midterm Flashcards
1
Q
head-to-toe assessment (neurological)
A
- observation: alert/sedated/drowsy
- assessment: orientation (person, place, time, situation), confusion
- glasgow coma scale (eye opening, best verbal response, motor response)
- PERRLA
- motor strength (handgrip, push/pull/wiggle)
- facial symmetry
- slurred speech/language disturbance
- perceptual disturbances
- drift
2
Q
pain
A
observation: non-verbal behaviour (agitation, cries)
- assessment: scale (0-10), LOTARRP
- use of opioids/analgesics, effects of pain on function and mood, symptoms that may increase suffering
3
Q
respiratory
A
- observation: resp rate, quality, rhythm, depth, accessory muscle
- SOB?
- cough (dry/productive), sputum (colour, quality, consistency, blood)
- breath sounds (crackles, wheezes)
- SpO2
- chest excursion (movement of diaphragm), nasal flaring, pursed lips, work of breathing (orthopnea, dyspnea)
4
Q
cardiovascular
A
- edema (pitting/non-pitting)
- skin warmth, colour, turgor, cap refill
- movement and sensation to extremities
- dizziness/light headedness
- BP, HR, temp, apical HR
- peripheral pulse, heart sounds (murmur/rub), chest pain (location, intensity, precipitating factors)
5
Q
GI
A
- abdomen soft/distended/rounded/tender
- bowel sounds present/absent
- nausea, vomiting, discomfort
- last BM
- colostomy (stoma appearance, big intact), tube feed (type, amount, continuous), perianal & sacrococcygeal areas (lesions, external hemorrhoids, ulcers)
6
Q
GU
A
- urine colour, character, amount, frequency
- continent/incontinent
-pain/burning/discharge with voiding
- vaginal discharge, painful or swollen tissues, menstrual bleeding, penile pain or swelling, testicular pain, heaviness, enlargement
7
Q
integumentary system
A
- skin turgor/colour/moisture/texture
- skin lesions/ecchymoses/hematoma
- dressings
- wound assessment (length, width, depth, colour, drainage)
- hair condition (colour, thickness, texture)
- scalp condition (lesions, lumps)
- nail condition (colour, cleanliness, length)
8
Q
what is a MSE
A
- psychological equivalent of a head to toe assessment that describes the mental state and behaviours of the person being assessed. it includes both objective observations of the nurse and subjective descriptions given by the pt
9
Q
why do we do MSE
A
- provides information (assessment data) for diagnosis and assessment of disorder and response to treatment
- provides a snapshot at a point in time
- if another provider sees your pt it allows them to determine if the pts status has changed without previously seeing the pt
10
Q
to properly assess the MSE information about the pts….
A
history is needed including education, cultural, and social factors
- its important to ascertain what is normal for pt
11
Q
components of the MSE
A
appearance, behaviour, speech, mood, affect, thought process, thought content, cognition, insight, judgement, risk assessment
12
Q
appearance: what do you see
A
- cultural background, height, weight, apparent age, clothes, grooming, gait, psychomotor, posture, cooperative, eye contact, facial experience, grooming and hygiene, jewerly and cosmetic use, tattoos
13
Q
behaviour
A
agitation, hyperactivity, eye contact, attitude, attentiveness to interviewer
14
Q
speech
A
rate, volume, spontaneity, pressure, characteristics (accent or dialect)
- latency of response?
- production of speech
15
Q
mood
A
- emotional state the pt tells you how they feel
- placed in quotes since its what they are telling you
- rated on scale of 1 to 10
16
Q
affect
A
physical manifestation of mood
- type (euthymic, dysphoric (depressed))
- range (full, blunted, flat, labile)
- congruency
- stability
- appropriateness to content and situation
17
Q
thought process
A
HOW the person is thinking
- describes the rate of thoughts, how they flow and are connected
- normal: organized, tight, logical, coherent, goal directed
- abnormal: disorganized, incoherent, circumstantial, loose, flight of ideas, thought blocking
18
Q
tangential
A
move from thought to thought that relate in some way but never get to the point
19
Q
loose
A
illogical shifting b/w unrelated topics
20
Q
flight of ideas
A
quickly moving from one idea to another (mania)
21
Q
thought blocking
A
thoughts are interrupted (psychosis)
22
Q
perservation
A
repetition of words, phrases or ideas
23
Q
word salad
A
randomly spoken words
24
Q
thought content
A
WHAT the person is thinking
- refers to themes/content that occupy the pts thoughts
- preoccupations, ideas of reference, phobia, delusions
25
delusions
false fixed beliefs (absent, suspected, persecutory, religious, somatic, reference, grandeur)
26
preoccupations
suicidal or homicidal ideation (SI or HI), perseverations, obsessions, phobias
27
ideas of reference
misinterpretation of incidents and events in the outside world having direct personal reference to pt
28
control delusions
outside forces are controlling actions
29
erotomanic delusions
a person, usually of higher status, is in love with the pt
30
grandiose delusions
inflated sense of self-worth, power, or wealth
31
somatic delusions
patient has a physical defect
32
reference delusions
unrelated events apply to them
33
persecutory delusions
others are trying to cause harm
34
perception
hallucinations, illusions
35
hallucinations
misperception without an actual stimulus in the environment
36
hallucination types
visual, tactile, auditory, gustatory, olfactory, command
37
illusions
misperceptions of exisiting stimuli. actual perceptions are distorted or altered so they appear to be something different
38
cognition
level of arousal, orientation, concentration & attention, memory, intellectual capacity, abstraction/concrete thinking
39
short term/immediate memory
give client unrelated words to remember, ask the person to repeat right away, distract for about 5 mins & ask them to repeat
40
recent memory
ask client qts about current events in past 24 hr or few days
41
long term/remote memory
ask client qts about place of birth, various schools, occupations, history of presenting illness, important known events
42
insight
cognitive awareness of person's surroundings
43
different levels of insight
- full insight: recognizes that signs/symptoms are part of illness, able to modify behaviour, full cooperation w/ treatment
- partial insight: recognizes problems but does not attribute to illness, may understand that others see them as ill, some behaviour changes, variable cooperation
- impaired/no insight: denial of illness or denial of any problems, blames others, has no capacity to understand concerns by others, poor adherence with treatment
44
judgement
process that leads to a decision or an action, during assessment, what the client did or didn't do with respect to the illness, judgement is assessed by the ability for client to the ability to anticipate the consequences of one's behaviour and make decisions to safeguard their well being and that of others
45
poor judgement evidenced by
impulsivity or engaging in actions with high probability of damaging consequences such as shop lifting, buying sprees, promiscuity, physical assault, reckless driving
46
other assessments
- CIWA, CAGE questionnaire, DSM-5, beck depression inventory, PHQ9 for depression, HONOS rating scale
47
diabetes
multisystem disease related to abnormal insulin production, impaired insulin utilization, or both
- organ: pancreas --> islets of langerhan --> alpha & beta cells
48
prediabetes
blood glucose levels that are higher than normal, but not yet high enough to be diagnosed as type 2
49
metabolic syndrome
also have high blood pressure, high levels of LDL cholesterol & triglycerides, low levels of HDL cholesterol & excess fat around the waist
50
types of diabetes
type 1, type 2, gestational, secondary
51
pathophysiology of diabetes
- disorder of the endocrine system (pancreas)
- destruction of beta cells in the pancreas (insulin deficiency) or defective insulin receptors on tissues (glucose unable to be transported into cells)
- counterbalance of glucagon and insulin fails
- blood glucose rises resulting in hyperglycemia
52
what is type 1 diabetes
- autoimmune destruction of beta cells causing little or no insulin production
- prone to ketosis
- abrupt onset
53
what is the fasting BG for type 1
7mmol/L or Hg A1C > 6.5%
54
what polys are in type 1
polyuria, polydipsia, polyphagia
55
when is type 1 most common
children/adolescents
56
type 2 diabetes
- slower onset, 90% of cases, exercise and diet management essential, oral hypoglycemic agents effective in controlling blood sugars but some require insulin
57
risk factors for type 2
40 or older, first degree relative with type 2, member of high risk population, history of prediabetes, gestational, delivery of baby over 9 lbs
58
gestational diabetes
temporary condition that occurs during pregnacy, increased risk of developing diabetes to both mother and child
- affects 3.7% non aboriginal, 8-18% aboriginal
59
cardinal signs of hyperglycemia
- excessive thirst (polydipsia), excessive hunger (polyphagia), polyuria excessive urination (greater than 2.5 or 3L over 24 hrs), weight loss, blurred vision, fatigue
60
normal blood glucose
4.0 to 6.0 mmol/L when fasting
up to 7.8mmol/L 2 hrs after eating
61
diabetic complications
organ damage is associated & vascular risk factors
62
organ damage associated with diabetes
- microvascular (small vessels) (retinopathy, neuropathy, nephropathy)
- macrovascular (larger vessels) (coronary, cerebrovascular, peripheral)
63
vascular risk factors (diabetes)
- high cholesterol or other fats in blood
- hypertension
- overweight
- abdominal obesity
64
key elements in diabetes management
- education, nutrition, weight management, physical activity, insulins & oral hypoglycemics, lifestyle management
65
insulin
power hormone, produced by beta cells
66
what does insulin do
helps store glucose in liver as glycogen
conversion of glycogen to fat stores in muscle tissue and adipose tissue
67
what is the important factor about insulin
only hormone that has the capacity to lower blood sugar; BG levels MUST be done prior to admin
68
types of insulin
rapid acting (clear), short acting (clear), intermediate acting (cloudy), long acting (clear), mixed (cloudy)
69
basal-bolus preferred (long acting) for...
stability with bolus as needed vs sliding scale insulin dosages according to BG levels
70
routes for insulin
- subcutaneous (most common), IV (emergencies, short-acting), insulin pens, insulin SC pumps
71
unopened insulin vial kept in fridge, opened vial stored either...
room temp or fridge & expires in 30 days after opening, always mark date the vial is opened
72
what is the first line treatment for type 2 diabetes
biguanide metformin
73
action of biguanide metformin
1. decreases glucose production by liver
2. decreases intestinal absorption of glucose
3. improves insulin receptor sensitivity in the liver, skeletal muscle, and adipose tissue, increased glucose uptake by these organs
74
side effects of biguanide metformin
GI: abdominal bloating, anorexia, nausea, cramping, feeling of fullness, flatulence, diarrhea, metallic taste in mouth, vitamin B12 reduction
***DOES NOT CAUSE HYPOGLYCEMIA****
75
what is the oldest group of medication for type 2
sulfonylureas gliclazide, glyburide, glimepiride
76
sulfonylureas gliclazide, glyburide, glimepiride must have
functioning beta cells
77
sulfonylureas gliclazide, glyburide, glimepiride action
1. stimulates insulin secretion from beta cells of pancreas
2. improves the sensitivity to insulin in tissue
3. decreases the production of glucagon
78
side effects of sulfonylureas gliclazide, glyburide, glimepiride
GI: nausea, epigastric fullness and heartburn, photosensitivity, skin eruptions, and weight gain
79
sulfonylureas gliclazide, glyburide, glimepiride may cause
hypoglycemia
80
nursing assessment and care for diabetes
blood glucose level, follow proper agency policies and procedures, assess client's knowledge & provide client education as necessary, ensure meal trays are available, oral hypoglycemia agents admin 30 min before meals, oral hypoglycemia agents take one week to be effective
81
aboriginal diabetes key points
among highest risk populations for diabetes
82
screening for diabetes for aboriginals
should be done every 1 to 2 years
early indentifications of diabetes in preg should be emphasized and post-partum screening
83
what is hypoglycemia
glucose levels becomes too low - blood sugars under 4mmols, however if the patient does not have stable blood sugar and the BS lowers these symptoms may occur
84
hypoglycemia can be caused by
too much insulin, too little food, exercising too vigorously or drinking too much alcohol
85
signs and symptoms of hypoglycemia
heart palpitations, fatigue, pale skin, shakiness, anxiety, sweating, hunger, irritability, tingling sensation around mouth, crying out during sleep
86
hypoglycemia worsening signs and symptoms
confusion, abnormal behaviour, visual disturbances (blurred vision), seizures, loss of consciousness, may appear intoxicated (slur words and unsteady gait)
87
treatment hypoglycemia
oral glucose, IV glucose, glucagon (IM or SC)
88
diabetic ketoacidosis
serious complication of diabetes that occurs when the body produces high levels of blood acids called ketones
89
diabetic ketoacidosis develops when
the body can not produce enough insulin
90
without enough insulin, what happens (diabetic ketoacidosis)
body begins to break down fat as fuel
91
diabetic ketoacidosis produces
a buildup of acids in the bloodstream called ketones, eventually leading to DK
92
DKA (muscle cells
muscle cells become starved for energy, your body may respond by breaking down fat stores
process forms toxic acids known as ketones
left untreated, diabetic ketoacidosis leads to coma
93
signs and symptoms of DKA
flushed, hot dry skin
blurred vision
polyuria
polydipsia
drowsiness
decreased LOC
tachypnea
strong, fruity breath
loss of appetite
abdominal pain
vomiting
confusion
94
diabetic ketoacidosis most common
type 1 diabetes but can occur in type 2 & gestational
95
treatment for DKA
IV fluids, small amounts of insulin, replacement of electrolytes
96
hypersomolar hyperglycemic syndrome (HHS)
complication diabetes often triggered by infection or illness, involves extremely high blood glucose level w/o significant presence of ketones, excess sugar passes from blood to urine, triggering a filtering process that draws tremendous amounts of fluid from your body
97
left untreated, HHS
life-threatening dehydration & coma
98
HHS most common in
elderly adults who have type 2
99
treatment of HHS
IV fluids, small amounts of insulin, replacement of electrolytes
100
what is schizophrenia
disturbance of the brain's functioning, seriously disturbs the way ppl think, feel and relate to others
101
schizophrenia is one of the most..
severe, complex mental illness and is present in all cultures
102
has there been a cause found for schizophrenia?
no, although there is a clear genetic link
103
men & women are affected ? related to schizophrenia
equally
104
when is mens and womens onset of schizophrenia
men: first episode in late teens/early 20s
women: usually few years later than men
105
how does the illness start
gradually, ppl begin to have symptoms but they & family may not be aware of illness, may be rapid as well
106
the course of schizophrenia is
unique & unpredictable & differs from person to person
107
what shows prmise for increased rates of recovery in ppl with first onset of schizophrenia
early intervention
108
phases of schizophrenia
prodromal, aute, recovery
109
prodromal phase aspects
- early symptoms may be vague & hardly noticeable
- may be changes in the way the person describes their thoughts, feelings, perception
- begin to lose interest in usual activities
- easily confused
- trouble concentrating
- apathetic
- prefer to spend most days alone
- become intensely preoccupied with religion
-
110
how long can the prodromal phase last
weeks or months
111
acute phase
- clear psychotic symptoms
- may include delusions, hallucinations, marked distortions in thinking
- most frightening to person experiencing symptoms & others around them
- most times hospitalized
112
recovery phase
- after symptoms stabilized goal is recovery
- some will recover back to previous level of functioning
- some will require medications & support for the rest of lives
113
goal of recovery for schizophrenia
regain the previous level of functioning and improve the quality of life for patient
114
symptoms of schizophrenia divided into 3 cateogires
positive, negative, cognitive
115
positive symptoms include
delusions, hallucinations
116
delusions are
false fixed beliefs that usually involve a mistinterpretation of the experience (grandiose, persecutory, somatic)
117
hallucinations are
all 5 senses (olfactory, gustatory, auditory, visual, somatic)
- most common are auditory & visual
118
negative symptoms of schizophrenia include
affective flattening, alogia, avolition/apathy, anhedonia, inattention, ambivalence
119
what is affective flattening
diminished emotional responsiveness = few expressive gestures, changes in facial expression, poor eye contact, lack of vocal inflection and decreased spontaneous movements
120
what is alogia
poverty of speech and content
121
avolition/apathy
lack of interest, enthusiasm, decrease in the motivation to initiate and perform self-directed purposeful activities
122
anhedonia
inability to experience pleasure - few recreational activities/interests, detached, uncommunicative, impaired social and personal relationships, distant
123
inattention
impaired concentration, social inattentiveness; poor rapport, lack of focus during conversation
124
ambivalence
not able to make decisions or contribute to conversations with others
125
neuro-cognitive symptoms for schizophrenia
- loss of short-term memory & organizational skills in planning, prioritizing & decision making
- disorganized thinking and speech
- disorganized behaviour = slow, rhythmic or ritualistic movements
126
suicide risk for persons with schizophrenia
40-50% ppl attempt
approx 12-15% succeed
127
treatment options for schizophrenia
hospitalization, electroconvulsive therapy, medications
128
hospitalization for schizophrenia
crisis periods or times of severe symptoms, this may be necessary to ensure safety, proper nutrition, adequate sleep and basic hygiene
129
electroconvulsive therapy for schizophrenia
do not respond to drug therapy, ECT may be considered, may be helpful for someone who also has depression or a mood disorder
130
what is the essential treatment for schizophrenia
medications
131
what kind of medication is most common for schizophrenia
antipsychotics
132
antipsychotics are thought to ...
control symptoms by affecting the brain neurotransmitter dopamine
133
the goal of treatment with antipsychotic medications is to
effectively manage symptoms at the lowest dose possible
134
medications for schizphrenia can cause serious side effects, ppl with schizo may be reluctant to take them? t/f
TRUE
135
pts who are resistant to taking medication consistently may need to be given....
injections instead of oral
136
how antipsychotics work?
- reduce or increase the effect of neurotransmitters in the brain to regulate levels
- effect of blocking dopamine transmission in the brain which decrease positive symptoms
137
what are the newer antipsychotic medications and what do they effect
risperidone, olanzapine, quetiapine effect other neurotransmitters in the brain including serotonin which effect both positive & negative symptoms
138
1st generation antipsychotics examples and side effects
- typical/conventional
- dopamine receptor antagonist (haldol, clopixol, loxapine)
- extrapyramidal symptoms
- sedation
- orthostatic hypotension
- weak anticholinergic side effects
- development of movement disorder (tardive dyskinesia)
139
2nd generation antipsychotics
created to produce less side effects
- clozapine, risperidone, olanzapine
140
side effects of 2nd generation antipsychotics
weight gain, anticholinergic side effects, sedation, agranulocytosis
141
what can be seen in clozapine
agranulocytosis
142
agranulocytosis is
blood disorder characterized by decrease in WBC
143
how often does blood work for agranulocytosis
qweek for 6 months and then q2weeks
144
fatalities related to agranulocytosis are due to
compromised immune system
145
symptoms of agranulocytosis
chills, mouth ulcerations, sore throat, fatigue, signs of infection, hyperthermia
146
neuroleptic malignant syndrome
**MEDICAL EMERGENCY**
- 3-9 days after beginning or a change in medications
147
neuroleptic malignant syndrome symptoms
sweating, tremor, changes in LOC, tachycardia, leukocytosis, difficulty swallowing, incontinence, elevated/labile blood pressure
148
extrapyramidal symptoms
- seen in up to 90% of pts getting typical antipsychotics
- involuntary & uncontrollable movement disorder caused by meds
149
signs of extrapyramidal symptoms
- akinesia (weakness)
- akathisia (restlessness)
- acute dystonic reactions (muscle spasms)
- parkinsonism
- pisa syndrome
- rabbit syndrome
150
acute dystonic reaction
- appear early in neuroleptic treatment (first 3 days)
- 1st to appear & most dramatic
- more common in young male
- severe involuntary muscle spasms
- difficulty swallowing
- stiff neck, torticollis
- oculogyric crisis (rotation of eyes upward)
- extreme facial grimacing
- thick tongue, protrusion of tongue
151
parkinsonism
- mask like face
- tremor at rest
- rigidity of muscles
- motor retardation
- hypersalivation (drooling)
- shuffling gait, stooped posture
- incidence increases with age
- develop within a few weeks to months
152
akinesia
- slowed movement
- immobility, weakness
- fatigue
- lack of muscle movement
- painful muscles
- develop mostly by 3rd week in 33% of pts
153
akathisia
- restlessness, restless legs, jittery feeling, nervous energy
- leg swinging or repeated crossing
- need to rapidly sit & stand
- need to movement or pacing
- foot shuffling
- could be confused for agitation or anxiety
154
rabbit syndrome
fast rhythmic movement of the lips
155
tardive dyskinesia
- involuntary movement appearing later in treatment (chronic exposure to dopamine receptor-blocking agents)
- worsen with stress or trying to hide
- will stop with sleep
156
what is used to treat EPS and other movement disorders induced by meds?
antiparkinsonian agents
157
antiparkinsonians examples
anticholinergic (good for all EPS) benztropine, procyclidine
- antihistaminergic (diphenhydramine = good for all except akinesia)
- benzodiazepine (clonazepam = good for acute dystonia & akathisia) (diazepam = good for all EPS) (lorazepam = good for all except akinesia)
158
psychosocial interventions for schizophrenia
individual therapy, social skills training, family therapy, vocational rehabilitation & supported employment
159
vocational rehab & supported employment
helping ppl w/ schizo prepare for, find and keep jobs
160
psychosis
conditions that affect the mind where there is some loss of contact with reality
- first experience = first episode psychosis
161
psychosis often starts
in adolescence or young adults when individuals starting to develop own identity, form long term relationships, and plan future
162
what different b/w psychosis & schizophrenia
1. schizo is mental illness that CAUSES psychosis
2. schizo also has other positive and negative symptoms
3. schizo isnt only cause of psychosis
- delirium, depression, bipolar, schizoaffective, borderline all can cause psychosis
163
symptoms of psychosis
hallucinations, delusions, paranoia, disorganized thoughts, disorganized speech, feelings & behaviour also affected
164
what is a psychotic episode
- period of time when symptoms of psychosis are strong & interfere with reg life
- length can be hours to days to weeks to months
165
stages of psychosis
prodromal, acute, recovery
166
prodromal phase of psychosis
1st phase before psychosis becomes obvious
- changes in thoughts, feelings, perceptions, behaviours
167
acute phase of psychosis
- typical psychotic symptoms emerge
- psychosis easiest to recognize and diagnosis
- most ppl begin recieving treatment
168
recovery phase of psychosis
- symptoms that are apparent in the acute phase may still be present
- majority of ppl recover from their first episode
169
common prodromal symptoms
- social withdrawal
- reduced concentration, attention span
- depressed mood
- sleep disturbance
- anxiety
- suspiciousness
- irritability
- skipping school or work
170
psychotic symptoms
emerge in acute phase, are intense, active & continuous, interfere w/ normal functioning, frequently categorized as positive or negative
171
positive symptoms of psychosis
delusions, hallucinations (seeing, feeling, smelling, or tasting something isn't there), disorganized speech or behaviour (person may move quickly from one topic to the next)
172
negative symptoms of psychosis
- displaying little emotion
- poverty of speech
- difficulty thinking or generating new ideas
- decreased ability to initiate tasks
- lowered levels of motivation
173
other problems that often occur with psychotic symptoms
depression, anxiety, suicidal thoughts or behaviours, substance abuse, difficulty functioning, disturbed sleep
174
recovery phase of psychosis
- acute symptoms lessen & start to fade
- some symptoms may linger
- problems with work or school, depression, anxiety, social problems, decreased self esteem may be evident
175
causes of psychosis
- no definite answers
- multiple theories though: biology, genetics, brain changes, stress, drugs
176
biology theory of cause of psychosis
neurotransmitter dysfunction
177
genetic theory cause of psychosis
at increased risk if close relative has psychosis
178
brain changes cause of psychosis
found in some individuals
179
stress cause of psychosis
a vulnerability to psychosis
180
drugs cause of psychosis
can induce psychosis, or increase vulnerability
181
angina is
recurring chest pain or discomfort
182
angina occurs when
heart muscle (myocardium) doesn't receive enough blood and oxygen to meet body needs
183
symptoms of angina
- a pressing, squeezing, or crushing pain, usually in chest under sternum
- pain radiating in arms, shoulders, jaw, neck
- weakness/fatigue
- occurs in response to exertion and is relieved by rest
- lasts 3-5 mins
- emotional stress may cause
184
causes of angina
- occurs when the heart's workload (and need for oxygen) exceeds the ability of the coronary arteries to supply
- coronary blood flow can be limited when the arteries are narrowed by atherosclerosis
185
stable angina
- chest pain or discomfort that typically occurs when activity or stress
- episodes of pain or discomfort are provoked by similar or consistent amounts activity or stress
186
unstable angina
pattern of symptoms change
- usually angina stays constant, any change is serious
- change reflects sudden narrowing of a coronary artery bc an atheroma has ruptured or a clot as formed
- risk of heart attack is high
- considered an acute coronary syndrome
187
angina diagnosis
- complete medical history
- ECG
- stress test
- echocardiography
- CT
- cardiac catheterization
188
echocardiography
uses ultrasound waves to produce images of the heart, shows heart size, movement of muscles, blood flow through heart valves, and valve function
189
cardiac catheterization
contrast agent is injected into an artery & x-rays are taken to locate narrowing, occulsions, and other abnormalities
190
treatment for angina
- attempts to slow/reverse the progression of coronary artery disease by dealing with risk factors
- quitting smoking is crucial
- a low-fat, varied diet that's low in carbs & exercise are recommended
- weight loss if needed
191
risk factors for angina
hypertension, high cholesterol levels
192
medical treatments for angina
- nitrates (nitroglycerine spray)
- beta-blockers (metoprolol)
- calcium channel blockers (verapamil)
- antiplatelet drugs (aspirin)
- percutaneous coronary intervention (balloon angioplasty, stent)
- coronary artery bypass graft surgery
193
what are the leading causes of death in canada
heart disease & stroke
194
most deaths from heart attacks are caused by
ventricular fibrillation of heart
195
what is the % of survival if you make it to the ED w/ MI
90%
196
heart attack symptoms
- chest pain or pressure
- pain
- fullness
- squeezing sensation of chest
- jaw pain
- toothache
- headache
197
what is heart attack
death of heart muscle from the sudden blockage of a coronary artery by a blood clot
198
blockage of a coronary artery deprives the heart muscle of
blood and oxygen, causing injury to the muscle, injury to the heart muscle causes chest pain and chest pressure sensation
199
if blood flow is not restored to the heart muscle within
20-40 mins, irreversible death of heart muscle begins
200
causes of heart attack
- atherosclerosis
201
atherosclerosis
- gradual process = cholesterol plaques deposited in walls of arteries
- plaques cause hardening of walls & narrowing of inner channel of artery
- those arteries cant deliver enough blood to maintain normal function of parts of body they supply
202
problem with atherosclerosis
can be silent (no symptoms)
203
what can accelerate early atherosclerosis
smoking, hypertension, elevated cholesterol, diabetes mellitus especially if there is family history of early onset
204
the cause of the rupture of plaque to causes the formation of the clot is unknown but contributing factors include
nicotine exposure, elevated LDL cholesterol, elevated levels of adrenaline, hypertension
205
more heart attacks occur b/w
4am-10am because of the higher blood levels od adrenaline released from the adrenal glands
206
symptoms of heart attack
- chest pain/pressure
- jaw pain, toothache, headache
- nausea, vomiting, epigastric discomfort
- heartburn/indigestion
- arm pain (left arm)
- upper back pain
- general malaise (vague feeling of illness)
- asymptomatic (common in diabetes mellitus)
207
women are more likely to have atypical heart attack symptoms like
- neck & shoulder pain
- abdominal pain
- nausea
- vomiting
- fatigue
- shortness of breath
208
what are the complications of a heart attack
- heart failure
- large amount of muscle dies, ability to pump blood to the rest of body is diminished
- body retains fluid
209
cholesterol that is combined with low-density lipoproteins (LDL) is the
"bad" cholesterol that deposits cholesterol in arterial plaques = elevated levels of LDL cholesterol associated w/ increased risk of heart attack
210
cholesterol combined with HDL is the
"good" cholesterol = decreases risk of heart attack
211
family history of heart disease
- ppl w/ history have increased risk of heart attack
- higher risk of early coronary heart disease including heart attack or sudden death before age 55 in males & before 65 in female
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how is a heart attack diagnosed?
ECG, blood tests
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what are cardiac enzymes
proteins that are released into the blood by dying heart muscles
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what are the cardiac enzymes
creatine phosphokinase (CPK) & troponin
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series of blood tests for the enzymes performed over a 24hr period are useful not only in confirming the diagnosis of a heart but...
the changes in their levels over time also correlates with the amount of heart muscle that has died
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people who think they are having heart attack should
- chew 2 aspirins STAT after calling 911
- increases chances of survival by reducing the size of the clot
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decreasing the hearts workload also helps limit tissue damage, what is given to do this
beta-blocker to slow heart rate
- slowing heart rate enables the heart to work less hard and reduce the area of damaged tissue
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most ppl also given what for heart attack
anticoagulant drug (heparin) to help prevent the formation of additional blood clots
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medical treatment options for heart attack
- O2 given via nasal prongs = providing more O2 to heart helps keep tissue damage min
- ppl experiencing extreme discomfort = morphine used to calm and reduce workload
- given nitroglycerine = relieves pain by reducing the workload of heart & possibly by dilating arteries
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heart failure occurs
when heart muscle becomes weak & can't pump enough blood to meet the body's needs = not enough blood flow to provide the body's organs with O2 & nutritions
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term heart failure means
heart is not working efficiently
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how does the heart compensate for heart failure
beats faster or more forcefully but eventually these fail & heart becomes more & more impaired
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heart failure results from a condition that
forces the heart to work harder & faster to keep blood flowing & may involve right, left, or both sides
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there are 2 basic problems in heart failure
systolic dysfunction, diastolic dysfunction
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systolic dysfunction
occurs when the heart can't pump enough blood to supply all the body's needs
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diastolic dysfunction
occurs when the heart cant accept all the blood being sent to it
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causes of heart failure
- coronary artery disease
- persistent hypertension
- heart attack
- diabetes
- arrhythmias
- heart valve disease
- heart valve damage
- viral infection
- an enlarged wall
- certain kidney conditions
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coronary artery disease (CAD)
condition that causes narrowing of arteries that supply the heart with blood, can damage & weaken
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persistent hypertension
forces the heart to pump against higher pressure, which causes it to weaken over time
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arrhythmias
abnormal heart rhythms causing pump inefficiently
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heart valve disease
caused by abnormalities been present since birth or developed over time
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heart valve damage
caused by rheumatic disease or infection
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viral infection
of heart muscle can weaken heart
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enlarged wall
b/w heart chambers (genetic condition) may be cause
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certain kidney conditions
increase BP & fluid buildup can increase the risk of HF by placing more stress on heart
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the heart compensates in 3 ways for HF
- dilating (enlarging) to form a bigger pump
- adding new muscle tissue to pump harder
- beating at a faster rate
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appearance of HF symptoms can be
delayed for years bc heart tries to compensate
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as the heart compensates, several things happen...
- heart can't pump well enough to pump blood through body & back to heart again
- blood backs up into legs & lungs, causing fluid build up = edema of ankles & legs, shortness of breath (pulmonary edema)
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right-sided HF
blood backs up into body
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right-sided HF causes...
edema of feet, ankles, & legs = leading to frequent urination at night, sudden weight gain, weakness, vertigo, painful stomach bloating
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left-sided HF
pulmonary edema can cause breathing problems = SOB, dyspnea (lying down), wheezing, coughing up blood tinged mucus, a dry cough, weakness, chest pain, rapid pulse
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diagnosing HF
exam to check for edema in legs & fluid in lungs
- dr order blood & urine tests, ECG, chest xray
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ejection fraction
proportion of blood that gets pumped out
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treating & preventing HF
- managed with lifestyle adjustments & medication
- cutting back on fluids
- staying active but avoiding triggering HF symptoms
- lower sodium intake to 2.3g daily (less sodium reduces fluid retention)
- wearing special elastic stockings = reduce swelling in legs caused by fluid retention
- weight management program
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HF can be treated with the following medications
- ace inhibitors
- angiotensin receptor blockers
- certain beta-blockers
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ace inhibitors
expand blood vessels, allowing blood to flow more easily & making the heart's work easier or more efficient
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angiotensin receptor blockers
useful in place of ACE inhibitors when they can't be used or sometimes in addition
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certain beta-blockers
(metoprolol, bisoprolol)
- proven to help improve heart function
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digoxin increases the
force of the pumping action of the heart
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diuretics (furosemide) help the body
elimiate excess salt & water
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ways to maintain/improve heart health
- control hypertension
- eat a healthy diet
- exercise
- maintain blood sugar
- maintain healthy cholesterol levels
- quit smoking
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CAD is a type of
blood vessel disorder that occurs when fatty deposits (plaques) build up inside arteries (atherosclerosis)
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the major cause of CAD is
atherosclerosis
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risk factors for CAD (modifiable)
- hypertension
- high blood cholesterol & triglyercides
- diabetes
- unhealthy weight
- unhealthy diet
- too much alcohol
- not enough physical activity
- smoking
- stress
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non-modifiable risk factors
- age
- sex (increases after menopause)
- family history
- women who had pre-eclampsia during pregnancy
- indigenous heritage
- south asian & african heritage
- socioeconomic status
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symptoms of CAD
- angina
- SOB
- fatigue
- pain
- dizziness
women experience different symptoms suchas
- vague chest discomfort
- fatigue
- sleep difficulties
- indigestion
- anxiety
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what is the first symptom of CAD
heart attack
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how is CAD diagnosed
- full med history (full physical)
- chest xrays
- angiography
- echocardiogram
- ECG
- stress test
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treatment for CAD
- medications (anti-platelets, ACE inhibitors, beta-blockers, calcium channel blockers, nitroglycerine)
- surgical and non-surgical procedures (percutaneous coronary intervention, coronary artery bypass surgery, lifestyle)
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acute coronary syndrome
sudden blockage of a coronary artery, causes angina or heart attack
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ppl who experience an acute coronary syndrome have
chest pressure, SOB, and fatigue
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symptoms of acute coronary syndrome
- may occur at rest or during exertion
- pain in back, jaw, neck, arm
- nausea
- chest pain (described as tightness or heaviness)
- SOB
- loss of consciousness
- pain in the upper abdomen
- sweating
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ST elevation myocardial infarction (STEMI) refers to
ST segment elevation of a pts ECG who generally have cardiac biomarkers (elevated troponin level) which indicate necrosis of heart muscle
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management of STEMI focuses on
early reperfusion therapy by thrombolytic or revascularisation w/ percutaneous coronary intervention
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non ST segment elevation acute coronary syndrome
symptomatic ppl whose 1st ECG shows no ST elevation
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NSTEMI
ppl who have not had ST elevation on their ECG, however, subsequent cardiac biomarkers are elevated
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define health
objective process characterized by functional stability, balance & integrity & viewed on a continuum
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determinants of health
complex interactions b/w social and economic factors, the physical environment & individual behaviours that determine health
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disease
condition that a practitioner views from pathophysiological model
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illness
experience of symptoms and suffering, refers to how the disease is perceived, lived with, & responded to by individuals & families
271
health promotion
process of enabling people to increase control over,and to improve their health
272
disease prevention
reduce the number of ppl afflicted with chronic diseases/health conditions and the cost burden on health care system
273
canadian health act
federal legislation for health care insurance thats publically funded. its objective is to set out health care policy to protect, promote, and restore the physical & mental well-being of ppl & to facilitate reasonable access to health services without barriers
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primary prevention
aimed at preventing the onset of disease/condition
275
example of primary intervention
immunizations, seat belts, education & counselling
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secondary prevention
aimed at early diagnosis & prompt treatment
277
secondary prevention examples
screening examinations for pre-clinical evidence of cancer or pap smears
278
tertiary prevention
aimed at decreasing complications & negative health effects in an individual with established disease
279
tertiary prevention examples
meds & lifestyle change to normalize blood glucose levels in pts with diabetes
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primary health care
approach to health and a spectrum of services beyond traditional health care system (health promotion, illness & injury prevention, diagnosis & treatment)
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psychosocial rehab
range of social, educational, occupational, behavioural, and cognitive interventions to increase role performance & promote recovery in persons with illness
282
case management
collab process of assessment, planning, facilitation, an advocacy for options and services to meet an individual's health needs through communication and available resources
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who is the federal health minister
dr. jane philpott
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who is provincial health minister
adrian dix
285
health regions in bc
fraser health, interior health, island health, northern health, vancouver coastal health
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health informatics
discipline at the intersection of infomation science, computer science & health care, deals with resources, devices, and methods required optimizing the storage, retrieval, and use of information in health
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what is legislation
laws enacted by a legislative body
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what are some laws that are enacted by psych nurses
- mental health act
- hospital act
- health professions act
- health care consent & care facility (admission) act
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what is the relationship of psychiatric nursing to other professional
- looked at as professionals in mental health
- looked at as part of a team
290
2 main purposes of mental health act
- provides authority, crtieria, & procedures for invountary admission & treatment
- contains protections/safeguards for the rights of ppl involuntary admitted to facilities
291
adults may be admitted voluntary for treatment of mental disorders under which acts?
hospital & mental health act
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what are 3 methods of arranging for involuntary treatment
- physicians medical certificate = form 4, 2nd form 4 must be completed within 48 hrs for continue involuntary admission
- police intervention = section 28, police apprehend person & take to physician for exam which then determines if pt is certifiable or not
- order by judge = form 10 (completed by judge), form 9 (is completed by anyone with. areason to believe a person meets criteria for involuntary admission)
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what 4 criteria for involuntary admission under section 22
- suffering from mental illness
- requires psych treatment in designated facility
- require care & supervision through designated facility to prevent the persons a substantial mental deterioration or for the persons own protection or others
- not suitable as voluntary pt
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is it necessary to ahve involuntary pts sign form 5 (consent for treatment)
not necessary for pt to sign b/c pt can refuse & the director can sign to give consent, it is mandatory to have form 5 signed as this give consent to provide psych treatment
295
what type of treatment does the form 5 give consent to
psych treatment
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1st form 4
medical certificate (48 hrs)
297
2nd form 4
medicate certificate (1 mont)
298
1st form 6
renewal certificate (1 month)
299
2nd form 6
renewal certificate (3 mon)
300
3 form 6 & so on
renewal certificate (6 months)
301
what is form 11 & who signs
request for 2nd opinion (pt)
302
what is form 13 & how often staff required to give form & review it with pt
- pt rights
- given upon admission, transfers to another facility, pt status changes from voluntary to involuntary, when renewal certificates are completed
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how is rights info given to pts
- pt must be given a copy of form 13 & have info explained. tothem
- form must be signed & copy retained on pts chart
- if pt doesn't understand, must be repeated as soon as person is able to understand
- facility should provide assistance to ppl who may not understand their right info
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what rights do involuntary pts have
- hospital name & location
- right to be informed of reasons why person was admitted
- right to contact, retain, & instruct lawyer
- right to regular reviews (renewals)
- right to apply for a review panal hearing
- right to have validity of the detention determined by court
- right apply to court for discharge
- right to second medical opinion
305
what is review panel & what form is required
- form 7
- independent tribunal established to coonduct review panel hearings under MHA
306
what difference b/w pt who has been discharged from hospital & an involuntary pt who has been on extended leave
when pt is discharged they no longer certified & have no conditions to follow
- if pt place on extended leave = means pt is still an involuntary pt on a leave from hospital longer than 14 days with conditions they must follow (FORM 20)
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what is form 21 & who completes it
directors warrant
- authorizes peace officers (police) to apprehend a person & take them designated facility
