test 1 Flashcards
Nasal surgery after care
don’t strain, lift heavy, swim, or blow nose
why shouldn’t you blow nose after epistaxis or nasal surgery
could dislodge clot
rhinoplasty
nose job- reconstruction
could be cosmetic or post traumatic
septoplasty
reconstruction of septum
what should you monitor for in facial swelling
ABCs
why should you stay sitting up after nasal surgery
to reduce aspiration
what antihistamines dont make people drowsy
2nd generation, such as allegra
what is perennial allergic rhinitis
allergies that could happen randomly with triggers. Such as anytime you go around a cat
episodic allergy
comes and goes
intermittent allergy
happens less than 4 weeks out of year
persistent allergy
happens more than 4 weeks a year
what causes histamine release
IgE response
common viruses of common cold
rhinovirus (mild)
coxsackievirus & adenoviruses (more severe)
acute viral rhinopharyngitis
common cold
how does cold spread and how is it treated
airborne droplet- can survive for 3 days
treated symptomatically. rest
when is influenza season
sept-april
what route is inactivated flu vaccine
IM
what route is live flu vaccine
nasal
what infleunza viruses are worst
A and B
Diagnostics and meds for flu
diagnosis- symptoms, rapid flu
meds- zanamivir (relenza), oseltamivir (tamiflu), peramivir (rapivab)
who is at high risk for thrush
immunosupressed
acute pharyngitis
inflammation of throat, 90% viral
when can brain death occur
3-5 mins
manifestations of airway obstruction
choking, stridor, accessory muscles, retractions, nasal flaring, wheezing, tachycardia, cyanosis
when can you speak with a trach
when cuff is deflated
point of trach
establish airway, bypass obstruction, removal of secretions, mechanical ventilation
complications of trach
airway obstruction
body image
subcut. emphysema (crackles in skin from air)
aspiration
bleeding
infection
head and neck cancer causes
Tobacco/alcohol use
HPV
what gender is head/neck cancer more common in
Men
head/neck cancer symptoms and diagnostics
white patch, hoarseness, lump, blood
assess structures, bimanually palpate, look for leukoplakia or erythroplakia, laryngoscopy, CT
what does TNM staging look at
tumor site
nodes
metastasize
treatment for head/neck cancer
surgery
radiation
chemo
targeted therapy- targets a specific protein
brachytherapy- implants radioactive seeds
What surgeries are partial laryngectomy requiring only a temporary trach
supraglottic and supracricoid laryngectomy, and hemilaryngectomy
surgery requiring permanent trach
total laryngectomy- will cause voice loss
voice restoration options for voice loss
transesophageal puncture** best quality
electrolarynx
esophageal speech- air in esophogus
acute bronchitis symptoms
cough, clear sputum, headache, malaise, hoarseness, myalgias, dyspnea, chest pain
treatment is supportive
what type of infection is acute bronchitis usually caused by
virus
pertusis
whooping cough. caused by gram neg baccilus
pertusis characteristics
violent uncontrollable coughing
2 stages : catarhall, paroxysmal
can last 6- 10 weeks
treated by abx
what does CDC recomend for pertusis
TDAP (tetanus, diphtheria and pertussis) vaccine for ages 11 and up
when does pneumonia occur
when defense mechanisms are impaired or overwhelmed with the amounts of infectious agents
Gas exchange decreases , alveoli fill with debris and mucus production increases
community acquired pneumonia
doesn’t happen in hospital
treatment can be at home
medical care associated pneumonia (MCAP)
Occurs 48 afters of being in hospital environment, from hospital association, vent, or health care
more difficult to treat because of multidrug resistance
most common cause of pneumonia
bacterial
types of pneumonia
viral
bacterial
mycoplasma
aspiration
necrotizing
opportunistic
what pneumonias are treated with antibiotics
bacterial, mycoplasma
what can happen in necrotizing pneumonia
lung tissue becomes thick liquid mass.
will require long time antibiotics
what opportunistic pneumonia can spread to other organs
pneumocystis jiroveci (PJP)
pneumonia symptoms
cough, fever, chills, tachycardic, tachypnea, dyspnea, pleural pain, malaise, resp distress, decreased breath sounds
Older adults may present differently , may be hypothermic or normothermic
pneumonia care
vaccination for high risk or ages 65&up
antibiotics
o2
physiotherapy
rest
increase fluids
elevate HOB
ambulate
good oral care
cough
deep breaths
causes of lung abscesses
aspiration, periodontal disease, IV drug use, malignancy, PE, TB, parasitic or fungal diseases
lung abscess signs and symptoms
develops slowly
foul brown sputum
hemoptysis
fever/chills
night sweats
pleuritic pain
dyspnea
anorexia
lung abscess diagnosis and treatment
chest x-ray, decreased breath sounds, dullness on percussion, crackles
treated with o2, abx (macrolide), rest, fluid, percutaneous drainage, pneumonectomy
DONT USE CHEST PT- dont want to mobilize for progression
causes of lung cancer
smoking, pollution, radiation, asbestos
more common in males, blacks, whites
non small cell lung cancer (NCSLC)
most common cause of lung cancer
Can be treated with surgeries, chemo, radiation, targeted therapy
small cell lung cancer (SCLC)
not as common, metastasize is more likely. death is more common
chemo is main treatment
diagnostics for lung cancer
chest x-ray, CT, MRI, biopsy, H&P, renal and liver labs
lung cancer maniefestations
chronic cough
lobular pneumonia
blood tinged sputum
dyspnea
wheezing
chest pain
later- anorexia, fatigue, n/v. palpable lymph nodes, dysrhythmias
segmental/wedge resection
small portion of lung is removed
lobectomy
removes a lobe/lobes
pneumondectomy
removes one lung
pneumothroax symptoms
dyspnea
anxiety
cyanosis
tachycardia
pleural pain
asymmetrical chest wall expansion
decreased breath sounds
causes of pneumothorax
ruptured air sac
thoracentesis
trauma
secondary infection
pneumothorax diagnosis and treatment
diagnosed by chest xray, ABG
treated by chest tube, o2
tension pneumothorax
Med emergency due to mediastinal shift.
Pushes on heart causing cardio and resp symptoms. Cyanotic, fast HR. clients can die from inadequate cardiac output
trauma pneumothorax
from trauma such as gun shot
air enters pleural space due to opening in chest wall
emergency treatment- use vent dressing
what is spontaneous pneumothorax usually caused by
ruptured blebs
chylothorax
pneumothorax from lymphatic fluid
iatrogenic pneumothorax
caused by med proedure puncture
hemothorax
blood in plueral space
chest tubes needed
how much fluid should plueral space have
5-15 mL
pleural effusion
accumulation of fluid in the pleural space
classified by:
transudative- clear, pale
exudative- inflammation. treated w thoracentesis
symptoms- dyspnea, cough, occasional chest pain
diagnosed by chest xray, CT
Emphysema
collection of purulent fluid space
pleurodesis
helps prevent by injecting med into plueral cavity for about 8 hours with chest tube
thoracentesis
removes fluid for thoracic cavity with needle’
removing too much at once can cause hypotension, pulm embolism, etc
what veins do lethal PE commonly originate in
femoral or iliac
diagnosed by CAT scan
who is at risk for PE
immobility, obesity, history, smokers, woman with oral contraceptives
symptoms of PE
sudden sharp chest pain
dyspnea
hypoxia
tachycardia
hemoptysis
PE nursing care
o2
IV fluids
vitals
low molecular heparin***, oral anticoagulants
embolectomy
meds require long term use- 6 months
coronary artery disease (CAD)
plaque build up- atherosclerosis
- may be accompanied with chronic stable angina, but if not taken care of then can be unstable angina
most common type of heart disease
CAD
CAD risk factors
modifiable- obesity, diet, htn, smoking, metabolic syndrome
non-modifiable- age, gender , genetics
how often should you exercise with CAD
30 mins/day 5 times a week
meds for CAD
statins- restrict lipoprotein production. SE- muscle ache, weakness, rhabdomyolysis. This is the most common drug gaven for this.
Niacin- inhibits LDL and triglyceride synthesis. SE- Flushing
fibric acid derivatives- reduce triglycerides, increase HDL. Could increase bleeding and effect antihyperglycemic drugs
Bile acid sequestrants- GI side effects, could reduce absorption of other drugs
ezetimibe (zetia)- decrease cholesterol absorption
aspirin- antiplatelet (prevents clotting)
clopidogrel (plavix)- antiplatelet
angina
Oxygen demand is greater than oxygen supply, causing ischemia, causing chest pain
usually from insufficient blood flow
s/s- pain, pressure, squeezing or heavy feeling, cold due to lack of o2
chronic stable angina
PREDICTABLE. from activity, stress, etc
arteries are 70% blocked or 50% left ascending. Could be reversible but usually not.
no abnormalities on EKG
unstable angina
occurs when resting. Pain last greater than 10 mins and is unpredictable. Needs immediate care. ECG shows ST depression.
prinzmetal’s angina
rare. Occurs at rest with or without CAD. Patients must have history of migraines or Raynaud’s. Treatment is exercise, nitroglycerin, CCB
microvascular angina
from myocardial ischemia from microvascular disease. more common in women. Pain may radiate to neck, jaw, shoulders. Brought on by physical exertion. Treatment is nitroglycerin
EKG shows ST elevation
STEMI.
angina goal
reduce o2 demand and/or increase o2 supply
angina drugs and care
aspirin
short acting nitrates- SL. 1 tablet every 5 mins up to 3 times. Call 911 if not relieved. SE- headache, dizzy, hypotn
long acting nitrates- For reducing frequency or prizmentals. Could be PO, transdermal. Covers 24hr period
ACE and ARBs-Vasodilates and reduces blood volume
beta blockers- reduce cardiac output. SE- bradycardia, depression, hypotn. Be careful in patients with asthma and diabete
calcium channel blockers- Cause systemic vasodilation and reduce HR. SE- fatigue, headache, peripheral edema
lipid lowering agents
sodium current inhibitor- GI side effects
gold standard to identify and localize CAD
cardiac catheterization
percutaneous coronary intervention (PCI)
Procedure to widen narrowed arteries by balloon and stent placement
pre procedure for cardiac cath
make sure patient is NPO
see if patient has allergy to dye or shrimp (similar iodines)
baseline assessment
CBC labs
administer drugs- prob heparin
pt education
post procedure cardiac cath
assess site for hematoma, bruit, bleeding-Check for bruit every 15 mins for first hr after procedure
ECG
IV infusion of antianginals
monitor for complications
pt education
acute coronary syndrome (ACS)
prolonged ischemia from clot leading to MI.
EMERGENCY
cardiac biomarkers need to be done- troponin is best indicator
STEMI
total occlusion. only have 90 mins to fix
NSTEMI
partial occlusion, want fixed within 12-72 hours
ACS manifestations
pain
SNS stimulation
BP and HR go up to try and improve circulation and urine output goes gown because kidneys aren’t getting enough perfusion
crackles, JVD, hepatic enlargement
S3 or S4 heard
N/V
Fever- not as common
ACS complications
dysrhythmias
HF- do daily weights
cardiogenic shock
papillary muscle dysfunction
ventricular septal wall rupture
pericarditis
dressler syndrome
Decreased o2 and nutrients. Left ventricle issues. Require aggressive care. Need increased o2
cardiogenic shock
Causes mitral valve regurgitation, murmurs. We will see rapid deterioration In this
papillary muscle dysfunction
Pericarditis and fever that develops 1-8 weeks after MI. happens in immunocompromised. Indicator is pericardial friction rub, elevated wbc.
dressler syndrome
ventricular septal wall rupture sign
loud systolic murmur
this is rare
electrolytes to look at for cardio
magnesium and potassium
Pulmonary edema
left ventricle fails causing increased pulmonary venous pressure, lung alveoli become filled with serosanguinous fluid
s/s- wheezing, crackles, accessory muscles, RR<30
MAD DOG for pulmonary edema
morphine- helps relieve anxiety and decrease work of breathing
aminophylline- bronchodilator
digitals- helps increase cardiac output
diuretics
oxygen
Gas- ABG
acute pericarditis
inflammation of pericardial sac
s/s- severe chest pain worse with deep inspiration and when supine.
Hallmark finding- pericardial friction rub
complications
pericardial effusion- fluid
cardiac tamponade-Severe complication. Causes compression on heart. Signs- narrow pulse pressure, tachypnea, decreased BP
acute pericarditis treatment
NSAIDs
antibiotics
pericardiocentesis
pericardial window
ACS diagnostics and care
12 lead EKG
troponin T <0.1mcg/L
troponin I <0.5mcg/L
creatine kinase (CK) <4-6% of total CK
myoglobin
chest xray
o2 stat above 93%
cardiac cath
nitro
aspirin
morphine
statin
ACE and ARB
beta blocker
thromblytic
antidysrthymic
MONA- immediate treatment of MI
Morphine
Oxygen
Nitroglycerin
ASA- aspirin
advantages of PCI over CABG
faster reperfusion
alternative to surgery
local anesthesia
ambulatory normal activity in 3-4 days
length of stay shorter
faster return to work
complications of PCI
dissection/rupture of artery
abrupt closure
acute stent thrombosis
failure to cross blockage
in silent restenosis
drugs for ACS
nitroglyc
antiplatelets
morphine
Beta blockers
ACE and ARBs
CCB
anticoagulant
antidysrhythmic
thrombolytics- for STEMIS
lipid lowering agent
stool softener
SE and contraindications of thrombolytics
may cause bleeding
dont use in active bleeding, severe hypotension, post surgical patients, recent traumatic CPR pts
ICD
defibrillation
administers electric shock
infective endocarditis
Caused by clots or bacteria’s typically, or IV drug use
blood turbulence in heart allows organism to infect previously damaged valves or other endothelial surfaces
manifestations- can involve multiple organs, low grade fever, chills, weakness, malaise, fatigue, anorexia, murmur, heart failure
diagnosed by blood cultures (3 sets over 1 hour from 3 diff sites), echo, chest x-ray, ecg, cardiac cath
care antibiotics- long term
valve replacement
ACS is also known as
MI
STEMI vs NSTEMI
STEMI- elevated ST
NSTEMI- EKG is normal
regurgitation
valve doesn’t close well.
can cause backflow
stenosis
narrowing
diagnostics and treatments for valve diseases
echo, cath
valve repair surgery
symptom management- diuretics, beta blockers, anticoagulants, vasodilation, antidysrhythmics, antibiotics
prevent future complications
mitral valve stenosis
increased left atrial pressure and volume, increase in pulmonary vasculature. results in decreased blood flow from left atrium to left ventricle.
s/s- dyspnea, murmur, fatigue, palpitations, hemoptysis, hoarseness
risk for AFIB
contractures develop with adhesions
mitral valve regurgitation
incomplete valve closure and backward flow of blood
s/s- thready pulse, cool and clammy, murmur
complications
acute- pulmonary edema
chronic- left atrial enlargement, ventricular hypertrophy
mitral valve prolapse
mitral valve leaflets prolapse back into the left atrium during systole
usually valve closes effectively
most patients are symptomatic
chest pain unresponsive to nitrates
aortic valve stenosis
obstruction of blood flow from left ventricle to aorta
-LV hypertrophy
increased myocardial o2 consumption
HIGH MORTALITY IF NOT TREATED
s/s- angina, syncope, DOE, quiet S1, diminished or absent S2, systolic murmur, S4
complication- pulmonary htn, HF
aortic valve regurgitation
backward blood flow from the ascending aorta to left ventricle
acute- emergency
complication- pulmonary htn, right ventricular failure
aortic valve regurgitation acute manifestations
sudden signs of CV collapse
dyspnea
chest pain
hypotension
cardiogenic shock
aortic valve regurgitation chronic manifestations
could be symptomatic
DOE, orthopnea, paroxysmal dyspnea
angina
‘water hammer” if severe- strong beat but the beat collapses in the middle
soft/absent S1
S3 or S4
murmur
tricuspid valve stenosis
typically always from rheumatic fever
s/s - fluttering discomfort in neck, fatigue, RUQ pain
pulmonic valve stenosis
almost always congenital
causes right ventricular HTN and hypertrophy
s/s- syncope, dyspnea, angina
Venous Thromboembolism (VTE) manifestations
unilateral leg edema, tenderness, dilated superficial veins, paresthesia, erythema, fever
VTE diagnostics and treatments
blood studies
venous compression ultrasound
duplex ultrasound
CTV
contrast venography
magnetic resonance venogragy
treatment- prevention, anticoagulant therapy, thrombolytic therapy, surgical intervention
post thrombotic syndrome
spider veins, edema, redness, cyanosis, increased pigmentation, pain during compression, venous ulceration
complication of VTE
major complication of a VTE
pulmonary embolsim
acute arterial ischemia
sudden interruption of arterial blood supply to tissue, organ or extremity. caused by embolus or trauma
manifestations- pain, pallor, pulseless. paralysis, paresthesias
care- anticoagulants, surgical thrombectomy, surgical bypass, amputation
why do woman die more of CAD then men
dont report it
6 Ps of acute arterial ischemia
pain, pallor, pulseless. paralysis, paresthesias,polar
