Test 5 Flashcards
What is asthma?
Asthma is a chronic disorder characterized by periods of reversible airflow obstruction. Asthma attacks are caused by hyperreactive airways leading to contraction of the muscles surrounding the airways and inflamed airways
What are some signs and symptoms of asthma?
Wheezing
Coughing
Dyspnea
Chest tightness
What can trigger an asthma attack in a patient?
Inhalation of airborne allergens Pollutants Airway infections Exercise Emotional stress
What is COPD
COPD is chronic obstructive pulmonary disease characterized by chronic airflow limitation that Is not fully reversible. COPD includes two obstructive airway diseases: chronic bronchitis and emphysema.
What is chronic bronchitis?
Chronic bronchitis is development of obstruction of the trachea and bronchi due to hypersecretion of mucus. Caused by irritants such as cigarette smoke, air pollution, or respiratory infection.
What are some signs and symptoms of chronic bronchitis?
Productive cough
Dyspnea upon excerption
What is emphysema?
Emphysema is caused when the alveolar walls are destroyed leading to permanent abnormal enlargement. The most common cause is cigarette smoking.
What are some signs and symptoms of emphysema?
Underweight
Barrel chested
SOB with minimal exertion
What is RSV?
RSV is respiratory syncytial virus. Mostly found in children. RSV can lead to serious, sometimes life-threatening problems such as pneumonia or bronchiolitis, an inflammation of the small airways of the lungs. Transferred by droplets.
What are some signs and symptoms of RSV in children and infants?
A high-pitched whistling or wheezing noise when they breathe
Being unusually upset or inactive
A cough with yellow, green, or gray mucus
Trouble breathing or pauses in their breaths
Refusing to breastfeed or bottle-feed
Signs of dehydration: lack of tears when crying, little or no urine in their diaper for 6 hours, and cool, dry skin
What is SIDS?
SIDS is sudden infant death syndrome. The exact cause of SIDS id unknown but is thought to be caused by a defective portion of the brain that controls breathing and arousal from sleep. Occurs within infants 2-6 months old.
What is cystic fibrosis?
Cystic fibrosis is an inherited disorder that is causes the lungs and digestive system to get clogged with mucus.
What are some signs and symptoms of cystic fibrosis?
Persistent cough with phlegm Postnasal drip Wheezing Shortness of breath Sinusitis Inability to exercise Male infertility Repeated lung infections Foul-smelling, bulky greasy stools Poor growth and low body weight despite a good appetite Blockage in the intestinal especially in newborns Diarrhea/constipation
What is an ejection fraction?
Ejection fraction is a measurement of the percentage of blood leaving your heart each time it contracts. The ejection fracture measures your left ventricular output. Measured by echocardiogram. (Transesophageal echocardiogram Pt remains NPO)
What are the values for ejection fraction?
An ejection fraction of 55% or higher is considered normal. If the ejection fraction is 50-55% it is considered borderline. If the ejection fraction is below 50% it is considered reduced and is a possible indicator of a heart disease or disorder.
What is a murmur?
A murmur is a sound produced in your heart from a defect in a heart valve. Heart murmurs can be heard through a stethoscope as a whooshing or swishing sounds. Some murmurs can be harmless but others can indicate an underlying disease.
What is the difference between a grade 1 and grade 6 murmur?
A grade 1 heart murmur is barely audible. A grade 6 heart murmur is very audible and very loud with a thrill present (A thrill is a palpable vibration over the site of the murmur).
What are the grades of heart murmurs?
Grade 1: Faint murmur that can only be heard after a few seconds have elapsed.
Grade 2: Faint murmur that is heard immediately.
Grade 3: Moderate murmur intensity.
Grade 4: Loud murmur, a thrill may be present
Grade 5: Loud murmur that can be heard if only the edge of the stethoscope is in contact with the skin, a thrill is present
Grade 6: Loud murmur that can be heard with the chest piece just removed from and not touching the skin, a thrill is present
What is pulmonary circulation?
The pulmonary circulation is the portion of the circulatory system which carries deoxygenated blood away from the right ventricle, to the lungs, and returns oxygenated blood to the left atrium and ventricle of the heart.
What is systemic circulation?
Circulation of blood throughout the body through the arteries, capillaries, and veins, which carry oxygenated blood from the left ventricle to various tissues and return venous blood to the right atrium.
What is coronary circulation?
Coronary circulation is the circulation of blood in the blood vessels that supply the heart muscle. Coronary arteries supply oxygenated blood to the heart muscle, and cardiac veins drain away the blood once it has been deoxygenated.
What are some factors that effect pulse rate?
Stress Drugs Fever Sickness Exercise
How does age affect perfusion?
Older adults tend tends to decrease as arteries stiffen and lead to higher blood pressure along with decreased cardiac output by approximately 30-40%. Increased risk of tachycardia, hypertension, and kidney issues.
What are Korotkoff sounds?
Korotkoff sounds are found when taking a manual blood pressure with a cuff and stethoscope. The first sound heard when deflating the cuff indicates the systolic blood pressure, while the last sound indicates diastolic blood pressure.
What are some tests that can be done to test adequate oxygen perfusion?
Capillary refill SpO2 readings Stress tests Skin assessments (Skin should be warm and dry not cool and clammy as this could indicate decreased blood flow) Blanching Pulses AMS
What is Virchow’s triad?
Virchow’s triad or the triad of Virchow describes the three broad categories of factors that are thought to contribute to thrombosis. The three points of the triad that lead to thrombosis are:
Stasis of blood flow
Endothelial injury
Hypercoagulability
What is deep vein thrombosis?
Condition where blood clots form deep within the patients veins. Deep vein thrombosis can be caused by obesity, sedentary lifestyle, heart disease, heavy smoking, or surgeries and etc.
What are some signs and symptoms of DVT?
Swelling of foot, ankle, or leg, usually on one side
Cramping of the affected leg that usually begins in the calf
Severe leg pain
Skin on the affected area is warmer than the skin on surrounding areas
Bluish, reddish, or pale colored skin over the affected area
(some can be asymptomatic)
What are some signs and symptoms of hypertension?
Severe headache Severe anxiety Shortness of breath Nosebleed Feeling of pulsations in the neck or head (many are asymptomatic)
What is PVD?
PVD is peripheral vascular disease caused by buildup of fatty materials inside of veins and arteries and hardening of them as well.
What are some signs and symptoms of PVD?
hat disappears after rest
Painful cramping in the hip, thigh, or calf muscles
Weakness or numbness, tingling, or feeling of pins and needles in the lower legs or feet
Coldness in the lower leg or foot
Sores on the legs, feet, or toes that do not heal
Change in color of the legs
Loss of hair or slow growing hair on the legs and feet
Slow growing toenails
Shiny skin on the legs
Weak pulse or no pulse in the legs or feet
How would you treat SIDS?
The only way to treat SIDS is to perform infant CPR
What are risk factors for SIDS?
Overheating Co-sleeping History of respiratory illness Premature or underweight Family history of smoking Prone or side sleeping positions
How would you diagnose cystic fibrosis?
Cystic fibrosis can be detected from a genetic test or a sweat test. Sweat test values are as follows:
<39 mmol/L=Neg
40-59=Further testing
> or = 60=Positive
What are some bronchodilators that are used to treat asthma?
Albuterol- Short acting Salmeterol- Long acting Atrovent- Short acting Tiotropium- Long acting Theophylline- Long acting
What are some side effects of albuterol and salmeterol that need to be monitored?
Anxiety, tachycardia, and nervousness
What is a side effect of Atrovent and tiotropium?
Dry mouth
Why is theophylline no longer recommended to be given?
Theophylline is toxic to humans in certain amounts with the therapeutic range only being between 10-20 TR
What are some anti inflammatory medications given to treat asthma?
Corticosteroids
Montelukast-Oral
Cromolyn- Inhaled
What should the patient do after taking an inhaled corticosteroid? What is a consequence of not doing this?
After taking an inhaled corticosteroid the patient should rinse their mouth. If the patient does not rinse after taking, thrush can develop in the mouth.
What is Parkinson’s disease?
Parkinson’s disease is a progressive nervous system disorder that affects movement. Symptoms start gradually, sometimes starting with a barely noticeable tremor in just one hand. Tremors are common, but the disorder also commonly causes stiffness or slowing of movement.
What is multiple sclerosis?
MS happens when your immune system attacks a fatty material called myelin, which wraps around your nerve fibers to protect them. Without this outer shell, your nerves become damaged. Scar tissue may form.
What is a seizure?
Sudden, uncontrolled electrical disturbance in the brain which can cause changes in behavior, movements, feelings, and consciousness.
What s&s would you see with left sided heart failure?
Low ejection fraction
Pink frothy sputum
What s&s would you see with right sided heart failure?
JVD
Fluid overload
What can be done to the heart to treat blood pressure?
Affecting heart-Calcium channel blockers, Beta blockers
Affecting vessel- ACE inhibitors, ARBs, Nitrates
Ace inhibitors
End in -pril
Result in angioedema, dry cough, increase potassium levels, hypotension
ARBs
End in -sartan
Most same side effects as Ace inhibitors. Treat the same
Nitrates
Extremely potent vasodilator. CANNOT BE SWALLOWED. Can cause rebound tachycardia.
Beta blockers
End in -lol
Beta 2s effect the lungs (can exacerbate asthma symptoms). Beta 1s effect the heart.
Beta blockers block epinephrine and norepinephrine from binding to receptors that stimulate a sympathetic nervous system response
Beta 1 receptors are located in the heart and kidneys
Beta 2 receptors are found in the lungs and GI system
Calcium channel blocker
End in -pine
Blocks calcium from entering cells
What are three types of diuretics?
Loop
Thiazide
Potassium sparing
What are some side effects of diuretics?
Hypotension
Electrolyte imbalance
What are some signs and symptoms of multiple sclerosis?
Fatigue Depression Speech issues Swallowing Mood swings Trouble thinking Nystagmus Optic neuritis Cant hold urine Cant go to the bathroom Romberg's sign Lhermitte's sign Uhthoff's sign
What are some symptoms of digoxin toxicity?
Bradycardia
Fatigue
Nausea
Halo vision around lights
Normal PT level
10-12
Normal levels become elevated by 1.5-2x when given blood thinners
Normal INR level
Around 1
Normal PTT
30-45 seconds
Normal levels become elevated by 1.5-2x when given blood thinners
When should coumadin therapy be halted before surgery?
5-7 days
What is the antidote for coumadin?
Vitamin K
What are signs and symptoms of venous PVD?
Brown pigment around ankle May have cyanosis when dependent Warm Pulses are normal Dull achy pain May have cramps at night Ulcers are usually noted on legs and ankles, superficial but large May have dull pain and are edematous
What are signs and symptoms of arterial PVD?
Smooth shiny thin skin with decreased hair
Pallor with elevation, Rubor when dependent
Cool, decreased or absent pulses
Sharp pain that increases with walking
Dependency that improves pain
Ulcers if present are painful, circular, necrotic on lower legs, heels and toes, no edema
How would you treat arterial PVD?
Stop smoking Topical antibiotic Fibrinolytic medications Embolectomy or endarterectomy Bypass surgery Angioplasty Amputation
How would you treat venous PVD?
Elevation Compression hose Possible fibrinolytic agents Compression dressing Systemic antibiotics Vein ligation Debridement
What are some medications that are taken to treat multiple sclerosis?
Beta interferon Corticosteroids Bladder- oxybutynin, bethanechol Fatigue- Amantadine, modafinil Spasms- Baclofen, diazepam Tremors- propranolol, isoniazid
What medications are taken to treat Parkinson’s disease?
Sinemet carbidopa/ levodopa Azilect Comtan Requip Cogentin
What is the antidote to heparin?
Protamine sulfate
What are the different types of seizures?
Tonic-Clonic Absence Myoclonic Atonic or Akinetic (Drop Attacks) Simple partial Complex partial
What is a Tonic-Clonic seizure?
Tonic phase usually begins with an aura then moves into stiffening and rigidity of the muscles of arms and legs for usually 10-20 seconds followed by loss of consciousness. Clonic phase consists of hyperventilating and jerking of the extremities and lasts about 30 seconds.
What is a Absence seizure?
Brief seizure that lasts seconds. Individual may or may not lose consciousness. Victim appears to be day dreaming. More common in children.
What is a Myoclonic seizure?
Presents as a brief generalized stiffening or jerking of the extremities. Victim may fall from seizure.
What is an Atonic or Akinetic seizure?
A sudden momentary loss of muscle tone. Victim may fall as a result of this seizure.
What is a Simple Partial seizure?
Produces sensory symptoms accompanied by motor symptoms. Victim remains conscious and may report an aura.
What is a Complex Partial seizure?
Psychomotor seizure characterized by periods of altered behavior which the client is not aware. Client loses consciousness for a few seconds.
What are some safety procedures that could be done to protect a patient with Parkinson’s?
Removing rugs from the home
Using shoes without rubber soles
Using a single tip cane
Using a “Marching” type gait to prevent the feet from shuffling
When a freeze up occurs do not push through
What should Parkinson’s medications not be taken with?
Protein rich foods. Many medications compete with protein in the stomach and will not be as effective. Vitamin B6 is also not indicated to be taken.
What type of diet is recommended for patients with epileptic disorders?
High fat and low carb diet also known as a keto diet.
What is an Anticholinergic used for? What does it do? When should the medication not be taken?
An anticholinergic is a medication used in Parkinson’s patients that blocks Ach and decreases muscle rigidity and some signs and symptoms of Parkinson’s.
Medication will not be given if the patient has glaucoma. Do not abruptly stop taking the medication and do not ingest alcohol when taking.
What is Carbidopa/Levodopa (Sinemet)? What does the medication do? What should not be taken with this medication?
Carbidopa/Levodopa (Sinemet) is a medication used to treat Parkinson’s disease. Levodopa is an agent that is converted into dopamine when it reaches the brain, but is broken down easily, so carbidopa is given along with it (1:4 ratio) to increase its effectiveness.
B6 and B6 rich foods should not be taken with this medication.
What medications are used to treat long acting seizures?
Diazepam and Lorazepam
What is used to “shake” out secretions in patients with cystic fibrosis? When is this performed? What should the patient do when this is occuring?
Chest physiotherapy is done on the patient in the morning 1-2 hours before eating. The patient should huff cough during this in order to cough up any secretions.
What are some signs and symptoms of right sided heart failure?
Ascites JVD Weight gain Peripheral edema Oliguria
What are some signs and symptoms of left sided heart failure?
Crackles and wheezes Cough Dyspnea Nasal flaring Orthopnea Retractions Tachypnea
