if they become toxic from the medication?

blue halo

involuntary, prolonged (>4 hours), abnormal and painful erection that continues beyond, or is unrelated to, sexual stimulation.

priapism

is a component of metabolic syndrome

erectile dysfunction ; cardiovascular disease

why should patients with cardiac history not take viagra or clialis

blood pressure will drop -nitroglycerin will drop blood pressure too

stores and transport sperm

epididymitis

muscle pain

myalgia

infection of the testes.

orchitis

Painful urination Dribbling Frequency Urosepsis

prostatitis

what can cause prostatitis on the health care end

inserting foley catheter but not sterile

scrotal cancer is associated with

chimney sweeps

BPH is what kind of renal problems

post renal

Solitary, painless, firm, fixed lesion with poorly defined borders.

BRCA

2 causative factors of ovarian cancer

talc powder and western diet- high fat diet

how to test for ovarian cancer/breast cancer

CA-125 >65-70 means a malignant tumor

non modifiable of breast cancer

``` Obesity Physical inactivity Caffeine ETOH Cigarette smoking Birth control pills ```

mature into new osteocytes

osteoblasts

mature, permanent bone cells

osteocytes

reabsorb old osteocytes

osteoclasts

Important regulators of calcium and phosphate levels in the blood.

parathyroid hormone

what 2 have a reverse relationship

calcium and phosphate

hypocalcemia sign

chvosteks or trousseaus

who do you expect to have hypocalcemia

multiple myeloma -affected by calcium

what is vitamin D

a steroid hormone

attaches bone to bone

ligament

injury, or bruise, that results from direct trauma and is usually caused by striking a body part against a hard object.

contusion

difference between contusion and hematoma

The pain and swelling of a hematoma take longer to subside than those accompanying a contusion.

joint ligaments or capsule surrounding the joint, resembles a strain, but the pain and swelling subside more slowly.

sprain

stretching or partial tear in a muscle or a muscle–tendon unit.

strain

how to treat sprain or strain

Rest Ice Compression Elevation

bone is broken and it is protruding through the skin

compound or open

occurs due to the migration of fat particles from the bone marrow at the time of trauma or during reaming of the intramedullary canal; causes the release of inflammatory mediators with endothetial lung damage and hypoxia

fat embolism syndrome

short of breath | confusion- LOC

fat embolism syndrome

treatment for fat embolism

statin and heparin

Fever Swelling, warmth and redness over the area of the infection Pain in the area of the infection Fatigue

osteomyelitis

can cause no symptoms or signs with people who are immunosuppressed, old, or young

osetomyelitis

immune symptom is low with this drug

steroids - causes sugar to increase

osteoporosis risk factors

``` Alc use Corticosteroid use Calcium low Estrogen low Smoking Sedentary lifestyle - no physical activity ```

First manifestations Skeletal fractures Dowager hump Pain

osteoporosis

buffalo hump is for

cushing syndrome- high cortisol levels

osteoporosis treatment

``` calcium (kale) - can cause constipation / renal stones vitamin D exercise prevent falls stop smoking good nutrition ```

Disorder of the bone remodeling; body absorbs old bone but makes bad new bone

Paget Disease

causative factor for paget disease

osteoblasts

treatment for paget disease

biphosphonates and calcium, vit D

body’s immune system –mistakenly attacks the joints.

rheumatoid arthritis

how are the joints affected in rheumatoid arthritis

symmetrically

rheumatoid arthritis genetic marker

Human Leukocyte Antigen (HLA)

Rheumatoid Arthritis: Blood Test

Erythrocyte Sedimentation Rate (ESR)

``` Morning stiffness for 30 minutes or longer More than one joint is affected Small joints (wrists, certain joints of the hands and feet) are affected The same joints on both sides of the body are affected Along with pain, many people experience fatigue, loss of appetite and a low-grade fever. ```

rheumatoid arthritis

Nonsteroidal anti-inflammatory drugs NSAIDs Corticosteroid medications Disease-Modifying Antirheumatic Drugs DMARDs JAK inhibitors Surgery

medications for rheumatoid arth

Red meat and organ meats (liver, tongue and sweetbreads) Shellfish such as shrimp and lobster Refined carbohydrates (white bread, white rice, pasta, sugar) Processed foods (chips, snack foods, frozen dinners) Sugary beverages

gout

#1 shock state for burns

hypovolemia

which degree of burn hurts

second degree

burn patients could have burns on the inside so what should you be caution of

their airway

how much fluid and how fast they need it

parkland

rapid breakdown of muscle that causes the release of intracellular contents including myoglobin(protein), into the extracellular space and bloodstream.

Rhabdomyolysis

Rhabdomyolysis triad

Myalgias Weakness darkened urine

autonomic dysreflexia can cause

pressure ulcers

difference between Purpura and Petechiae

Petechiae is smaller

Most common invasive cancer More on fair skin persons with history of tanning

basal cell carcinoma

multiple myeloma test

UA; bence jones proteins

acute lymphobastic leukemia

lymph system sudden onset seen more in children

acute myeloid leukemia

bone marrow | in adults

chronic lymph leuk

adult poor prognosis lymph system HALLMARK SIGN-high wbc count

chronic myeloid leukemia

philadelphia chromosome

hodgekins lymphoma

reed sternberg

hypocalcemia cats

convulsions arrythmias tetany spasms

if they are taking viagra you cannot give

nitrates -bp will go down

if they are taking viagra you cannot give

nitrates -bp will go down

guys with epididymitis younger than 35 is caused by

stds

older than 35

bacteria-e.coli or sudamonas

where should you get vitamin d

fish liver or radiated milk

can leave the bone marrow and go into the blood stream and might not show up until days later

fat embolism

related to obstructive shock

cardiac tamponade

foods high in potassium

``` avocado banana potatoes spinach beans citrus juices fish ```

foods high in phosphorus

``` meat fast food cheese seeds milk canned foods cola ```

GFR normal kidneys

60 or above

GFR kidney disease

15-60

kidney failure

less than 15

peaked t waves

hyperkalemia

u wave

hypocalcemia