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ANATOMY AND PHYSIOLOGY > SEMESTER 2 FINALS > Flashcards

SEMESTER 2 FINALS Flashcards

1
Q

Myocardial Infarction definition

A
  • (STEMI or NSTEMI)-ST elevated or not
  • DEATH OF HEART MUSCLE
    MYOCARDIAL CELLS PERMANENTLY DESTROYED (necrosis)
  • SECONDARY TO PARTIAL OR COMPLETE BLOCKAGE OF CORONARY ARTERY
  • emergency event Tx needed ASAP
  • caused by CAD
  • if blood supply to LADA is blocked that’s really bad, supplies 50% of blood to heart
  • necrosis can be min. If Tx within 1 hr
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2
Q

M.I. S/S normal and atypical

A
  • angina main s/s: crushing pain radiating to either shoulder/arm & jaw that don’t stop with nitro
  • SOB, restlessness , dizzy, nausea, sweating, s3/s4 gallop
  • atypical S/S: women, no pain, epigas./abd. Pain, chest cramping, fatigue, anxiety/doom, falls
  • tx: M.O.N.A
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3
Q

M.I. Labs and prehospital care

A
  • labs— potassium, magnesium, CK-mb shows heart damage
  • prehospital— if 3 nitro tabs & sitting don’t work for angina, TAKE 1 ASPIRIN/2 BABY ASPIRIN, CALL 911, DONR SELF DRIVE
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4
Q

C.A.D

A
  • blood can’t flow to coronary artery»s/s ischemia, angina, caused by atherosclerosis
  • -STATIN meds: lowers LDLs (bad cholesterol), don’t take with grapefruit, s/e rhabdomyalsis, hepatotoxicity,i.e. Atvorstatin
  • low cholesterol diet, no smoking, workout
  • tx: PTCA (artery compress balloon), atherectomy (removes plaque), stents (mesh plasty), CABG (vessel graft for block..Leg, mammary..hug a pillow)
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5
Q

Cardiac biomarker

A
  • CK, troponin, myoglobin…will be elevated in M.I.
  • c-reactive : CAD / MI risk, <10 normal
  • troponin 1&2 show MI , stay high 5-7 days
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6
Q

Modifiable & non modifiable risk factors HEART

A
  • modify—wt, diet/liquor, smoking, workout,diabetes
  • non-modify—sex, genes, family history, race, diabetes
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7
Q

DVT

A
  • form of thrombophlebitis ..in deep veins usually in LE
  • discoloration, swelling, warmth, redness, edema
  • can cause pulmonary embolism
  • tx: low wt or regular heparin, Coumadin, rest, TEDs, thrombectomy, vena cava filter, elevate legs, skin integrity (ulcers)
  • nursing: risk factors, relieve pain, administer meds per INR PT
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8
Q

Diuretics

A
  • reduces blood vol./ARTERY PRESSURE, By urinating out electrolytes and water
  • used for HTN, HF (CHF esp.), etc
  • K-sparing: Spironolactone (Aldactone)..Watch potassium lvl for elevations
  • k-wasting: thiazide (hydrochlorothiazide) (chlorothiazide) potassium for decrease
  • Loop: furosemide (lasix), torsemide (demadex)…daily wt. & I/O
  • oldest most studied antiHTN med
  • PTs should swing legs on bed’s edge for some minute before standing to avoid syncope
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9
Q

Beta blockers

A
  • used for HTN because they relieve blood pressure / HR/decrease cardiac output
  • TREAT HTN HF , CHF, A. fib, can prevent MI
  • S/E: bradycardia, fatigue, dizzy
  • avoid with COPD/asthma PTs
  • if its a HR under 60 HOLD med call HCP
  • -LOL drugs i.e. metroprolol
  • stopping use=rebound HTN
  • Beta 2 agonist: bronchodilation
    Beta 2 blocker: bronchoconstriction
    Alpha 1 agonist: vasoconstriction
    Alpha 1 blocker: vasodilation
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10
Q

Heart failure

A
  • L-side: blood backs up from l vent to l atrium&raquo_space;to lungs»alveolar/pulmonary edema ..MI. regurgitation/sentosis causes
  • R-sided: fluid backs up in lungs causing pulmonary pressure from L sided-failure ..Systemic
  • r sided– cor pulmonale, L side H.F., stenosis
  • heart will compensate for this by working harder but that can make it worse
  • r-side s/s: jvd, peripheral edema, organmegaly- RUQ pain, alt asp elevated, hepatic venous stasis, wt. gain
  • l-side s/s: paroxysmal noc., lung congestion, restlessness, fatigue, confusion, orthopnea, fatigue, cyanosis
  • tx: ACE & diuretic, report dry cough (from ACE), daily wt. 2-3lb wt gain..report to Dr.
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11
Q

Cardiac valve replacement

A
  • mechanical: durable, creates fast flow…thrombus risk, anticoagulant forever
  • bio: I.e. pig, cow etc, needs to be replaced more because it’s organic
  • Ineffective Endo. can occur from vegetation growth
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12
Q

Pulmonary edema

A
  • life threatening (resp. distress), l side HF complication ..from alveolar fluid build up
  • s/s: orthopnea, paroxysmal dyspnea, frothy bloody coughs, pallor, wheezing/gurgling, crackles on ascultation, diaphoresis, anxiety
  • dx: X-ray, abg, ecg, hemo monitoring..respiratory acidosis risk
  • tx: vitals, digoxin/lanoxin, diuretics, high Fowler, M.O.N.A., output
  • NANDAs–impaired gas, decresed C.O., fl. vol. excess, anxiety r/t suffocation fear
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13
Q

Cholesterol

A
  • fatty material, too much in arteries causes plaque&raquo_space;CAD, atherosclerosis, heart issues
  • LDLs bad <100, HDLs good,>60 total cholesterol: 200<
  • treat with betas, -STATIN meds
  • to lower LDL, low fat low low salt diet, no smoking, workout
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14
Q

Aneurysm

A
  • balloon in a brain artery…if under 4 cm PT may not have s/s
  • AAA most common …pulsing abd. mass & pain , rupture, back/flank pain
  • saccular-1 side dilated, fusiform-entire artery dilated, dissecting—tear causing cavity
  • care: med regimen, avoid stress, betas, no lifting
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15
Q

Cardiac angiography

A
  • dye inserted to see vessels, blood flow, vessels for graft use, sees clots
  • get consent, dye allergies, NPO 4 hrs preop, v.s., pulses, inj site assess, npo until gag reflex back, hemorrhage monitor
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16
Q

Cardiac Cath

A
  • sees heart anatomy & flow, coronary pressure/chambers/ great vessels, assess CO/O2 sat.
  • dye injected into cath»femoral vein
  • pre: consent, dye allergies, NPO/conscious sedation
  • post: monitor bleeds, pressure device bedside, no flexing leg, v.s. P pulses taken, fluids to flush dye
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17
Q

Nitroglycerin

A
  • vasodilator drug used for angina
  • take pre-activities that causes angina
  • rise slow after taking&raquo_space;dizzy
  • keep in dark bottle
  • max 3 pills 5 mins apart…have PT sit down. If that doesn’t work start emergency procedures
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18
Q

Venous insufficiency

A
  • chronic ; damaged/aging valves cause blood pooling in LE
  • can cause venous ulcers»on ankles, discolored hard leathery skin with edema
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19
Q

Peripheral Artery Disease

A
  • chronic worsening artery narrow
  • reduced blood supply…ischemia
  • labs: MRI CT, arteriography, ankle-brachial index
  • s/s: intermittent claudication (activity pain), cold red-purple skin, faint/absent pulses, hair loss/dry skin
  • tx: low fat low car low cholesterol diet, -STATINs, thrombolytics, PTA, atherectomy, stents, aortic-femoral bypass, DON’T elevate LE
  • NANDAS: pain, ineffective tissue perfusion, activity intolerance, info deficit
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20
Q

HTN Emergency

A
  • normal : 90/60-129/79, stage 1 HTN: 130/80-139/89, stage 2: 140/90>
  • >180/120, organ damage, PT should rest while 911 is called
  • BP needs to be lowered ASAP, kidneys heart brain at risk…gradual approach to fix
  • caused by non compliance, stopping meds
  • HTN caued by increasing blood vol., blood vicosity, PVR
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21
Q

Orthostatic hypotension

A
  • caused by repositioning
  • lying to standing or sitting or vice versa causes BP
  • take BP/HR lying sitting and standing, 3 minutes/reading
  • reading differences >20 mm decline SYS, >10 mm DIA
  • with different readings, use arm with higher reading
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22
Q

Cardiac Tamponade

A
  • from non penetration trauma..Becks triad (low BP, JVD, muffled heart sounds), life threatening, pericardiocentesis ASAP, steroids & NSAIDs >pain, inflammation
  • pericarditis complication, fluid around membrane&raquo_space;pericardi. Effusion
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23
Q

Pericarditis

A
  • pericarium inflamed» vent. Fill reduced, from Lyme disease/ drug reaction/post-MI/neoplastic disease/rheumatic/trauma
  • s/s: substernal radiating/grating angina, friction rub, dyspnea (sit PT up)
  • labs: ECG, echo, CT, MRI, WBC, c-reactive
  • tx: pericardiocentesis, antibiotics, NSAIDs, hemodialysis, pericardial window, pericardiectomy , rest
24
Q

Aortic regurgitation

A
  • blood backflow to LV because A. Valve doesn’t close»reduced CO
  • rhemautic/endocarditis/Aortic dissection cause
  • s/s: none early, dyspnea, fatigue, corrigan’s (forceful/quickly collapsing pulse), angina, wide pulse pressure
  • labs: echo, Doppler/TEE, cardio MRI, cardio cath
  • tx: vasodilator, valve replacement with propylactic antibiotic
25
Q

Cardiac blood flow

A
  • inferior/superior vena cava»R atrium» tricuspid»R vent.»pulmonic valve»pulmonary arteries»lungs»pulmonary veins(4)»L atrium&raquo_space;mitral»L vent.»aortic valve»aorta»systemic circulation
26
Q

Cardiac Output

A
  • amt of blood ejected from L vent. In 1 minute …stroke vol. X HR
  • avg. 60-80 mL/beat, avg. resting 5-6 L
  • L has to pump 5x harder to accommodate CO for body
  • CO drop can activate angiotensin and sympathetic systems
  • measures heart’s efficiency
27
Q

Arrhythmias

A
  • rhythm disturbance in conduction
  • instead of SA node, impulse begins at AV, atrial or ventricles
  • s/s: angina, syncope, dyspnea, tachy, palpitations, faint pulses, dizzy
  • emergency: V Tachy, V Fib, Asystole
  • tx: if stable amiodarone (antiarrythmic) & magnesium. betas, ca channel blocks, digoxin, ablation (heart scarring), cardioversion, CPR, vasopressin (BP low med), epinephrine , pacemaker, defibrillation , blood thinners
28
Q

Blood transfusion

A
  • used for hemorrhaging, fe deficit anemia, sickle cell, HIV/AIDS, hemolysis
    assess for reactions, monitor V.s., Id PT by DOB & blood type
  • washed, warmed, infuse w/ NSS
  • reactions : febrile (fever), urticaria (hives), hemo (incompatible, cells burst) , anaphylactic allergy (use frozen blood), circulatory Overload, Warm Angina, SOB
  • cross match for compatibility prior
29
Q

rheumatoid arthritis

A
  • chronic, progressive systemic inflammation of synovial joints/connective tissues/major organs/joint cartilage..may be pathogen caused, destroys joints
  • pannus»bony tissue»mobility loss..any connective tissue can be hurt with RA
  • early s/s: with exacerbations, bilateral, symmetrical, swollen warm painful stiff joints, stiff post-rest, activity relieves pain, low fever, fatigue, weakness, anorexia .. pain early A.M/wake up
  • late s/s: joint deformed, secondary osteoporosis
  • no test for dx..RF, RBC, ESR, C-reactive high..xray
  • tx: NSAIDs, gold salts, antimalarials, fish oil, antioxidants, corticos, capsaicin cream, antibiotics, warm compress
30
Q

arthritis

A
  • autoimmune disease, wears/tears joint cartilage, inflammation, swelling of joint …infection or injury
  • osteoarthritis: bone on bone (crepitus)»bone spurs, narrow joint space, joint deteriorates, hebdens–high, bouchards-below….tx: NSAIDs, synvec in knees, pain with activity, unknown cause
  • age, obesity, mechanical stress on joint
  • S/S - Joint pain or stiffness, problems with ADLs, bony nodes on the joints of their fingers (Heberden’s and Bouchard’s)
31
Q

Traction

A
  • pulleys/weights applying force after major fracture..skin traction or skeletal traction, can be used for wks.-mos.
  • maintain extremity alignment, avoid soft tissue injury, immobilize fracture
  • rope know not on bed, wts hang free, Pt bed centered
  • skin– wt pulls on tape/boot, is attached to skin, buck’s–hip fracture waiting for surgery..5-10 lb wt. bedrest..sponge boatrussell’s–kids/adults..hip/femur fracture.. popliteal sling, knee flexed…check pulse,check for integrity, HOB flat FOB up for countertraction..lifting trapeze..pills for leg..rest, bryant’s–kids/infants >30lbs, pelvic–herniated disc, .cervical-herniated disc too..sling to weights
  • Pt may have Orthostatic hypotension once out of traction
32
Q

skeletal traction

A
  • directly in bone»osteomyelitis risk, metal pin, pins tx asepsis, no ointment no Betadine (corrodes),bedrest w/ continuous traction
  • LE traction-no feet drop, trochanter roll/Pt care on unaffected side, UE traction–TOTAL CARE
33
Q

fracture

A
  • bone break (Trauma, patho.), open–skin breaks..tachy, HTN can happen..closed–no break… soft tissue edema, muscle hemorrhage, ruptured nerves, severed tendons 48-72 hr–hematoma..1 week–callus (union)
    *6 wks.-1 yr to heal, vit. c&d/calcium/protein/water to heal
  • s/s–pain, decreased ROM, limb rotation, edema, bruising, crepitus, spasm..complete: 2 piece, incomplete–not 2 pieces
  • pain control, prevent more injury..in emergency: splint PT, dont realign/straighten, bleed control, cover openings
  • closed red.–manual bone align..open red.–realign with hardware, usually hip..fixator: outer hardware»myelitis risk
  • elderly (women esp.) fractures caused by osteoporosis (i.e. pathological fx), phosphoric acid
  • comminuted, spiral fracture, impacted(bone into bone), a
34
Q

MSK Meds

A
  • Bone resorption inhibitors: alendronate,risedronate–osteoporosis/hypercalcemia/paget’s, s/e diarrhea/nausea/headahce/ bone pain
  • Uric inhibitor: allopurinol, febuoxtat–uric acid decrease/serum acid..for/prevents gout attacks..s/e: diarrhea/abd. pain/naursea
  • skeletal relaxants–muscle/back pain & strains, spascity, relieves pain but not not fully understood
  • DMARDs–hydroxychloroquine, sulfasalazine,suppress inflammation, used for R.A., used with -SONEs/NSAIDs, dont used with active infection
  • usually take med with milk/food/frink
35
Q

Gout

A
  • arthritis …built up uric acid from purine breakdown, found in men more, s/s: inflamed joints/big toe(acute), renal stones (chronic)..
  • find high acid crystals&raquo_space;joint fluid analysis
  • attacks–NSAIDs, cholicine, steroids, indocin, zyloprim
  • care–avoid aspirin ASA&Diuretic, no alcohol/anchovies/shellfish/organ meat, encourage fluids
36
Q

Amputations

A
  • surgical (diabetes, gangrene), trauma (accident/lawnmower)»keep body part on ice until ER, may be savable
  • prosthetic fitting, support/adjustment, keep tourniquet bedside, dressing assessment
  • phantom pain from brain/spine, phantom pain–is real pain..tx Lyrical, inderal, alevil, neurotonin, lie PT prone 30 mins
37
Q

Cirrhosis

A
  • clay colored stool…bile duct
  • clotting deficiences, hepatorenal syn., encephalopathy,
  • caused by liquor, Hep B&C..liver scarring
  • s/s: jaundice, LLQ pain,
38
Q

Hiatal Hernia

A
  • lay down post meal
    *stomach slides up through diaphragm hiatus to thorax; lower esophageal doesn’t close
  • s/s: burning substernal pain, indigestion, full feeling, dysphagia, bleeds, common in smokers, obese PTs, PTs >50, pregnant PTs, hiatal hernia usually w GERD
  • dx: barium swallow , esophagoscopy
  • sliding vital hernia most common, para esophageal rare …complications : Barrett’s esophagus, esophagitis, aspiration pneumonia
39
Q

Ostomy

A
  • diet: low residual (leaves gut fast) used for PTs prep for surgery
  • stoma should be beefy red..moist, not dusky/purple/blue
  • cramping during irrigation»pinch tube
  • normal soft stool reg. diet, fresh ostomy..liquid
40
Q

appendicitis

A
  • Appendix inflamed,
  • s/s: McBurney’s point–pain travels to R low side, rebound tenderness, RLQ pain, WBCs elevated,fever,
  • CBC, CT, ultrasound, Keep NPO, surgery asap unless peritonitis (burst»infection) infection ..surgery on hold
  • abscess/perforation–fever, pain
41
Q

General Med Surg

A
  • pre-op: find out what PT ate&raquo_space;aspiration, GI needs to be clear prior to surgery
  • fresh Post-OP: fever normal»inflammatory response
  • ASA toxicity
    *
42
Q

THR (hip replacement)

A
  • when other options have been exhausted, cement/bone graft, most common: hip, any synovial joint can be replaced
  • No adduction 90 degrees past midline, no internal rotation, no flexion past 90 degrees, A frame should always be in room, no leg crossing, teach PT to push off from chair using armrests, raised commode, no waist bending/armless chairs, no pillow under knee
  • trochanter roll, dislocation»“POP”, pain, usually from rotating, limb can shorten, early ambulation OOB same day as Op, discharge assessment on admission, prophylactics»infection
  • post=op: hypovolemia observe, incision site check, V.S., wt bear pr Dr.’s order, protein for healing, calcium for bones, vit. D for absorption
43
Q

TKR (knee replaced)

A
  • TKR–pillow under ankle»edema prevention, no flexing»scar tissue
44
Q

Hepatitis Vaccines and M.O.T.

A

Hep A –fecal to oral, shell fish/undercooked meat, has vaccine, water contamination
Hep B–blood/body fluids, B vaccine covers Hep D too
Hep C–needle, has vaccine
Hep D–blood
Hep E–traveler’s diarrhea, water contamination …no vax in USA yet

45
Q

GI Meds

A
  • Antacids, Lactulose (lowers Ammonia lvls), PPIs (OMEPRAZOLE..lowers acid..GERD, Mallory-Weiss, Gastric bleed), antiemetic (stops vomiting), ASA (PUD, ) H2 antagonist, antibiotics for infection (appendicitis), Corticos (-SONEs..tx inflammation..crohn’s), antidiarrheals,
46
Q

Tubes and Things

A
  • GI tubes: for feeding, removing gas/secretions, nutrition/meds/hydration, post-op healing, Motility view…NG thru nose into stomach..temp., free water, PT high fowler’s, assess patency and residual, check placement, stop feed is too much residual/Pt cramping or pain/aspiration & CALL HCP
47
Q

Ulcerative colitis

A
  • inflammation in lg colon/rectum, autoimmune/allergy response
  • s/s: abd. pain, diarrhea, butt bleed, poop emergency, 5-20 liquid stools/day…hemorrhage/perforation/obstruction/peritonitis can occur
  • scopies and biopsies to see issue..avoid irritating food, colon may be removed, PN, fluids, same meds as crohn’s
48
Q

Diverticulitis

A
  • bowel hernia/outpouching, diverticulum inflamed, >60 at risk, usually in sigmoid, caused by poor fiber intake or constipation
  • s/s: constipation& diarrhea, LLQ pain. weakness, bleed, fever..sigmoidoscopy, barium enema to dx
  • NG tube, pain control, NPO, surgery to treat, slow increase of soft, high fiber food
49
Q

GI diagnostics

A
  • Lab: CBC, electrolytes, CEA, bilirubin, Liver/pancreatic enzymes
  • stool: black/tar–upper GI bleed, frank–rectal bleed, Occult–not visible to naked eye, clay–bile absent, fresh blood–low GI Bleed
  • 3 series test: occult– no meat 2-3 pre-test, bleeding can cause +/-, ova–parasite, NO URINE, sample fresh/warm
  • Barium –#1 test for GI diagnostics, poop immediately post-op(clay, white), fluids…swallow: fluoroscopy, NPO 6-8 hrs pre-op, long test time, esophagus/duodenum seen, laxatives, poop normal color after 3 days, fluids (12 cups), watch constipation, enema: for colon, low res/clear liquid diet 2-5 days & laxes pre-op, cant use with perforation or obstruction
    WITH GI STUDIES BOWELS MUST BE CLEAR OR OP RESCHEDULED
50
Q

Anemias

A
  • low hemoglobin»bad amt. O2 to tissues»impaired RBCs made, blood loss..nutritional–low fe, folic, B12..fe anemia–less RBCs, red meat..pernicious..no B12 absorption, sickle cell–sickle shaped RBCS clump»pain..aplastic–marrow turns fatty
  • dx: CBC, marrow biopsy, fe profile, sig./colonoscopy, occult test, Hgb, WBC count, smear (sickle)
  • S/s: pallor, fatigue, SOB, dyspnea, dizzy, tachy(pnea/cardia), sickling(sickle), ecchymosis/bleeding/death (aplastic), organmegaly (sickle)…black/asian/mediterranean PTs at risk
  • tx: marrow transplant (aplastic), eliminate cause, fe foods, safety»dizzy=falls, B12 shots(pernicious..absorption), Iv can discolor skin, take with Vit. C, dont take with Ca, liquid iron (stains..straw), steroid/hormone therapy (aplastic), correct O2 lvls (sickle)correct identifying issues..alot of anemia are irreversible, Blood transfusion

NANDA: RISK FOR ACTIVITY R/T HYPOXIA

51
Q

Hemophilia

A
  • hereditary, low clotting factors (thrombocytopenia), blood doesnt clot..Hemophilia A&B most common, A: 80% of all..VIII lacking, B: 15%..IX lacking
  • S/s: females: carriers, from dads..males: affected..injury/random(maybe bleeding joints), hemarthrosis, elbow/knee/ankle joint deformity, severe or moderate random bleeds
  • dx: factor lvl test, long PTT
  • TX: incurable, prolong life, blood trans. post surgery/injury, cryoprecipitate,DDAVP, VII/IX reconstituted via IV, LOOK FOR BLEEDING, no contact sports, acute: hypovolemia risk..V.S…pain..
52
Q

Blood Transfusion & complications

A
  • assess V.S., ID PT DOB/blood type, blood washed/warmed, blood administered 30 mins after leaving blood bank)
  • febrile(fever), urticaria (hives), hemolysis(warm chest/ back pain, SOB), anaphylaxis (Will re’c frozen blood til stable)
  • circulatory overload (crackles, SOB), stay with PT 15 mins post-transfusion, V.S. before/during/after
53
Q

HTN Crises

A
  • Urgency: high BP w/ no organ damage..headache, nosebleed, SOB, anxiety
  • EMERGENCY: BP >180/120, reduce BP have PT rest, CALL 911, organs at risk r/t damage, heart brain kidneys at risk…caused by untreated HTNM, med noncompliance..USE NITROPRUSSIDE!
54
Q

Multiple Myeloma

A
  • plasma cell cancer interfering with with RBC production (marrow)..Ca leaking out of bone into blood antibodies made are useless, incurable tx with pain/symptom management, usually men, 3-7 yrs to live, multiple tumors devour bone, possibly from chemical or toxin exposure/allergies&sensitivities
  • dx: xray (swiss holes), CBC, marrow biopsy, urine studies
  • s/s: pain, joint swelling, neuro. symptoms. malaise, fractures
  • tx: manage disease, chemo, hi-dose corticos (-SONEs) for bone destruction, laminectomy/calucil tx., stem cells transplant..assess neuro(spine»back/leg pain), assess renal(stones), evalute PT free from injury/infection, monitor hypercalcemia
  • Risk for infection r/t compromised immune function, Risk for injury: fracture r/t weakened bones; complications of immobility; complications of hypercalcemia
55
Q

Hodgkin’s Lymphoma

A
  • Hodgkin’s s/s: night sweats, piritus, fever,

ANATOMY AND PHYSIOLOGY (11 decks)

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