Med-Surg 2 Exam 1

Front 1

Describe a patient who is fully conscious

Back 1

A&O x4. Comprehends spoken & written words

Front 2

Describe a pt who is confused

Back 2

Unable to think rapidly & clearly, easily bewildered, poor memory, short attention span, misinterprets stimuli, impaired judgement

Front 3

Describe a pt who is disoriented

Back 3

Not aware of or not oriented to time, place or person

Front 4

What is the term for a pt who is not aware of or not oriented to time, place or person?

Back 4

Disoriented

Front 5

What is the term for a pt who is unable to think clearly, misinterprets stimuli, & has impaired judgment?

Back 5

Confused

Front 6

What is the term for a pt who is A&OX4 and comprehends spoken & written words?

Back 6

Fully conscious

Front 7

What is the term for a pt who is lethargic, responsive to verbal or tactile stimuli but quickly drifts back to sleep?

Back 7

Obtundation

Front 8

What does obtundation mean?

Back 8

Pt is lethargic, responsive to verbal or tactile stimuli but quickly drifts back to sleep

Front 9

What is typical assessment of a pt in a stupor?

Back 9

Generally unresponsive, briefly aroused by vigorous, repeated or painful stimuli, may shrink away from or grab @ source of stimuli

Front 10

What is the term for a pt who is generally unresponsive but may be briefly aroused by vigorous, repeated or painful stimuli, may shrink away from or grab @ source

Back 10

Stupor

Front 11

What is typical assessent of a pt who is semicomatose?

Back 11

Does not move spontaneously; unresponsive to stimuli, (may stir, moan or withdraw but no actual arousal)

Front 12

What is the term for a pt who is assessed as not moving spontanously & is unresponsive to stimuli?

Back 12

Semicomatose

Front 13

What would a typical assessment of a coma pt show?

Back 13

Unarousable; will not stir or moan in response to any stimulus; may have non-purposeful response… no attempt to withdraw

Front 14

What is the term for a pt who is unarousable; will not stir or moan in response to any stimulus; may have non-purposeful response but no attempt to withdraw?

Back 14

Coma

Front 15

What would a typical assessment of a pt who is in a deep coma show?

Back 15

Completely unarousable , unresponsive to any kind of stimulus including pain; absence of brainstem reflexes, corneal, papillary & pharyngeal reflexes & tendon & plantar reflexes

Front 16

What is the term for a pt who is completely unarousable, unresponsive to any stimulus including pain and has absence of ALL reflexes?

Back 16

Deep coma

Front 17

What are 4 ways to apply painful stimuli?

Back 17

Supraorbital pressure, trapezius squeeze, mandibular pressure, sternal rub

Front 18

What 9 things do you look for in a neurological assessment?

Back 18

LOC, memory, pupillary response (PERRLA 4/2, consensual), Eye Movement (nystagmus), Visual abnormalities (blurred vision, diplopia), facial symmetry (tongue deviation), speech, motor response, sensation

Front 19

What 6 things do you assess for in the pt w/ a coma?

Back 19

Pupillary response, pain response (withdrawal), reflexes (corneal, babinski), posturing (decorticate and decerebrate), dolls eyes, caloric testing

Front 20

The Glasgow Coma Scale assesses the level of consciousness by testing what 4 things?

Back 20

Best eye opening response, best motor response, best verbal response, best score (15, if the condition deteriorates the score decreases)

Front 21

If a pt has a score of 15 on the Glasgow Coma Scale, what would you have observed?

Back 21

Spontaneous eye opening, orientated, obeys commands

Front 22

What is the term used when a pt is unresponsive, absent reflexes, no spontaneous resp., pupils fixed & dilated, flat EEG, & absent ocular responses to head turning

Back 22

Brain death

Front 23

What is the word that means violent shaking?

Back 23

Concussion

Front 24

What is a momentary interruption of brain function that may lead to immediate, brief, loss of consciousness on impact? Altered consciousness can last seconds or hours

Back 24

Concussion

Front 25

What are some other s/s of a concussion besides altered consciousness?

Back 25

HA, drowsiness, confusion, dizziness, and visual disturbances

Front 26

What is the term for bruising of brain tissues?

Back 26

Contusion

Front 27

What is the most common area for a contusion of the brain?

Back 27

The base of the frontal and temporal lobes

Front 28

What is a contrecoup injury?

Back 28

A contusion in the line opposite the site of impact (secondary impact)

Front 29

What is a contusion in the line opposite the site of impact?

Back 29

Contrecoup injury

Front 31

What is the type of injury caused by an external force contacting the head, suddenly placing the head in motion?

Back 31

Acceleration injury

Front 32

What is the type of injury that occurs when the mocing head is suddenly stopped or hits a stationary object?

Back 32

Deceleration injury

Front 33

What type of fracture is a simple clean break in which the impacted area of the bone bends inward & the area around it bends outward?

Back 33

Linear skull fracture

Front 34

What type of fracture accounts for about 80% of skull fractures?

Back 34

Linear skull fracture

Front 35

What type of skull fracture causes bone to be pressed inward into the brain tissue to at least the thickness of the skull?

Back 35

Depressed skull fracture

Front 36

What type of skull fracture can involve the sinuses and temporal bone (middle ear)

Back 36

Basilar skull fracture

Front 37

What type of skull fracture can cause CSF to leak through the tear if dura is disrupted causing rhinorhea or otorhea?

Back 37

Basilar skull fracture

Front 38

What is battle's sign?

Back 38

Blood noted over the mastoid process in a basilar skull fracture

Front 39

What causes racoon's eyes in a pt with a basilar skull fracture?

Back 39

Bilateral periorbital ecchymosis

Front 40

What results from arterial bleeding into the space between the dura and the inner table of the skull?

Back 40

Epidural hematoma

Front 41

What is often caused by a fracture of the temporal bone which houses the meningeal artery and causes declining LOC from drowsiness to coma

Back 41

Epidural hematoma

Front 42

What are the s/s of an epidural hematoma?

Back 42

Severe HA, vomiting, fixed dilated pupil on same side as hematoma, hemiparesis or hemiplegia, seizures

Front 43

What results most often from venous bleeding into the space beneath the dura and above the arachnoid?

Back 43

Subdural hematoma

Front 44

What results from tearing of the bridging veins within the cerebral hemispheres or from a laceration of brain tissue?

Back 44

Subdural hematoma

Front 45

Which causes bleeding that occurs more slowly - a subdural or epidural hematome?

Back 45

Subdural hematoma bleeds more slowly

Front 46

What are the 3 categories of subdural hematomas?

Back 46

Acute, sub-acute, chronic

Front 47

Define an acute subdural hematoma

Back 47

Presents within 48 hours after impact.

Front 48

Define a sub-acute subdural hematoma

Back 48

Presents between 48 hours and 2 weeks

Front 49

Define a chronic hematoma

Back 49

Lasts from 2 weeks to several months after injury

Front 50

Which has a higher mortality rate - subdural hematoma or epidural hematoma?

Back 50

Subdural hematoma

Front 51

Define an intercerebral hemorrhage

Back 51

Accumulation of blood within the brain tissue caused by tearing of small arteries & veins in the subcortical white matter

Front 52

Where is the most common location of an intercerebral hemorrhage?

Back 52

Frontal or temporal lobes

Front 53

What type of hemorrhage is caused by the tearing of small arteries & veins in the subcortical white matter?

Back 53

Intracerebral hemorrhage

Front 54

Where is cerebrospinal fluid located?

Back 54

Between the arachnoid and the brain

Front 55

If a blood vessel ruptures on the surface of the brain what type of hemorrhage is caused?

Back 55

Subarachnoid hemorrhage

Front 56

What type of brain hemorrhage causes a "thunderclap" headache, vomiting, seizure, isolated dilation of a pupil, and neck stiffness?

Back 56

Subarachnoid hemorrhage

Front 57

Approximately how many subarachnoid hemorrhages are fatal?

Back 57

50%

Front 58

What are some problems that survivors of subarachnoid hemorrhage may have?

Back 58

Neuro or cognitive impairment

Front 59

What is the most common cause of subarachnoid hemorrhage?

Back 59

Aneurysm (85%)

Front 60

Approximately how many people die of a subarachnoid hemorrhage before getting to a hospital?

Back 60

10-15%

Front 61

What are 2 treatments for subarachnoid hemorrhage?

Back 61

Clipping (craniotomy), or coiling (endovascularly)

Front 62

What drug is used to reduce vasospasm and ischemia in a pt with subarachnoid hemorrhage?

Back 62

Nimodipine

Front 63

What is a normal ICP range?

Back 63

10-15mmHg

Front 64

Increased ICP is an acute ________

Back 64

Medical emergency!

Front 65

Cerebral blood flow accounts for what percentage of cardiac output?

Back 65

15%

Front 66

What is the formula for calculating cerebral perfusion pressure?

Back 66

MAP-ICP=CPP

Front 67

The intracranial compartment is a rigid container & it consists of 3 components: Brain __%, Blood__% & CSF__%

Back 67

Brain 80%, Blood 10%, and CSF 10%

Front 68

What is the Monroe-Kellie Hypotheses?

Back 68

To maintain WNL ICP, a change in volume of one compartment must be offset by a reciprocal change in volume of another compartment

Front 69

What are some early S/S of increased ICP?

Back 69

Decreased LOC, confusion, restlessness, lethargy, pupillary dysfunction, vision changes, HA, deterioration of motor function

Front 70

What are some later S/S of increased ICP?

Back 70

Decr. LOC, stuporous, coma, dilated pupils (no reaction to light), hemiplegia, vomiting, HTN, bradycardia, hyperthermia, papiledema, cushings triad, herniation syndromes

Front 71

Define Cushing's Triad

Back 71

Classic late sign of increased ICP. Sever HTN, widened pulse pressure, bradycardia & irregular respirations

Front 72

What is the goal of treatment of ICP?

Back 72

To maintain the cerebral pulse pressure

Front 73

What are 3 specific treatments of increased ICP?

Back 73

Surgery, placement of drain, VP shunt

Front 74

Why is Mannitol used to treat ICP?

Back 74

It is an osmotic diuretic used to reduce water content of the brain d/t the establishment of osmotic gradient btw brain intravascular compartment

Front 75

Name a drug used to decrease cerebral and/or spinal cord edema

Back 75

Decadron

Front 76

What is the most common barbiturate used to help decrease ICP?

Back 76

Pentobarbital

Front 77

Why would you hyperventilate a pt with increased ICP?

Back 77

To cause cerebral vasoconstriction and decrease ICP

Front 78

What is a method that can be used to decrease the amount of CSF?

Back 78

Intraventricular drain

Front 79

What is a typical fluid restriction for a pt with increased ICP?

Back 79

65-75% of normal maintenance fluids

Front 80

Would you want to treat a pt with increased ICP with hyperthermia or hypothermia?

Back 80

Hypothermia

Front 81

Why do you need to elevate the head of the bed for a pt with increased ICP?

Back 81

To promote intracranial drainage, and promote venous drainage

Front 82

What is the problem caused by viruses or bacteria that infect the tissues (meninges) and sometimes the fluid that surround the brain & spinal cord?

Back 82

Meningitis

Front 83

What are the 2 most common causes of bacterial meningitis?

Back 83

Streptococcus pneumoniae or neisseria meningitidis

Front 84

What is the type of meningitis that is most likely to occur in areas of high population density?

Back 84

Meningococcal meningitis

Front 85

What are some of the S/S of bacterial meningitis?

Back 85

Restlessness, agitation, irritability, severe HA, nuchal rigidity, + Brudzinski's sign, + Kernig's sign, chills, high fever, photophobia, increased ICP signs, petechial rash, altered LOC, confusion

Front 86

What are the common S/S of viral meningitis?

Back 86

Fever, photophobia, HA, myalgias, and nausea

Front 87

How are primary tumors in the brain named?

Back 87

According to the cell or tissue from which they originate

Front 88

More than 50% of primary brain tumors are __________

Back 88

Glioblastomas

Front 89

How many people with cancer develop brain metastasis?

Back 89

25%

Front 90

Name the 4 types of neuroglial cells

Back 90

Astrocytes, oligodendrocytes, ependymal cells and microglia

Front 91

What is the most common type of glioma?

Back 91

ASTROCYTOMA

Front 92

What is the most common type of benign brain tumor?

Back 92

Meningioma

Front 93

What is the most malignant type of brain tumor?

Back 93

Glioblastoma

Front 94

What type of brain tumor can cause endocrine dysfunction?

Back 94

Pituitary tumor

Front 95

What medications are commonly used in the treatment of brain tumors?

Back 95

Decadron (antiinflammatory to reduce cerebral and spinal cord edema) and dilantin

Front 96

What is the stereotactic radiosurgical procedure that uses a high dose of ionized radiation to focus 210 beams of gamma radiation into a brain tumor?

Back 96

Gamma Knife

Front 97

What is the term that describes an abnormal, sudden, excessive, uncontrolled electrical discharge of neurons within the brain?

Back 97

Seizure

Front 98

During which type of seizure does the patient lose consciousness for 1-3 minutes?

Back 98

Complex partial seizure

Front 99

During which type of seizure does the patient remain conscious, but the pt often reports an aura before the seizure starts?

Back 99

Simple partial seizure

Front 100

What type of seizure involves both cerebral hemispheres, lasts 2-5 minutes, and is characterized by stiffness or rigidity of muscles, and jerking of all extremities?

Back 100

Tonic-clonic seizure

Front 101

What is the procedure used for clients with partial-onset seizures that don't respond to AED's, reduces the # of seizures and improves quality of life?

Back 101

Vagal nerve stimulation

Front 102

Name several medications used in the tx of seizures

Back 102

Depakote, dilantin, tegretol, lamictal, topamax, phenobarbital

Front 103

What are some of the risk factors contributing to coronary heart disease?

Back 103

Diabetes, HTN, high LDL's, Low LDL's, menopause, no physical activity or exercise, obesity, and smoking

Front 104

What is the term for chest pain caused by decreased coronary blood flow?

Back 104

Angina

Front 105

Describe stable angina

Back 105

Chest pain with moderate to prolonged exertion, associated with atherosclerotic plaque, relieved by rest and/or nitro, managed w/ CaCh Blockers, beta blockers

Front 106

Other than physical exertion, what are some triggers for stable angina?

Back 106

Exposure to cold, eating a heavy meal, stress

Front 107

Describe unstable angina

Back 107

Pain occurs increasingly, at rest or w/ activity, causes limitations to any activity

Front 108

Which is more of a risk for MI unstable or stable angina?

Back 108

Unstable angina

Front 109

Describe Prinzmetal or variant angina

Back 109

An atypical angina occurs with coronary artery spasm most often at night (no atherosclerotic lesion)

Front 110

What are the s/s of variant angina?

Back 110

Substernal chest pain radiates across the sternum, neck, arms, shoulder and jaw, tight, dull, constant, dyspnea, pallor, anxiety, fear, tachy, diaphoresis, indigestion, N/V, upper back pain

Front 111

How is MI/angina diagnosed?

Back 111

12-lead EKG - reveals which and location

Front 112

What are the characteristics of angina noted on an EKG?

Back 112

ST depression, T-wave inversion, or both

Front 113

What leads would show changes with an inferior MI?

Back 113

II, III, AVF (ST elevation) with reciprocal changes in V1-V4

Front 114

What types of rhythms might accompany an inferior MI?

Back 114

1st degree AVB, 2nd degree Type I & II, complete HB, bradycardia

Front 115

What leads would show changes with an anterior MI?

Back 115

Leads VI-4 ST segment elevation, with reciprocal changes in II,III and AVF

Front 116

What is indicated if ST elevation is noted in leads V1 and V2?

Back 116

May indicate septal involvement

Front 117

What additional rhythms could be noted with an anterior MI?

Back 117

LBBB, RBBB, 2nd degree type II and complete HB

Front 118

What type of MI shows ST elevation in leads I, AVF and leads V5 and V6?

Back 118

Lateral MI

Front 119

What does a thallium stress test show?

Back 119

It can determine which areas of the heart are receiving inadequate perfusion during stress

Front 120

What is the purpose of a dobutamine ECHO?

Back 120

Sound waves take pictures before, during, and after periods of exertion. Dobutamine causes heart to beat faster & more vigorously & reveals areas of cardiac tissue with decreased perfusion.

Front 121

What is the procedure performed by using a mini hi frequency ultrasound transducer mounted on a gastroscope tube - gives a pic of the posterior heart?

Back 121

Transesophageal echocardiography (TEE)

Front 122

What is the procedure used to determine the extent and exact location of obstruction of coronary arteries?

Back 122

Cardiac cath

Front 123

What are some important pre-op procedures for a pt undergoing cardiac cath?

Back 123

Consent, allergies to dye… seafood, iodine, NPO 6-8 hrs, shave and clean w/ antiseptic as directed, IV access, teach about flushed feeling as catheter is passed & dye injected

Front 124

What are some important post-op things to remember with a cardiac cath?

Back 124

Keep pt flat w/affected leg straight for 6-8 hrs. bedrest up to 12 hrs, pulses q30 min for 2 hrs, tehn q4h. Ck femoral site for bleeding

Front 125

What should you do if bleeding occurs at the femoral site after a cardiac cath?

Back 125

Remove dressing, direct pressure w/ 2 fingers. Pressure to insertion site, direct hand pressure or device up to 2 hrs, Notify dr. if numbness/tingling, loss of pulse or cool extremity. Force fluids

Front 126

What is the procedure in which one or more arteries are dilated with a balloon catheter to open the vessel lumen and improve arterial flow?

Back 126

Percutaneous transluminal coronary angioplasty (PCTA)

Front 127

What is the most important lab to check for diagnosing cardiac damage?

Back 127

Troponin

Front 128

Other than troponin, what labs can indicate cardiac damage?

Back 128

CPK - MB, LDH

Front 129

How do you tx an MI?

Back 129

Assess, HOB 30-45*, O2 keep above 90%, IV access, diagnostic testing, nitro IV drip - titrate to pain and syst BP >90, morphine: titrate 2-4 mg q5min

Front 130

Why is morphine used during tx of MI?

Back 130

decreases anxiety, decreases afterload

Front 131

What meds are given to a pt experiencing MI?

Back 131

Morphine, ASA, thrombolytics (within 6 hrs of 1st symptom), heparin, glycoprotein IIB/IIIa inhibitors, CaChBlockers, beta blockers, stool softeners

Front 132

What is the most important thing to watch for in a pt on thrombolytics?

Back 132

Bleeding

Front 133

When are the best results seen in a pt taking thrombolytic medications?

Back 133

Best results are within 30 min.

Front 134

Why are glycoprotein Iib/IIIa inhibitors given to a pt experiencing an MI?

Back 134

Inhibit clot formation

Front 135

Why are CaChBlockers given to a pt experiencing an MI?

Back 135

Dilate coronary arteries and reduce vasospasm

Front 136

Name 3 CaChBlockers given to a pt experiencing an MI

Back 136

Verapamil, Nifedipine, and Diltiazem

Front 137

What are the SE of CaChBlockers to watch for in a pt taking them for MI?

Back 137

Bradycardia, hypotension, <contractility

Front 138

Why might beta blockers be given to a pt experiencing an MI?

Back 138

Slows HR and decreases myocardial contractility, decreases workload of the heart.

Front 139

What are some priority nursing interventions for a pt Post-MI?

Back 139

Monitoring EKG, (PVC's), assess, monitor for complications, report BP less than 100 syst or 25 lower than baseline, bedrest 24-36h, stool softeners, liquid diet initially, progressive ambulation

Front 140

What is phase 1 of an exercise program post MI?

Back 140

The ability to walk 50 feet

Front 141

What is important to teach to family of a pt post MI?

Back 141

CPR

Front 142

When can a pt resume sexual relations following an MI?

Back 142

5-8 weeks, when they can walk up 2 flights of stairs or a 3/4 mile walk without SOB and no use of VIAGRA!

Front 143

What is another term for heart failure class IV?

Back 143

Cardiogenic shock

Front 144

What happens to the ventricle in cardiogenic shock?

Back 144

Necrosis of more than 40% of the ventricle has occurred

Front 145

What is the term for the amount of blood pumped out of the heart with each heart beat?

Back 145

Ejection fraction

Front 146

Does the ejection fraction reflect atrial or ventricular function?

Back 146

Ventricular

Front 147

What is the priority goal for a pt in cardiogenic shock?

Back 147

Increase perfusion to al tissues

Front 148

What drugs are used for a pt experiencing cardiogenic shock?

Back 148

Diuretics, Vasopressors and positive inotropes, dobutamine, dopamine, nipride, digoxin, and morphine

Front 149

Why is dobutamine used for cardiogenic shock?

Back 149

Increases myocardial contractility without causing tachycardia

Front 150

What is the problem with using dopamine for peripheral vasoconstriction in cardiogenic shock?

Back 150

It can cause tachycardia

Front 151

What procedure is used to improve myocardial perfusion during an acute MI to reduce preload and afterload and help facilitate left ventricular function?

Back 151

Intraaortic Balloon Pump (IABP)

Front 152

What are you looking for when checking ABG's in a pt experiencing cardiogenic shock?

Back 152

Acidosis and O2

Front 153

How often are VS monitored for a pt experiencing cardiogenic shock?

Back 153

Every 15-30 min

Front 154

What is the most common graft location for CABG?

Back 154

Internal mammary artery

Front 155

What is the most common type of cardiac surgery?

Back 155

CABG

Front 156

What is the goal of CABG?

Back 156

To increase O2 to myocardium

Front 157

Does CABG affect a pts lifespan?

Back 157

NO!

Front 158

Does CABG improve quality of life for pts?

Back 158

YES 80-90% of pts are pain free after 1 year, 70% pain free at 5 yrs

Front 159

What condition do you monitor a pt for post CABG?

Back 159

Cardiogenic shock!

Front 160

What specific things should be monitored post CABG?

Back 160

Eletrolytes, blood loss, urine output, temp, dysrhythmias

Front 161

What does a pacemaker do?

Back 161

Maintains heart rate when pt's intrinsic pacemaker fails

Front 162

What is the type of pacemaker that paces only if the client's own rate falls below the set rate?

Back 162

Synchronous or demand pacemaker

Front 163

What is the type of pacemaker that paces regardless of the client's own rate?

Back 163

Asynchronous or fixed rate pacemaker

Front 164

What follows a spike on an EKG of a pt with a pacemaker?

Back 164

A p wave or a QRS

Front 165

If the electrode is in the _______ the spike is in front of the p wave and if it is in the ______ the spike is in front of the QRS.

Back 165

Atria, ventricle

Front 166

What is the difference between failure to sense and failure to capture?

Back 166

Failure to sense - there is no spike on the EKG. Failure to capture - there is a spike but no response from the atria/ventricle follows the spike (p wave or QRS missing)

Front 167

Where is a temporary pacemaker placed?

Back 167

Via antecuital, femoral, jugular, or subclavian vein into the right atrium or ventricle

Front 168

What is the most important intervention for a pt who has just received a temporary pacing device?

Back 168

Limit movement of the left arm!!! Do not want to dislodge pacing wire from heart

Front 169

What is important to remember when taking a BP on a pt with an external pacing device?

Back 169

Take BP on the right side!

Front 170

What is the term for an abnormal dilation of the arterial wall caused by localized weakness & stretching in the medial layer or wall of an artery?

Back 170

Aneurysm

Front 171

What is the goal for a pt with an aortic aneurysm?

Back 171

Limit the progression of the disease by modifying risk factors, control BP to prevent strain, and prevent rupture

Front 172

What is the most common location for an aortic aneurysm?

Back 172

Abdomen

Front 173

What do you suspect if on assessmt of a pt you note a pulsation in the upper abdomen slightly to the left of midline, tenderness on palpation, flank pain, & a systolic bruit?

Back 173

Abdominal aortic aneurysm

Front 175

What are the symptoms of a thoracic aortic aneurysm?

Back 175

Pain extending to the shoulders, neck, lower back or abd, syncope, dyspnea, cyanosis, weakness, SOB, horseness, difficulty swallowing

Front 176

What are the signs of a ruptured aortic aneurysm?

Back 176

Severe abdominal or back pain, signs of shock,

Front 177

Systolic heart failure is characterized as an ejection fraction of less than _____%

Back 177

50%

Front 178

What are some of the common causes of heart failure?

Back 178

Diabetic Cardiomypathy, CAD, alcoholic cardiomyopathy, valvular disease

Front 179

What are some common causes of diastolic heart failure?

Back 179

HTN, Severe aortic stenosis, ischemic myocardial disease, CAD, hypertensive cardiomyopathy

Front 180

What is the type of heart failure in which the heart cannot fully relax during diastole which disrupts the filling?

Back 180

Diastolic heart failure

Front 181

What is the type of heart failure in which there is inadequate pumping of the ventricles?

Back 181

Systolic heart failure

Front 182

What are some causes of left sided heart failure?

Back 182

HTN, coronary artery and valvular disease

Front 183

What are some causes of right sided heart failure?

Back 183

Left sided heart failure, right ventricular myocardial infarction or pulmonary HTN

Front 184

What are some causes of high-output heart failure?

Back 184

Increased metabolic needs, septicemia, anemia

Front 185

What are some causes of acute heart failure?

Back 185

Myocardial infarction, mitral or aortic regurgitation

Front 186

What happens to the heart that causes heart failure to occur?

Back 186

Hypertorphy and remodeling due to the inability of myocytes to adapt to increased wall stress in order to maintain adequate cardiac output

Front 187

How does increased preload help sustain cardiac performance?

Back 187

More blood to fill the heart = increased cardiac output for better perfusion

Front 188

Why does the heart adapt with hypertrophy?

Back 188

It is an attempt to increase contractile force of the heart

Front 189

What hormones are released by the body to cause vasoconstriction to increase afterload?

Back 189

Epinephrine, norepinephrine, vasoactive substances endothelin-1 and vasopressin

Front 190

When RAAS system is stimulated by decreased perfusion during heart failure what happens to increase the preload and cause more stress on the heart?

Back 190

Aldosterone is released increasing sodium and water retention

Front 191

What is the priority neuro assessment for a pt in a coma?

Back 191

Pupils

Front 192

After pupils what is the next priority assessment for a pt in a coma?

Back 192

Nail be pressure

Front 193

What do doll's eyes indicate?

Back 193

Brain death

Front 194

What is caloric testing? What is it testing for?

Back 194

Ice water in the ear canal. Eye should move towards irritation. If not, indicates brain death

Front 195

*TEST* What is the ONLY way to definitively diagnose brain death?

Back 195

Cerebral perfusion scan

Front 196

*TEST* What is the most common type of skull fracture?

Back 196

LINEAR

Front 197

*TEST* Key signs of basilar skull fracture?

Back 197

Battle's sign and raccoon's eyes

Front 198

*TEST* What is the most important thing to watch with an epidural hematoma?

Back 198

Rapid LOC decline or neurological function

Front 199

What is the difference between an epidural, subdural and intercerebral hematoma?

Back 199

Epidural = arterial, subdural = venous, intracerebral = both small arterial and venous

Front 200

What type of hemorrhage includes CSF?

Back 200

Subarachnoid hemorrhage

Front 201

*TEST* What is the drug of choice for a pt w/SAH to reduce vasospasm?

Back 201

Nimodipine

Front 202

*TEST* What is a ventriculostomy?

Back 202

Placing a drain in the ventricle of the brain to drain CSF

Front 203

*TEST* what is the procedure in which a drain is placed in the ventricle of the brain to drain CSF?

Back 203

Ventriculostomy

Front 204

*TEST* What should CPP reading be?

Back 204

>50

Front 205

*TEST* how do you calculate CPP?

Back 205

MAP-ICP = CPP (MAP= systolic - diastolic/3 +diastolic)

Front 206

How do you increase CPP?

Back 206

By decreasing ICP or increasing BP

Front 207

What is a later sign of increased ICP or decreased pulse? BAD

Back 207

Bradycardia

Front 208

*TEST* What is Cushing's Triad?

Back 208

Late sign of increased ICP = Severe HTN with widened pulse pressure, bradycardia, & irregular respirations

Front 209

*TEST* What is the most important drug for decreasing ICP?

Back 209

Mannitol

Front 210

*TEST* What is important to remember when administering mannitol to a pt?

Back 210

Give rapidly and Use a filter!

Front 211

Why do you use a filter when administering mannitol?

Back 211

Precipitate

Front 212

Where should a ventricular drain be located?

Back 212

Foramen of monroe

Front 213

What drug is used to decreased ICP by decreasing water content of the brain?

Back 213

Mannitol

Front 214

What 3 things contribute to ICP?

Back 214

CSF, edema, vascularity

Front 215

What is the most important measure of ICP?

Back 215

CPP

Front 216

What is a low measure of CPP?

Back 216

Anything below 50

Front 217

Why is Decadron used?

Back 217

To reduce spinal cord or cerebral edema

Front 218

What is the drug most often used to put a pt into a barbiturate coma?

Back 218

Pentobarbitol -

Front 219

Why would a pt with increased ICP be put into a barbiturate coma?

Back 219

reduces cerebral metabolism & oxygen requirements and can protect brain cells with a decreased CPP

Front 220

What does a low PCO2 do for a pt with increased ICP?

Back 220

Will cause vasoconstriction and decreases ICP

Front 221

Where should the bed be positioned for a pt with increased ICP?

Back 221

HOB 25-30*

Front 222

What is suspected if a pt has a + Brudinski's or Kernig's sign?

Back 222

Bacterial or septic meningitis

Front 223

What does Brudinski's or Kernig's sign indicate?

Back 223

Nuchal rigidity - bacterial or septic meningitis

Front 224

What is the most common type of glioma?

Back 224

Astrocytoma

Front 225

What is the most malignant type of glioma?

Back 225

Glioblastoma

Front 226

What 2 medications are commonly used in pts with brain tumors?

Back 226

Decadron (decreases swelling) Dilantin (prevention of seizures)

Front 227

If a pt has hemiparesis on the right side where is his tumor located?

Back 227

On the left side of the brain

Front 228

What are some signs of dilantin toxicity?

Back 228

Nystagmus, rash, (also causes gum hyperplasia)

Front 229

What is the cause of chest pain of angina?

Back 229

Ischemia

Front 230

What is stable angina?

Back 230

Chest pain with exertion

Front 231

How is angina relieved?

Back 231

Nitroglycerin

Front 232

What type of meds might be used other than nitroglycerin to relieve angina?

Back 232

CaChBlockers, Beta Blockers,

Front 233

What type of angina is secondary to vasospasm?

Back 233

Prinzmetal or variant angina

Front 234

What is labines sign?

Back 234

Grabbing at the chest

Front 235

What does ST segment depression indicate?

Back 235

Ischemia/angina

Front 236

Where is the most common location for an MI?

Back 236

Right coronary artery (inferior MI)

Front 237

What is a cardiac catheterization used for?

Back 237

To determine exact extent & location of obstruction of coronary arteries

Front 238

What is the most important thing to check after a cardiac cathterization?

Back 238

Bleeding!!

Front 239

What do you do if a post cardiac cath pt c/o numbness or tingling in toes?

Back 239

Check for bleeding @ puncture site - apply pressure if bleeding

Front 240

What is the best indicator of MI?

Back 240

Troponin

Front 241

What is the purpose of nitro for a person experiencing angina?

Back 241

Reduces afterload AND preload

Front 242

What is the purpose for using Morphine in a pt with an MI?

Back 242

Reduces afterload - causes vasodilation

Front 243

What things do you need to remember prior to thrombolytic administration?

Back 243

All foleys, IV's, lab draws done BEFORE - BLEEDING!

Front 244

Can a pt use viagra following and MI?

Back 244

NO - contraindicated as long as they are using nitrates

Front 245

What is cardiac tamponade?

Back 245

Fluid around the heart

Front 246

What is ejection fraction?

Back 246

The amount of blood pumped out of the heart during each beat

Front 247

What does ejection fraction reflect?

Back 247

Ventricular function

Front 248

What interventions are used to reduce ICP?

Back 248

HOB elevated, midline position, stool softener

Front 249

Name drugs used to tx cardiogenic shock?

Back 249

Dobutamine (increases contractility), Dopamine (peripheral vasoconstriction), diuretics (decrease preload), vasopressors (increase afterload)

Front 250

What is the most powerful vasodilator?

Back 250

Nitroprusside

Front 251

What is the main reason to get a CABG?

Back 251

Increase ADL's (DOES NOT IMPROVE LIFESPAN!)

Front 252

What is the best reflection of cardiac output?

Back 252

BP and urine output

Front 253

When a pt is experiencing cardiogenic shock do you give vasopressors or inotropic drugs first?

Back 253

Inotropic drugs BEFORE vasopressors

Front 254

What is the most common cause of a subarachnoid bleed?

Back 254

Cerebral aneurysm

Front 255

What is the main problem caused by a cerebral aneurysm? How is it treated?

Back 255

Vasospasm - Nimodipine

Front 256

How do you treat an abdominal aortic aneurysm that is too small to be surgically removed? (Less than 5 cm)

Back 256

Keep BP down - 130-150

Front 257

What is the main symptom of an abdominal aortic aneurysm?

Back 257

Pulsatile mass in the abdomen

Front 258

What is a drug used for status epillepticus?

Back 258

Ativan (Benzodiazipine) followed by Cerebex

Front 259

What is a long term complication of dilantin use?

Back 259

Gingival hyperplasia

Front 260

What is the difference between an epidural and a subdural bleed?

Back 260

Epidural - arterial (Rapid) Subdural - venous (slower, deadly)

Front 261

What is the valve problem caused by rheumatic fever?

Back 261

Mitral valve stenosis

Front 262

What drugs are used for valve problems?

Back 262

Diuretics, betablockers, dig, O2, Nitrates, vasodilators, coumadin

Front 263

What do BNP's do?

Back 263

Reduce aldosterone & ADH to decrease hypervolemia

Front 264

What is the sympathetic response to HF?

Back 264

Beta 1 (increase HR and contractility) and Alpha 1 (powerful vasoconstrictor)

Front 265

What are the S/S of CHF?

Back 265

Angina, tachy, JVD, decreased sys BP, increased diasolic BP, S3 or S4, edema, cardoimegaly, weight gain, (RUQ tenderness, ascites - late)

Front 266

What is the goal of management of CHF?

Back 266

Optimize heart function - tissue perfusion!

Front 267

Are calcium channel blockers used in the treatment of CHF?

Back 267

NO

Front 268

What is the cause of infective endocarditis?

Back 268

Platelet fibrin vegetation grows on endocardium

Front 269

What is the most common treatment for pericarditis?

Back 269

NSAIDS

Front 270

What are the common symptoms of pericarditis?

Back 270

Harsh pain increased upon breathing, coughing, supine position, swallowing

Front 271

What are the priority nursing interventions for a pt with cardiac tamponade?

Back 271

Monitor CVP, heart tones (muffled), hypotension

Front 272

What is the FIRST thing you do when a pt tells you they have chest pain?

Back 272

REST - then EKG, drugs, etc…