Midterm 2 Flashcards
1
Q
Carbohydrates
A
controls blood glucose and insulin metabolism
sugar, starch, fiber
2
Q
soluble and insoluble fiber
A
lowers LDL
3
Q
LDL
A
low density lipoprotein
a high LDL level may increase the risk of coronary artery disease and stroke
bad cholesterol
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
5
Q
Low glycemic index
A
carbs the digest slowly are low on the glycemic index
raise the blood sugar slowly
starch, insoluble fiber
6
Q
proteins
A
essential and nonessential amino acids
helps with the nitrogen balance
complete (animal) vs incomplete (plant) protein
7
Q
Essential amino acids
A
9 amino acids that are not produced in the body that must be consumed
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
9
Q
Fats (lipids)
A
saturated vs unsaturated fatty acids
monounsaturated and polyunsaturated fatty acids
trans fatty acids
cholesterol
triglycerides
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)
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)
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
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
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
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
16
Q
Fluid restrictions
A
heart failure (HF)
chronic kidney disease (CKD)
17
Q
Fluid loss
A
sweating, elimination, respiration
18
Q
Vitamins
A
essential to metabolism
antioxidants
fat soluble -> A, D, E, K
water soluble -> B, C (need to be taken often)
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).
20
Q
minerals
A
catalysts for biochemical reactions
macrominerals -> Ca, Na, K
microminerals -> Fe, Mg (needed in smaller amounts)
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
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
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
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
25
primary wound healing
tissue surfaces are closed
little tissue loss
increased healing speed
lower risk of infection
ex. surgical incision
26
secondary wound healing
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
27
tertiary wound healing
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
28
stages of wound healing
bleeding -> inflammatory -> proliferative -> remodelling
29
factors that delay the inflammatory response
necrotic tissue, repeated pressure, trauma, foreign bodies, infection, poor nutrition, alcohol (ETOH), drug, and cigarette use
30
slough
bacteria/dead tissue
31
partial thickness wounds
heal quicker
epidermis and maybe into the dermis
regeneration occurs through -> hemostasis, inflammation, epithelial proliferation, migration (epidermal re-establishment)
32
full thickness wounds
takes longer to heal
extend into the dermis -> deep wound
33
pressure injury (PI)
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
34
classifications of PI
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
35
incontinence associated dermatitis (IAD)
dermatitis = skin inflammation
redness with/without blistering, erosion, loss of barrier function
result of chronic exposure of the skin to urine or fecal matter
36
IAD and PI
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
37
nutritional screening
look for individuals who are malnourished or at a nutritional risk
38
integument screening
look for individuals who are immobile, incontinent, malnourished, or at risk due to medical devices
39
BMR
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
40
timeline of wound healing
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
41
ageing heart
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
42
heart position in thorax
base = top
apex = bottom
the apex is at the 5th ICS, 5-9 cm from the midsternal line
43
aorta
biggest artery in the body
44
coronary arteries
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
45
endocardium
inner layer
the regulator
46
epicardium
the outer or surrounding layer
anchor/ protector
47
myocardium
muscle
contractions
48
RBC
aka erythrocytes
carries O2 with hemoglobin
lives for 120 days
45% of blood
49
WBC
aka leukocytes
fights off infections
lives for 12 - 20 days
<1% of blood
50
platelets
clotting factors
will increase if there is an infection
lives for 6 days
<1% of blood
51
volume of blood
5L or 10 units
10% of body weight
52
plasma
transports nutrients, hormones, proteins
55% of blood
53
erythropenia
decreased red blood cells
54
thrombocytopenia
decrease in platelets
55
leukopenia
decrease in white blood cells
56
____poesis
creation of WBC,RBC,PLT
57
____cytosis
increase of WBC,RBC,PLT
58
____penia
decrease of WBC,RBC,PLT
59
myocardial pump
right side = pulmonary
left side = systemic
120/80
systolic/diastolic
blood pressure is controlled by baroreceptors
60
Low BP
vasoconstriction is increased -> sympathetic nervous system
61
High BP
vasodilation, cardiac output is decreased -> parasympathetic nervous system
62
barorecptors
stretch sensitive fibers located primarily on the aortic arch and each of the carotid sinuses
63
commonly replaced valves
mitral and aortic valves
the left sided valves
64
S1
atrioventricular valves closing
end of diastole
tricuspid (right) and mitral (left) valves
65
S2
semilunar valves closing
end of systole
pulmonary (right) and aortic (left) valves
66
left sided heart failure
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
right sided heart failure
impacts the systemic blood flow
peripheral venous congestion
peripheral edema
renal failure
68
systemic circulation
arteries -> arterioles -> capillaries -> oxygenated to de-oxygenated -> capillaries -> venule -> vein
69
arteries
carry blood away from the heart
all arteries carry oxygenated blood except for the pulmonary arteries
it is a high pressure system
70
veins
carry blood towards the heart
all veins carry deoxygenated blood except for the pulmonary veins
low pressure system, relies of valves and muscles
71
cardiac output
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
stroke volume
amount of blood ejected during each cardiac cycle
73
stroke volume : preload
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
hypovolemia
a condition that occurs when your body loses fluid, like blood or water
Symptoms include weakness, fatigue and dizziness
75
stroke volume : afterload
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
stenosis
abnormal narrowing of passages
77
what does preload and afterload impact
cardiac output and stroke volume
78
MAP
mean arterial pressure
the average arterial pressure throughout one cardiac cycle
79
stroke volume : contractility
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
SNS
sympathetic nervous system
flight or fight response
81
cardiac conduction
ANS influence
sinoatrial (SA) node is the hearts pacemaker -> electrical
myocardial contraction -> mechanical
82
SA node
forms an impulse and passes it along a conduction system
83
conduction pathway
SA node -> AV node -> the bundle of His -> right and left bundle branches -> Purkinje fibres
84
albumin
most abundant protein found in plasma
helps keep fluid from leaking out of blood vessels and going into other tissues
85
lymphatic systems
a group of organs, vessels and tissues that protect you from infection and keep a healthy balance of fluids throughout your body.
86
Ischemia
inadequate blood flow to an organ or part of the body
87
tachycardia
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
bradycardia
heart rate is too slow -> under 60BPM
decreased HR = decreased cardiac output
can be benign -> in healthy persons/athletes
89
dysrhythmia
deviation from the normal sinus rhythm
can be tachy or brady
regular or irregular
90
dysrhythmia vs arrhythmia
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
Tachy arrhythmias
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
brady arrhythmias
can cause a greater decrease in cardiac output
decreased HR= decreased cardiac output
heart block or medication SE
93
Stenosis and obstruction, degeneration and regurgitation
risk factors -> age, smoking, HTN, birth defect
assessment -> murmurs
treatment -> lifestyle, intervention, surgery
94
myocardial ischemia
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
STEMI
a total blockage of the coronary artery and the heart muscle is currently dying
96
NSTEMI
a partial blockage of an artery, does not cause as much heart muscle damage
97
HTN complications
MI
CVA
HF
kidney disease
vascular dementia
disease in the retina
98
HTN risk factors
SODA
stress, smoking, sitting for long periods of time
obesity, oral contraceptives
diet, diseases
african american men, age
99
CHF
congestive heart failure
100
Troponin
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
creatine kinase (CK)
increased amounts of CK in the blood are indicators of muscle damage -> heart attack, skeletal muscles injuries, strenuous exercise
an inflammatory marker
102
CRP
inflammatory marker
produced by the liver and indicates inflammation or infection
103
BNP
the harder your heart works to pump blood the more BNP it produces
high levels can indicate heart failure
104
Electrocardiogram (ECG/EKG)
assess STEMi and dysrhythmias
records the electrical signals in the heart
105
echocardiogram (ECHO)
ultrasound
assesses valves, blood flow, and heart wall motion
assess-> contractility and ejection fraction (EF%)
106
coronary angiogram
aka heart catheterization
assess-> heart defects, heart valves, narrowing or blockages, O2 levels
puncture site in the groin or wrist
107
chest x-ray
can see airways, bones, cardiac silhouette, diaphragm, lung tissue
can help diagnose fluid pneumothorax, fracture
108
stress test
evaluate exercise tolerance
usually walking on a treadmill
109
hemoglobin
carries O2
a protein in RBC
110
anemia
a deficiency of red blood cells or of hemoglobin in blood
acute -> acute hemorrhage, traumatic injury
chronic -> crohns, menstruation, rheumatoid arthritis
111
hypoxia
reduced level of tissue oxygenation
changes to LOC and VS to compensate -> late signs
apprehension, restless, trouble concentrating, dizziness
112
hypoxemia
low levels of oxygen in your blood
113
systems involved in erythropoiesis
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
Neural regulation od resp system
respiratory centre -> pons and medulla (automatic)
cerebrum -> thinking
hypothalamus (ANS) -> stress anxiety pain
115
chemical regulation of resp system
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
central chemoreceptors
detect CO2
117
peripheral chemoreceptors
detect O2 and pH
118
eupnea
normal, unlabored breathing
119
inhalation
the diaphragm contracts -> moves down
is an active process, the pressure is decreased in comparison to atmospheric pressure
120
exhalation
the diaphragm relaxes -> moves up
is a passive process, the pressure is increased in comparison to atmospheric pressure
121
ventilation
Resp rate
122
perfusion
blood flow
to have adequate preload, there myst be enough hydration, cardiovascular, and muscle function to ensure venous return to right atrium
123
diffusion
O2 and CO2 exchange in the alveoli
124
atelectasis
partial or complete collapse of the lung-> caused by a blockage of air passages or pressure on the lung
125
kyphosis
hunching of the back
126
hypercapnia
excessive CO2 in the bloodstream caused by inadequate respiration
127
apnea
no breathing
128
cardiomyopathy
chronic disease of the heart muscle -> leads to arrhythmias
129
hyperventilation
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
tachypnea
breathing too fast -> shallow breathing
131
pulmonary embolism
when a blood clot gets stuck in an artery in the lung, blocking blood flow to part of a lung
132
hypoventilation
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
factors that affect supply of oxygen
anemia
hypovolemia -> decreased volume of circulating blood in the body
kyphosis
altitude
muscular dystrophy
134
factors that affect the demand of oxygen
fever
infection
exercise
metabolic demand
135
oxygenation in the older adult
increase:
- chest diameter
- chest wall rigidity
- airway resistance
- risk of respiratory infections
decreased:
- cough reflex
- cilia
-alveoli
136
smoking
leading cause of cancer death in canada
137
increased weight
= decreased lung expansion
138
asthma
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
COPD
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
Treatment of COPD and asthma
avoid triggers
quit smoking/avoid second hand smoke
take inhaled steroids and inhaled bronchodilators
antibiotic therapy is more commonly used for COPD exacerbations
141
cyanosis
peripheral cyanosis is rare and indicates very poor perfusion
EMERGENCY
142
pulmonary edema
too much fluid in the lungs
occurs in left sided heart failure
143
asthma exacerbation
aka asthma attack
brought on by trigger, inappropriate/ineffective treatment plans
can cause permanent damage if not treated
144
COPD pathophysiology
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
COPD assessment findings
diminished breath sounds, wheezes, crackles at the lung bases
barrel chest
distant heart sounds
low SpO2
peripheral cyanosis (rare)
tachypnea/tachycardia
colds
146
COPD exacerbation
increased: dyspnea, fatigue, cough, mucus, wheezing, crackles, new orthopnea (shortness of breath while laying down)
change from baseline
fever, sore throat, feeling unwell
147
COPD complication
atelectasis
resp infections
lung cancer
anxiety
right sided HF (cor pulmonale)
148
abnormal assessment findings
increased/decreased RR
WOB
dyspnea (SOB of SOBOE)
accessory muscle use
cyanosis
cough
hypoxia (tissues)
hypoxemia (paO2)
149
wheezes
narrowed airways
asthma, COPD
150
crackles
fluid
COPD, HF
151
diminished breath sounds
COPD
152
absence of breath sounds
air -> pneumothorax
no lung
153
pneumonia
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
primary hypertension
you dont know the cause
155
secondary hypertension
there is an underlying cause causing HTN
156
for optimal tissue healing
the client must be in a state of positive nitrogen balance -> indicated that protein levels are high enough to contribute to wound healing
157
ketosis
when your body doesn't have enough carbohydrates to burn for energy -> burns fat creating ketones
158
ASA (asprin)
an anti platelet medication and can prolong hemostasis
increase the risk for bleeding
159
frank starling law
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
