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203 Cards in this Set
- Front
- Back
What are Denny lines?
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folds of skin at the lash line
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What are allergic shiners?
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bags under the eyes
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What are some concerns when it comes to endoscopy?
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concern is loss of gag and swallow reflex, monitor for breath sounds
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What is carcinoma of the larynx associated with?
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smoking, alcohol, chronic laryngitis, vocal abuse, family history
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What are some of the signs and symptoms of carcinoma of the larynx?
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persistent hoarseness with or without ear pain, difficulty swallowing, (hoarse longer than 2 weeks)
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How is cancer of the larynx diagnosed?
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endoscopy, biopsy, CT
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What are the treatment options for a patient diagnosed with carcinoma of the larynx?
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surgical resection, radiation, chemotherapy
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What position should you have a patient in that has just had a total larngectomy? Why?
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Semi fowlers with the next flexed
because it will help to prevent drainage and tension on the suture line |
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When your patient has a trach tube what would you need to monitor for?
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air leaks, infection, signs of aspiration, dyspnea due to edema, secretions
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Define "obstructive lung disease"
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disease state characterized by airflow obstruction
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What specific diseases does "obstructive lung disease" include:
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chronic bronchitis, bronchiectasis, asthma, emphysema, cystic fibrosis
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What % of obstructive lung disease is associated with smoking?
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90%
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What % of COPD goes undiagnosed?
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3%
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Who is nicknamed a "blue bloater"? Why?
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someone with chronic bronchitis because they tend to have cyanosis
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What are some of the pathophysiologic signs of a "Blue bloater"?
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thickening of the mucous membrane, increased number of goblet cells, tissue irritation, excessive mucous production, airflow obstruction
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Who is nicknamed a "pink puffer" and why?
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someone with emphysema because they tend to have a ruddy look to their skin (look red)
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Do patients with emphysema have difficulties with inspiration or expiration?
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expiration
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What is the most common s/s of emphysema?
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diminished breath sounds
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What are some s/s of obstructive lung disease?
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cyanosis, barrel shaped chest, dyspnea and exercise intolerance, wheezing, crackles, rhonchi, decreased breath sounds, prolonged expiration, orthopnea, cough with sputum in the AM, weight loss, high hematocrit, RIGHT HEART FAILURE (jugular vein distention, edema,hepatomegaly)
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How is obstructive lung disease diagnosed?
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PFT, chest X-ray, ABG
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What are some treatments for a patient diagnosed with obstructive lung disease?
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stop smoking, inhaled beta agonist (bronchodilators), inhaled anti-cholinergics
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What are some examples of inhaled beta agonists?
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albuterol (short acting), salmeterol (long acting), formoterol (long acting), levalbuterol (short acting)
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What are some examples of inhaled anti-cholinergics (bronchodilators)?
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atrovent, spiriva, albuterol and ipratropium combined
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When is a beta agonist used in relation to when an anti-cholinergic is used?
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a bet agonist is used as a PRN medication while an anti-cholinergic is used as a controller medication
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what is the first sign of theophyllin toxicity?
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nausea
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What is the stimulus to breath in a patient with Obstructive lung disease?
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low O2
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What are some of the nursing concerned when it comes to a patient with obstructive lung disease?
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gas exchange, airway clearance, nutrition, hydration, infection, activity intolerance, sleep disturbance, knowledge deficit
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Define Pneumonia
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acute inflammation of the lung tissue which affects gas exchange
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What is the leading cause of infectious disease in the US?
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Pneumonia
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How is Pneumonia classified?
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as either CAP (community acquired pneumonia) or HAP (hospital acquired pneumonia)
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What are some of the ways that we can prevent pneumonia?
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flu vac. every year, pneumococcal vac., treatment of URI/bronchitis, suctioning, ambulation, spirometer, hand washing, respiratory treatments
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What are some of the s/s of pneumonia?
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fever, chills, altered mental status, tachypnea, tachycardia, chest pain, cough, sputum production, crackles, decreased breath sounds
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How is pneumonia diagnosed?
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chest x-ray, sputum cultures, ABG, WBC
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What type of diet is required in the treatment of pneumonia?
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high in protein, calories, fluids
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What is the number one cause of infectious disease deaths in the world?
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tuberculosis
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What type of infection is tuberculosis?
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respiratory acquired infection
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What are some of the risk factors for contracting tuberculosis?
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HIV (immunosuppression), homeless, very young, very old, living in crowed, unsanitary conditions, poor nutrition, Alcohol/drug abuse, coming/going to country where disease is prevalent
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What is the best way of preventing active TB?
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BCG vaccination
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What are some of the s/s of TB?
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cough, blood streaked sputum, weight loss, fever, night sweats, positive skin test
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How is TB diagnosed?
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Tuberculin skin testing (PPD), chest x-ray
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What are some of the treatment options for patients with TB?
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isolation until symptoms subside (3 neg. smears), lifestyle changes to improve health, drug therapy
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What are some of the side effects of the drug ISONIAZID (TB drug)?
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peripheral neuritis, rash, fever, hepatitis
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Why does a patient taking ISONIAZID need to take vitamin B6 daily?
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to offset neuropathy
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What are the side effects of the TB drug RIFAMPIN?
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hepatitis, fever, thrombocytopenia, BODILY FLUID TURN ORANGE
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What are the side effect of the TB drug ETHAMBUTOL?
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optic neuritis, rash, GI upset, (causes visual impairment so pt. must have monthly visual checks)
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What are some of the nursing concerns when it comes to caring for a pt. with TB?
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eduction, oxygenation, nutrition, fluids, protection of others
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What is the most frequent cause of cancer deaths in both men and women in Northern America?
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Lung cancer
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What percentage of lung cancer cases are associated with cigarettes?
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87%
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What are some ways to help prevent the occurance of lung cancer?
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Stop smoking, avoid second hand smoke, precautions with occupational exposure, CT under study
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Where does most lung cancer arise from?
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bronchii
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What are the s/s of lung cancer?
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persistent cough unresponsive to treatment, hemoptysis, dyspnea, wheezing, pain, fatigue, weight loss
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How is lung cancer diagnosed?
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chest x-ray, sputum cytology, bronchoscopy and biopsy, CT and MRI
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Why should you never clamp a chest tube?
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because it can cause a mediastinal shift or tension pneumothorax
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What is subcutaneous emphysema?
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caused by air leaks from the pleural space into SQ tissue
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Should patients with a pneumonectomy have a SQ emphysema? Why?
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No, if they do then it means that there is air leaking from the bronchial stump and you need to let the dr. know immediately
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What should you do if you notice blood at the incision site of a chest tube?
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blood on the dressing is unusual due to chest tube, should be reported
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What position should you have a patient in if they just had a pneumonectomy?
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Patient should lie on the operative side so that drainage does not enter into the remaining lung
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Define ARDS (adult respiratory distress syndrome)
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acute hypoxemic respiratory failure without hypercapnea
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What is ARDS associated with?
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shock, trauma, infection, emboli, aspiration, inhaled toxic agents, pancreatitis
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What are the s/s of ARDS?
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tachypnea, dyspnea, use of accessory muscles, cyanosis, dry cough, fever, crackles, altered sensorium
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How is ARDS diagnosed?
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pulmonary function studies, ABG, chest x-ray
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What are some of the treatment available for pt. with ARDS?
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ventilatory support and PEEP, oxygen, fluid volume management, treating the underlying cause of the problem
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What is flail chest?
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multiple ribs or sternum fractured at more than one place
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What do the coronary arteries do?
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supply the myocardium with adequate volumes of blood
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What does the coronary sinus do?
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dumps blood that has been circulated through the myocardium back in to the right atrium
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when does perfusion of the coronary arteries occur?
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during diastole
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Discribe the conduction system of the heart.
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electrical activity begins in the SA node, travels through the internodal pathways to the AV node, travels down through the bundle of HIS, the right and left bundle branches and then finally to the purkinje fibers
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What is normal cardiac output (CO)?
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4-7L/m
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What is cardiac index? What is normal cardiac index?
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it represents the CO in terms of L/m/square meter of body surface
Normal is 2.7 - 3.2L/m |
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What is inotropic?
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increases the force of myocardial contractions
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What is chronotropic?
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increases the rate of myocardial contractions
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What does an echocardiography do?
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it records the movement of the cardiac walls and valves
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What does a stress test evaluate?
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the cardiovascular response to a progressively graded work load
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What does a myocardial nuclear perfusion imagining test allow for?
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allows for the vasodilation of the coronary arteries after the administration of Persantine giving information about coronary artery blood flow
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What is the antagonist for Persantine?
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Aminophyllin
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Explain a Transesophageal Echocardiography
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The pt. swallows a tranducer that allow ultrasonic imaging of the cardia structures and the great vellels via the esophagus
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What does a thallium scan do?
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evaluates regional myocardial perfusion
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What does a cardiac cath do?
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it provides information related to the structure and function of the cardiac chanbers, valves and great vessels
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What is the most definitive yet most invasive, diagnostic heart test?
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cardiac cath
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Explain a right sided heart cath?
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provides information regarding the right heart chambers and valves and pulmonary arterial circulation
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Explain a left sided hear cath?
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provides information regarding the pressures of the left side of the heart, valvular competency and left ventricular function
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When your pt returns to the floor from having a heart cath what should you as the nurse be checking frequently?
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vital signs, pedal pulses
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How should your patient be positions after having had a femorally approached heart cath?
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elevate bed only 30 degrees
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What is done when your pt is having an electrophysiologic study performed?
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you are purposefully inducing a lethal rhythm
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Define CAD (coronary artery disease)
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any condition that affects the coronary arteries. Decreased blood flow results in either ischemia or infarction
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what is the leading cause of death in the US?
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CAD
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What are the risk factors for CAD?
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Non-modifiable:
age and sex race family history Modifiable: hyperliproteinemia hypertension, dietary patterns, obesity, diabetes, smoking |
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Define angina
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occurs when myocardial oxygen demands exceed myocardial ozygen supply
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Define STABLE angina
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the person is kind of familiar with the s/s of angina
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Define UNSTABLE angina
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an increase in the frequency and severity of their attack and the pattern is no longer predictable
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What are some clinical manifestations of angina?
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chest pain, diaphoresis (clammy, sweaty), N/V, dyspnea, relieved with rest or medication
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What does taking Nitroglycerin do for a pt?
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causes vasodilation of the vascular system both in the coronary arteries and in the peripheral arteries
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How should nitrogycerin tablets be taken?
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can take 3 nitroglycerin tablets 5 minutes apart
After the 3rd one, call 911 |
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When your patient is instructed to take nitroglycerin what patient teachings should you be addressing?
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take meds as directed, change position slowly, avoid alcohol, advise that they may develop a headache and aspirin or tylenol may be taken for it
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How should nitroglycerin tablets be stored?
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in original dark bttle and replaced every 6 months
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What should you be checking after giving your pt. a beta blocker?
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pulses because it slows down the heart rate
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What are some examples of beta blockers?
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inderal, lopressor, tenormin (generics will all end in OLOL
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What are some examples of calcium channel blockers?
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calan, verapamil, procardia, cardizem
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How do calcium channel blockers work?
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by preventing the flow of calcium into the cells resulting in relaxation of the smooth muscles of the myocardium (desired effect) and a reduction in myocardial contractility (an undesired effect)
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What is Acute Coronary Syndrome?
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Pt. with coronary atherosclerosis have varying degrees of coronary artery occlusion which may end in myocardial infarction or sudden cardiac death
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Define myocardial infarction
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death of myocardial tissue due to a blcokage of the one or more branches of the coronary arteries.
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Explain a NON Q wave infarct?
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ischemia or infarct that does not extend al the way through the myocardium
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Explain a Q wave infarct?
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ischemia or infarct extends all the way through the wall of the myocardium
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What is a myocardial infarction?
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death of myocardial tissue due to a blockage of the one or more branches of the coronary arteries
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What are some EKG changes that might occur if your pt. is having an MI?
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pronounced Q wave, ST segment increases, T wave inversions
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What are some of the s/s of an MI?
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Pain (most common), restlessness/denial, shortness of breath, dyspnea, S3 and S4 may be present, murmur many be present, incr. HR and decr. BP, N/V, diaphoresis
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What is a silent MI?
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an MI occurs but the patient had no complaint of chest pain
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What are some interventions for an MI?
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provide oxygen, relieve pain, decrease workload of the heart, comfort, rest, monitor for dysrythmias, promote nutrition
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What is the most common complication for a pt with an MI?
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dysrhythmias
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What is the primary antiplatelet agent used?
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aspirin
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How soon after the onset of an MI would you need to use fibrinolytics?
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within 6 hours, after that the tissue has died
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Explain heart failure?
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occurs due to a decrease cardiac output because of the ischemic or infarcted myocardium
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Explain a dysrhythmia?
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occurs secondary to ischemia, May see bradycardia, heart blocks or ventricular ectopy
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Explain pericarditis?
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occurs due to inflammation of the pericardial lining
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What is cardiac death and what is it usually due to?
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death that occurs unexpectantly to a person who was okay prior to their death, usually due to a V.F.
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What is CHF?
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a state in which the heart no longer is able to pump an adequate supply of blood to meet the demands of the body
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Explain LSHF?
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left ventricular CO is less than the volume of blood received from the pulmonary circulation
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Is LSHF systolic or diastolic?
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can be both
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Explain RSHF
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right ventricular CO is less than volume received from the peripheral circulation
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What causes RSHF?
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can be due to LSHF or some problem with pulmonary constriction
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What are the s/s of LSHF?
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dyspnea, orthopenia, noctural dyspnea, fatigue, pain, anxiety, edema, rales and rhonchi
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What are the s/s of RSHF?
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peripheral edema, ascites, distended neck veins, diuresis at rest, may also include S/S of LSHF
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How do you diagnose CHF?
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clinical symptoms, chest xray, BNP level
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What is PE?
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really bad heart failure
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Describe PE
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fluid is forced into the alveoli due to increased pulmonary capillary pressure due to a decrease in CO
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What are the s/s of PE?
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restlessness/uneasiness, profound dyspnea, pallor, blood tinged secretions, wheezing, cyanosis, tachycardia
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What position would you place a PE pt. in?
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high fowlers
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Why would you be administering morphine to a PE pt.?
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1. decreases respiratory rate 2. decreases anxiety
3. act as a vasodilator to decr. preload and afterload |
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Where would you place a chest tube for a pt. with a pneumothorax?
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placed high
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where would you place a chest tube for a tp. with a hemothorax?
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placed low
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What do you do if a chest tube comes out?
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cover the opening and call the dr. immediately
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What are some of the causes of a PE?
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DVT of legs (most common), emboli of the pelvic vessels, atrial fibrillation, fat emboli, air emboli
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What are some of the risk factors for a PE?
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any condition that causes:
venous stasis, hypercoagulability, vascular wall damage |
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What conditions put your pt. at risk for a PE?
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Hx of previous DVT, prolonged immobility, recent surgery esp. gyn or ortho, obesity, CHF/MI, central venous cath. adv. age, cancer, smoking, stroke, trauma, hypercoagulability
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What are some s/s of a PE?
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dyspnea, tachypnea, tachycardia, pleuritic CP, hemoptysis, distended neck veins, syncope, hypotension, low grade fever, petechiae
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How is a PE diagnosed?
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pt. Hx, EKG and chest xray, Pulmonary angiography
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What is the most definitive test for a PE?
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pulmonary angiography
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What is D-dimer?
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blood test that tells you about coaguability. If elevated, usually a PE
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What will you be monitoring if your pt. is on coumadin?
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PT/INR
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What is an aneurysm?
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points of weakness, dilation or outpouching of an artery
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Where is an aneurysm most commonly found?
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in the aorta
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What are some of the causes of an aneurysm?
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atherosclerosis, cong. birth defects, trauma, infections, connective tissue disorders
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What are some of the risk factors for an aneurysm?
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smoking, hypertension, genetic predisposition
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What is a fusiform aneursym?
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uniform dilation all around the aorta
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What is a dissecting aneurysm?
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involves a separation or tear in between the layers of the blood vessel which can extend so that there is an acumulation of blood in this new cavity
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Which type of aneurysm do we worry about the most?
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dissecting
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What are the s/s of an aneurysm?
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they are asymptomatic. If they are leaking or ruptured than they may cause severe pain, signs of shock, decreased RBC, incr. WBC
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What is a AAA and what are its s/s?
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abdominal aotic aneurysm. palpable mass, systolic bruit, c/o abd. pain or back pain
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What is a TAA and what are its s/s?
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Thoracic aortic aneurysm, chest wall pain, back, flank, abd. pain, dyspnea, cough, wheezing
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What does your typical aneurysm pt. look like?
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male, over 60, mildly obese, sedentary, smoker, hypertension, CAD, DM
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What is the purpose for a central venous line?
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IV therapy for longer than 7 days, medication requiring central access for safe administration (dopamine), blood products rapid infusion, TPN
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What are some of the complications of a central venous line?
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bloodstream infection (BSI), septic thrombophlebitis, endocarditis, metastatic infection (arthritis), air emolism, occlusion
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What happens if the SA node stops functioning?
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The AV node takes over
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What does the U wave represent?
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the repolarization of the perkinjee fibers
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What does the T wave tell us?
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if the pt. has eschemia or infarction
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What does the P wave represent?
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atrial depolarization
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What does the PR interval represent?
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atrial depolarization and repolarization
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What does the QRS represent?
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ventricular depolarization
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What does the T wave represent?
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ventricular repolarization
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What should the PR interval normally be?
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.12- .20 seconds
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What is a normal QRS interval?
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should be no greater than 0.12 seconds
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Explain a normal sinus rhythm?
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its regular, the rate is 60 -100 bpm, P wave is normal and upright, PRI is .12-.20 sec. and constant, QRS is liess than .12sec
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What is pericarditis?
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inflammation of the sac of the pericardium whick may be chronic or acute
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What can cause pericarditis?
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infectious agents, trauma, radiation, malignancy, following an acute MI, autoimmune disorder, renal failure post pericardiotomy pts.
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What are s/s of pericarditis?
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pain, dyspnea, pericardial friction rub, temp, elevated WBC, symptoms of CHF, may also have atrial fib.
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What is pericardial effusion? How is it treated?
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buil up of fluid which restricts cardiac function, treated with pericardiocentesis/pericardial window
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What is cardiac tamponade?
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once a pt gets pericardial effusion and too much fluid builds up it becomes cardiac tamponade. Fluid that builds up in the pericardial sac that restricts ventricular filling
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What are some of the s/s of a cardiac tamponade?
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low cardiac output (low BP), distended neck veins (RSHF-fluid is backed up)decr. PMI, decr. heart sounds/pulse pressure, tachycardia
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What are some diagnostic tests for pericarditis?
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Echo, EKG, cardiac enzymes, CXR
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What are the nursing interventions for a pt. with ACUTE pericarditis?
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treat the underlying cause, antibiotics, NSAIDS, steroids, pain control, pericardial window/pericardiocentisis
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What are some nursing interventions for a pt. with CHRONIC pericarditis?
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pericardiectomy (removal of pericardial sac)
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What is myocarditis?
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inflammation of the myocardium
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What causes myocarditis?
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can be unknown, infection, drugs, chemicals, radiation, autoimmune/metabolic disorders, "crack heart"
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What are the s/s of myocaridits?
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flu-like symptoms, dyspnea, palpitations, chest pain over the pericardium with pericardial friction rub, CHF, syncope, pericardial effusion
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What is a true definative test for myocarditis? What is its accuracy rate?
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endomyocardial biopsy, only 40% accuracy rate.
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What is infective enocarditis?
|
infection of the endocardium in which the valves of the heart are most often affected but may involve any area of the endocardium
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Who is at risk for endocarditis?
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pt. with rheumatic valvular disease, CHD or DHD, immunosuppressed pts. IV drug abusers
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What are the s/s of endocarditis?
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fever/chills, fatigue, anemia, anorexia, weight loss, murmur, heart failure, petechiae, oslers nodes
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How is endocarditis treated?
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ID the infecting organism, antibiotic therapy, surgical valve replacement
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What is rheumatic fever?
|
a systemic inflammatory disease that can involve the heart, kidneys, CNS, skin and connective tissue
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What causes rheumatic fever?
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after untreated strep tonsillitis or strep throuat due to group A beta hemolytic strep
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What is rheumatic carditis?
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damage to the heart as a result of rheumatic fever
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What are the s/s of rheumatic carditis?
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tachycardia, cardiomegaly, murmur, pericardial friction rub, precordial pain, symptoms of heart failure, pos. for staph infection
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What are some tests used to diagnose RHD?
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ASO titer, ESR and C-reactive protein(tells about inflammation),CBC, ECHO, EKG
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What are some of the interventions used for RHD?
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support, large doses of aspirin, steroids, PCN
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What does the mitral valve do?
|
separates the left atrium from the left ventricle
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What does the aortic valve do?
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seperates the left ventricle from the aorta
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Define stenosis
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the orafice is restricted and forward blood flow is restricted
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define regurgitation
|
the valves fail to close properly and the blood is allowed to flow backwards
|
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When does mitral stenosis most often occur?
|
due to rheumatic fever
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What are pts. with mitral stenosis at risk for?
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development of atrial fibrillation
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What are the s/s of mitral stenosis?
|
CXR will show enlarged LA
symptoms of RSHF and LSHF |
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What are some interventions for a pt. with mitral stenosis?
|
digoxin (incr. force), diuretics (rem. excess fluid), beta blockers (decr. HR), Cal.channel blockers (decr. afterload), low sodium diet, try to convert atrial fib.
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What should all pts. with valve disease be on prior to any invasive procedure?
|
prophylactic antibiotics
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What are the causes of mitral regurgitation?
|
rheumatic heart disease, ruptured papillary muscle
|
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What are the s/s of mitral regurgitation?
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same as RSHF and LSHF
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What is mitral valve prolapse and what percentage of the population has it?
|
one or both of the leaflets may be floppy or prolapsed back into the atria during systole, 10% of pop. has this.
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What are the s/s of mitral valve prolapse?
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asymptomatic sometimes, atypical chest pain, palpitations, fatigue, dizziness, dyspnea, anxiety
|
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What are the s/s of aortic stenosis?
|
angina, syncope, dyspnea
|
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What are some later signs of aortic stenosis?
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fatigue, weakness, orthopnea (LSHF), PND (LSHF), peripheral edema (RSHF), JVD (RSHF), ascites (RSHF)
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How can you differentiate between an aortic regurgitation and an aortic stenosis?
|
an aortic stenosis has a harsh, rough, mid-systolic murmur while the aortic regurgitation presents a soft, blowing aortic diastolic murmur
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what are the signs of LSHF?
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nocturnal dyspnea, blood tinged sputum, exertional dyspnea, cyanosis, orthopnea, cough
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What are the signs of RSHF?
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fatigue, peripheral venous pressure, ascites, cyanosis, peripheral edema, anorexia and complaints of GI destress, distended jugular veins
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