Use this PREP Flashcards
Angina
Chest pain related to temporary deficiency of oxygen in the myocardium.
MI
Results from prolonged blockage of coronary arteries and leads to death of myocardial cells.
S1
Lubb sounds caused by the closure of the mitral and tricuspid valves at the beginning of systole.
S2
Dupp sounds caused by the closure of the aortic and pulmonic valves at the end of systole.
Systemic circulation
Carries oxygenated blood from the left ventricle to all parts of the body via the aorta, and returns deoxygenated blood to the right atrium.
Pulmonary circulation
Carries deoxygenated blood from the right ventricle to the alveoli of the lungs via pulmonary trunk, and returns oxygenated blood to the left atrium via the pulmonary vein.
Blood flow through the right side of the heart
Chambers on the right side of the heart collect blood and transport to the lungs.
Blood flow through the left side of the heart
Chambers on the left side of the heart collect blood from the lungs and transport to the rest of the body.
Atria
Upper chambers of the heart which blood comes into through veins.
Ventricles
Lower chambers of the heart that pump blood away through arteries.
Cardiac output
The amount of blood pumped out of the ventricles in one minute, measured by heart rate x stroke volume.
Stroke volume
The amount of blood ejected from the heart in one contraction.
Location of the apex of the heart
5th intercostal space, midclavicular line.
Location of the base of the heart
2nd intercostal space, top of chest.
Location of valves (APTM)
Upper = aortic and pumonic valves. Lower = tricuspid and mitral valves.
Right sided heart failure
Right ventricle cannot eject sufficient amount of blood to the lungs, blood backs up in the venous system.
Symptoms of right sided heart failure
Distended JVP, weight gain despite having low appetite, peripheral oedema.
Left sided heart failure
Left ventricle cannot pump blood effectively to the systemic circulation, blood backs up in the pulmonary system and pulmonary venous pressure increases.
Symptoms of left sided heart failure
Decreased ejection fraction, SOB, cough, pulmonary congestion, crackles.
Ejection fraction
Measurement of the amount of blood pumped out of the left ventricle with each heartbeat.
What happens to ejection fraction in heart failure
Left ventricle pumps out less than adequate blood supply to the body. Less than 40%.
Metoprolol
Cardioselective beta blocker which lowers BP and HR by blocking the uptake of noradrenaline and adrenaline at beta receptor sites on the heart, lungs, kidney or brain.
Contraindication of beta blockers
Not to be used in patients with respiratory illness due to side effect of bronchospasm which can worsen symptoms.
Clexane
Anticoagulant drug which prevents the formation of blood clots and is commonly used for prophylaxis of DVT or PE in surgical patients. Administered in the abdomen, subcutaneously.
Risk of clexane
High risk of bleeding, antidote is protamine.
Dabigatran
Direct thrombin inhibitor for prevention of stroke in people with AF, or prophylaxis of DVT after orthopaedic surgery.
Warfarin
Anticoagulant used for patients with previous PE, DVT or prosthetic heart valves. Works by interfering with the synthesis of vitamin K in the liver, which is usually needed for the synthesis of plasma proteins which form clotting factors.
Diuretics
Drugs which inhibit the reabsorption of sodium and chloride in the nephron to induce diuresis and natriueresis (excretion of salt) which results in the excretion of excess fluid. Used in HF patients at risk of fluid overload.
Salbutamol
Short acting beta agonist used as a reliever for acute symptoms of asthma and COPD. Works by activating adrenoreceptors in bronchial smooth muscle to dilate airways and relax bronchial smooth muscle.
Digoxin
Cardiac glycoside used to treat HF and arrythmias. Inhibits the active transport of sodium and potassium across cell membrane to slow contractions, reduce workload of the heart and increase cardiac output.
Digoxin implications
Toxicity. Has a narrow therapeutic range and needs to be monitored closely for signs of toxicity. Symptoms include hypokalaemia, hypercalcaemia and hypomagnesaemia.
Nursing responsibility for digoxin
Monitor closely for signs of toxicity. Monitor potassium levels in patients taking diuretics due to increased risk of hypokalaemia. Take apical pulse as part of regular vital signs and listen for arrythmia.
Morphine
Strong opioid analgesic and controlled drug used for severe pain and only when NSAIDs are not enough.
Ibuprofen
NSAID commonly used for mild to moderate pain, also treats fever and swelling.
Function of the lymphatic system
Drains excess interstitial fluid, removes foreign bodies and transports lipids to the blood.
Lymph nodes are palpable when
The body is fighting infection or if there is a malignant mass.
Benign vs malignant
Malignant masses will be fixed in position, hard in consistency, and very tender. You need to note the shape, location and mobility of any mass.
Abdominal assessment order
Inspection, auscultation, percussion and palpation.
Things to remember prior to abdominal assessment
Ask if patient has recently emptied bladder as assessment is better when bladder is not full, ask patient to point out tender areas first and always watch for facial grimacing or knees drawn up.
Purpose of musculoskeletal assessment
To assess ROM of joints, muscle strength and mobility.
Purpose of neurological assessment
To assess level of consciousness, coordination, balance and sensation.
S1 is loudest at
The apex due to closure of the mitral and tricuspid valves at the start of systole.
S2 is loudest at
The base due to closure of the aortic and pulmonic valves at the end of systole.
JVP
Jugular venous pressure. Pressure in the right atrium reflected in the internal jugular vein, if present means there is a back up of blood in the atrium, sign of HF.
Parts of mental health assessment
MSE, functional enquiry, AOD and risk assessment.
Ectopic pregnancy
When a fertilised egg is implanted somewhere other than the uterine lining, usually in the fallopian tubes.
Why is ectopic pregnancy potentially fatal?
Can cause internal haemorrhage which can lead to shock and could impact future reproduction.
Can a women get pregnant if she has had an ectopic pregnancy?
Yes.
Nursing interventions for ectopic pregnancy
Monitor blood loss, reassure patient, give appropriate analgesia, Q15 obs, elevate legs, stay with patient and keep comfortable, monitor closely for signs of shock.
Assessment for ectopic pregnancy
COLDSPA including past history of periods, pregnancy, UTIs, smoking, drinking, family history, pain score and whether they have referred shoulder tip pain, family support, can I ring anyone?, how much have they had to eat and drink, urinary pattern. Take vital signs, may have hypotension related to blood loss.
Spontaneous abortion (miscarriage)
Natural termination of pregnancy before 20weeks gestation.
Inevitable abortion
Symptoms are uncontrollable (bleeding, uterine cramping, cervix is dilated.
Incomplete abortion
Some products of conception are retained, usually placenta. Can result in haemorrhage leading to shock. Increased risk of infection.
Nursing interventions for inevitable abortion
Promote relaxation, monitor vital signs frequently, monitor bleeding, emotional support, signs of shock.
Pre-eclampsia
HTN in pregnancy, often accompanied by oedema.
Eclampsia
Critical condition in which high BP, proteinuria and oedema results in seizures.
Signs of ectopic pregnancy
Pain in legs, lower abdomen and shoulder tip, nausea
Cause and significance of proteinuria in pregnancy
Caused by damage to the renal glomeruli as a result of raised BP, causing leakage of plasma proteins into the blood. Common indication of pre-eclampisa and needs to be reported immediately.
Maternal risks of diabetes
Increased risk of HTN, infection, c-section due to larger baby, difficult labour and post-partum haemorrhage.
Risk of diabetes to fetus
Increased risk of mortality, spontaneous abortion, hypoglycaemia, traumatic delivery or pre-term birth.
Why gestational diabetes occurs in women
Pancreas cannot meet added demand for insulin in pregnancy. Liver cannot metabolise carbohydrates efficiently for the mother as it priorities them for the fetus to enhance growth and development, so decreased insulin sensitivity for mother.
Why are pregnant women at risk for developing DVT?
Increased production of procoagulation factors in pregnancy, venous stasis occurs in lower extremeties as a result of compression against the uterus, damage to vessel walls.
Advice for pregnant women to avoid DVT
Gentle exercise, hydration and avoid restrictive clothing that would compromise venous return.
Anticoagulant management in pregnancy
Warfarin is contraindicated due to risk to fetus. Clexane is used as is does not cross the placental barrier.
The main reasons for PPH
Delayed involution of uterus, retained placental fragments and significant cervical lacerations.
Concerns of peurperal (uterine) infection postpartum
Spread of fever to newborn, fear of problems conceiving in future, endometriosis.
Mastitis
Inflammation of mammary gland from breastfeeding.
Signs of mastitis
Red, swollen, enlarged, painful breast area, difficulty or avoidance of breastfeeding, fever.
Nursing considerations for mastitis
Encourage to breastfeed to empty milk supply and to encourage bonding with baby, administer pain relief as prescribed (probably NSAIDs to treat fever), cooling cares, emotional support, encourage hydration, change positioning.
Transient depression
Postpartum blues, usually lasts a few hours to a few days following birth due to hormonal changes.
Signs and symptoms of transient depression
Alteration in mood with feelings of anxiety, tearfulness, irritability and sadness.
Postpartum depression
Low mood and feeling of inadequacy that lasts for weeks or months following birth.
Signs and symptoms of postpartum depression
Decreased energy levels, loss of appetite, feelings of worthlessness, isolation, negative emotions towards baby, motor agitation, negative future outlook, relationship difficulties, crying, fear of harming self or baby, difficulty completing ADLs.
Postpartum psychosis
Severe postpartum condition indicated by restlessness, sleep disturbances, delusions, hallucinations, disorganised behaviour and withdrawal.
Difference between postpartum depression and psychosis
Psychosis has symptoms of hallucinations, delusions and disorganised behaviour.
Ways to prevent mastitis
Wash hands before breastfeeding, express milk regularly, encourage infant to feed from most tender breast to reduce inflammation, massage swollen areas as infant feeds, contact LMC if fever develops.
Cause of mastitis
Bacteria enters the breast through broken skin on the nipple, then enters the milk where it multiplies and blocks milk ducts. Treated with ABs.
Folic acid in pregnancy
Responsible for the RBC production in pregnancy and supply to foetus to reduce neural defects from developing. Can prevent baby from having intellectual issues or spina bifida.
How to increase intake of folic acid in pregnancy
Can take supplements or maintain levels through leafy greens, fish, meat and eggs. Steaming vegetables will enhance intake of nutrients.
Signs of shock
Rapid pulse, pallor, cool and clammy skin, pupil dilation, fatigue, tachypnoea, central cyanosis, low BP, loss of consciousness.
Immunisations recommended in pregnancy
Pertussis and Influenza
Advice for pregnant women to avoid oedema
Do not sit or stand for too long, gentle regular exercise, drink plenty of water, avoid the heat, elevate feet, reduce salt intake.
Antacids in pregnancy
Avoid OTC antacids containing magnesium during last trimester as can interfere with contractions.
How to avoid epistaxis in pregnancy
Sleep with head slightly elevated, take warm baths to reduce congestion, sometimes a nasal spray can help.
Urinary frequency
Educate on keegel exercises. Can be caused by hormonal changes or by baby pushing on uterus.
Morning sickness advice
Usually ends after first trimester. Advise small but frequent meals, avoid caffeine, drink lots of water and try ginger.
Complications of smoking in pregnancy
Increases risk of spontaneous abortion, increases risk of delayed fetal neurological and intellectual development, low birth weight, increased risk of infection and increased risk of SUDI.
Nutritional advice for pregnant women
Eat a range of foods from the four main food groups (carbohydrates, fruit/veg, milk products and meat).
Food to avoid in pregnancy
Raw fish, processed and deli meat, sushi, soft-serve ice cream, hummus, soft cheeses, unpastuerised milk products, cold prepacked meat, food containing raw egg, artificial sweeteners, alcohol.
Symptoms of alcohol withdrawal
Agitation, fever, seizures, tremors, confusion, disturbed sleep, sensitivity to light, elevated HR and BP, nausea and vomiting.
Risks of alcohol withdrawal
Dehydration leading to arrythmia, hypotension, renal failure, pneumonia and infection.
Major implication of long term alcohol abuse
Vitamin deficiency (commonly B1) due to liver damage, impaired absorption and increased metabolic demand.
Alcohol assessment
Type of alcohol consumed, time of last drink, average number of drinks consumed in a day, are they drinking as soon as they wake, do they use alcohol to calm tremors, past history of seizures (increases risk of withdrawal seizures by 70%), past history of hallucinations, co-morbidities, current goals relating to alcohol use.
Nursing considerations for alcohol assessment
Obtain consent, vital signs, MSE, administration of thiamine (vitamin B1 due to impaired absorption of vitamins as a result of liver damage) as prescribed, risk assessment, discuss their rights, process for making complaints, benefits and side effects of medications, Q30min obs with alcohol withdrawal scale.
Physical alcohol examination
Vital signs, general appearance (agitation, malnutrition and premature ageing), signs of intoxication, spider veins or bruising, pulse rate and BP, signs of withdrawal.
GTN
Glyceral trinitrate. Short-acting cardiac drug used to restore perfusion through coronary arteries and to relieve chest pain (angina). Works by binding to nitrate receptors in vascular smooth muscle and relaxing the muscle, causing vasodilation in peripheral veins which decreases preload and venous return to the heart, so decreases oxygen demand.
Preload
Volume of blood in the ventricles at the end of diastole.
Afterload
The force against which the ventricles contract to expel blood.
Symptoms of angina
Chest pain, SOB, pain radiating to jaw, neck or shoulder, feeling faint, nausea, vertigo and anxiety.
Moa of Morphine
Binds to and deactivates Mu receptors to block neural transmission and alter pain perception and response.
Administration of Morphine
Always double independently checked. Naloxone and Oxygen must be readily available. Resp rate must be recorded hourly throughout infusions due to risk of sedation and decreased resp rate. Infusion must always be administered via a pump
CDHB policy on morphine administration
Nurse must stay with patient for at least five mins after each dose. Obs to be taken after first five mins, 15mins or when EWS is elevated.
Morphine observations must include
Pain score, sedation score, resp rate, BP, HR, SpO2, EWS.
Insulin
Dominant hormone of the fed state which lowers BGL. Produced in the pancreatic islets.
Glucagon
Dominant hormone of the fasted state responsible for increasing BGL when too low.
Other hormones that can increase BGL
Cortisol (stress hormone), adrenaline and growth hormone.
Hyperglycaemia is caused by
Insulin resistance, insulin deficiency or abnormal glucagon synthesis.
Signs and symptoms of diabetes
Polyuria, polydipsia, polyphagia, ketosis, weight loss, abdominal pain, nausea and vomiting, dry mouth, increased resp rate, fatigue, recurrent infections, slow wound healing.
Type one diabetes
Occurs when the pancreas cannot make any insulin. Daily injections are required. Results from high breakdown of proteins and fats leading to accumulation of ketone bodies which can lead to ketosis or diabetic acidosis.
DKA
Diabetic ketoacidosis. Medical emergency due to cerebral oedema.
Type two diabetes
Pancreas does not make enough insulin or body does not use insulin as it should. Can be affected by lifestyle and diet.
Gestational diabetes
Occurs due to hormonal changes and incorrect use of insulin by the body in pregnancy.
Metformin
Biguanide used for management of diabetes. Lowers BGL by increasing insulin receptor sensitivity and increasing glucose uptake (gluconeogenesis).
Why is metformin used as first line treatment for T2DM?
Has less side effects, does not cause weight gain like other oral antidiabetics. Slow titration can reduce risk of side effects such as nausea and GI upset.
Contraindications of metformin
Risk of lactic acidosis so should be avoided in patients with cardiac, renal, liver or respiratory disease.
Corticosteroids
Respiratory drugs used in conjunction with SAMAs to prevent respiratory distress. Used in chronic asthma to decrease airway obstruction. Should use a spacer.
Antiemetics
Drugs such as metoclopramide or cyclizine used to relieve symptoms of nausea and vomiting.
MOA of antiemetics
Inhibits the dopamine receptor in the chemoreceptor trigger zone and desensitises it to impulses from the GI tract.
Contrainindications of antiemetics
Not to be used in patients with complete bowel obstruction or parkinsons disease.
Proton pump inhibitors
Drugs such as omeprazole used to control symptoms of GORD. Bind irreversibly to the fastric proton pump to prevent the release of gastric acid.
Benzodiazepines
First line of treatment for anxiety disorders. Work by depressing the activity in the brainstem and limbic systems and increase action of GABA to produce anxiolytic and sedative effects. Not to be taken with other CNS depressants due to sedative effect.
Contraindications of benzodiazapines
People with COPD or respiratory illness, liver disease, sleep apnoea, or drug dependence.
SSRIs
Antidepressants that block the uptake of serotonin to control symptoms of anxiety, depression and sometimes as an adjunct for schizophrenia.
Serotonin syndrome
Onset is usually rapid and life threatening. Symptoms include increased HR, shivering, diaphoresis, pupil dilation, hyperactive bowel sounds, HTN, fever, agitation.
MOA of antipsychotics
Block dopamine receptor sites to reduce positive symptoms of psychosis.
Typical antipsychotics
First generation of antipsychotic drugs which work by blocking dopaminergic receptor sites but cause adverse effects such as dry mouth, weight gain, constipation, postural hypotension, nasal congestion, sedation and ammenorrhoea.
Extrapyramidal side effects (typical antipsychotics)
Parkinsoniam symptoms such as tremor, rigidity and bradykinesia, dystonia, akathisia.
Atypical antipsychotics
Newer class of antipsychotics which work by selectively targeting dopamine receptors and some serotonin receptors. Have less serious side effects, though there is a major risk of diabetes and metabolic syndrome.
Metabolic syndrome
Caused by atypical antipsychotics. Cluster of obesity, high BP, high LDL, high BGL leading to increased risk of diabetes and CVD. Serious risk for people with schizophrenia and BPAD as they already have a genetic predisposition to developing diabetes.
Nursing education for use of atypical antipsychotics
Careful monitoring if weight gain and BGL, monitoring of blood tests, education related to lifestyle management and health behaviours.
Neuromalignant syndrome
Risk for use of all antipsychotics Symptoms include fever, unstable vital signs and muscle rigidity. Occurs within first few weeks of a drug change and needs to be stopped immediately and patient to be rehydrated.
Pathophysiology of asthma
Irritant causes inflammatory response of bronchospasm and mucous secretion that occludes bronchioles, causing SOB and chest pain. Membranes lining the bronchi swell.
Pathophysiology of COPD
Chronic disease including emphysema, asthma and chronic bronchitis. Airway is triggered by an irritant which causes bronchoconstriction and irreversible airway obstruction, hindering air flow.
Pathophysiology of atherosclerosis
Irritant causes damage to endothelium of blood vessels. Cholesterol deposits build up and form plaque in broken parts of the endothelium. Blood vessels eventually die. Leads to CAD. Caused by smoking, pollution and unhealthy/fatty diet.
Pathophysiology of heat failure
Caused by structural or functional abnormalities of the heart which leads to the inability to pump enough blood to vital organs as a result of insufficient cardiac output and increased demand on the heart. Commonly caused by IHD.
Pathophysiology of IHD
Any condition that causes abnormal structure and function of the heart.
RAAS system and heart failure
Baroreceptors sense drop in BP and adrenaline and noradrenaline are released by the SNS. Low cardiac output and vasoconstriction results in decreased renal perfusion, causing the kidneys to release renin, triggering the RAAS response. This mimics the SNS and increases HR, BP and contractility of the heart. This is the compensatory mechanism of the heart in heart failure.
Nutritional advice
MOH recommends eating a variety of foods including vegetables, fruit, grains and food such as whole grain carbohydrates that are naturally high in fibre, some milk products, some nuts/fish/meats, lower sugar intake and alcohol consumption and try to aim for about 30mins exercise a day.
Eating well and exercising regularly will
Make you feel better in yourself and reduce your risk of developing diabetes, heart disease and some cancers.
Sounds heard at the apex and base of lung field on auscultation
Vesicular sounds (inspiration is longer than expiration).
Sounds heard between scapulae on auscultation
Bronchovesicular sounds (inspiration is same length as expiration).
Why do we percuss back?
To locate lung fields for auscultation
On percussion, lung fields should sound
Mostly resonant, with dullness at diaphragm.
Sound that should be heard in all quadrants of abdomen on percussion
Tympany as there should be no fluid in the abdomen
Paralytic ileus
Usually temporary paralysis of the ileus and inability to complete peristalsis. Commonly caused by abdominal surgery and activation of SNS which tells body to slow digestion as a compensatory mechansim.
Perforated bowel
A hole is formed in the GI tract and bowel contents can flow into abdominal cavity where sepsis can occur.
Compartment syndrome
Important syndrome to be aware of following fracture.
Signs of compartment syndrome
Pain that is unrelieved by medication, pallor, absent pulses, parasthesia and parlysis.
Nursing interventions for compartment syndrome
Neurovascular assessment. Keep leg at heart level. Remove restrictive clothing. Notify doctor immediately.
Positive symptoms of schizophrenia
Delusions and hallucinations, disorganised speech.
Negative symptoms of schizophrenia
Anhedonia (no pleasure from things they would normally enjoy), blunted affect and poverty of speech and thought.
What is a positive symptom?
Symptoms that are added when a person is unwell such as delusions or hallucinations. Not usually present.
What is a negative symptom?
Symptoms that take away such as blunted affect, anhedonia which take away pleasure and expression due to illness.
