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388 Cards in this Set
- Front
- Back
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5 types of loss
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necessary, actual perceived, maturational, situational
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necessary loss
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replaced by-better/different/expect loss to be recovered; can cause unbearable change in our security/safety; long term effects: our physical & psychological well being; death of a loved one, divorce, loss of independence
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actual loss
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person/object can no longer be felt, heard, known; ex: loss of body part, child, relationship, role at work; objects worn out, misplaced, stolen, ruined in disaster
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perceived loss
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loss uniquely defined by client; ex: confidence; easily overlooked and misunderstood
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maturational loss
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normal in development process; ex: child going to school first time
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mourning
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outward expression of loss
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bereavement
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includes grief and mourning; not linear; cannot be precisely predicted; may take years; does not proceed in sequential stages; does not get over the loss ( learns to live with it)
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theories of grief
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kubler-ross stages of dying
bowlbys phases of mourning wordens four tasks of mourning dual process model |
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kubler ross theory of grief
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denial, anger, bargaining, depression, acceptance
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bowlbys attachment theory
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numbing, yearning and searching, disorganization and despair, reorganization
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wordens four tasks of mourning
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accept reality, work through pain and grief, adjust to the environment, emotionally relocate and move on
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types of grief
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normal, anticipatory, complicated, disenfranchised
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normal grief
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normal feelings, behaviors, reactions to a loss
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anticipatory grief
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disengaging, letting go before actual death
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complicated grief
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trouble progressing through normal phases
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types of complicated grief
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chronic, delayed, exaggerated, masked
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chronic complicated grief
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active mourning,normal grief reactions that last a long time; cannot get past grief
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delayed complicated grief
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normal grief, suppressed or postponed
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exaggerated complicated grief
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overwhelmed with grief, cannot function,may reflect phobias, self destructive behavior
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masked complicated grief
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survivors not aware of that behavior
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disenfranchised grief
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loss experienced but cannot openly be acknowledged, socially sanctioned, or publicly shared
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factors influencing loss and grief
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human development, psychosocial, socioeconomic, personal relationships, nature of loss, culture and ethnicity, spiritual beliefs
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how does hope relate to grief and loss
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provides comfort, enhances coping, influences survival; as nurses we are to encourage hope, not deflate or make promises we cannot keep
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we must support patients in ___________ their grief not _____________ it
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expressing; repressing
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things to implement with terminal patients
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health promotion, therapeutic communication, demonstrate caring behavior, provide information, promote hope, faciliate mourning
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what are the goals of palliative care
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comfort, symptom relief, maintain dignity/self esteem, support
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list some goals of the palliative care nurse
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establish caring relationship with patient and family; provide appropriate symptom control measures; prevent abandonment and isolation; maintain patient dignity and self esteem; comfortable, peaceful environment at death
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how can we provide support for a grieving family
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educate on disease process; encourage them to express their grief openly to patient; inform them of outside resources; allow them to share their concerns with you; assist them with decision making
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what are the general requirements, goals and services of hospice
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less than 6 months to live; family centered, physician directed, control of symptoms, nursing services, bereavement follow up, trained volunteers
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list some indications of impending death
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change in vital signs; irregular or thready heart rate; bp decrease; change in respiratory pattern; cheyne-stokes (periodic breathing, periods of apnea), death rattle (acute pulmonary edema, crackles); LOC; hearing is last sense to disappear; eyes may remain open
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who provides postmortem care in the hospital
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nurse/aides
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who pronounces death
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physician or designee
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4 fundamental things nurses should remember after a patient death
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faith, love, memory, one another
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ways for nurses to cope with patient death
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attend viewing or funeral, send letter of sympathy to the family
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five stages of grief
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denial, anger, bargaining, depression, acceptance
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list the differences between grief and depression
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grief = identifiable loss, focus is on the loss, fluctuating ability to feel pleasure, variable physical symptoms, closeness of others is usually reassuring, fluctuating emotions; depression = loss may or may not be identifiable, focus is on self, inability to feel pleasure, persistent self destructive response, persistent isolation from others and self, fixed emotions
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list the components of spiritual health
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spirituality, well being, faith, religion, hope
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spiritual distress
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impaired ability to experience and integrate meaning and purpose in life through connectedness with self, others, art, music, literature, nature, and/or power greater than oneself
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according to our caring lecture, what are the most important things for beginning nurses to know
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client is more than their data; bonding; success is in the relationship established; leads to a working phase where client and nurse are involved in patients care and client will accept help as needed
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what is caring
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universal concept; influences way people think, feel and behave in relation to one another;
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list the theories of caring
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benner and wrubel=caring is primary; leininger=transcultural caring; watson=transpersonal caring; swanson=theory of caring
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benner and wrubel-caring is primary
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people matter; specific and relational for each encounter; describes essence of excellent nursing care
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leininger-transcultural caring
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caring is universal; varies among cultures; essential human need
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watson-transpersonal caring
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promotes healing and wholeness; rejects disease orientation to healthcare; places care before cure; emphasizes nurse client relationship
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swanson-theory of caring
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defines caring as a nurturing way of relating to a valued other, toward whom one feels a personal sense of commitment and responsibility; mutal give and take;
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swansons 5 dimensions of caring
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knowing; being with; doing for; enabling; maintaining belief
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how to express caring in nursing
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presence, touch, listening, knowing, competence, spiritual caring, family caring, doing the little things/extra mile
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Zones of personal space
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public > 12 feet
social 4-12 feet personal 18 inches to 4 feet intimate up to 18 inches |
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zones of touch
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social-permission not needed-hands, arms, shoulders, back; consent-permission needed-mouth, wrists, feet; vulnerable-special care needed-face, neck, front of body; intimate-great sensitivity needed-genitalia, rectum
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define pain
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complex phenomenon composed of sensory experiences and emotion, cognition and motivation; is what the patient says it is
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swansons 5 dimensions of caring
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knowing; being with; doing for; enabling; maintaining belief
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pain managment needs to include _______ and needs to be _________
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client's quality of life; systematic
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how to express caring in nursing
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presence, touch, listening, knowing, competence, spiritual caring, family caring, doing the little things/extra mile
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describe the nature of pain
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involves physical, emotional and cognitive components; physical and/or mental stimulus; is exhausting and demands energy; interferes with relationship
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swansons 5 dimensions of caring
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knowing; being with; doing for; enabling; maintaining belief
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types of pain
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acute/transient; chronic/persistent; chronic episodic; cancer; inferred physiological; idiopathic
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Zones of personal space
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public > 12 feet
social 4-12 feet personal 18 inches to 4 feet intimate up to 18 inches |
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how to express caring in nursing
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presence, touch, listening, knowing, competence, spiritual caring, family caring, doing the little things/extra mile
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acute/transient pain
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protective, identifiable, short duration
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zones of touch
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social-permission not needed-hands, arms, shoulders, back; consent-permission needed-mouth, wrists, feet; vulnerable-special care needed-face, neck, front of body; intimate-great sensitivity needed-genitalia, rectum
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Zones of personal space
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public > 12 feet
social 4-12 feet personal 18 inches to 4 feet intimate up to 18 inches |
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define pain
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complex phenomenon composed of sensory experiences and emotion, cognition and motivation; is what the patient says it is
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chronic/persistent
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is not productive and has no purpose or may not have identifiable cause
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zones of touch
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social-permission not needed-hands, arms, shoulders, back; consent-permission needed-mouth, wrists, feet; vulnerable-special care needed-face, neck, front of body; intimate-great sensitivity needed-genitalia, rectum
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pain managment needs to include _______ and needs to be _________
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client's quality of life; systematic
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define pain
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complex phenomenon composed of sensory experiences and emotion, cognition and motivation; is what the patient says it is
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describe the nature of pain
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involves physical, emotional and cognitive components; physical and/or mental stimulus; is exhausting and demands energy; interferes with relationship
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pain managment needs to include _______ and needs to be _________
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client's quality of life; systematic
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types of pain
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acute/transient; chronic/persistent; chronic episodic; cancer; inferred physiological; idiopathic
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describe the nature of pain
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involves physical, emotional and cognitive components; physical and/or mental stimulus; is exhausting and demands energy; interferes with relationship
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acute/transient pain
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protective, identifiable, short duration
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chronic/persistent
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is not productive and has no purpose or may not have identifiable cause
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types of pain
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acute/transient; chronic/persistent; chronic episodic; cancer; inferred physiological; idiopathic
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acute/transient pain
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protective, identifiable, short duration
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chronic/persistent
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is not productive and has no purpose or may not have identifiable cause
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chronic episodic pain
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occurs sporadically over an extended duration
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cancer pain
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can be acute or chronic
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inferred physiological
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musculoskeletal, visceral or neuropathic
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idiopathic
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chronic pain without an identifiable physical of psychological cause
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effects of pain
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sleep deprivation; chronic=depression, increased disability, suppression of immune function; acute=can affect respiratory, cardiovascular, endocrine and immune systems; stress response increases metabolic rate and cardiac output, and increases risk for physiologic disorders
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transduction
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Thermal, chemical, or mechanical stimuli usually cause pain. The energy of these stimuli is converted to electrical energy. This energy conversion is transduction. Transduction begins in the periphery when a pain-producing stimulus sends an impulse across a sensory peripheral pain nerve fiber (nociceptor), initiating an action potential
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transmission
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Cellular damage caused by thermal, mechanical, or chemical stimuli results in the release of excitatory neurotransmitters such as prostaglandins, bradykinin, potassium, histamine, and substance P (Box 43-1). These pain-sensitizing substances surround the pain fibers in the extracellular fluid, spreading the pain message and causing an inflammatory response (Renn and Dorsey, 2005). The pain fiber enters the spinal cord via the dorsal horn and travels one of several routes until ending within the gray matter of the spinal cord. At the dorsal horn substance P is released, causing a synaptic transmission from the afferent (sensory) peripheral nerve to spinothalamic tract nerves, which cross to the opposite side
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perception
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the point at which a person is aware of pain
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modulation
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Once the brain perceives pain, there is a release of inhibitory neurotransmitters such as endogenous opioids (endorphins and enkephalins), serotonin (5HT), norepinephrine, and gamma aminobutyric acid (GABA), which work to hinder the transmission of pain and help produce an analgesic effect. This inhibition of the pain impulse is the fourth phase of the nociceptive process known as modulation.
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portions of the nervous system responsible for sensation and perception of pain
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afferent pathways = composed of nociceptors (pain receptors)
efferent pathways = responsible for modulating pain sensation |
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neurotransmittors are _____ and consist of ___
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excitatory; substance P, serotonin, prostaglandins, bradykinin
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neuromodulators are _____
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inhibitory
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role of CNS in pain
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interprets pain signals; helps in discrimination and localization of pain; activates coping responses such as fight or flight, release of corticosteroids, cardiovascular response; modulates spinal pain transmision
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gate control theory
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pain impulses are transmitted from specialized skin receptors that act as a gate, opening and closing the afferent pathways to the transmission of painful stimuli
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pain threshold
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point at which pain is perceived; patient feels and reports pain; mainly biological but may be influenced by social and emotional factors
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pain tolerance
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ability to endure intensity of pain; expression or behavior; more psychological and social
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categories of pain
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somatic, visceral, neuropathic, psychogenic
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somatic pain
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skin, bone and connective tissue; localized, constant ache; acute: incisions, muscle spasms
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visceral pain
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organs and body cavity lining; diffuse, deep, cramp; acute: intestine and chest;
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portions of the nervous system responsible for sensation and perception of pain
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afferent pathways = composed of nociceptors (pain receptors)
efferent pathways = responsible for modulating pain sensation |
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neurotransmittors are _____ and consist of ___
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excitatory; substance P, serotonin, prostaglandins, bradykinin
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neuromodulators are _____
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inhibitory
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role of CNS in pain
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interprets pain signals; helps in discrimination and localization of pain; activates coping responses such as fight or flight, release of corticosteroids, cardiovascular response; modulates spinal pain transmision
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gate control theory
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pain impulses are transmitted from specialized skin receptors that act as a gate, opening and closing the afferent pathways to the transmission of painful stimuli
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pain threshold
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point at which pain is perceived; patient feels and reports pain; mainly biological but may be influenced by social and emotional factors
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pain tolerance
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ability to endure intensity of pain; expression or behavior; more psychological and social
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categories of pain
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somatic, visceral, neuropathic, psychogenic
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somatic pain
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skin, bone and connective tissue; localized, constant ache; acute: incisions, muscle spasms
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visceral pain
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organs and body cavity lining; diffuse, deep, cramp; acute: intestine and chest;
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neuropathic pain
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nerves, cns; injury to cns structure; poor localization, shocks, sharp, numb; acute: phantom pain, nerve compression
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psychogenic pain
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no known physical cause; not imaginary and may be just as intense and distressing as somatogenic pain
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things to assess in pain management
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location, quality, relief measures, effect of pain, influence on ADLs
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PQRST pain assessment
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P-what provokes the pain and palliative measures
Q-quality of pain R-region and radiation of pain S-severity and setting T-timing |
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first line of cancer pain treatment
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acetaminophen, aspirin/NSAIDS = adjuvants
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second line of cancer pain treatment or pain out of control
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opioids-sustained release, immediate release; NSAIDS; adjuvants
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refractory cancer pain treatment
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spinal/epidural; opioids-clonidine, local anesthetic; selective nerve blocks; neuroblative procedures; ketamine; total sedation
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ethics
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philosophical ideals of right and wrong behavior
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ethical
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in conformity with moral norms or standards of professional conduct
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sources of ethical standards
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utilitarian, rights approach, fairness or justice, common good, virtue
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utilitarian ethical standard
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most good, least harm; deals with consequences of decision
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rights approach ethical standard
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best protects and respects moral rights of those affected; begins with idea of human dignity and freedom of choice
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fairness or justice ethical standard
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all equals treated equally; based on some standard that is defensible
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common good ethical standard
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best for community/society; basis for many laws; protection of public is more important than individual member's rights
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virtue ethical standard
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actions consistent with certain ideal virtues; decisions directed at maintaining or attaining ideal virtues
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autonomy
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knowledge and freedom to decide what medical treatment patient wishes to pursue
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beneficence
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duty to do good and actively promote benevolence; includes non malfeasance (duty not to inflict harm as well as to prevent or remove harm)
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nonmaleficence
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not to cause harm; prevent harm, remove harm
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confidentiality
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active respect for and pursuance of protection for indiviual privacy; hippa
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double effect
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some actions can be morally justified even though consequences may be a mixture of good and evil; must meet 4 criteria
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4 criteria of double effect
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action itself is morally good or neutral; agent intends the good effect and not the evil; good is not achieved by the evil; there is no favorable balance of good over evil
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fidelity
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duty to be faithful to one's commitments, implicit and explicit
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justice
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cases should be treated alike; triage is exception
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paternalism
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intentional limits on another's autonomy; justified by appeal to beneficence or welfare of needs of another; prevention of evil/harm
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respect for persons
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closely tied to autonomy; promotes individuals' ability to make autonomous choices
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sanctity of life
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life is the highest good
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veracity
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obligation to tell the truth and not to lie or deceive others
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who governs nursing code of ethics
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ANA
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4 fundamental responsibilities of nurses according to ICN Code of Ethics
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promote health, prevent illness, restore health, alleviate suffering
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who regulates nursing in texas
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Texas Board of Nursing; administers Nurse Practice Act
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who obtains informed consents
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physician/practitioner
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euthanasia
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intentional termination of life
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active euthanasia
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acting to purposely cause a person's death
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passive euthanasia
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hastening of death by altering some form of support
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terminal sedation
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used in dying patients to relieve suffering
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assisted suicide
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patient actively seeks physician/nurse to help them commit suicide; illegal in all but oregon, washington and montana
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flags of ethical dilemmas
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action or situation involves actual or potential harm to someone or something; a possibility of a violation of what we consider right or good; is this issue about more than what is legal or what is most efficient?
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skeletal system is composed of what types of bones
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long, short, flat, irregular
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functions of the skeletal system
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protection, calcium regulation, red blood cell production and reservoir
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joints
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connections between bones
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four types of joints
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synostatic, cartilaginous, fibrous, synovial
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synostatic joint
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bone joined by bone; no movement but bony tissue bw the two gives strength and stability
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cartilaginous joint
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when joint is complete it ossifies; sternocostal joint
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fibrous joint
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ligament or membrane united to bony surface; limited amount of movement; ligaments are flexible and stretch
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synovial joint
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ball and socket joints; interphalanged (fingers)
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ligaments
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white shiny flexible bands of fibrous tissue; bind joints together; connect bones and cartilage; protective function; aids in joint flexibility and support
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tendons
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white fibrous bands that connect muscle to bone; very strong, thick; flexible or inflexible
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longest tendon in the body
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achilles
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cartilage
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nonvascular; supports connective tissue; usually flexible but can ossify with age; found in joints, trachea, ear, nose
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eccentric muscle tension
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controls speed of movement
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concentric muscle tension
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contraction, muscle tension, resulting movement (isotonic contractions)
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isometric muscle tension
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increase in muscle tension; no shortening or active movement in muscle
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benefits of exercise to mobility
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maintains joint mobility and function
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types of exercise
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active = isotonic, isometric, resistive
range of motion=active, passive |
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observe body alignment when
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assess standing, sitting or lying while patient is unaware
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comatose patients should be placed in _____ position for body alignment assessment
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supine
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conscious bedfast patients should be placed in _____ position for body alignment assessment
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lateral (observe from foot of bed)
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therapeutic effects of bed rest
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reduces physical activity and o2 consumption; reduce pain; allow ill or debilitated patient to rest; allows for uninterrupted rest
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immobility causes muscular deconditioning at a rate of _____ per day
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3%
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atrophy
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tendency of cells to decrease in size and function
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metabolic changes of immobility
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disrupts normal metabolic functions, acid/base balance, fluid and electrolyte balance, decreases appetite, slows down peristalsis promoting constipation
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respiratory changes of immobility
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atelactasis, hypostatic pneumonia, decreased vital capacity
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assess respiratory every _____ with immobile patients
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2 hours
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interventions for prevention of respiratory side effects of immobility
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change position, TCDB, respiratory therapy, maintain patent airway
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cardiovascular changes of immobility
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orthostatic hypotension; thrombus
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muscular effects of immobility
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increased fatigue, atrophy
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skeletal effects of immobility
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impaired calcium metabolism, joint abnormalities
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urinary elimination changes of immobility
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urinary stasis, renal calculi, urinary catheterization; urinary output decreases 5-6 days after immobilization
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integumentary changes of immobility
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pressure ulcers
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psychosocial and developmental changes of immobility
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depression, sleep interruption, lack of socialization, dependence, lack of mental and physical stimulation
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normal values for WBC
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5000-10000 per cu mm
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normal values for sodium
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136-145 mEq/L
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normal values for potassium
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3.5-5.5 mEq/L
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normal values for calcium
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8.5-10.5 mg/dl
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hematocrit description and values
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what % of blood is RBCs; normal = 40%
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hemoglobin normal values and types of hemoglobin
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12-16 gms (Women)
13-18 (men) Hgb A = adult Hgb F= fetal Hgb S = sickle cell |
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which systems regulate the acid base balance
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lungs (h2co3 --> <--- co2 + h2o --> co2 exhaled, respiratory-carbonic acid)
kidneys=regulate H+ and/or HCO3-, metabolic-bicarbonate) |
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1 unit of PRBC should increase Hct _____ or Hbg by _____
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2-3%; 1
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electroencephalogram
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graphic recording of electrical activity of the brain used to identify and evaluate patients with seizures, detect pathologic conditions of brain cortex and confirm brain death
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bronchoscopy
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permits endoscopic visualization of the larynx, trachea and bronchi by either flexible fiberoptic bronchoscope or a riged bronchoscope to look for abnormalities, biopsy, aspiration of specimens, control of bleeding, removal of foreign bodies, brachytherapy, palliative laser obliteration
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colonoscopy
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allows for direct visualization of the rectum, colon and small bowel
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esophagogastroduodenoscopy
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allows direct visualization of the upper GI tract by means of a long flexible fiberoptic lighted scope
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chest xray
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most commonly obtained xray study because it can indicate so much information about heart, lungs, bony thorax, mediastinum and great vessels
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computed tomography abdomen
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used in evaluating abdominal organs; radiographic procedure used to diagnose pathologic conditions
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magnetic resonance imaging
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noninvasive diagnostic technique that provides valuable information about body's anatomy; does not require exposure to ionizing radiation
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culture
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thoughts, communications, actions, customs, beliefs, values, and institutions of racial, ethnic, religious, or social groups
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ethnicity
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a shared identity related to social and cultural heritage such as values, language, geographical space, and racial characteristics; feel a common sense of identity
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race
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limited to common biological attributes shared by a group such as skin color or blood type
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emic
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inside or native perspective
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etic
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an outsider's perspective
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enculturation
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socialization into one's primary culture as a child
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acculturation
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process of adapting to and adopting a new culture
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assimilation
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when an individual gradually adopts and incorporates the characteristics of the dominanat culture
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transcultural nursing
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comparative study of cultures to understand similarities and differences across human groups
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culturally congruent care
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care that fits the person's valued life patterns and set of meanings; patterns and meanings are generated from people themselves, rather than from predetermined criteria; sometimes different from the values and meanings of the healthcare system
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culturally competent care
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ability of a nurse to bridge cultural gaps in caring, work with cultural differences, and enable clients and families to achive meaningful and supportive caring; cultural competence is the synthesis of all three levels
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5 parts of culturally competent care
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awareness, skill, knowledge, encounters, desire (ASKED)
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cultural assessment
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systematic and comprehensive examination of the cultural care values, beliefts and practices of individuals, families and communities
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assessment of the musculoskeletal system
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overall appearance, posture, gait and mobility, bone integrity, muscle strength and tone, joint size and mobility, pain, neurovascular status
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assess gait and mobility from _____
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behind
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kyphosis
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increased forward curvature of spine
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lordosis
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sway back; common in pregnant and obese
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scoliosis
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lateral deviation of the spine
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crepitus
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grating sound at the point of abnormal motion
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clonus
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rhythmic contraction of muscle or muscle groups
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3 things to evaluate during neurovascular assessment
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circulation, motion, sensation
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compartment syndrome
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major neurovascular problem caused by pressure within muscle compartment due to swelling from crushing injury
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symptoms of compartment syndrome
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pain, numbness, tingling, loss of movement
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treatment of compartment syndrome
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surgery
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degenerative joint disease
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aka osteoarthritis; most common joint disease
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contracture
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abnormal shortening of the muscle or joint; leading cause is immobility
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effusion
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excessive joint fluid escapes into the body cavity
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symptoms of effusion
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warm and inflamed
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most common site of effusion
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knee
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range of motion
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maximum amount of movement available to a joint; measured in degrees
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flexion
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bending of the joint
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extension
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straightening of the joint
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hyperextension
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movement beyond normal alignment of a joint
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abduction
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moving away from midline
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adduction
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moving toward the midline
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rotation
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turning around a specific axis
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circumduction
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cone like movement
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suppination
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turning upwards
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pronation
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turning downward
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inversion
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turning inward
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eversion
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turning outward
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osteoporosis
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abnormal loss which leaves bone thin
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bone xrays determine _____
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bone density, erosion, texture and changes
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CT scans detect _____
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tumors of soft tissues or ligament and tendon injuries
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arthrography
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identifies acute or chronic tears of joint capsule or ligaments; dyes leak out of joint if tear is present
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bone density scan
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done through xrays or ultrasounds; determines bone mineral density of hip, wrist or spine to estimate the extent of osteoporosis
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thyroid function can evaluate bone _____
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metabolism
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elevated alkaline phosphates can indicate what in relation to the musculoskeletal system
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early fracture healing and metastatic disease
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casting provides _____ of fracture but permits _____ of patient
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immobilization; movement
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types of casting
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short extremity, long extremity, walking cast, body cast, spica
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to reduce swelling related to edema....
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elevate to heart level and use ice
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most pain (of bone breaks) is relieved through _____
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immobilization, elevation to heart level, cold application and usual doses of analgesics
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external fixators are used with what type of fractures
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comminuted
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purpose of skin traction
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control muscle spasm or immobilize area
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skeletal traction is applied _____ and used with ______ fractures
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directly to the bone; femur, tibia, humerus and capine
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complications of traction
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skin breakdown, pneumonia, nerve pressure, circulatory impairment, DVT, urinary stasis and infection
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how many mL of wound drainage are expected in the first 24 hours and how many after that?
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200-500 mL in first 24 hours; by 48 hours 30 mL or less in 8 hours
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potential complications of total hip patient
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dislocation of hip prosthesis; excessive wound drainage, thromboembolism, infection, avascular necrosis, loosening of prosthesis
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never flex hip more than _____ with total hip patient
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90
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do not elevate head of bed more than _____ with total hip patient
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60
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things to avoid with total hip patient
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internal or external rotation, hyperextension and acute flexion; do not cross legs; hips should not be lower than knees
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second leading cause of medical visits
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musculoskeletal disorders
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treat bursitis and tendonitis with _____
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NSAIDS, ice, heat
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loose bodies
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when articular cartilage wears and bone erodes, released into join
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carpal tunnel syndrome
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caused by entrapment of the nerves, usually the median, as they pass through the carpal tunnel at the wrist; caused be repetitive motions, hypothyroidism, pregnancy, arthritis
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hallux valgus
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bunion, deformity of great toe, deviates laterally, caused by heredity, narrow shoes, aging; special shoes, steroid injection or corrective surgery to treat
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morton's neuroma
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swelling of lateral branch of median plantar nerve
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most common sites affected by metastatic bone disease
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skull, spine, pelvis, femur, humerus, polyostatic
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osteomyelitis
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bone infection
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three modes of infection of osteomyelitis
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extension of soft tissue infection, direct bone contamination, hematogenesis
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this causes 70-80% of osteomyelitis infections
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staph aureus
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most common malignant bone tumor
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osteosarcoma
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benign bone tumors
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osteochondroma, bone cysts, giant cell tumors (osteoclastoma)
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malignant bone tumors
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sarcoma, myeloma, osteosarcoma
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bone tumors are usually
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secondary
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most common primary tumor sites when a patient has a secondary bone tumor
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kidney, prostate, lung, breast, thyroid, ovary
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contusions
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injury from a blow from a blunt object; subsurface tissue is injured but skin is not broken; many small vessels rupture and bleed into tissue (bruise); aka ecchymosis
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strain
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to stretch beyond proper point or limit with microscopic muscle tears with some bleeding into the tissue; caused by overuse, overstretching or excessive stress (tendon)
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avulsion
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bone fragment pulled away by ligament or tendon
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sprain is caused by
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wrenching or twisting motion (ligament)
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RICE treatment for strains/sprains
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rest, ice, compression, elevation
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subluxation
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partial dislocation; bones are slipped apart
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lateral and medial collateral ligaments of the knee
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provide stability at sides of knee; injured when knee is struck from side
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anterior and posterior cruciate ligaments of knee
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stabilize forward and backward movement; injured when knee struck from front or back
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meniscal injuries/cartilage injuries of knee
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cushions contact between tibia and femur; injured when knee is twisted
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symptoms of fractures
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pain, loss of function, deformity, crepitus, swelling and discoloration
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fracture complications
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shock, fat embolism, compartment syndrome, delayed union, nonunion, avascular necrosis, complex regional pain syndrome
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causes of amputation
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PVD, gangrene, trauma, deformities, chronic osteomyelitis, malignant tumors
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types of amputations
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syme's amputation, BKA, AKA, hip disarticulation, upper extremity amputation, staged amputation
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complications of amputation
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hemorrhage, infection, skin breakdown, phantom limb pain
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how much does the heart weigh
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less than 1#, about fist size
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systole
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blood ejected from chambers, approximately 70mL of blood per beat
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diastole
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chambers refill with blood
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list the layers of the heart from inner to outer
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endocardium, myocardium, epicardium
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pericardium
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thin fibrous sac encasing the heart and root of great vessels
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layers of the pericardium
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visceral, parietal
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which layer of the pericardium is closest to the heart
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visceral
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when are the coronary arteries perfused
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during diastole
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automaticity
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ability to generate electrical impulse automatically
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conductivity
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ability to pass impuse to next cells
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conductivity
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ability to pass impulse to next cells
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contractility
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ability to shorten the fibers in the heart while receiving the impulse
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positive intropic effects of contractility _____ the force of muscle contraction
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strengthen
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negative inotropic effects of contractility _____ the force of muscle contraction
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weaken
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what is the pacemaker of the heart
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sinoatrial node
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av node
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slows conduction between atria and ventricles
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bundle of his
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travels thru to purkinje fibers
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purkinje fibers
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causes venticles to contract
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ventricle function related to conduction
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generate impulse in event of failure of other two nodes
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cardiac action potential
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response of myocardium to electrical impulse
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depolarization
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contraction/shortening; Na enters cell, K+ exits cell, Ca+ enters
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repolarization
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relaxation/lengthening
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absolute refractory periods
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regardless of strength of impulse, will not contract
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relative refractory periods
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may contract IF pulse is strong enough
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what is the purpose of the refractory period
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protect heart; keep from sustained contraction
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list teh mechanical events of the cardiac cycle
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systole (av valves close, s1 contraction, rapid increase pressure, semilunar valves open), diastole (semilunar valves close, S2), atrial kick (little bit of blood that is left before the ventricles contract)
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cardiac output
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stoke volume times the heart rate; 4-8 liters per minute
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stroke volume
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amount of blood ejected per heart beat
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cardiac index
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cardiac output divided by body mass index; adjusts for body size
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cardiac capacity
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approx 70 mL in resting state
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preload
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end diastolic volume, stretching of muscle fibers, starlings law
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starlings law
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the greater the stretch of the heart muscle the more forcefully they contract
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how to increase preload
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the greater the preload the greater the cardiac output and increased stroke volume; vasoconstrictors increase preload
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how to decrease preload
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diuresis, vasodilators, loss of blood or other body fluids
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how is afterload increased
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vasodilation
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how is afterload decreased
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vasoconstrictors/vessel disease
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afterload is directly related to
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systemic vascular resistance
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increased contractility results in increased
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stroke volume, sns
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which meds increase contractility
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digoxin, dopamine, dobutamine
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how is contractility decreased
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hypoxemia, acidosis, certain meds
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which med decreases contractility
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beta blockers
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ejection fraction
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total ventricular filling volume; normal is 65%
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where are baroreceptors located
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aortic arch and carotid arteries
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function of baroreceptors
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control of heart rate; sensitive to changes in bp; with elevated bp, transmit impulses to medulla, stimulates PNS and results in lower HR and BP; which low bp, there is less baroreceptor stimulation which increases SNS which equals vasoconstriction, resulting in increased HR and BP
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where are chemoreceptors located in the vascular system
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aortic arch and carotid body
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function of chemoreceptors in vascular system
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increase in heart rate; responsive to decreased arterial 02 pressure (hypoxia), increased arterial co2 pressure (hypercapnia) and pH of the blood (decreased)
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list 3 layers of blood vessel from inner to outer
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tunica intima, tunica medica, tunica externa or adventitia
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smaller vessel radius = _____ pressure
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greater
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bruit
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turbulent blood flow
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mechanism of action for digoxin
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increases force and velocity of myocardial contraction, resulting in positive inotropic effects, produces antiarrhythmic effects by decreasing the conduction rate and increasing the effective refractory period of the AV node
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gender differences for women during cardiovascular assessment
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smaller heart and arteries, increased risk of occlusions, hemodynamics are increased, effects of estrogen
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s/s of acs/mi in women
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shoulder and upper back pain, SOB and extreme fatigue, epigastric pain; prodromal= unusual fatigue, sleep disturbances, SOB; acute= SOB, weakness, fatigue
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blood pressure
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cardiac output X SVR; determined in part by cardiac output, SVR, blood volume, elasticity of arterial wall
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SVR
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systemic vascular resistance
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pulse qualities
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0-absent
1+-weak, thready, difficult to palpate 2+-normal pulse 3+-slightly increased, full pulse 4+-strong bounding, can't be obliterated |
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which pulse assessment is an estimate of right heart function
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jugular venous pulsation
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where is s1 heard
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best at apical or mitral area
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where is s2 heard
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best at aortic area
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assessment sites for heart
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aortic, pulmonic, tricuspid, mitral, epigastric
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p wave represents
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atrial depolarization
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qrs complex represents
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ventricular depolarization
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t wave represents
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ventricular repolarization
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five phases of cardiac action potential
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0=upstroke or rapid depolarization, initiates heartbeat
1=early rapid repolarization 2=plateau 3=final rapid repolarization 4=resting membrane potential; diastolic depolarization |
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hypertension is defined as systolic bp > or diastolic bp >
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systolic > 140mm/hg
diastolic > 90 hg |
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primary hypertension
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etiology unknown, unidentified cause; previoiusly as essential hypertension; 90% to 95% of clients with HTN have primary hypertension
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secondary hypertension
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cause is known, related to underlying pathology or condition such as: chronic renal disease, oral contraceptives induced, primary aldosteronism, pheochromocytoma, thyroid or parathyroid disease, coarctation of the aorta, renovascular disease, cushings syndrome, sleep apnea
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vascular resistance is determined by
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arterioles; diameter changes in response to stimuli, SNS, circulating epinephrine and norepinephrine (from the adrenal cortex), RAA, atrial natriuretic peptide and brain natriuretic peptide, adrenomedullin, vasopressin, vessel compliance
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factors affecting blood pressure
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stress, obesity, diet, kidney, age, alcohol consumption, heritable component
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risk factors for heart disease
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htn with: smoking, diabetes, dyslipidemia, kidney disease, obesity, physical inactivity, age, family history of heart disease
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prolonged or uncontrolled HTN leads to
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heart disease, stroke, chronic kidney disease, peripheral artery disease, retinopathy
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hypertensive crisis
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extremely elevated bp (>180/20) and must be lowered to prevent or halt organ damage
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functions of the vascular system
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supplies oxygen to tissues; supplies nourishment to tissue; removes waste from tissues
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arteries
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carry oxygenated blood
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veins
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carry deoxygenated blood
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lymphatic vessels
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collects lymphatic fluid from vessels and transports to venous circulation
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right lymphatic duct
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right side of head, neck, thorax and upper rms
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thoracic duct
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rest of body
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regional lymph nodes
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lymph passes thru regional nodes before entering venous system
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cellulitis cause
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infectious process; bacteria enter skin via open entry area and bacteria release toxins
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s/s of cellulitis
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swelling, localized redness, pain, fever, chills, sweating
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lymphedema
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condition of the lymphatic system where lymph does not drain into the venous circulation, but collects in tissues
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stages of lymphedema
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0=subclinical
1=tissue soft and pitting edema present; decreases with elevation 2=tissue firmer (less pitting), does not decrease with elevation 3=gross enlargement and misshapen; skin breakdown and infection may result |
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elephantiasis
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occurs after chronic lymphedema
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lymphangitis
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acute inflammation of lymphatic channels
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lymphadenitis
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acute or suppurative
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list 4 common venous disorders
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venous thrombosis=aggregates of platelets
deep vein thrombosis=found in deep veins thrombophlebitis=inflammation of vein wall phlebothrombosis=thrombus without inflammation |
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virchow's triad
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three factors that promote venous thrombosis; stasis of blood, vessel wall injury, altered blood coagulation
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phlegmasia cerulea dolens
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involves entire extremity; massive swelling, tense, painful, cool; massive iliofemoral venous thrombus
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best option for dvt treatment
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prevention
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ways to prevent dvt
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elastic compression, intermittent pneumatic compression devices, positioning, exercise, mobilization
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chronic venous insufficiency
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obstruction of venous valves; reflux r/t incompetent valves; pain, aching, heaviness; postthrobotic syndrome=chronic venous stasis with edema, pain, altered pigmentation, stasis dermatitis
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venous stasis ulcers
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approx 75% are from venous insufficiency; open inflamed sore develops secondary to poor venous return, results in necrosis; large, superficial, and exudative, usually at medial or lateral malleolus
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varicose veins
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dilated, tortuous superficial veins due to incompetent valves; treatment is ligation, thermal ablation and sclerotherapy
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arteriosclerosis
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hardening of arteries
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atherosclerosis
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plaque or atheromas
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peripheral arterial occlusive disease
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arterial insufficiency
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raynauds disease
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arterial vasoconstriction in digits
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most common disease of arteries
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arteriosclerosis
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patho of arteriosclerosis
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muscle fibers and endothelial lining of arteries become thick; not isolated to singe vessel, diffuse throughout body; occurs with atherosclerosis; plaque builds up in lumen causing decreased diameter thru which blood can flow
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signs and symptoms of atherosclerosis
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intermittent claudication, labs, TIAs, stroke
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risk factors for atherosclerosis
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nicotine, diet, HTN, control of diabetes, obesity, stress, sedentary lifestyle, elevated c reactive protein, hyperhomocysteinemia, age, gender, genetics
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complications from atherosclerosis
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atheroma, hemorrhage, ulceration, calcification, thrombosis (may result in myocardial infarction, stroke and gangrene)
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atheroma
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plaque mass on arterial wall
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peripheral artery disease
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peripheral arterial insufficiency of the extremities
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s/s of PAD
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claudication pain, resting pain in forefoot, pallow, rubor, cyanosis, weak or absent peripheral pulses, altered skin integrity
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patho of arterial ulcers
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caused by ischemia and pressure
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appearance of arterial ulcers
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small deep circular; usually on toe tips or web spaces of toes
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patho of raynauds disease
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vasoconstriction leads to cyanosis as deoxygenated blood pools in affected digit; when vasospasm stops blood returns rapidly; white to blue to red; bilateral and symmetric
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treatment of raynauds
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minimize exposure to cold, stop smoking, pharmacological intervention, sympathectomy
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