MedSurgs2 Exam1 Flashcards
Anaphylaxis: Type#, Onset time, Caused by
Type 1
Within seconds to minutes
Caused by exposure to specific allergen
Anaphylaxis FX (2)
widespread
↓ blood vessel tone
↓ cardiac output
Anaphylaxis Onset S/S Subj (5)
Uneasiness Apprehension Weakness Anxiety Impending Doom
Anaphylaxis Onset S/S Skin (5)
Generalized itching Urticaria (hives) Erythema Angioedema (swelling of eyes), lips, and tongue Itchy Skin
Anaphylaxis Onset S/S Respiratory (9)
Bronchconstriction Mucosal Edema ↑ Mucous production Respiratory Distress Wheezing, Crackles, Hoarseness, Stridor "Lump in Throat"
Anaphylaxis Onset S/S Cardio (6)
Hypoxemia HypoTN Rapid/Weak Irregular Pulse (also by vasodilation or ↑ capillary leak) Faint Diaphoretic
Anaph. # Criterias
3
Ana. Criteria 1
Onset and Fx (3x3)
Within mins - hrs
Swelling - Swollen lips, uvula, and hives
Respiratory distress - dyspnea, wheezes, low peak expiratory rate
HypoTN r/in ↓ perfusion r/in organ d/fx - r/in LoC, incontinence, hyptonia, absent reflexes
Ana. Criteria 2
Onset and Fx (1 + 1x3)
Within min - hrs of >2 of the following
Any Criteria 1
GI - N/V, cramping, ab. pain
Ana. Criteria 3
Onset and Fx (2)
Within mins - hrs of…
HTN with BPS
Education for Leukemic Pt on Infx Protection (8)
Oral/Hand/Skin Care/Hygiene Ø Crowds Protective Equipment Flu/Pneumonia Vaccines Recgonize S/S of Infx
Leukemia (What is it and the Fx?)
Acute or Chronic?
Cancer r/in uncontrolled production of “Blast” WBC.
r/in production of immature d/fxal cells and ↓ RBC output
Can be both Acute (sudden/short) and Chronic (slow/long).
Leuk. and WBC?
Even though pt might have normal WBC levels, they are immature and Ø fight off infx
Leuk. S/S Cardiovascular (↑ 2, ↓ 1)
↑ HR, RR
↓ BP
Leuk. S/S Respiratory (3)
Murmurs/Bruits
Ab.normal breath sounds
Leuk. S/S Subj. (5)
Fatigue Neurological Changes Headache Fever Bone/Joint pain
Leuk. S/S Skin and GI (4)
Bleeding
Cool/Pallor Skin
Intestinal Changes
Transplants Throughout the Years (10)
Kidney focal point
1912 - transplanting blood vessels
1930 - skin grafting for burns common
end of 1940 - kidney transplant for 6 mo.
1954 - first renal transplants b2n twins
1960 - Imuran (Azathoproine) immunosuppression
↑ Renal transplant survival rates b/c other immunosuppressions.
Liver/Pancreas transplant
↓ Success rate for ♥ transplants 1968 - 1970
Cyclosporine developed
Acute Rejection Onset Graft HLA recognized as...? Type of response Cells do what? R/in?
days - months
HLA antigens are recognized as foreign (non-self)
Type 4 cell-mediated Hypersensitive Response
T Lymphocytes/Macrophages proliferate attach and destroy donor tissue
Cytotoxic antibodies, which further aggravates acute rejection process
AIDS pts should?
LIVE GOOD
Appropriate interventions with Thrombocytopenia pt (10)
Handle gently Ø IM or Venipunctures Pressure Needle stick in the same site for 10 minutes until Ø bleeding Smallest needle necessary Observe sites q2h for bleeding Ice Traumas Test Urine/Stool for blood
NO BUTT BREAKERS (enemas, lube, anal sex)
Measure abdominal girth
PTT and INR Ranges and r/t anti-coagulant
25 - 35 r/t Heparin
2.0 - 3.0 r/t Warfarin
Sick Cell Anemia
What is it?
Fx?
Genetic dz r/in anemia, pain, early death caused by pair of HbS alelles
40% total hemogloblin have abnormal HbS, r/in ↓ O2… they also chain together and clump.
Thrombocytopenia important educations (+5)
SEE Interventions + Electric shavers Avoid mouth trauma Ø blow nose/insert objects Ø contact sports firm shoe soles
Blood Transfusion Pre-Procedure
3 steps
3 notes
3 steps
2 notes
2 stepsCHIPPI Assess values (Packs RBCs for
Blood Transf. Intra-Procedure 3, 6
RNC24 VDM+1CD
Remain w/ pt first 15 - 30 minutes, assess
Notify provider if Rx occur
Complete in 2 - 4 hr to avoid bacterial grwoth
Vitals Dispose Monitor labs (CBC, Hgb, Hct) should rise approx. 1 g/dL per unit Chart Document response
Blood Trans and older pts (2)
Asses more frequently.
↑ risk ▲ pulse, bp, rr, rx, overload, cardiac/renal fx
Use of Cardiac Monitor during Blood Trans.
Use to find MI
MI Age/EKG visual FX (6)
Start - ↓ T Hours - ↑ ST Hours+ - ↑↑ ST Hours - 2 days - ↑ ST + ↓ T Days - Weeks - ↓ Q and T Months - Years - ↓↓ Q only
Ischemia ♥
What is?
Skin S/S
EKG fx?
↓ O2 to ♥
Pallor
↓ T wave
Injury ♥
What is?
Skin S/S
EKG fx?
Ø perfusion b/c tissue dmg
Cyanosis
↑ ST
Infarction ♥
What is?
Skin S/S
EKG fx?
Necrosis ♥
Black
“Significant” Q wave
Acute MI ♥
Non ST Elevation MI (NSTEMI) What. EKG.
ST Elevation MI (STEMI) What. EKG.
NSTEMI
▲ ST and T ind/ myocardia ischemia
STEMI
↑ ST in 2 contiguous leads ind/ myocardial infarction/necrosis and req. intervention ASAP
Re/Depolarization
DE - AP when “-“ cells develop charge. Ind/ ability to respond to stimuli by initiating impulse which r/in contraction
RE - Return to baseline
P, PR segment, PR Interval, QRS Complex, and T waves
P - Atrial depolars.
PR segment/interval - time from AV node to Ventricles
PR interval - time from Atrial Depolars to Ventricles (P - R)
QRS - time for Vent. Depolars (Q - R)
T - ventricular Repolars.
MI Education (3)
Assess emotion
Take care of self
Treat angina w/ rest and 3 SL nitro. If f d/fx, seek medical attention
Baroreceptor Stimulation of Pts with HypoTN
What is?
Fx?
Receptors in arch of aorta that rx to ↑ BP
Inhibit vasomotor center in pons of medulla r/in ↓ BP
Fx Fibrinolytic Drugs
Clot busters
↓ MI, thrombosis, strokes, SOB (pind. clot)
Give within first or after 6 hrs (+6 hrs r/in tissue dmg to ♥)
Be aware of bleeding
Angina Pectoris
Chronic Stable Angina (CSA)
Unstable Angina
Imba. arteries in O2 supply to ♥, r/in ischemia
Chest d/comfort w/ prolong exertion, assoc/w atherosclerotic plaque. Fix w/ rest/nitroglycerin
Chest d/comrt @ rest. ↑# and level/time. >15 minutes, poorly tx’d w/ rest/nitroglycerin
Percutaneous Transluminal Cornoary Angioplasty (PTCA)
What is and Fx?
Stent used to re-open clotted artery with balloon.
PTCA Pt Care Look for... 3 S/S 2 Hypo 1 Dys 3 perscriptions
Look for S/S vessel closure... Chest pain Bleeding Rx to Contrast medium HypoTN, Kalemia, Dysrhythmias
Usually prescribed long-term nitrate/dual anti-platelet therapy (aspirin/thienopyridine)
K supplements b/c HypoK
K Normal range and Fx of
↑ 4
ECG 4
Ectopic beats?
3.5 - 5.0 mEq/L
↑ ind/ ♥ block, Vfib, bradycardia, HypoHTN
Tall T’s, longer PRs, Flat Ps, Wide QRS
Ectopic beats (beats outside conduction system)
Cardiac Markers (3)
Serum Markers
Serum Cardiac Enzymes
Serum Lipids
Serum Markers (2, 1) Ranges and ind/
Troponins (↑ ind/ MI or Injury)
Troponin T -
Serum Cardiac Enzymes (2)
Ranges and ind/
Creatine Phosphokinase Myocardial Bands (CK-MBs) ↑ in/d MI occurs - 0% of total CK
Creatine Kinase (CK) - ↑pind/ Myo, brain, skeletal injury or necrosis.
♀ 30 - 135 u/L
♂ 55 - 170 u/L
Serum Lipids (5)
Total - ↑ ind/ ↑% CAD
400 - 1000 mg/dL
Cholesterol - ↑ ind/ ↑% CAD
adult 122 - 200 mg/dL
older adult 144 - 280 mg/dL (+70)
Triglycerides - ↑ ind/ ↑% CAD
♀ - 35 - 135 mg/dL
♂ - 40 - 160 mg/dL
LDL - ↑ ind/ ↑% CAD
60 - 80 mg/dL
HDL - ↑ protects from CAD
♀ - >55 mg/dL
♂ - >45 mg/dL
Modifiable (4) vs. Nonmodifiable Fx
Cigarettes, inactivity, obesity, stress,
BORN THIS WAY
Stroke Volume, Preload, Afterload
SV - blood ejected LV
Preload - myofiber stretch @ end of diastole before contraction
Afterload - pressure/resistance on Vents. b/c blood vessels
Infarction vs. Necrosis
Infarction (2)
Injury Zone
Necrotic Zone
THE IMAGE (3)
Infarction - necrosis or cell death r/t severe ischemia which can r/in necrosis
Restore perfusion before irreversible!
Injury zone - some survive/die
Necrotic zone - die Ø restore r/in permanent scar tissue
From inside to out…
Area of necrosis
Area of injury
Area of ischemia
