Semester One - Perfusion Flashcards
Hypertension (what is it, risk factors, treatments, assessments, considerations)
- What is it: Consistently high blood pressure, more than 140/90
- Risk factors: history, nutrition, obesity, stress, chronic pain, high alcohol intake, drugs, bad stuff.
- Treatment: ACE inhibtors, calcium channel blockers, diuretics, ARB, lifestyle
- Assessment: blood tests, urinalysis.
- Considerations: Lifestyle
Hyperlipidaemia (what is it, symptoms, risk factors, treatment, considerations, assessment)
- What is it: elevation of one or more of lipo protients in blood (bad fats)
- Symptoms: can lead to atherosclerosis, high blood pressure, cold extremities
- Risk factors: history, nutrition, obesity, stress
- Treatment: lifestyle changes – diet. Statins – (statins slow down natural cholesterol production.)
- Considerations: can show no symptoms but can suddenly rupture causing a stroke or MI.
- Assessment: blood test, symptoms
Acute coronary syndrome
This is most commonly due to occlusion of a coronary artery following the rupture of a vulnerable atherosclerotic plaque.
- Ranges in severity from unstable angina (reversible, angina that occurs at rest) to myocardial infarction (heart attack)
- Heart attack is an extended interruption of blood flow to the heart causing death or damage of heart cells.
Assessment: ECG
Treatment: O2 therapy, morphine, asprin
Angina (what is it, symptoms, triggers, treatment)
- What is it: chest pain due to not enough blood flow to the heart.
- Symptoms: shortness of breath, chest pain, nausea, belching, dull, heavy, crushing. Pain in left arm.
- Triggers: occur when increased oxygen demand – during exercise, stress.
- Treatment: GTN spray (acts on vascular smooth muscles to produce arterial and venous vasodilation)
relieved by rest. - Angina is basically a symptom of acute coronary syndrome.
Heart failure (what is it, causes, symptoms, treatment, left side vs right side, considerations)
- What is it: when the heart is unable to meet the body’s needs.
- Causes: alterations to normal heart function – increased need eg. Pregnancy
- Symptoms: SOB, low extremity oedema, breathless when lying down, nausea.
- Treatment: diuretics, ARB or ACE inhibitors then beta blockers, improving signs and symptoms, decrease hospital admission, goals.
- Left side heart failure: this is the cause of right sided heart failure, respiratory symptoms due to backflow of blood in to lungs.
- Right sided heart failure: impacts body. Engorgement of abdominal organs.
- Considerations: imbalance of fluids, acid/base, imbalance due to medication, imbalance in RAAS.
What is COPD?
COPD – umbrella term for chronic bronchitis, asthma and emphysema
Chronic bronchitis (what is it, causes, symptoms, treatment, assessment, considerations)
- What is it: Inflammatory process causing injury which causes changes in bronchi and bronchioles.
It is a chronic inflammation that destructs celia, thickens the bronchial cell wall creating a thick mucus impacting normal respiration. - Causes: smoking, pollution
- Symptoms: hypoventilation (lack of gas exchange) and hypercapnia (too much O2), cough, struggling to breathe on exertion, cyanosis, breathing out issues.
- Treatment: do not use oxygen therapy as it can make the hypoxic drive think that it doesn’t need to breathe anymore, bronchodilators.
- Assessment: pulmonary function test, blood gas.
- Considerations: quit smoking, smelly jobs – paint etc. avoid infection, preventing further infection.
What is the hypoxic drive?
The hypoxic drive is a form of respiratory drive in which the body uses oxygen chemoreceptors instead of carbon dioxide receptors to regulate the respiratory cycle.
Emphysema (what is it, causes, symptoms, treatment, assessment)
- What is it: permanent damage to alveoli making the lungs less able to recoil. Meaning old air gets trapped in the lungs which means good oxygen rich air cannot fit.
- Causes: smoking
- Symptoms: lack of gas exchange, laboured breathing, pigeon chest, air trapping.
- Treatment: no treatment
- Assessment: blood gas
Chronic asthma (what, causes, symptoms, treatment, assessment)
- What is it: inflammation of the bronchioles due to hyper responsiveness of the airways. Airways respond in an abnormal exaggerated response. Inflammatory mediators released – histamine, mast cells and prostaglandins causing oedema restricting airways.
- Causes: dust, cockroaches, exercise, allergies.
- Symptoms: wheeze, SOB, bronchospasm, swelling, mucous plug formation.
- Treatment: managing symptoms, avoiding triggers, inhalers.
- Assessment: peak flow, skin allergies, triggers, signs and symptoms, use of accessory muscles, LLFRP (look, listen, feel, rate, position)
Tuberculosis (what, considerations, symptoms, assessment)
- What is it: bacteria enters respiratory tract via airbourne droplets –> activate immune response. Macrophages catch them and isolate them – this will be latent as the person is asymptimatic. This can change if the person has low immunity and TB symptoms can arise. In other cases TB can overwhelm the immune system and person becomes symptomatic and very sick.
- Considerations: can be asymptomatic.
- Symptoms: fever, night sweats, cough, weight loss.
- Assessment: sputum sample.
Rheumatic fever and pharyngitis (what, causes, treatment, symptoms)
- What is it: Develops following a pharyngitis infection, Group A Beta hemolytic streptococcus (GAS) attaches to epithelial cells of upper respiratory tract, produces a series of enzymes that invade and damage human tissue.
Causes: pharyngitis - direct contact with secretions.
Treatment: pharyngitis - antibiotics
Symptoms: pharyngitis (sore throat), generalized inflammatory response – pain in joints, limited range of motion due to inflammation, polyarthritis is usually earliest and most frequent sign.
What sort of risk factors may the nurse notice at a pre op assessment that might impact on their anesthetic risk and post op recovery?
Medical History Medication use Physical limitations/Disabilities Surgical/Anaesthetic History Psychosocial/Emotional status Baseline observations i.e. weight, vital signs Consent and pt. understanding/education Post op support
There are two principal components to the stress response to surgery:
the neuroendocrineresponse and thecytokineresponse.
What can stimulate the neuroendocrine and cytokine response following surgery?
- noxious afferent stimuli
- local inflammatory tissue factors
- pain and anxiety
- starvation
- hypothermia and shivering
- haemorrhage
- acidosis
- hypoxemia
- infection
How can the cytokine response be minimised?
It is diminished by minimally invasive surgery, especially laparoscopic techniques. This is because the cytokine component of the stress response is stimulated bylocal tissue damageat the site of the surgery itself and is not inhibited by regional anesthesia.
What stimulates the neuroendocrine response?
The neuroendocrine response is stimulated by painful afferent neural stimuli reaching the CNS. It may be diminished and sometimes eliminated altogether by dense neural blockade from a regional anesthetic technique.
What are cardiovascular complications that can occur post-operatively?
Haemorrhage Hypotension and Shock Arrhythmias MI Hypertension CVA Deep vein thrombosis
What are some respiratory complications that can occur post-operatively?
Atelectasis/Pneumonia Hypoventilation Airway obstruction Pulmonary oedema Pulmonary Embolism
What are some renal complications that can occur post-operatively?
Urinary Retention
Acute Kidney Injury
What are some GI complications that can occur post-operatively?
Post op ileus (paralytic ileus)
Acute gastric dilation
Post op nausea and vomiting
Constipation
What are some cognitive complications that can occur post-operatively?
Delirium Hypoxia Perioperative stroke Medications effects Electrolyte abnormalities
Angiotensin Converting Enzyme (ACE) Inhibitor (how do they work, side effects, uses and common suffix)
How do they work? Angiotensin 2 increases BP. - ACE inhibitors bind to ACE in the RAAS system to prevent the production of angiotensin 2, reducing vasoconstriction. - Prevents release of aldosterone What are some common side effects? - Dizziness - Headache - Low BP - Dry cough - Rash Example: Used to lower BP, (usually ends in ‘pril’).
Calcium channel blockers (how do they work, side effects, uses and common suffix)
How do they work?
- Inhibit the movement of calcium ions across cell membranes of myocardium and arterial muscle cells
- This alters action potential and blocks muscle cell contraction
- Depresses myocardial contractility
- Relaxes and dilates arteries
- Decreases BP and venous return
What are common side effects? - Light headedness - Dizziness - Low BP - Constipation - GI upset - Peripheral oedema – not pushing the blood/fluid around. Examples: used for hypertension (sometimes ends in ‘dine’)
