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NRSG 126 > Midterm 2 > Flashcards

Midterm 2 Flashcards

1
Q

Carbohydrates

A

controls blood glucose and insulin metabolism

sugar, starch, fiber

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2
Q

soluble and insoluble fiber

A

lowers LDL

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3
Q

LDL

A

low density lipoprotein

a high LDL level may increase the risk of coronary artery disease and stroke

bad cholesterol

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4
Q

High glycemic index

A

foods with a high glycemic index raise blood sugars quickly

these foods are easily digested and metabolized

soluble fiber, simple carb, complex carb

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5
Q

Low glycemic index

A

carbs the digest slowly are low on the glycemic index

raise the blood sugar slowly

starch, insoluble fiber

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6
Q

proteins

A

essential and nonessential amino acids

helps with the nitrogen balance

complete (animal) vs incomplete (plant) protein

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7
Q

Essential amino acids

A

9 amino acids that are not produced in the body that must be consumed

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8
Q

nonessential amino acids

A

11 amino acids that are synthesized in the body and do not need to be consumed through our diet

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9
Q

Fats (lipids)

A

saturated vs unsaturated fatty acids

monounsaturated and polyunsaturated fatty acids

trans fatty acids

cholesterol

triglycerides

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10
Q

saturated vs unsaturated fatty acids

A

saturated fatty acids have hydrocarbon chains connected by single bonds only (solid at room temp and come from animal sources)

unsaturated fatty acids have one or more double bonds (usually liquid at room temp and come from plant sources)

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11
Q

monounsaturated and polyunsaturated fatty acids

A

monounsaturated fatty acids have only one double bond

polyunsaturated fatty acids have more than one double bond (better for you than monounsaturated, reduces the risk of heart disease)

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12
Q

Trans fatty acids

A

increases your “bad” cholesterol and lowers your “good” cholesterol

manufactured fats created through a process of hydrogenation -> stabilizes polyunsaturated fats to prevent them from going bad

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13
Q

cholesterol

A

a waxy substance found in blood -> is needed to build healthy cells

to much cholesterol increases your risk of heart disease -> can develop fatty deposits in your vessels

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14
Q

triglycerides

A

a type of fat found in your blood

your body converts unused carbs into triglycerides to be stored for energy later -> stored in fat cells

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15
Q

water

A

most adults need 3L/day

helps regulate body temp

cells depend on a fluid environment

kidneys can filter over 170L of fluid per day

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16
Q

Fluid restrictions

A

heart failure (HF)
chronic kidney disease (CKD)

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17
Q

Fluid loss

A

sweating, elimination, respiration

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18
Q

Vitamins

A

essential to metabolism
antioxidants

fat soluble -> A, D, E, K

water soluble -> B, C (need to be taken often)

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19
Q

fat soluble vs water soluble vitamins

A

fat-soluble (easily stored in fat upon absorption) and water-soluble (washed out and not easily stored).

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20
Q

minerals

A

catalysts for biochemical reactions

macrominerals -> Ca, Na, K

microminerals -> Fe, Mg (needed in smaller amounts)

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21
Q

Nutrition in older adults

A

they have an increased risk of malnutrition

changes in senses -> taste and smell

may need more fiber and vitamins

may be changes that occur to the body that impact eating

follow nutritional advice that aligns with health status

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22
Q

Atherosclerosis

A

is the thickening or hardening of the arteries caused by a buildup of plaque in the inner lining of an artery.

it can rupture and cause a partial or total occlusion

high levels of triglycerides and LDL (bad fat and cholesterol) can lead to atherosclerosis

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23
Q

Wound classifications -> acute vs chronic

A

acute -> sudden onset, heal rapidly
ex. surgery wound, skin tear

chronic -> delayed healing, cause of wound is often not removed
ex. venous ulcers, diabetic ulcers, PI can become chronic

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24
Q

skin tear

A

epidermis thins = risk of tear

dehydration, poor nutrition, certain illnesses, and steroid use can increase risk of skin breakdown

any open area is at risk for infection

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25
Q

primary wound healing

A

tissue surfaces are closed

little tissue loss

increased healing speed

lower risk of infection

ex. surgical incision

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26
Q

secondary wound healing

A

great loss of tissues -> edges cant be brought together

longer repair/ healing time

greater chances of scarring

increased chance of infection

ex. burn, PI, skin tear, surgical wound dehiscence (reopening)

can lead to tertiary

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27
Q

tertiary wound healing

A

needs to be kept open -> contaminated

great risk of infection

requires surgical closures

more connective scar tissue

ex. PI with infection, wound kept open for drainage

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28
Q

stages of wound healing

A

bleeding -> inflammatory -> proliferative -> remodelling

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29
Q

factors that delay the inflammatory response

A

necrotic tissue, repeated pressure, trauma, foreign bodies, infection, poor nutrition, alcohol (ETOH), drug, and cigarette use

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30
Q

slough

A

bacteria/dead tissue

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31
Q

partial thickness wounds

A

heal quicker

epidermis and maybe into the dermis

regeneration occurs through -> hemostasis, inflammation, epithelial proliferation, migration (epidermal re-establishment)

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32
Q

full thickness wounds

A

takes longer to heal

extend into the dermis -> deep wound

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33
Q

pressure injury (PI)

A

a change in or a break in the skin caused by an injury or trauma related to pressure

usually over a bony prominence

result of pressure, sheer, or friction

affected by moisture, perfusion, comorbidities

low pressure over a long period or high pressure over a short period

occludes blood flow, nutrients -> results in cell death

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34
Q

classifications of PI

A

stage 1, 2, 3, 4, unstageable, or deep tissue injury

1-> skin is intact with non-blanchable redness, may be painful

2-> partial thickness loss of dermis, shallow open wound with a red wound bed without slough

3-> full thickness tissue loss, subcutaneous fat may be visible, muscle and bone are NOT exposed, slough may be present

4-> full thickness tissue loss with exposed bone or muscle, slough may be present

unstageable-> full thickness tissue loss in which the base is covered by slough in the PI, unable to determine the true depth

deep tissue injury-> purple or maroon localized area, intact skin or blood filled blister

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35
Q

incontinence associated dermatitis (IAD)

A

dermatitis = skin inflammation

redness with/without blistering, erosion, loss of barrier function

result of chronic exposure of the skin to urine or fecal matter

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36
Q

IAD and PI

A

IAD = high risk for PI, increased risk of infection

IAD are “top down” injuries where PIs are believed to by “bottom up” injuries

both have common risk factors

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37
Q

nutritional screening

A

look for individuals who are malnourished or at a nutritional risk

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38
Q

integument screening

A

look for individuals who are immobile, incontinent, malnourished, or at risk due to medical devices

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39
Q

BMR

A

basal metabolic rate

the amount of energy that is expended at rest in a neutral environment after the digestive system has been inactive for 12 hrs

the amount of energy your body needs to maintain homeostasis

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40
Q

timeline of wound healing

A

hemostasis and inflammation (immediate and 1-3 days) -> fibrin and platelets form a loose blood clot, causes a release of histamine which stimulates vasoconstriction, increases the delivery of WBC

proliferation and migratory stage (4 -21 days after) -> clot dries forming a scab, fibroblast enter the wound and secrete collagen and causes the endothelial cells to proliferate -> forms granulation tissue

maturation and remodelling (21 days to 1 year) -> scar tissue forms via fibrosis, has denser arrangement of collagen fibers and reduced elasticity

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41
Q

ageing heart

A

thickening blood vessel walls
narrowing lumen
less elastic vessels

pulmonary vascular tension, risk of orthostatic hypertension ( form of low blood pressure that happens when standing after sitting or lying down. ), systolic BP all increases with old age

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42
Q

heart position in thorax

A

base = top

apex = bottom

the apex is at the 5th ICS, 5-9 cm from the midsternal line

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43
Q

aorta

A

biggest artery in the body

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44
Q

coronary arteries

A

supply the heart with blood -> specifically the myocardium

when the heart relaxes during diastole the remaining blood in the aorta flows back into the coronary arteries

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45
Q

endocardium

A

inner layer

the regulator

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46
Q

epicardium

A

the outer or surrounding layer

anchor/ protector

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47
Q

myocardium

A

muscle

contractions

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48
Q

RBC

A

aka erythrocytes

carries O2 with hemoglobin

lives for 120 days

45% of blood

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49
Q

WBC

A

aka leukocytes

fights off infections

lives for 12 - 20 days

<1% of blood

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50
Q

platelets

A

clotting factors

will increase if there is an infection

lives for 6 days

<1% of blood

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51
Q

volume of blood

A

5L or 10 units

10% of body weight

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52
Q

plasma

A

transports nutrients, hormones, proteins

55% of blood

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53
Q

erythropenia

A

decreased red blood cells

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54
Q

thrombocytopenia

A

decrease in platelets

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55
Q

leukopenia

A

decrease in white blood cells

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56
Q

____poesis

A

creation of WBC,RBC,PLT

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57
Q

____cytosis

A

increase of WBC,RBC,PLT

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58
Q

____penia

A

decrease of WBC,RBC,PLT

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59
Q

myocardial pump

A

right side = pulmonary

left side = systemic

120/80
systolic/diastolic

blood pressure is controlled by baroreceptors

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60
Q

Low BP

A

vasoconstriction is increased -> sympathetic nervous system

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61
Q

High BP

A

vasodilation, cardiac output is decreased -> parasympathetic nervous system

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62
Q

barorecptors

A

stretch sensitive fibers located primarily on the aortic arch and each of the carotid sinuses

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63
Q

commonly replaced valves

A

mitral and aortic valves

the left sided valves

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64
Q

S1

A

atrioventricular valves closing

end of diastole

tricuspid (right) and mitral (left) valves

65
Q

S2

A

semilunar valves closing

end of systole

pulmonary (right) and aortic (left) valves

66
Q

left sided heart failure

A

impacts the lungs

failure leads to pulmonary congestion and pressure

heavy wet lungs
pulmonary edema
increased pulmonary venous pressure
dyspnea -> laboured breathing
alveoli is filled with fluid
difficult for gas exchange to occur

left heart failure is most common cause of right heart failure

67
Q

right sided heart failure

A

impacts the systemic blood flow

peripheral venous congestion
peripheral edema
renal failure

68
Q

systemic circulation

A

arteries -> arterioles -> capillaries -> oxygenated to de-oxygenated -> capillaries -> venule -> vein

69
Q

arteries

A

carry blood away from the heart

all arteries carry oxygenated blood except for the pulmonary arteries

it is a high pressure system

70
Q

veins

A

carry blood towards the heart

all veins carry deoxygenated blood except for the pulmonary veins

low pressure system, relies of valves and muscles

71
Q

cardiac output

A

the amount of blood the heart beats in L/min -> 4-6 L/min

cardiac output = HR (# beats per min) x stroke volume (amount of blood ejected during each cardiac cycle)

72
Q

stroke volume

A

amount of blood ejected during each cardiac cycle

73
Q

stroke volume : preload

A

ventricular stretch at the end of diastole
-> relaxed and filling

increased preload = volume overload or high pressure -> heart failure

decreased preload = low volume or decreased venous return -> hypovolemia

preload can increase myocardial O2 demand

74
Q

hypovolemia

A

a condition that occurs when your body loses fluid, like blood or water

Symptoms include weakness, fatigue and dizziness

75
Q

stroke volume : afterload

A

resistance the heart overcomes to eject blood from the ventricles

3 Vs= vessel diameter, valves, viscosity

increased afterload = increases wall tension and O2 needs, increased resistance from left ventricle -> HTN or aortic stenosis

decreased afterload = decrease resistance from left ventricle -> distributive shock-sepsis, anaphylaxis

76
Q

stenosis

A

abnormal narrowing of passages

77
Q

what does preload and afterload impact

A

cardiac output and stroke volume

78
Q

MAP

A

mean arterial pressure

the average arterial pressure throughout one cardiac cycle

79
Q

stroke volume : contractility

A

ability of the heart to contract and the force at which it contracts

increased contractility = stimulation of the SNS, meds

decreased contractility = HF, hypoexmia, meds

80
Q

SNS

A

sympathetic nervous system

flight or fight response

81
Q

cardiac conduction

A

ANS influence

sinoatrial (SA) node is the hearts pacemaker -> electrical

myocardial contraction -> mechanical

82
Q

SA node

A

forms an impulse and passes it along a conduction system

83
Q

conduction pathway

A

SA node -> AV node -> the bundle of His -> right and left bundle branches -> Purkinje fibres

84
Q

albumin

A

most abundant protein found in plasma

helps keep fluid from leaking out of blood vessels and going into other tissues

85
Q

lymphatic systems

A

a group of organs, vessels and tissues that protect you from infection and keep a healthy balance of fluids throughout your body.

86
Q

Ischemia

A

inadequate blood flow to an organ or part of the body

87
Q

tachycardia

A

Heart rate is too fast -> over 100BPM

can cause a decrease in cardiac output

decreased preload -> ventricular filling

decreased O2 to the heart and increased myocardial O2 demand

can be benign -> exercise

88
Q

bradycardia

A

heart rate is too slow -> under 60BPM

decreased HR = decreased cardiac output

can be benign -> in healthy persons/athletes

89
Q

dysrhythmia

A

deviation from the normal sinus rhythm

can be tachy or brady

regular or irregular

90
Q

dysrhythmia vs arrhythmia

A

If you experience an arrhythmia, the rhythm of your heartbeat is too fast or too slow. If you experience dysrhythmia, the rate of your heartbeat is irregular, but it’s still within a normal range.

91
Q

Tachy arrhythmias

A

the symptoms of a fast HR are worsened -> worse when it is irregular

decreased preload
decreased O2 to the heart
increased myocardial O2 demand

Afib
ventricular tachycardia
ventricular fibrillation

92
Q

brady arrhythmias

A

can cause a greater decrease in cardiac output

decreased HR= decreased cardiac output

heart block or medication SE

93
Q

Stenosis and obstruction, degeneration and regurgitation

A

risk factors -> age, smoking, HTN, birth defect

assessment -> murmurs

treatment -> lifestyle, intervention, surgery

94
Q

myocardial ischemia

A

O2 supply/demand imbalance

angina
ACS (acute coronary syndrome) -> group of conditions that include ST-elevation myocardial infarction (STEMI) and NSTEMI, and unstable angina)
MI

treatment -> lifestyle, meds, intervention, surgery

95
Q

STEMI

A

a total blockage of the coronary artery and the heart muscle is currently dying

96
Q

NSTEMI

A

a partial blockage of an artery, does not cause as much heart muscle damage

97
Q

HTN complications

A

MI
CVA
HF
kidney disease
vascular dementia
disease in the retina

98
Q

HTN risk factors

A

SODA

stress, smoking, sitting for long periods of time

obesity, oral contraceptives

diet, diseases

african american men, age

99
Q

CHF

A

congestive heart failure

100
Q

Troponin

A

cardiac markers

a protein found in the cells of heart muscle, they are usually very low

if the heart muscle is damaged troponin levels will rise

101
Q

creatine kinase (CK)

A

increased amounts of CK in the blood are indicators of muscle damage -> heart attack, skeletal muscles injuries, strenuous exercise

an inflammatory marker

102
Q

CRP

A

inflammatory marker

produced by the liver and indicates inflammation or infection

103
Q

BNP

A

the harder your heart works to pump blood the more BNP it produces

high levels can indicate heart failure

104
Q

Electrocardiogram (ECG/EKG)

A

assess STEMi and dysrhythmias

records the electrical signals in the heart

105
Q

echocardiogram (ECHO)

A

ultrasound

assesses valves, blood flow, and heart wall motion

assess-> contractility and ejection fraction (EF%)

106
Q

coronary angiogram

A

aka heart catheterization

assess-> heart defects, heart valves, narrowing or blockages, O2 levels

puncture site in the groin or wrist

107
Q

chest x-ray

A

can see airways, bones, cardiac silhouette, diaphragm, lung tissue

can help diagnose fluid pneumothorax, fracture

108
Q

stress test

A

evaluate exercise tolerance

usually walking on a treadmill

109
Q

hemoglobin

A

carries O2

a protein in RBC

110
Q

anemia

A

a deficiency of red blood cells or of hemoglobin in blood

acute -> acute hemorrhage, traumatic injury

chronic -> crohns, menstruation, rheumatoid arthritis

111
Q

hypoxia

A

reduced level of tissue oxygenation

changes to LOC and VS to compensate -> late signs

apprehension, restless, trouble concentrating, dizziness

112
Q

hypoxemia

A

low levels of oxygen in your blood

113
Q

systems involved in erythropoiesis

A

kidneys sense hypoxia -> kidneys will release erythropoietin -> bone marrow will create RBC (erythropoiesis) -> RBC are used for 120 days -> liver breaks down RBC -> bile is excreted via intestines

114
Q

Neural regulation od resp system

A

respiratory centre -> pons and medulla (automatic)

cerebrum -> thinking

hypothalamus (ANS) -> stress anxiety pain

115
Q

chemical regulation of resp system

A

chemoreceptors -> detect CO2, O2, pH, central = CO2, peripheral = O2 and pH

mechanoreceptors are throughout the entire resp tract

chemoreceptors act on the brainstem and then the brain stem activates the muscle of breathing

116
Q

central chemoreceptors

A

detect CO2

117
Q

peripheral chemoreceptors

A

detect O2 and pH

118
Q

eupnea

A

normal, unlabored breathing

119
Q

inhalation

A

the diaphragm contracts -> moves down

is an active process, the pressure is decreased in comparison to atmospheric pressure

120
Q

exhalation

A

the diaphragm relaxes -> moves up

is a passive process, the pressure is increased in comparison to atmospheric pressure

121
Q

ventilation

A

Resp rate

122
Q

perfusion

A

blood flow

to have adequate preload, there myst be enough hydration, cardiovascular, and muscle function to ensure venous return to right atrium

123
Q

diffusion

A

O2 and CO2 exchange in the alveoli

124
Q

atelectasis

A

partial or complete collapse of the lung-> caused by a blockage of air passages or pressure on the lung

125
Q

kyphosis

A

hunching of the back

126
Q

hypercapnia

A

excessive CO2 in the bloodstream caused by inadequate respiration

127
Q

apnea

A

no breathing

128
Q

cardiomyopathy

A

chronic disease of the heart muscle -> leads to arrhythmias

129
Q

hyperventilation

A

increased ventilation ->deep rapid breaths

eliminates more CO2

less O2 reaching tissues and hypoxia, dizzy, short of breath, light headed

causes-> anxiety, drugs, infection, shock, hypoxia with PE

can lead to alkalosis

130
Q

tachypnea

A

breathing too fast -> shallow breathing

131
Q

pulmonary embolism

A

when a blood clot gets stuck in an artery in the lung, blocking blood flow to part of a lung

132
Q

hypoventilation

A

inadequate ventilation

retains more CO2

causes-> severe atelectasis, excess O2 with COPD, alkalosis

feeling sleepy, changes in LOC, cardiac arrest, convulsions

can lead to acidosis

133
Q

factors that affect supply of oxygen

A

anemia
hypovolemia -> decreased volume of circulating blood in the body
kyphosis
altitude
muscular dystrophy

134
Q

factors that affect the demand of oxygen

A

fever
infection
exercise
metabolic demand

135
Q

oxygenation in the older adult

A

increase:
- chest diameter
- chest wall rigidity
- airway resistance
- risk of respiratory infections

decreased:
- cough reflex
- cilia
-alveoli

136
Q

smoking

A

leading cause of cancer death in canada

137
Q

increased weight

A

= decreased lung expansion

138
Q

asthma

A

a chronic condition in which your airways narrow and swell, may produce extra mucus

SOB
coughing
wheezing
chest tightness
difficulty breathing
difficulty participating in activity

chronic inflammation in the bronchioles

no cure, but manageable

indigenous = increased risks
obesity
lung infections as a child

139
Q

COPD

A

a group of diseases that cause airflow blockage and breathing related problems

umbrella term for emphysema (alveoli are damages and enlarged) and chronic bronchitis

affects circulation which can lead to fluid retention-> a complication of lt side HF

focus on symptom management

risk factors-> asthma, air pollution, smoking, repeated lung infections

140
Q

Treatment of COPD and asthma

A

avoid triggers
quit smoking/avoid second hand smoke
take inhaled steroids and inhaled bronchodilators

antibiotic therapy is more commonly used for COPD exacerbations

141
Q

cyanosis

A

peripheral cyanosis is rare and indicates very poor perfusion

EMERGENCY

142
Q

pulmonary edema

A

too much fluid in the lungs

occurs in left sided heart failure

143
Q

asthma exacerbation

A

aka asthma attack

brought on by trigger, inappropriate/ineffective treatment plans

can cause permanent damage if not treated

144
Q

COPD pathophysiology

A

ventilation -> bronchitis: swollen airways and increased sputum production, asthma

diffusion-> emphysema stops the diffusion of O2 and CO2 through the cell membrane, chronic hypercapnia

perfusion-> inefficient exchange of CO2 and O2

145
Q

COPD assessment findings

A

diminished breath sounds, wheezes, crackles at the lung bases

barrel chest
distant heart sounds
low SpO2
peripheral cyanosis (rare)
tachypnea/tachycardia
colds

146
Q

COPD exacerbation

A

increased: dyspnea, fatigue, cough, mucus, wheezing, crackles, new orthopnea (shortness of breath while laying down)

change from baseline

fever, sore throat, feeling unwell

147
Q

COPD complication

A

atelectasis
resp infections
lung cancer
anxiety
right sided HF (cor pulmonale)

148
Q

abnormal assessment findings

A

increased/decreased RR
WOB
dyspnea (SOB of SOBOE)
accessory muscle use
cyanosis
cough
hypoxia (tissues)
hypoxemia (paO2)

149
Q

wheezes

A

narrowed airways

asthma, COPD

150
Q

crackles

A

fluid

COPD, HF

151
Q

diminished breath sounds

A

COPD

152
Q

absence of breath sounds

A

air -> pneumothorax
no lung

153
Q

pneumonia

A

Pneumonia is an infection of one or both of the lungs caused by bacteria, viruses, or fungi.

air sacs are filled with pus and other liquid

154
Q

primary hypertension

A

you dont know the cause

155
Q

secondary hypertension

A

there is an underlying cause causing HTN

156
Q

for optimal tissue healing

A

the client must be in a state of positive nitrogen balance -> indicated that protein levels are high enough to contribute to wound healing

157
Q

ketosis

A

when your body doesn’t have enough carbohydrates to burn for energy -> burns fat creating ketones

158
Q

ASA (asprin)

A

an anti platelet medication and can prolong hemostasis

increase the risk for bleeding

159
Q

frank starling law

A

the increased filling pressure of the right heart results in increased cardiac output

the heart is able to increase its stroked volume appropriately according to venous return

NRSG 126 (3 decks)

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