NRSG258 - part 5 Flashcards

Question

Congestive Cardiac Failure

Answer 1

occurs when the heart is unable to pump oxygenated, nutrient rich blood out at a rate that meets the metabolic demands of the body, causing a back-up of blood in the venous circuit and leading to oedema. Results from any structural or functional cardiac disorder that impairs the ability of the ventricle to fill or eject blood.Diagnosed when LVEF < 40%

Answer 2

``` Myocardial disease - (2/3 of all CHF –from fibrosis from IHD + AMI) Arrhythmias Valve disease Pericardial disease Congenital heart disease COPD (right sided HF) ```

Answer 3

Preload Afterload Contractility Heart rate

Answer 4

represent the stretch on the ventricles as a consequence of ventricular filling. (venous return relates directly to end diastolic volume) i.e intravascular blood volume

Answer 5

resistance downstream to the left ventricle which it has to overcome in order to eject blood from the heart. i.e arterial vasoconstriction increases resistance

Answer 6

the force of contraction to ensure the adequate stroke volume is ejected. The degree of myocardial fibre shortening

Answer 7

Chronic Progressive condition Main problem is the body becomes resistant to the normal effects of insulin and/or the body loses the capacity to produce enough insulin in the pancreas to meet demand. 1. There is a decreased intracellular reaction to insulin causing a decreased uptake of glucose by the tissue 2 Causing an unchecked regulation of glucose production/release by the liver (gluconesis& Gluconeogenesis) 3. To overcome this there needs to be an increase in the amount of insulin secreted. 4. However if the beta cells cannot keep up with the increased demand for insulin, glucose level rises above normal level and T2DM develops.

Answer 8

``` Weight Sedentary lifestyle diet HTN Apple shaped body ```

Answer 9

A family history of diabetes ATSI background Age * Over 55 years of age - the risk increases as we age * Are over 45 years of age and are overweight * Are over 35 years of age and are from an Aboriginal or Torres Strait Islander background Are a woman who has given birth to a child over 4.5 kgs, or had gestational diabetes when pregnant, or had a condition known as Polycystic Ovarian Syndrome.

Answer 10

results from cell deprivation of nutrients as glucose is not entering the cells in sufficient amounts which stimulates increased food intake

Answer 11

the osmotic effect of glucose in the urine draws water from the bloodstream increasing production of urine

Answer 12

the water being lost from the body in the urine leads to dehydration which triggers increased thirst in an attempt to rehydrate the cells

Answer 13

Obese patients have a higher risk of surgical and anaesthetic complications (BMI over 30) and post operative wound infections Obesity stresses the cardiac and pulmonary systems and makes access to the surgical site and anaesthesia administration more difficult. Some inhaled anaesthetic agents are absorbed and stored in adipose tissue, and therefore leave the body more slowly prolonging recovery/wakening times. Diabetes mellitus is also associated with increased risk of perioperative infection and postoperative cardiovascular morbidity and mortality and longer hospital stays. Persistent hyperglycemia is a risk factor for endothelial dysfunction, postoperative sepsis, impaired wound healing, and cerebral ischemia. Surgery and general anaesthesia cause a increase in stress response which alters glucose metabolism. Key aspect of the perioperative management is glycemic control through close monitoring, adequate fluid and caloric repletion, and judicious use of insulin

Answer 14

Pulmonary oedema is the accumulation of fluid within pulmonary interstitial spaces and ultimately within the alveoli. The excess fluid occurs as a result of changes in pressure within the pulmonary vessels or from changes in vascular permeability Pulmonary capillary pressure exceeds plasma oncotic pressure and forces fluid into the alveoli, interfering with gas exchange. Cardiogenic pulmonary oedema is associated with heart failure

Answer 15

Patient adaptation-ADL’s in 6-8 weeks, no heavy lifting, psychological support, identify coping mechanism Colostomy care Assess stoma and surrounding skin: * Pink stoma - healthy; pale - anaemic; dusky blue - necrotic * Mild to moderate swelling - till 2-3 weeks is normal; moderate to severe swelling -obstruction of stoma * Small amount of oozing - normal; moderate to large bleeding -coagulation problem or GI bleed ``` Wash stoma with mild soap & water Use of skin barrier Use of pouch - leave ¼ of skin around the stoma Colostomy irrigations Regulate bowel function Treat constipation ```