Med Surg Test 1 part 1 Flashcards
Cxr
Chest x ray
Peak flow meter measures
lung capacity
V/q scan
nuclear medicine scan that uses radioactive material (radiopharmaceutical) to examine airflow (ventilation) and blood flow (perfusion) in the lungs.
purpose of V/Q scan
look for pulmonary embolism (PE)
gallium scan
look for swelling (inflammation), infection, or cancer in the body. It uses a radioactive material called gallium and is a type of nuclear medicine exam.
before an ABG test,
check that platelet levels are norma
do an Allen test
Hypoventilation assessment findings
Diminished breath sounds,
decreased respiratory effort,
use of accessory muscles
Hypoventilation interventions
Position q2h to promote ventilation/perfusion matching,
encourage slow deep breaths
Impaired Gas Exchange interventions
evaluate ABG
suction as indicated
Not positioning
the best way to determine need for O2 therapy
ABG
CO2 narcosis
loss of sensitivity to high levels of CO2
If a large volume of nitrogen in the lungs is replaced with oxygen, the oxygen may subsequently be absorbed into the blood, reducing the volume of the alveoli, resulting in
Absorption atelectasis
Tracheostomy indications
Long term airway management Upper airway obstruction Upper airway bleeding Inability to clear lower airway secretions Long term mechanical ventilation Sleep apnea Laryngeal or tracheal fracture Airway burns
oral care: Avoid glycerin swabs or mouthwash containing
alcohol
Weaning from a Tracheostomy Tube: gradually decrease
tube size
Weaning from a Tracheostomy Tube: cuff is deflated when patient can manage
secretions
patient that can NEVER be intubated
laryngectomy
pink puffer
emphysema
emphysema sputum
minimal
chronic bronchitis sputum
excessive
cor pulmonale is common in which COPD
chronic bronchitis
Cor pulmonale
hypertrophy of right side of the heart with or without heart failure resulting from pulmonary hypertension
In copd, pulmonary htn is caused by constriction of the
pulmonary vessels in response to alveolar hypoxia with acidosis further potentating the vasoconstriction.
Goal for copd pt: eats over
50% of diet
2 very important questions to ask an asthma pt
have you ever taken steroids
ever been intubated because of asthma
Peak expiratory flow rate
a person’s maximum speed of expiration, as measured with a peak flow meter, a small, hand-held device used to monitor a person’s ability to breathe out air
incentive spirometer
used to help patients improve the functioning of their lungs
ipratropium
Cholinergic antagonists
montelukast
Leukotriene antagonists
Immunomodulators
cromolyn
Stepwise approach for managing asthma: quick relief
short acting bronchodilator, up to 3 treatments at 20 minute intervals
course of systemic corticosteriods
Stepwise approach for managing asthma: step 2
symptoms 80%
Low dose inhaled steroids,
cromylyn,
leukotriene modifier,
course of systemic steroids
Stepwise approach for managing asthma: step 3
-daily symptoms with pef >60
low to medium dose inhaled steriods,
theophylline,
leukotriene modifier
Stepwise approach for managing asthma: step 4
symptoms or continual or frequent at night, pef
high dose inhaled steroids, steroids, long acting inhaled b agonists
status asthmaticus
Severe, life-threatening, acute episode of airway obstruction
Intensifies once it begins, often does not respond to common therapy
status asthmaticus Treatment
IV fluids,
potent systemic bronchodilator,
steroids,
epinephrine,
helpful eating pattern for someone with lower resp problem
4 to 6 smaller meals a day
An accumulation of fluid within the intrapleural space that may reflect and increase in pleural fluid formation or a decrease in its reabsorbtion from the intrapleural space or both
Pleural effusion
An inflammation of the lung parenchyma usually associated with a marked increase in interstitial and alveolar fluid
Pneumonia
Pneumonia: the breath sounds over the area of consolidation will be
bronchial breath sounds
common adventitious sounds with pneumonia
Wheezing, rhonchi, crackles
Pleurisy
inflammation of the pleura
Virchow’s triad
Venous stasis
Endothelial injury
Hypercoagulable state
Pulmonary embolism symptoms
chest pain
Fast/irregular HR
Light headed
Fast breathing
Acute Respiratory Failure: ABG value: Pao2
less than 60
Acute Respiratory Failure: ABG value: Sao2
less than 90
Acute Respiratory Failure: ABG value: Paco2
greater than 50
Acute Respiratory Failure: ABG value: pH
less than 7.30
Raynaud’s Disease
some areas of your body — such as your fingers and toes — to feel numb and cold in response to cold temperatures or stress. In Raynaud’s disease, smaller arteries that supply blood to your skin narrow, limiting blood circulation to affected areas
Buerger’s Disease,
inflammation and thrombosis in small and medium-sized blood vessels, typically in the legs and leading to gangrene. It has been associated with smoking.
Acute coronary syndrome
Any condition brought on by a sudden reduction or blockage of blood flow to the heart.
total fat in diet should be less than
30%
major SE of statins
liver issues
men and women waist sizes
men less then 40 women 35
total cholesterol
less than 200 is desired
over 240 is high
LDL level
less than 100 is desired
desired triglyceride
less than 150
Pt w/o CVD or DM and LDL 70-189 mg/dl and 10 year risk of CVD >=7.5%
Moderate or high intensity statin therapy
Pt 40-75 w DM and LDL 70-189 mg/dl w/o clinical atherosclerotic disease
Moderate statin therapy
treatment for Pt w clinical atherosclerotic disease
high intensity statin
Pt w LDL levels >= 190 mg/dl. Ie. Familial hypercholerterolemia
high intensity statin
HTN formula
CO times PVR
the best diuretic for uncomplicated HTN
thiazide
stage 2 SBP
over 160
stage 2 DBP
over 100
3 common causes of secondary HTN
Primary aldosteronism
Pheochromocytoma
Cushing’s syndrome
normal bun range
7 to 20
normal creatinine levels
0.7 to 1.3
severe PAD
blue limbs
white when you raise it
red when you lower it
The 6 P’s- Neurovascular assessment
Pain Pallor Pulselessness Paresthesia Paralysis Poikilothermy
PAD Diagnostic Assessments (3)
Ankle-brachial index (ABI)
Exercise tolerance testing
Plethysmography
Small arterioles and arteries constrict in response to cold, nicotine, caffeine or stress.
Raynaud’s Syndrome
good class of drug for Raynaud’s
CCB
Inflammatory disease of small and medium-sized arteries AND veins of the extremities
Buerger’s Disease(thromboangitis obliterans)
Buerger’s Disease most common manifestation
pain
Digital ulcers (gangrene), and S & S of ischemia, cold sensitivity, color changes
Buerger’s
Buerger’s dx test
arteriogram
Aneurysm
permanent localized dilation of artery, enlarging artery to twice its normal diameter
May be caused by sudden tear in aortic intima, opening way for blood to enter aortic wall
Aortic Dissection
Aortic Dissection pain described as
tearing, ripping, stabbing
Aortic Dissection is life
threatening
Aortic Dissection- emergency treatment: reduce
BP
Unstable angina- pain lasts longer than
15 minutes
pain: Sudden, squeezing, vice like, substernal and may radiate
angina
pain: Sudden w/o precipitating factors, intense stabbing, viselike, elephant sitting on chest, substernal and may radiate
MI
pain: Sudden, sharp, stabbing, substernal
Pericarditis
pain: Variable, moderate ache, worse on inspiration, lung fields
Pleural pain
pain: Variable, squeezing, heartburn, substernal, may be relieved w antacids
GI
pain: Variable, in response to stress or fatigue, dull ache to sharp stabbing, may be associated w numbness in fingers. Not well located
anxiety
angina is relieved with
rest, ntg, o2
MI is relieved with
morphine
O2
Pericarditis is relieved with
sitting upright/forward
anti inflammatory
Pt with chest pain: checks labs for
troponin
creatinine kinase
myoglobin
chest pain: position pt in
semi fowlers
drug given before Percutaneous Transluminal Coronary Angioplasty
Clopidogrel
MI common dysrrthymias
VF and VT
cardiogenic shock involves urine output less than
30ml
Normally, only a low amount of BNP is found in your blood. But if your heart has to work harder than usual over a long period of time, such as from heart failure,
the heart releases more BNP
Digoxin purpose
treat heart failure and heart rhythm problems
If HF patient is SOB, position in
High Fowler
Indications for Worsening or Recurrent Heart Failure
Cold symptoms
Excessive awakening at night to urinate
Development of dyspnea/angina at rest
edema
the main idea of right side HF
systemic congestion
the main idea of left side HF
decreased output
right side HF manifestations
JVD
Edema
Liver enlargement
Nocturia/polyuria
left side HF manifestations
Orthopnea
Oliguria
Weakness
Confusion
Drugs that Enhance Contractility
Digoxin
Inotropic drugs
Beta-adrenergic blockers
Digoxin (cardiac gyloside) effects on HR and Contractility
decrease HR
Increase contractility
dig toxicity manifestations
cardiac
N/V
Drugs Used to Reduce Afterload
ACE inhibitors
ARB
Human B-type natriuretic peptides
ARB
angiotensin blockers (sartan)
Pericarditis VS changes
decreased BP
increase HR
S/S: Fever, chills, joint pain, anorexia, nausea, weight loss
Pericarditis
Pericarditis/endocarditis administer
antibiotics
NSAIDS
Pericarditis: assess for
cardiac tamponade
pulsus paradoxus
Manifestations: Murmur Heart failure Arterial embolization Splenic infarction Neurologic changes Petechiae Splinter hemorrhages
Endocarditis
Endocarditis risk factors
Oral surgery
Skin rashes or lesions
Infections
Surgery or invasive procedures including IV placement
A fib pattern
irregularly irregular
A fib is associated with
atrial fibrosis and loss of muscle mass
Ventricular Dysrhythmias
More life-threatening than atrial dysrhythmias
Left ventricle pumps oxygenated blood through the body to perfuse vital organs and other tissues
Ventricular Tachycardia
repetitive firing of irritable ventricular ectopic focus, usually at 140-180 beats/min
Ventricular Fibrillation
result of electrical chaos in ventricles
Pacemakers
Complete heart block
2nd degree heart block with symptomatic brady
Bradycardia unrelated to drugs
wavy baseline with atrial electrical activity and irregular ventricular rhythm
A fib
ABG bicarb range
22 to 28
