module 2 Flashcards
preload
right heart blood return - muscle stretch *think volume
afterload
pressure in the l ventricles pump against- resistance in the peripheral pulses
heart failure
muscle is weak Co decreases kidney perfusion decreases UO decreases volume stays in the vascular space
renal glomerularnephritis
patho: inflammatory disease (STREP), antibodies lodge in the kidneys which causes scarring and decrease filtering
s/s: sore throat, malaise, headache
increase BUN and creatinine
urine: sediment, blood, protein
flank pain, increase BP and facial edema, decrease UO, increase SG, FVE
glomer tx
treat strep I&O daily weight activity/rest check VS diuretics restrict fluids diet: increase carbs, decrease na and protein
with a kidney client
decrease protein
nephrotic syndrome
excreting too much protein in the urine
s/s: massive proteinuria, hypoalbuminemia, edema, (anasarca), hyperlipidemia
tx: diuretics, ace inhibitor, prednisone, cyclophosphamide to shrink holes in the kidneys, daily weight, io
problems associated with protein loss
blood clots since losing protein normally prevents their blood from clotting so the blood starts clotting
high cholesterol and triglycerides
AKI
sudden episode of renal damage
pre renal: blood cant get to kidneys (hypotension, decrease hr, hypovolemia, shock)
intra renal: damage has occurred inside kidneys (glomerulonephritis, nephrotic syndrome, malignant HTN, dyes for tests, drugs/NSAIDS,
post renal: urine cant get out of the kidneys (enlarged prostate, kidney stone, tumors, uretral obstruction
hemodialysis
the machine works as the filter
3-4 times per week
usually on anticoagulants such a heparin
monitor blood pressure and electrolytes
peritoneal dialysis
peritoneum is the filter
filled with fluid then the fluid dwells and then its removed with all the toxins
if all the fluid doesnt come out- turn and reposition
2 types of peritoneal dialysis
CAPD done 4 times a day, 7 days a week
must have the desire and energy to be active in their treatment
APD happens at night and their exchange is done automatically while they sleep
nephrolithiasis/kidney stone
s/s: pain, nausea and vomiting, wbc in urine, hematuria
tx: increase fluids, ondansteron, NSAIDS or opiates, maybe surgery
chronic stable angina
intermittent decreased blood flow to the myocardium leads to ischemia
pain is from low oxygen due to exertion
rest relives the pain
tx: nitro, beta blockers, CCB, acetylsalicylic acid
cardiac cath
allergies to iodine and shellfish
check kidney function
acetylcysteine is usually given to help protect kidneys
post: monitor BLEEDING, lay flat for 4-6 hours after, report pain asap, pain, pallor, paresthesia, pulselessness, paralysis
unstable angina
decrease blood flow to myocardium which leads to ischemia and necrosis
rest does not relieve it
s/s: pain, crushing on their chest, pressure radiating to the left arm and left raw, cold/clammy, BP drops, SOB*
lab work for unstable angina
tx?
CPK-MB
Troponin
myoglobin
oxygen, aspirin, nitro, morphine
major arrhythmias
pulseless v tach, v fib, asystole.
defib, epi, amiodarone/lidocaine. lidocaine toxic- neuro changes.
amiodarone can lead to hypotension
what do thrombolytics end in
lase
dissolves the clot that is blocking blood flow to the heart muscle to decrease the size of the infarction
thrombolytics
PCI
stent placed with a balloon. given acetylsalicyclic acid or clopidogrel. think bleeding
CABG
bypass graft with vessel. usually done on the coronary artery occlusion. think bleeding
left sided HF
blood is not moving forward into the aorta and out of the body. if it doesnt move forward its going backward into the lungs
s/s: pulmonary congestions, dyspnea, orthopnea, tachy, crackles
*left=Lungs
right sided HF
blood is not moving forward into the lungs. so its moving backward into the venous system
s/s: jvd, edema, enlarged organs, weight gain, ascites
pacemakers
always worry if the heart rate drops below the set rate
post packemaker
monitor incision
immobilize arm
assist in passion ROM to prevent frozen shoulder
keep the client from raising the arm higher than shoulder height
pulmonary edema
fluid is backing up into the lungs. the heart is unable to move the volume forward
s/s: sudden onset, breathless, restless, severe hypoxia
tx: o2, morphine, furosemide/bumetanide, nitro
prevent: check lung sounds
cardiac tampanade
blood, fluid, or exudates have leaked into the pericardial sac resulting in compression of the heart
s/s: jvd, narrowed pulse pressure, increase CVP, decrease bp, muffled heart sounds
arterial disorders
arterial occulsion
intermittent claudication, cold extremity, decreased pulses
tx: surgery or lower the arteries
venous disorders
brown pigmentation around the ankle, edema, temperature is normal, ulcers if present on the ankles
another name for right sided heart failure
cor pulmonale
interventions to decrease preload
vasodilators elevate HOB low salt diet dangle the legs diuretics
vasodilators
ace inhibitors
arbs
nitro
these help with decreasing preload and afterload
chronic stable angina
decreased blood flow- ischemia
occurence? predictable
pain occurs because of decreased o2, usually from exertion
relieved with rest and nitro
unstable angina or mi
decreased blood flow - necrosis/ischemia
occurence? not predictable
pain occurs because of poor blood flow through the myocardial vessels
not relieved with rest and nitro
patient experiencing hypotension or myocardial shock
dopamine
compare and contrast glome and nephrotic
compare: inflammatory response within the glomerulus. toxins and malasie. increase BP. decrease UO. can lead to RF
g: strep. protein loss. hematuria. facial edema
n: idiopathic. massive protein loss. anasarca. hyperlipidemia. clotting problems
IF KIDNEYS ARE DAMAGED..RBC
will decrease because kidneys are not making erythropoietin
s/s of renal failure
anemia- decrease erythropoietin
HTN- retaining fluids, increase workload on the heart
itching frost- urea excess is surfacing to the skin
FVE/HR-kidneys arent working so fluid in the vascular space will continue to increase
interventions for increased toxins and metabolic waste
bedrest, diet low in protein and high in carbs and fats
interventions for fve
bedrest, I o , daily weight, vs q2 hours, cvp, assess lung sounds, restrict fluids, administer iv meds in the smallest amount possible
interventions for hyperkalemia
iv glucose and insulin polystyrene sulfonate loop diuretics low K diet calcium gluconate at bedside
