week 3 Flashcards
What does AVPU stand for?
Alert
Verbal
Pain
Unresponsive
What can increase HR and RR?
- Compensated shock
- Infection
- Stress
What can decrease RR?
- Medications (e.g. racemic)
- Exhaustion
What can cause decreased HR?
- Hypoxia
- End stage shock
What is angina?
- Symptom of coronary artery disease
- Chest pain due to lack of blood supply and oxygen to the heart
- Pain often spreads to shoulders, arm, neck and jaw
What does angina feel like?
- Squeezing
- Pressure
- Heaviness
- Tightness
- Pain in the chest
- Can be sudden or recur over time
How can angina be treated?
Depending on severity, can be treated by lifestyle changes, medication, angioplasty or surgery
What is atherosclerosis?
Build up of plaque
What is arteriosclerosis?
Thickening of walls of arteries
What is chronic stable angina?
- Same pattern of onset, duration, intensity of symptoms
- Pain lasts 5-15 mins
- Usually predictable - provoked by exertion
- Relieved by rest or GTN
What is unstable angina?
- New in onset, occurs at rest (or with minimal exertion), has a worsening pattern
- Other symptoms: SOB, fatigue, indigestion, anxiety
- Not relived with GTN
- Unpredictable
- Associated with plaque rupture exposing a thrombus
- MEDICAL EMERGENCY
What is acute coronary syndrome (ACS)?
The name given to three types of CAD that are associated with sudden plaque rupture: UA, N-STEMI, STEMI Unstable angina (partial occlusion) , Non elevated-ST Elevated MI (partial occlusion), ST Elevated MI (total occlusion).
How does the patient with acute coronary syndrome present?
Pale and clammy Chest pain/ Dyspnoea Nausea and vomiting Hypotensive Pulmonary oedema Collapse, sweating
Which acute coronary syndrome has a elevated ST segment?
STEMI
Which acute coronary syndrome doesn’t have a elevated ST segment but has elevated cardiac enzymes?
N-STEMI
Which acute coronary syndrome doesn’t have a elevated ST segment and doesn’t have elevated cardiac enzymes?
Unstable angina
What are complications of MI?
- Arrhythmias - atrial fibrillations, ectopic beats ( premature, irregular beats), heart failure, cardiogenic shock, pulmonary oedema, acute respiratory failure
- Cardiac arrest- only VF and VT are shock able. Asystole and PEA provide CPR and adrenaline
What are diagnostic studies for MI?
Lab Tests • (lipid profile)- high cholesterol • Serum cardiac markers (Trop T, CK) Medical Imaging • 12-lead ECG • Cardiac catheterisation + coronary angiography • Chest x-ray • Echocardiogram (heart ultrasound)
What are acute nursing interventions for cardiac problems?
- Pain assessment and relief – IV access
- Ongoing monitoring & assessment, cardiac monitoring, frequent vitals
- Rest and comfort; positioning (sit upright), bed rest, limited activity for 12-24 hours
- Alleviation of stress and anxiety
- Understanding patients emotional and behavioural reactions – life defining event - loss, grief, depression
Oxygen therapy; drug therapy: GTN and aspirin;
MDT CARE
• Rapid diagnosis and treatment extremely important
• Clinical decision making re treatment, pharmacology, surgical management (PCI, CABG)
How to reperfuse STEMIs with thrombolysis?
- dissolve thrombus (streptokinase)
* percutaneous catheter infusion (PCI)- allows stent insertion
What is surgical revascularisation - CABG?
coronary artery bypass graft- adding vessels/veins, to bypass the obstructed part of the artery
What are nursing interventions for acute heart failure:pulmonary oedema?
- C-XRAY
- Monitoring
- Treat cause
- Positioning
- Oxygen therapy– nasal prong, high flow, CPAP/BiPAP
- Drug therapy (cardiac Mx and anxiety Mx; intravenous)
- Daily weight
- Rest
- Regular assessment
- Combine physical, psychosocial and relational needs with each care encounter
What is heart failure?
sometimes known as congestive heart failure, occurs when your heart muscle doesn’t pump blood as well as it should.
What are the types of heart failure?
Right-sided heart failure. (Back-ups in the area that collects “used” blood)
Left-sided heart failure. (Failure to properly pump out blood to the body)
Congestive heart failure. (Fluid backs up into the lungs and tissues)
What is DKA?
serious complication of type 1 diabetes and, much less commonly, of type 2 diabetes. DKA happens when your blood sugar is very high and acidic substances called ketones build up to dangerous levels in your body
What are the three clinical features of DKA?
Hyperglycaemia- polyuria, polydipsia, polyphagia
Dehydration and electrolyte loss- Nausea/vom, LOC,
Acidosis - increased work of breathing and rate (Kussmual respirations), pale and clammy, cold,
What is HHNS (Hyperglycaemic hyperosmolar non-ketotic syndrome)?
Condition resulting from very high blood glucose levels. Can affect both types of diabetics, yet it usually occurs amongst people with T2DM
What are nursing assessments and interventions for DKA?
Treating hyperglycaemia – insulin infusion
Correcting dehydration- fluid infusion
Correcting electrolyte loss- Do not add to the first litre of fluid infused
Correcting acidosis
Monitoring of vital signs, LOC, ECG, O2 saturations, urine output – 1/24
Monitor FBC 1/24
What are signs of hypokalaemia?
Low blood levels of Potassium Fatigue Muscle weakness, leg cramps, soft, flabby muscles Nausea and vomiting, paralytic ileus Paraesthesia, decreased reflexes Weak, irregular pulse Polyuria Hyperglycaemia ECG changes: ST segment depression, flattened T wave, presence of U wave, Ventricular arrhythmias, bradycardia
What are the three categories of AKI causes?
prerenal, intrarenal and postrenal
What are prerenal causes of AKI?
Hypovlaemia
decreased cardiac output
vasodilation
decresased renovascular blood flow
What are intrarenal causes of AKI?
Nephrotoxic injury- antibiotics, contrst
interstitial nephritis
What are postrenal causes of AKI?
benign prostatic hyperplagia bladder cancer neuromuscular disorders- affect bladder function prostate cancer spinal cord disease strictures- narrowing of vessels trauma
What does RIFLE mean?
Risk- GFR < 75% Injury - GFR < 50% Failure - GFR < 25% Loss- complete loss of function End-stage kidney disease
What is nursing management for AKI?
Treat precipitating cause
Fluid restriction (600 mls + previous 24 hours loss) Fluid and electrolyte balance
Nutritional therapy (enteral nutrition)
Measures to lower potassium- lower potassium levels (insulin and dextrose)
Calcium supplements
Dialysis - Haemodialysis, Peritoneal
Monitor vital signs
Urine assessment
Respiratory assessment
Skin assessment
Prevent infection
Monitor fatigue and potential anxiety
Monitor of complications – arrhythmias, infection
What are the different types of dialysis?
Peritoneal
haemodialysis
