Patho exam 2 Flashcards
1
Q
Which cranial nerve forms the optic nerve?
A
Carnial nerve 2
2
Q
what are medications that dilate pupils?
A
mydratics
3
Q
What color is the optic disk normally?
A
yellow, circular, clearly defined
4
Q
What is responsible for central vision?
A
macula
5
Q
what is responsible for sharp vision?
A
fovea
6
Q
what visual reflex is a direction of eye towards an object attracting a persons attention?
A
fixation
7
Q
what impairs fixation?
A
drugs, alcohol, fatigue, inattention
8
Q
what rare condition does the pupil accommodate but does not react to light?
A
Argy II robertson pupil
9
Q
What 3 things occur with accommodation?
A
-pupil changes in size when object is brought closer to nose
-eyes should converge
-size of pupils decrease in response to object coming closer
10
Q
Which system decreases pupil size?
A
PNS
11
Q
which system increases pupil size?
A
SNS
12
Q
what is another term for increasing pupil size?
A
mydriasis
13
Q
what is another term for decreasing pupil size?
A
miosis
14
Q
what is the function of the lens?
A
bends light rays to fall onto retina
15
Q
what is the function of the ciliary body?
A
-changes shape of lens
-secretes aqueous humor
16
Q
what disease process is known as visual field loss secondary to optic nerve damage?
A
glaucoma
17
Q
what is the leading cause of preventable blindness?
A
glaucoma
18
Q
what are the two types of glaucoma?
A
-primary open angle glaucoma
-acute angle closure glaucoma
19
Q
what structures are affected by glaucoma?
A
-ciliary muscle
-trabecular meshwork
-canal of schlemn
20
Q
If ciliary muscle if relaxed what occurs?
A
Obstruction of the canal
21
Q
where is aqeuous humor produced?
A
ciliary muscle
22
Q
ciliary muscle is controlled by which system?
A
ANS
23
Q
what type of stimulation causes the ciliary muscle to relax which will block drainage?
A
SNS stimulation
24
Q
which system causes the ciliary muscle to contract to allow drainage of aqeuous humor?
A
PNS
25
what type of glaucoma is the most common form in the US?
primary open angle glaucoma
26
which type of glaucoma has progressive optic nerve damage, with eventual impairment of vision, and increased IOP?
primary open angle glaucoma
27
Does primary open angle glaucoma have symptoms?
not until significant and irreversible optic nerve damage occurs
28
what are the risk factors for primary open angle glaucoma?
-elevated IOP
-family history
-old age
-african and south american ancestry
29
how do you treat primary open angle glaucoma?
-reducing elevated IOP
-chronic therapy with drugs
30
how do drugs lower IOP for glaucoma?
assist with aqeuous humor outflow and decrease aqeuous humor production
31
what is the preferred route of drug therapy for glaucoma?
topical
32
if drug therapy for glaucoma are ineffective, what other interventions can be done?
surgical intervention
33
what are two surgical procedures for glaucoma?
-laser trabeculoplasty
-trabeculectomy
34
what cholinergic drugs can be given for glaucoma?
-acetylcholine
-echothiophate
35
what beta adrenergic blocking agents can be given for glaucoma?
timolol
36
what do cholingerics mimic
PNS actions of acetylcholine
37
what actions do cholinergics do?
-pupil constriction
-ciliary muscle contraction
-enhancing aqeuous humor drainage
-reducing IOP
38
what do beta blockers do for glaucoma?
block SNS nerve endings in ciliary epithelium to cause a decrease in aqeuous humor production
39
what is the MOA for direct acting miotic Acetylcholine?
constricts pupils
40
What is an example of a direct acting miotic?
acetylcholine
41
11What is the onset and peak of acetylcholine?
instant
42
iwhat is the duraction of action of acetylcholine?
10 minutes
43
what is another term for pupils constriciting?
miotics
44
what is an example of an indirect acting miotic?
echothiophate
45
what is the MOA for echothiophate?
inhibits cholinesterase enzymes which allows for pupils to constrict because acetylcholine is not broken down
46
what is the onset for echothiphate?
10-30 minutes
47
what is the duration of action for echothiophate?
7-28 days
48
why are indirect acting drugs not commonly used for long term use?
can cause cataracts
49
What are cholinergic drug adverse effects?
-abdominal cramps
-asthma attacks
-diarrhea
hypotension
-headache
-nausea
-vomiting
50
what is the drug class for timolol?
opthalmic beta adrenergic blocker
51
what are the indications for opthalmic beta adrenergic blockers?
acts on beta 1 and beta 2 receptors
52
what is the onset of timolol?
15-30 minutes
53
what is the peak for timolol?
1-2 hours
54
what is the duration of action for timolol?
12-24 hours
55
what are the side effects of timolol?
arrthymia, bradycardia, bronchospams, heartblock
56
what are adverse effects of beta adrenergic blocking agents LOCALLY?
minimal effects
57
what are adverse effects of beta adrenergic blocking agents SYSTEMICALLY?
heart and lungs are affected which can lead to bradycardia and bronchospasms
58
for beta adrenergic blocking agents, what type of agents are recommended or patients with asthma?
cardioselective
59
after instilling timolol through eye drops, what is the next step?
apply light pressure on lacrimal sac for 1 minute after instilling drug
60
why do you have to put pressure on the lacrimal sac after administering timolol?
to minimize systemic absoprtion
61
what are nursing implications for timolol?
-assess patient history
-med history
-baseline vitals
-visual acuity
-physical assessment of they eye
-contrainidcaitons
-avoid touching eye with the tip of the dropper
62
what are the steps to administering eye drops?
--remove any lenses prior
-clean debris
-have patient look at the ceiling
-place drops in conjuctival sac
-gently close eye
-apply pressure on inner canthus
63
which type of glaucoma is known as precipitated by displacement of iris which prevents aqeuous humor from exiting?
angle closure glaucoma
64
Another name for angle closure glaucoma is?
narrow angle glaucoma
65
how do you treat angle closure glaucoma?
Cannot treat and irrevesible vision loss within 1-2 days
66
what type of corrective surgery can be done for angle closure glaucoma?
-laser iridotomy
-iridectomy
67
how does angle closure glaucoma present itself?
-sudden onset
-painful
68
what drugs dilate pupils?
mydriatics
69
when do you use mydriatics?
-measure refraction
-intraocular exams
-introcular surgery
70
what drug loosens cerumen?
carbamide peroxide
71
what are 3 structures bridge sound to middle ear?
malleus, incus, stapes
72
what is the function of the middle ear?
-conducts sound vibrations from outer to inner central hearing
-protects inner ear by reducing amplitude of sounds
-eustachian tube allows for equalization of pressure
73
what does cerumen protect against?
fungus and bacteria
74
what is the function of the eustachian tube?
allows for passage of air and connects middle ear with nasopharynx
75
what parts of the ear does conductive hearing loss affect?
outer and middle ear
76
what happens in conductive hearing loss?
sound transmission is impaired to middle ear
77
what type of environments do patients prefer with conductive hearing loss?
noisy environments
78
how do you treat conductive hearing loss?
treat cause or recommend a hearing aid
79
what occurs in sensorineural hearing loss?
ability to hear sound but inability to understand speech
80
what can be done to help sensorineural hearing loss?
hearing aids make sounds louder but not clearer
81
what are clinical manifestations for hearing loss and deafness?
-early signs are often unnoticed by patients
-pressure from others is a big factor to get help
-understanding should be validated
-ineffective communication and interaction can be frustrtaing for both parents and cargivers
82
what is known as the perception of noise without actual source of noise?
tinnitus
83
what is known as the first sign of hearing loss?
tinnitus
84
What things may cause tinnitus?
-noise
-more than 200 drugs
85
What test can assess a patients hearing ability?
whisper test
86
how do you perform a whisper test?
-be out of patients line of sight
-whisper a sentence or series of words 1-2 feet away
-ask patient to repeat
87
what can cause conductive hearing loss?
cerumen buildup
88
what is the MOA for carbamide peroxide?
softens, loosens, and removes cerumen
89
what is the recommended dose for carbamide peroxide?
BID for 4 days and then reevaluate
90
what are the side effects for carbamide peroxide?
no known side effects
91
how do you assess the ear an adult?
pull pinna up and back
92
how do you assess the ear in a child?
pull pinna down and back
93
what are the contraindications for carbamide peroxide?
-ear drainage
-tympanic membrane rupture
-significant pain or irritation
94
what may be given for ear infections?
-antibiotics for infection
-steroids for reducing inflammation and itchiness
95
what are nursing and collaborative care management techniques for hearing loss?
environmental noise control
96
Otoxic is also known as?
renal toxic
97
What are 4 examples of ototoxic drugs?
-salicylates
-loop diuretics
-chemotherapy drugs
-antibiotics
98
what are 3 ototoxic substances?
-toulene
-carbon disulfide
-mercury
99
what are assistive devices and techniques for hearing loss?
hearing aids
100
what do hearing aids do?
-provide amplification
-sound lateralization
-speech discrimination
101
what is the known as the body's ability to resist disease?
immunity
102
what are the immune response functions?
-defend
-homeostasis
-surveillance
103
What do antibodies connect with to start the immune response?
antigen
104
what are the two types of immunity?
innate and adaptive
105
which type of immunity is present at birth, is the first line of defense, has a nonspecific response?
innate
106
innate immunity contains primarily which WBC?
neutrophils and monocytes
107
which type of immunity is cell mediated and specific?
adaptive
108
which type of adaptive immunity does NOT produce antibodies, goes through cell destruction through T lymphocytes, and destroys pathogens inside the cell?
cell mediated immunity
109
which type of adaptive immunity produces antigen specific antibodies, destroys cells through B cells, and destroys pathogens outside the cell?
humoral immunity
110
what is the patho of the immune response?
-pathogen invades (outside to inside)
-innate immunity kicks in and try to phagocytize pathogen
- if innate immunity fails, adaptive immunity kicks in
-macrophages and dendritic cells present antigen of pathogen to T cell
-T cell then differentiates into T helper or T killer
-T helper activates B cells and T killer destroys pathogen
-B cells secrete antibodies that help destroy pathogen and then create memory cells
111
what is known as the function to defend against pathogens?
immune response
112
what activates the immune response?
inflammation
113
inflammation is part of the immune response but may not always indicate what?
infection
114
what is known as when the defense system fails & pathogens takes over?
infections
115
what is a sequential reaction to cell injury?
inflammation
116
what response removes necrotic material?
inflammatory response
117
what response establishes environment suitable for healing and repair?
inflammatory response
118
what are the 3 phases of the inflammation?
-vascular response
-cellular response
-formation of exudate
119
what are examples of acute inflammation?
allergic reactions, chemical irritants, infection, trauma injury, burns
120
what are examples of chronic inflammation?
cardiovascular disease, neurological disease, arthritis, lupus
121
What occurs in the vascular response of the inflammatory reaction?
-after injury -> arterioles vasoconstrict
-histamine and other chemicals are released to dilate vessels
-chemical mediators cause increased capillary permeability
-serous exudate followed by exudate with plasma proteins such as albumin
-oncotic pressure draws fluid from blood vessels
-vasodilation and increased capillary permeability
122
what are the signs of vascular response?
redness, heat, swelling
123
In the vascular phase, what occurs with fibrinogen?
-fibrinogen leaves blood and is activated into fibrin
-fibrin strengthens blood clot formed by platelets
124
what do platelets release in vascular phase?
growth factors and start healing process
125
what are the functions of blood clots in vascular phase?
-trap bacteria
-prevent further spread
-framework for healing
126
what is chemotaxis?
neutrophils and monocytes move to site of injury
127
which inflammatory response accumlates WBCs at site of injury?
cellular response
128
which WBC move to site of injury during cellular response?
-neutrophils
-monocytes
-lymphocytes
129
What is the final phase of the inflammatory response?
exudate formation
130
what occurs in exudate formation?
-fluid and WBCs move from circulation to site of injury
-hemorrage may occur: rupture of blood vessels
131
what are local clinical manifestations of inflammation?
-redness
-heat
-swelling
-loss of function
132
what are systemic clinical manifestations of inflammation?
-leukocytes shift to left
-malaise
-nausea/anorexia
-fever
- increased heart rate and respiratory rate
133
what is the patho for fever?
-WBC release cytokines
-cytokines trigger onset of fever
-metabolic changes in hypothalamus
-synthesize prostaglandins which increase thermostatic point
-hypothalamus activates ANS
-ANS increases temp
-epinephrine is released
=fever
134
what are the 3 types of inflammation?
-acute
-subacute
-chronic
135
which type of inflammation has a healing process of 2-3 weeks, has no residual damage. and is predominately neutrophils?
acute inflammation
136
which type of inflammation has same features as acute inflammation but healing will last longer (weeks to months)?
subacute inflammation
137
which type of inflammation lasts weeks, months, or years, agent persists or repeatedly injures tissues, includes lymphocytes and macrophages?
chronic inflammation
138
where are corticosteroids secreted?
adrenal cortex
139
what are the two types of corticosteroids?
-glucocorticoids
-mineralcorticoids
140
What is the MOA for corticosteroids?
-inhibits inflammatory and immune response
141
why are corticosteroids not good for someone in an active immune response (active infection)?
surpresses immune response to fight
142
How do corticosteroids affect the body?
-increase BG levels
-increased breakdown of proteins to amino acids
-stimulates bone demineralization & stabilizes mast cells
143
What is an example of a glucocorticoid?
prednisone
144
what are the broad indications for prednisone?
-anti-inflammatory
-immunosurpressant
145
how do you administer prednisone?
oral
146
what are 3 contraindiactions for prednisone?
-allergy
-serious infections
-Diabetes mellitus
147
What do you avoid with prednisone?
-long term administration
-if patient presents with serious infection
-breastfeeding because it can be secreted in breastmilk
148
What is important about corticosteroids taper dosing?
should not be stopped abruptly
149
What does taper dosing allow for with corticosteroids?
-allows pituitary time to recover
-starts stimulating the normal production of endogenous hormones
150
what may a patient risk if they abruptly stop taking corticosteroids?
-causes endogenous production of hormones to stop
-causes impaired stress respone -> risk for crisis
151
long term steroid therapy may require what?
stress dose
152
what are potential adverse affects with prednisone?
-moon face
-hyperglycemia
-psychosis
-adrenal surpression
-insomnia
-nervousness
-impaired wound healing
-many drug reactions
153
what are nursing considerations with prednisone?
-monitor administration in patients with DM
-monitor for cardiac, renal, liver diagonosis due to alterations in elimination
-caution in patients with gastritis, reflux disease, or ulcer diagnosis because of potential for GI perforation
154
what keeps our gut in balance?
normal flora
155
which type of bacteria is easier to kill?
gram positive
156
what happens during infection?
-normal defense is compromised
-microorganisms take control
-body is overwhelmed and symptoms appear
157
what are signs and symptoms of infection?
-fever
-chills
-sweats
-redness
-pain
-swelling
-fatigue
-increased WBC
158
what is the normal lab values for WBC?
5,000 - 10,000 WBC
159
What is known as a microorganism that causes disease?
pathogen
160
what can assist the body to combat infection?
antibiotics
161
How are antibiotics most effective?
if combined with functional defense mechanisms
162
what is known as bacteria are present but not with over signs/symptoms?
colonization
163
if you treat colonization, what may happen?
can lead to drug resistance
164
what are the two types of infections?
-community associated infection
-health care associated infection
165
which type of infection is acquired by a person who has not been hospitalized or had a recent exposure?
community associated infection
166
a health care associated infection is also known as?
nosocomial infection
167
which type of infection is acquired while getting health care treament or in a hospital?
health care associated infection
168
which type of health care associated infection is difficult to treat, can be drug resistant, highly virulent, and is the top 10 leading cause of death in the US?
health care associate infections
169
what are the 3 types of antibiotic therapy?
-empiric
-definitive
-prophylactic (preventative)
170
which type of therapy requires immediate antibiotics and given antibiotics that can kill most organisms?
empiric therapy
171
When do you obtain a culture with empiric therapy?
prior to adminstation of antibiotics
172
which type of therapy does the lab identify microorganism and tests susceptibility to various antibiotics? based on the results, you will adjust the therapy
definitive therapy
173
which type of antibiotic will you use with definitive therapy?
narrow spectrum and least toxic drug
174
overuse of broad spectrum antibiotics can lead to?
resistance
175
Which type of therapy is used to prevent an infection in situations with high contamination, usually prior to surgury?
prophylactic therapy
176
when do you give antibiotics before surgery for prophylactic antibiotic therapy?
30 min prior
177
How will we know if antibiotics were therapeutic?
decreased signs and symptoms
178
how will we know if antibiotics were subtherapeutic?
signs anf symptoms do not improve
179
what are adverse effects of antiobiotcs?
-toxic levels such as serum levels are too high
-allergic or adverse reaction
-chills, joint pain, difficulty breathing, wheezing
180
what occurs in superinfections?
when antibiotics reduce or eliminate normal flora and other bacteria/fungi take over
181
what are 3 examples of a superinfection?
vaginal yeast infection, ABX associated diarrhea, C. Diff (serious superinfection)
182
what are signs and symptoms of C.Diff?
-watery diarrhea
-abdominal pain
-fever
183
what should be avoided with C. Diff
avoid taking probiotics
184
what is a patient at risk for with C. Diff?
dehydration or fluid imbalance
185
what are 4 categories/classes of antibiotics?
-penicillins
-cephalosporins
-macrolides
-tetracyclines
186
what is the MOA of antibiotics?
-interfere with bacterial cell wall synthesis
-interfere with protein synthesis
-interfere with replication of DNA and RNA
-antimetabolite action
187
what are the two type of antibiotics?
bacteriostatic and bactericidal
188
which type of antibiotic does not actually destroy bacterial just inhibits growth?
bacteriostatic
189
which type of antibiotic kills a wide variety of gram + and some gram - bacteria?
bactericidal
190
what should you do prior to administering antibiotics?
-review history of hypersensitivity or allergic reactions
-review WHAT the reaction was
-review current meds
-lab tests
-obtain cultures if possible
-full head to toe assessment (any rashes)
191
what occurs in bacterial resistant infections?
bacterial infections no longer respond to ABX treatment
192
bacterial resistant infections are due to what?
-overprescribing ABX
-lack of ABX completion
-education
193
what occurs with ABX resistance?
-bacteria survived
-adapt to surroundings
-mutate over time so that it can survive attack by bacteria
194
What are characteristics of beta lactamase antibiotics?
-will kill bacteria that contains beta lactam rings
-contributes to bacterial resistance
-stronger against bacterial strains
195
what is an example of a penicillin?
amoxicillin
196
what type of antibiotic are penicillins?
bactericidal
197
what are penicillins derived from?
mold on bread/fruit
198
what inhibitors do pencillins bind with?
beta lactamase inhibitors
199
what beta lactamase enzyme targets penicillin?
penicillinases
200
what is penicillins MOA?
-binds to penicillin building protein
-inhibits peptidoglycan which interefers with cell wall synthesis
-results in defective cell wall that is easily broken down
-bacterial death due to lysis
201
what are contraindications for penicillin?
-drug allergy
-increased risk for allergy to other beta lactam ABX
-cephalosporins
202
what are adverse effects of pencillins?
- GI system is most common
-may need to adjust doses for renal dysfunction
-unpredictable reactions -> stevens Johnson syndrome (unique rash on whole body)
203
What are penicillin specific nursing interventions?
-high rate of hypersensitivity/allergies
-assess for asthma, aspirin allergy, & sensitivity to cephalosporins
-monitor serum levels (potassium and sodium)
-take with water NOT juices
-take with food to avoid upset stomach
-epinephrine for anaphylactic reactions
-not all end in "cillin"
204
what is an example of a semisythetic antibiotic that is related to penicillin and has almost all the same characteristics?
cephalosporins
205
how can you administer cephalosporins?
IV and PO
206
what are the adverse effects of cephalosporins?
GI and skin
207
Cephalosporin has a high cross sensitivity with ?q
penicillin
208
what is the MOA for cephalosporins? (same as penicillin)
-binds to penicillin building protein
-inhibits peptidoglycan which interefers with cell wall synthesis
-results in defective cell wall that is easily broken down
-bacterial death due to lysis
209
what is an example of a 1st generation cephalosporin?
cefazolin
210
what kind of bacteria is cefazolin used for?
great for gram positive bacteria but limited with gram negative
211
how can you administer cefazolin?
parenteral use only
212
what are the indications for cefazolin?
-surgical prophylaxis
-susceptibility to staph infections
213
What are 3 specific nursing interventions for cephalosporins?
-thorough assessment of allergies
-note specific generation
-avoid alcohol or alcohol containing products
214
what is an example of a macrolide?
erythromycin
215
what is erythromycins MOA?
inhibit protein synthesis and is bacteriostatic
216
in high enough doses what is erythromycin?
Bactericidal
217
how can you administer erythromycin?
oral, IV, topic, opthalmic
218
what are 3 additional therapeutic effects of erythromycin?
-Irritates GI tract
-stimulates smooth msucle and GI motility
-beneficial to patients with delayed gastric emptying
219
what are 3 adverse affects of erythromycin?
-Nausea/vomiting/stomach irritation
-cardiac & liver related issues
-tinnitus & hearing loss
220
what are 4 macrolide specific nursing interventions
-reduce effectiveness of oral contraceptives
-not to be given with fruit juices
-assess cardiac and liver function
-baseline hearing status
221
what is an example of a tetracycline?
Doxycycline
222
what is MOA for doxycycline?
inhibit bacterial protein synthesis and is bacteriostatic
223
what does doxycycline bind to?
-magnesium
-calcium
-metallic ions
224
What will happen if you coadministrate doxycycline with milk, antacids, or iron salts?
reduces oral absorption of tetracycline (doxycyline)
225
what are 2 indications for tetracyclines?
-variety of gram - and gram + bacteria
-lyme disease, chlamydia, & adolescent/adult acne
226
what are 3 contraindications for tetracyclines?
-allergy
-pregnancy or lactating mothers
-children < 8 years old
227
what are 7 adverse effects of tetracyclines?
-teeth discoloration
-effects on fetal development
-photosensitivity
-alteration of intestinal and vaginal flora
-thrombocytopenia
-upset stomach
-reduction of oral contraceptives
228
what are 6 tetracycline nursing interventions?
-interacts with dairy products, antidiarrheals, calcium, magnesium, iron
-may potentiate effects of oral anticoagulants
-decrease effectiveness of oral contraceptives
-sun exposure
-fluids with oral doses
-monitor skin for IV administration
229
what are 2 examples of topical antimicrobials?
neomycin and polymyxin B
230
How are antibiotics different from topical antimicrobials?
differ in absorption, distribution, toxicities, and adverse effects
231
what type of antibiotic is neomycin and polymyxin B?
broad spectrum
232
over use of neomycin and polymyxin B can result in?
increased likelihood of future allergic reactions of the skin
233
what are 6 nursing considerations for antibiotics?
-administer within recommended time frames
-give with fluids/foods as indicated
-administer around the clock
-do not omit or double up doses
-check herbal supplements interactions
-monitor for hypersensitivty reactions
234
what 5 things should be assessed with antibiotics?
-full assessment, lab values, current meds, vitals signs
-previous reaction to antibiotics?
-obtain cultures if you can prior to starting abx
-most common side effect of abx = n/v/d
-monitor for allergic or hypersensitivity reactions
235
what is the 1st thing you do for hypersensitivity reactions?
stop medication, contact provider, monitor patient
236
when do hypersensitivity reactions happen?
-30 min or up to days later
-delayed responses can occur after 72 hours
237
what are symptoms of hypersensitivity?
-rash
-itching
-swelling of face, tongue or hands
-SOB
-wheezing
-if anaphylaxis -> epinephrine
238
what is another term for stroke?
cerebral vascular accident
239
infarcation results in?
cell death
240
what are the two types of strokes?
ischemic and hemorrhagic
241
what does the brain require?
oxygen and glucose to neurones
242
if bloodflow is interrupted, what happens?
-neurologic metabolism is altered - 30 secs
-metabolism stops - 2 min
-cell death - 5 minutes
243
what does the brain have to regulate blood flow?
cerebral autoregulation
-cerebral blood vessels change diameter in response to BP so blood flow is constant
244
during ischemia, what is impaired?
autoregulation of blood flow
245
if cerebral autoregulation is impaired, how is this a problem?
brain is dependent on systemic BP
246
what are 4 nonmodifiable risk factors?
-gender
-age
-ethnicity or race
-family history
247
what are 10 modifiable risk factors for strokes?
-hypertension
-heart disease
-diabetes
-smoking
-obesity
-sleep apnea
-metabolic syndrome
-lack of exercise
-diet
-drug/alcohol use
248
what is the cause for 90% of strokes?
smoking
249
what is known as a mini stoke, is a brief episode of neurologic dysfunction, without infarction but can progress to stroke?
transient ischemic attack
250
how long do transient ischemic attacks last?
< 1 hour
251
why do transient ischemic attacks happen?
microemboli or temporary clot that blocks blood flow
252
what is ischemia?
temporary periods of hypoxia due to decreased blood flow
253
what is infarction?
blood flow is cut off which leads to necrosis (cell death)
254
what is known as inadequate blood flow to brain due to a blockage of a cerebral artery by a blood clot?
ischemic stroke
255
what are the two types of ischemic strokes?
-thrombotic (blood clot stays put)
-embolic (blood clot travels)
256
which type of ischemic stroke is the most common, is normally preceded by a Transient Ischemic Attack, and the narrow vessel becomes occluded which results in infarction?
thrombotic
257
what are 3 risk factors for thrombotic stroke?
-hypertension
-DM
-atherosclerosis
258
what is the second most common ischemic stroke where an embolus lodges and occludes cerebral artery?
embolic stroke
259
how do most embolic strokes occur?
starts as plaque, breaks off, enters circulation, and lodges in narrow vessel
260
what are 4 common causes of embolic ischemic strokes?
-atrial fibrilation
-MI
-infective endocarditis
-rheumatic heart disease
261
what are 2 less common ways to have an embolic ischemic stroke?
air and fat emboli
262
what are characteristics of embolic ischemic strokes?
-severe manifestations
-develops suddenly
-no warning signs
-conscious with headaches
-neurological deficits (can be temporary if clot breaks up)
-recurrence is common
263
what is the patho for hemorrhagic strokes?
weakened blood vessels ruptures and bleeding into brain
264
what are the most common causes of hemorrhagic strokes?
aneurysms and AVMs
265
during hemorrhagic strokes where does the bleeding occur?
inracerebral (brain tissue) and into the subarachnoid space or ventricles
266
what is known as ballooing or bulging of a blood vessel that can leak or rupture?
aneurysm
267
what is known as an abnormal tangle of blood vessels, connection of arteries and veins, disrupts normal blood flow and oxygen, can weaken & rupture and lead to hemorrhage?
arteriovenous malformation (AVM)
268
what are clinical manifestations of strokes?
-neurological symptoms that are similar for ischemic and hemorrhagic because they both cause lack of blood flow to the brain
-related to location of stroke
-functions affected are related to artery involved
269
what are possible outcomes that strokes are related to?
-motor function and communication
-affect and intellectual function
-spatial perceptual problems (unaware of what is going on with you)
-elimination (dont know what it feels like if bladder is full so you dont pee)
270
what motor function abilities are affected with strokes?
-mobility
-respiratory function
-swallowing & speech
-gag reflex
-self care abilities
271
If a patient has a left sided stroke, which side of the body is affected?
right side (contralateral)
272
what is another term for difficulty communicating?
aphasia
273
what are the three types of aphasia?
receptive, expressive, and global aphasia
274
what type of aphasia is unable to comprehend what is being said?
receptive aphasia
275
what type of aphasia has the inability to produce speech?
expressive aphasia
276
what type of aphasia is the inability to communicate?
global aphasia
277
What are the AFFECT clinical manifestations for strokes?
patient is
-emtional, unpredictable
-frustrated
-outburts (inappropriate reactions to things and do not realize its wrong)
278
what are the INTELLECTUAL FUNCTION clinical manifestations for strokes?
patient will have
-memory issues
-left brain -> slow and cautious
-right brain -> impulsive
279
what are the SPATIAL - PERCEPTUAL clinical manifestations for strokes?
patient will:
-deny illness
-perception of self is off
280
which disease process results in half of your visual field is lost from each eye? (sensory perceptual problem)
homonymous hemianopsia
281
what do you monitor for in homonymous hemianopsia?
monitor for
-diplopia
-prosis
-loss of corneal refex
282
what is super important when it comes to strokes?
TIME
283
What is golden hour routine for strokes?
-get a CT scan within 20 min of arrival (to assess ischemic or hemorrhagic stroke)
-check glucose levels (any deviation from norm is DEADLY for strokes)
-assess using NIHSS scale (high score = worse stroke is)
-give fibrinolytic therapy if ischemic stroke
-surgical intervention if indicated to remove clots)
- 12 lead EKG & labs
-Door to needle time is typically 1 hour
284
How do you treat a stroke?
-multi drug approach
-supportive therapy
-pharmacological and surgical interventions
285
how do you diagnose a stroke?
CT scan w/o contrast bc it takes longer with contrast and will need an IV
**hemorrhagic will have a massive white blob on screen indicating bleeding while an ischemic will not show that
286
what acute care should be done for an ischemic stroke?
-prevent further damage and reduce disabilities
-gather history (onset and symptoms)
-go to stroke center if possible
-treat hypertension (SBP > 220 and DBP > 120)
** Increased BP constricts vesels bc brain is not getting blood flow** autoregulation which is not good for this time
-glycemic control
287
What surgical interventions can be done for ischemic stroke?
surgical/endovascular therapy such as an angioplasty
288
What acute care can be done for a hemorrhagic stroke?
-drug therapy
-NO anticoagulants or platelet inhibitor because there are no clots!
-main drug: antihypertensives
-normal - high BP (SBP less < 160)
-seizure precautions in acute phase
289
what term means any process that stops bleeding?
hemostasis
290
what is an example of mechanical hemostasis?
compression at bleeding site
291
what is an example of surgical hemostasis?
clamping or cauterization
292
what term refers to hemostasis occurs due to physiologic clotting of blood?
coagulation
293
What is the process of hemostasis?
-initial injury
-vasospasm (spasming to control blood loss)
-platelet plug formation
-coagulation
294
A tear in blood vessel is referred to as?
an injury
295
if there is an a leakage in a blood vessel, what is the hemostatic response?
vasoconstrict
296
what is the technical term for blood clot?
thrombus
297
if platelet plug is not enough, what steps in to strengthen the plug?
coagulation
298
what is the result of the coagulation pathway?
large clot forming substance fibrin
299
what are the two pathways for coagulation cascade?
extrinsic and intrinsic
300
What type of pathway are blood vessels damaged by penetration from the outside, thromboplastin is released and activates factor X?
extrinsic pathway
301
which pahway is a clotting response to trauma/internal damage inside the blood vessels, components in blood are present in inactive forms, and are activated when clotting factors come in contact with collage on inside of damaged blood vessels?
intrinsic pathway
302
what does thrombin do?
converts fibrinogen to fibrin
303
What are the functions for clot retraction and dissolution?
-counter mechanism to blood clotting
-keeps blood in fluid state
-antithrombin activity
-vessel and platelet activity
-fibrinolysis
304
What does antithrombin do?
antagonizes thrombin (prevents clotting)
305
what reverses the clotting process?
fibrinolysis
306
What starts the fibrinolytic system?
-activation of plasminogen
-fibrin binds to plasminogen and converts it to plasmin
307
what activates the fibrinolytic system?
-tissue plasminogen activator or thrombin
308
what is plamsin?
an enzymatic protein that breaks down thrombus
309
what is the pharmacological treatment for a stroke?
Anticoagulants
310
How can anticoagulants be used?
-as a preventative (TIA, thrombus, embolus)
-used to reverse or maintain hemostasis
311
what are characteristics of anticoagulants?
-all work in clotting cascade
-prevent formation of a clot by inhibiting clotting factors
-no directeffect on clot already formed
-prevents further thrombosis by lowering blood coagulability
-prevents extension of established blood clot
312
what are 4 contraindications for anticoagulants?
-drug allergy
-active bleeding
-high risk for bleeding
-risk vs benefit
313
what is an example of an anticoagulant?
heparin
314
What are characteristics of heparin?
-administered through IV or SQ
-weight based
-inds to antuthrombin III
-***turns off 3 major clotting factors***
-turns off coagulation pathway
-cannot lyse clots
Two types: LMWH or unfractioned
315
which type of heparin is a large molecule, will require frequent lab monitoring, is activated through partial thromboplatin time, is continuous IV, and weight based?
unfractioned heparin
316
which type of heparin is a small structure, synthetic, has a more predictable outcome, no lab monitoring is required, is bridge therapy, can only administer as injections and is known as enoxaprin?
LMWH
317
How is warfarin administered?
orally
318
what is warfarins MOA?
-inhibits vtiamin K synthesis
-inhibits production of certain clotting factors
319
what do you monitor on warfarin?
lab values only and drug interactions!
320
what can you educate a patient about on warfarin?
-foods high in vitamin K can decrease ability to prevent clot
-be consistent in diet
-herbal products
321
what are 4 adverse effects of anticoagulants?
-bleeding
-heparin induced thrombocytopenia**
-localized or systemic adverse effects
-depends on underlying illness
322
all toxic effects of anticoagulants result in what?
hemorrhagic in nature
323
what are signs and symptoms of anticoagulant toxicity and overdose?
-hematuria
-melena
-petechia
-ecchmyoses
-gum/mucus membrane bleeding (stop drug immediately
324
what are toxicity managements for heparin?
-stopping drug may be enough
-if overdose is significant -> protamine sulfate is an antidote
325
what is toxicity management for warfarin?
-discontinue medication FIRST
-toxicity inactivates vitamin K dependent clotting factors
-may take 36 hours to resynthesize clotting factors to reverse warfarin
-may need tranfusions of plasma, platelets
-administer antidote if needed (vitamin K orally or IV)
326
What to measure with anticoagulants?
-measure clotting time (high number indicates long time to clot)
HEPARIN -> measure activated partial thromboplastin time
COUMADIN-> prothrombin time and international normalized ratio
327
what is normal aPTT/PTT values? *Heparin*
normal 25-35 seconds
target on heparin: 60-88 seconds for heparin
328
what are normal PT values? *Coumadin*
normal 11-13 seconds
target on coumadin: 18 seconds
329
what are normal INR values?
normal 2-3
target level on warfarin: 2.5-3.5
330
What are functions of antiplatelets?
-prevents clot formation
-prevents platelet adhesion at site of blood vessel injury
-occurs BEFORE clotting cascade
331
what is a stimulator for platelet adhesion?
collagen
332
what is MOA for antiplatelets?
-affects cyclooxygenase pathways
-final enzymatic pathway that operates within platelets & on cell walls
333
what are the indications for antiplatelets?
-depends on drug
-aspirin -> stroke prevention
-clopidogrel -> reduces risk of thrombotic stroke & TIA
334
What does aspirin inhibit?
-inhibits clooxygenase in platelet
-inhibits enzyme so cannot regenerate which prevents formation of thromboxane (thromboxane causes vessels to constrict and platelets to clot
335
what are indications for aspirin?
stroke pervention
336
what are doses and route for aspirin?
dose: 81-325 mg
Route: oral and rectal
337
what are contraindications for aspirin?
-thrombocytopenia
-bleeding
-GI bleeding
338
What are characteristics of clopidogrel?
inhibits activation of fibrinogen attaching to platelet receptor
339
what are the indications for clopidogrel?
-reduces risk of thrombotic stroke
-TIA prophylaxis
-prevention of thrombosis
340
what are contraindications for clopidogrel?
-thrombocytopenia
-bleeding
-GI bleeding
341
what are adverse effects of clopidogrel?
-chest pain
-edema
-flu-like symptoms
-abdominal pain
-epistaxis
-rash
-pruritis
342
how can you administer clopidogrel?
oral only
343
What are nursing considerations for anticoagulants & antiplatelets?
During/after administration:
-assess skin, oral mucous membranes, gums, urine, stool
assess for bleeding after brushing, nosebleeds, shaving
Monitor labs:
-CBC
-Platelet count
-Clotting studies
-liver function tests
assess LMWH injection site
344
what is a deadly combo?
heparin with LMWH
