Med Surg Exam 1

Front 1

Normal Sinus rhythm characteristics

Back 1

- P, QRS, T wave present
- Regular heart rate
- Rate 60-100 BPM
- Normal PR, QRS, and QT intervals

Front 2

Sinus tachycardia characteristics

Back 2

- P, QRS, T wave
- Regular heart rate
- Rate >100 BPM

Front 3

Sinus tachycardia causes

Back 3

- Pain
- Fever
- Anxiety
- Activity
- Medications

Front 4

Sinus tachycardia treatments

Back 4

- May be none
- Treat underlying cause

Front 5

Sinus Bradycardia characteristics

Back 5

- P, QRS, T wave
- Regular heart rate
- Rate <60 BPM

Front 6

Sinus Bradycardia causes

Back 6

- Can be normal
- Drugs (B-blockers, dig, etc)
- Enhanced vagal tone
- Hypoxia

Front 7

Sinus bradycardia treatments

Back 7

Symptomatic
- Atropine
- Pacing
Asymptomatic
- Maybe none
- Adjust medication

Front 8

Atrial fibrillation characteristics

Back 8

- No P waves
- Irregular rhythm
- Fibrillatory (F) waves

Front 9

Atrial fibrillation causes

Back 9

- Sinus node is no longer in control of the heart
- Impulses are coming from everywhere in atria
- CHF, hypertension, MI, fluid overload, valve dx
- Emboli develop in quivering atria that can travel elsewhere

Front 10

Atrial fibrillation treatment

Back 10

- Rate control (CCB, B-blockers, amiodarone, dig)
- Rhythm control (ibutilide, amiodarone, cardioversion)
- RF abllation (go in, find the source of a fib and zap it out)
- Anticoagulation (heparin, warfarin)

Front 11

Atrial flutter characteristics

Back 11

- Regular flutter waves
- very fast but very regular

Front 12

Atrial flutter causes

Back 12

- Sinus node is no longer in control of the heart
- Impulses are coming from everywhere in atria
- CHF, hypertension, MI, fluid overload, valve dx
- Emboli develop in quivering atria that can travel elsewhere

Front 13

Atrial flutter treatment

Back 13

- Rate control (CCB, B-blockers, amiodarone, dig)
- Rhythm control (ibutilide, amiodarone, cardioversion)
- RF abllation (go in, find the source of a fib and zap it out)
- Anticoagulation (heparin, warfarin)

Front 14

PVCs characteristics

Back 14

- Wide bizarre QRS
- Premature complex
- Not associated with P waves

Front 15

PVCs causes

Back 15

- Ischemia/injury
- Drugs or electrolyte imbalances
- Invasive lines

Front 16

PVCs treatments

Back 16

- Watch for frequency
- Assess for cause and treat it
- Do not routinely give drugs to suppress

Front 17

Ventricular fibrillation characteristics

Back 17

- Chaotic quivering of ventricles
- Grossly irregular electrical activity
- Unable to recognize any waveforms
- No pulse

Front 18

Ventricular fibrillation causes

Back 18

- Drugs that increase QT
- Ischemia
- Electrolyte abnormalities
- Reduced EF

Front 19

Ventricular fibrillation treatments

Back 19

- Call code
- CPR
- Defibrillation
- Epinephrine or vasopressin
- Amiodarone
- Lidocaine

Front 20

Ventricular tachycardia characteristics

Back 20

- Wide QRS
- Rate > 100 BPM
- A.V dissociation

Front 21

Ventricular tachycardia causes

Back 21

- Electrolyte abnormalities (low potassium, low magnesium)
- Ischemia, acute MI
- Reduced EF, CHF

Front 22

Ventricular tachycardia treatments

Back 22

Pulse:
- EKG
- Vital sings
- Vagal maneuver
- Drug therapy
- Correct electrolytes
No Pulse:
- Call code
- CPR
- Defibrillation
- EPI or vasopressin
- Amiodarone
- Lidocaine

Front 23

Torsades de pointes characteristics

Back 23

- Twisting of VT around the baseline
- Rate > 250 BPM

Front 24

Torsades de pointes cause

Back 24

- Drugs that increase QT
- Electrolyte abnormalities
- Ischemia

Front 25

Tosades de pointes treatment

Back 25

- Defibrillation
- Magnesium
- Overdrive pacing

Front 26

P wave

Back 26

Atrial depolarization

Front 27

QRS wave

Back 27

Ventricular depolarization

Front 28

T wave

Back 28

Ventricular repolarization

Front 29

Normal PR range

Back 29

.12 - . 2

Front 30

Normal QRS range

Back 30

.04 - .11

Front 31

Normal QT range

Back 31

.36 - .44

Front 32

Angina pathophysiology

Back 32

Results when there is an imbalance between the heart's oxygen demand and supply

Front 33

Angina precipitating factors

Back 33

- Age
- Cigarette smoking
- Diabetes
- Hypertension
- Obesity

Front 34

Angina Manifestations

Back 34

- Chest discomfort (pressure, heaviness, tightness, squeezing, burning or choking sensation)
- Pain in back, neck area, jaw, or shoulders (referred pain)

Front 35

Angina Therapy

Back 35

- Nitroglycerin (vasodilator)
- Beta blockers and calcium channel blockers (decreases the heart's workload)

Front 36

Myocardial infarction pathophysiology

Back 36

Most common triggering event is the disruption of atherosclerotic plaque in an epicardial coronary artery which leads to a clotting cascase

Front 37

Myocardial infarction precipitating factors

Back 37

- Age
- Gender
- Diabetes
- Hypertension
- smoking
- Obesity

Front 38

Myocardial infarction manifestations

Back 38

- Chest pain (tightness, pressure, or squeezing)
- Radiating pain to left arm, lower jaw, neck, right arm, back, and epigastrium
- Shortness of breath, weakness, sweating, nausea, vomiting, and palpitations

Front 39

Myocardial infarction complications

Back 39

- May occur immediately following the heart attack
- Heart failure
- Aneurysm or rupture of the myocardium
- Arrhythmias

Front 40

Myocardial infarction therapy/management

Back 40

- Oxygen
- Aspirin
- Nitroglycerin may be administered

Front 41

Congestive heart failure pathophysiology

Back 41

Causes by any condition which reduced the efficiency of the myocardium, or heart muscle, through damage or overloading

Front 42

Congestive heart failure manifestations

Back 42

Left-sided
- Tachypnea
- Increased work of breathing
- Rales or crackles
- Cyanosis
Right-sided
- Peripheral pitting edema

Front 43

Congestive heart failure therapy/management

Back 43

- Improving the symptoms and preventing the progression of the disease
- Re-establish adequate perfusion and oxygen delivery to end organs (ABC are adequate)

Front 44

HCTZ (hydrochlorothiazide) use

Back 44

Management of mild to moderate hypertension.

Front 45

HCTZ (hydrochlorothiazide) therapeutic effects

Back 45

- Lowing of blood pressure in hypertensive patients and diuresis with mobilization of edema.

Front 46

HCTZ (hydrochlorothiazide) assess before

Back 46

- Assess patients, especially if taking digoxin, for anorexia, nausea, vomiting, muscle cramps, paresthesia, and confusion

Front 47

HCTZ (hydrochlorothiazide) NOTIFY CLINICIANS IF:

Back 47

- If signs of electrolyte imbalance occur
- Patients taking digoxin are at risk of digoxin toxicity because of the potassium-depleting effect of the diuretic.

Front 48

Metroprolol XL use

Back 48

- Decreases blood pressure and heart rate
- Decreases frequency of attacks of angina pectoris
- Decreases rate of cardiovascular mortality and hospitalization in patients with heart failure

Front 49

Metroprolol XL. To monitor

Back 49

- Monitor intake and output ratios and daily weights
- Assess routinely for signs and symptoms of CHF (dyspnea, rales/crackles, weight gain, peripheral edema, jugular venous distention)

Front 50

Metroprolol XL. To assess before

Back 50

- Take apical pulse before administering.
- If <50 BPM or if arrhythmia occurs, withhold medication and notify health care professional

Front 51

Enalapril uses

Back 51

- Alone or with other agents in the management of hypertension
- Slows progression of left ventricular dysfunction into overt heart failure

Front 52

Enalapril therapeutic effects

Back 52

- Lowers blood pressure in hypertensive patients.
- Improves symptoms in patients with CHF

Front 53

Enalapril Watch out for

Back 53

- Warn patient not to discontinue ACE inhibitor therapy unless directed by health care professional
- Increase risk of hyperkalemia with concurrent use of potassium supplements, potassium-sparing diuretics, potassium-containing salt substitutes, or angiotensin II receptor antagonists

Front 54

Losartan indications

Back 54

- Alone or with other agents in the management of hypertension
- Treatment of diabetic nephropathy in patients with type 2 diabetes and hypertension

Front 55

Losartan Therapeutic effects

Back 55

- Lowers blood pressure
- Slows progression of diabetic nephropathy (ibesartan and losatran only)
- Reduces cardiovascular death and hospitalization due to CHF in patients with CHF

Front 56

Losartan lab test considerations

Back 56

- Monitor renal function and electrolyte levels periodically
- Serum potassium, BUM, and serum creatinine may be increased.

Front 57

U/A lab values

Back 57

Males: (2-8)
Female: (2-7.5)

Front 58

U/A

Back 58

Urinalysis can reveal disease that have gone unnoticed because they don't produce striking signs or symptoms

Front 59

Calcium

Back 59

8.5 - 10.5

Front 60

Ionized Calcium

Back 60

4-5

Front 61

Chloride

Back 61

95-107

Front 62

Magnesium

Back 62

1.5-2.5

Front 63

Phosphate

Back 63

2.5-4.5

Front 64

Potassium

Back 64

3.5 - 5

Front 65

Sodium

Back 65

136 - 145

Front 66

BUN

Back 66

10-20

Front 67

Creatinine

Back 67

.7- 1.5

Front 68

Creatine phosphokinase

Back 68

Male 25-90
Female 10-70

Front 69

CPK means

Back 69

CPK levels rise 4-8 hours after an acute MI< peaking at 16to 30 hours and returning to baseline within 4 days

Front 70

Fasting glucose

Back 70

65-110

Front 71

Post prandial glucose

Back 71

up to 140

Front 72

Cholesterol

Back 72

<200

Front 73

HDL

Back 73

> 40

Front 74

LDL

Back 74

1 - 129

Front 75

triglycerides

Back 75

45 - 155

Front 76

Blood pressure measurement

Back 76

Measurement of the force applied to the walls of your arteries as your heart pumps blood through your body

Front 77

Chest x-ray

Back 77

A noninvasive medical test that helps physicians diagnose and treat medical conditions.

Front 78

ECG (electrocardiogram)

Back 78

Used to monitor your heart. An EKG record electrical signs as they travel through your heart.

Front 79

Nitroglycerin SL used for

Back 79

- Acute and long-term prophylactic management of angina pectoris
- Increases coronary blood flow by dilating coronary arteries and improving collateral flow to ischemic regions.
- Reduces myocadial oxygen consumption

Front 80

Nitroglycerin SL therapeutic effects

Back 80

- Relieves or prevents anginal attacks
- Increases cardiac output
- Reduces blood pressure

Front 81

Nitroglycerin SL TO DO

Back 81

- First dose should be taken while in a sitting or reclining position, especially in geriatric patients

Front 82

Nitroglycerin SL During Anginal attacks

Back 82

- Advise patient to sit down and use medication at first sign of attack
- Relief usually occurs within 5 min
- Dose may be repeated if pain isn't relieved in 5-10 min.
- Call health care professional or go to nearest emergency room if anginal pain is not relieved by 3 tablets in 15 min.

Front 83

ASA use

Back 83

- Prophylaxis of transient ischemic attacks and MI
- Decreases platelet aggregation

Front 84

ASA before hand

Back 84

- Administer after meals or with food or an antacid to minimize gastric irritation
- Food slows but does not alter the total amount abosrbed

Front 85

ASA do not

Back 85

- Do not crush of chew enteric-coated tablets
- Do not take antacids within 1-2 hr of enteric-coated tablets.
- If MI is impending, have patient chew ASA to increase speed of absorption

Front 86

Atorvastin uses

Back 86

- Lowers total and LDL cholesterol and triglycerides
- Slightly increases HDL
- Slows the progression of coronary atherosclerosis with resultant decrease in CHD- related evented

Front 87

Atorvastin lab considerations

Back 87

- Evaluate serum cholesterol and triglyceride levels before initiating, after 4-6 weeks of therapy, and periodically thereafter

Front 88

Atorvastin monitor

Back 88

- Monitor liver function tests, including AST, before, at 12 wk after initiation of therapy or after dose elevation, and then q 6 mo.
- If AST levels rise to 3 times nomral, HMG- C reductase inhibitor therapy should be reduced or discontinued

Front 89

Atorvastin STOP THERAPY if

Back 89

- If patients develops muscle tenderness during therapy, monitor CK levels.
- If CK levels are >10 times the upper limit of normal or myopathy occurs, therapy should be discontinued

Front 90

T-pa (tissue plasminogen activator) uses

Back 90

- Acute myocardial infarction (MI)

Front 91

Nitroglycerin SL TO DO

Back 91

- First dose should be taken while in a sitting or reclining position, especially in geriatric patients

Front 92

Nitroglycerin SL During Anginal attacks

Back 92

- Advise patient to sit down and use medication at first sign of attack
- Relief usually occurs within 5 min
- Dose may be repeated if pain isn't relieved in 5-10 min.
- Call health care professional or go to nearest emergency room if anginal pain is not relieved by 3 tablets in 15 min.

Front 93

ASA use

Back 93

- Prophylaxis of transient ischemic attacks and MI
- Decreases platelet aggregation

Front 94

ASA before hand

Back 94

- Administer after meals or with food or an antacid to minimize gastric irritation
- Food slows but does not alter the total amount abosrbed

Front 95

ASA do not

Back 95

- Do not crush of chew enteric-coated tablets
- Do not take antacids within 1-2 hr of enteric-coated tablets.
- If MI is impending, have patient chew ASA to increase speed of absorption

Front 96

Atorvastin uses

Back 96

- Lowers total and LDL cholesterol and triglycerides
- Slightly increases HDL
- Slows the progression of coronary atherosclerosis with resultant decrease in CHD- related evented

Front 97

Atorvastin lab considerations

Back 97

- Evaluate serum cholesterol and triglyceride levels before initiating, after 4-6 weeks of therapy, and periodically thereafter

Front 98

Atorvastin monitor

Back 98

- Monitor liver function tests, including AST, before, at 12 wk after initiation of therapy or after dose elevation, and then q 6 mo.
- If AST levels rise to 3 times nomral, HMG- C reductase inhibitor therapy should be reduced or discontinued

Front 99

Atorvastin STOP THERAPY if

Back 99

- If patients develops muscle tenderness during therapy, monitor CK levels.
- If CK levels are >10 times the upper limit of normal or myopathy occurs, therapy should be discontinued

Front 100

T-pa (tissue plasminogen activator) uses

Back 100

- Acute myocardial infarction (MI)

Front 101

T-pa (tissue plasminogen activator) therapeutic effects

Back 101

- Lysis of thrombi in coronary arteries, with preservation of ventricular function
- Improvement of ventricular function
- Increases risk of CHF or death
- Lysis of pulmonary emboli or deep vein thrombosis
- Lysis of trhombi causing ischemic stroke, drucing risk of neurologic problems

Front 102

T-pa (tissue plasminogen activator) Watch for

Back 102

- Assess patient carefully for bleeding every 15 min during the 1st hr of therapy, every 15-30 min during the next 8 hr, and at least ever 4 hour for the duration of therapy.
- If uncontrolled bleeding occurs, stop medication and notify physician immediately

Front 103

Signs of internal bleeding

Back 103

- Decreased neurologic status
- Abdominal pain with coffee- ground emesis
- Black, tarry stools
- Hematuria
- Joint pain

Front 104

Troponin levels

Back 104

Troponin I : less than 10 ug/L
Troponin T: 0 - 0.1 ug/L

Front 105

Troponin shows

Back 105

- These proteins are released when the heart muscle has been damaged
- The more damage to the heart, the greater the amount of troponin in the blood

Front 106

Myoglobin values

Back 106

0 - 85 ng/mL

Front 107

Myoglobin shows

Back 107

- When muscle is damaged, myoglobin is released into the bloodstream.

Front 108

D- Dimer values

Back 108

Around 500 ng/ml

Front 109

D- dimer shows

Back 109

- A fibrin degradation product, a small protein fragement present in the blood after a blood clot is degraded by fibrinolysis

Front 110

WBC

Back 110

4 - 11

Front 111

PTT (partial thromboplastin) time

Back 111

25 - 39 seconds

* If a person is taking blood thinners, clotting time takes up to 2 1/2 times longer

Front 112

PTT test

Back 112

A blood test that looks at how long it takes for blood to clot

Front 113

PT (prothrombin time)

Back 113

11 - 13. 5 seconds

Front 114

PT test

Back 114

A blood test that measures the time it takes for the liquid portion (plasma) of your blood to clot.

Front 115

Bleeding Time

Back 115

1 - 3 minutes

Front 116

Bleeding time test

Back 116

Looks at how fast small vessels in the skin close to stop bleeding

Front 117

Thallium scan

Back 117

- Examining the heart to obtain information about the blood supply to the heart muscle
- Thallium is injected in the blood to be used as a tracer

Front 118

Cardiac catheterization

Back 118

The insertion of a catheter into a chamber or vessel of the heart.
- X-ray opaque based contrast is injected to make the vessels show up

Front 119

PTCA (percutaneous translumial coronary angioplasty)

Back 119

- injecting a radio-opaque contrast agent into the blood vessel

Front 120

Furosemide uses

Back 120

- For edema due to heart failure, hepatic impairment or renal disease

Front 121

Furosemide Therapeutic effects

Back 121

- Diuresis and subsequent mobilization of excess fluid
- Decreases Blood pressure

Front 122

Furosemide assess

Back 122

- Assess fluid status
- Monior daily weight, intake and output ratios, amount & location of edema, lung sounds, skin turgor, and mucous membranes.

* Potassium supplements or potassium-sparing diuretics can be used to prevent hypokalemia*

Front 123

Furosemide Notify physician if

Back 123

- Thirst
- Dry mouth
- Lethargy
- Weakness
- Hypotension
- Oliguria

Front 124

Morphine uses

Back 124

Pain associated with MI

Front 125

Morphine therapeutic effects

Back 125

- Decreases severity of pain

Front 126

Morphine HIGH ALERT

Back 126

- Assess level of consciousness, blood pressure, pulse, and RR before and periodically during administration
* If RR is <10/min, assess level of sedation*

Front 127

Digoxin uses

Back 127

Treatment of CHF

Front 128

Digoxin therapeutic effects

Back 128

- Increases cardiac output
- Slows the heart rate

Front 129

Digoxin monitor

Back 129

- Monitor apical pulse for 1 full min before administration.
- Witholhd dose and notify physician if < 60 BPM
- Observe for signs and symptoms of toxicity

Front 130

Digoxin toxicity signs

Back 130

- Abdominal pain
- Anorexia
- Nausea
- Vomiting
- Visual distubrances
- Brady
- Other arrhythmias

* Hypokalemia, hypomagnesemia, or hyper calcemia may make the patient more prone for toxicity*

Front 131

pH

Back 131

7.35 - 7.45

Front 132

pCO2

Back 132

35 - 45

Front 133

pO22

Back 133

70-100

Front 134

HCO3

Back 134

19-25

Front 135

O2 sat%

Back 135

90-95

Front 136

CVP (central venous pressure)

Back 136

- Pressure of blood in the thoracic vena cava.
- Reflects the amount of blood returning to the heart and the ability of the heart to pump the blood into the aterial system.

Front 137

INR (international normalized ratio)

Back 137

How long it takes blood to clot
Normal - 1
Anticoagulant : 2 - 3
Watch and monitor : 4 +

Front 138

Doppler studies

Back 138

A non- invasive test that can be used to measure your blood flow and blood pressure by bouncing high-frequency sound waves off circulatingRBC

Front 139

Warfarin uses

Back 139

- Prophylaxis and treatment of: Venous thrombosis, Pulmonary embolism, Atrial fibrillation with embolization

Front 140

Warfarin therapeutic effects

Back 140

- Prevent thromboembolic events

Front 141

Warfarin ASSESS

Back 141

- Assess patient for signs of bleeding and hemmorrhage
- Monitor PT, INR, and other clotting factors during therapy

ANTIDOTE : VITAMIN K

Front 142

Plavix clopidogrel uses

Back 142

- Inhibits platelet aggregation by irreversibly inhibiting the binding of ATP to platelet receptors

Front 143

Plavix clopidogrel therapeutic effects

Back 143

- Decreased occurrence of atherosclerotic events in patients at risk

Front 144

Plavix clopidogrel Lab test considerations

Back 144

- Monitor bleeding time
- Prolonged bleeding time is expected
- Advise patient t0 notify health care professional if fever, chills, sore throat, or unusual bleeding or bruising occurs

Front 145

Heparin therapeutic effects

Back 145

- Prevents thrombus formation
- Prevents extension of existing thrombi

Front 146

Heparin Lab test considerations

Back 146

- Monitor activated PTT and hematocrit prior to and periodically throughout therapy

Front 147

Heparin toxicity and overdose

Back 147

ANTIDOTE: Protamine sulfate
- Overdose can often be treated by withdrawing the drug

Front 148

Systemic circulation

Back 148

Carries oxygenated blood away from the heart to the body, and returns oxygenated blood back to the heart

Front 149

Cardiac circulation

Back 149

The circulation of blood in blood vessels of the heart muscle

Front 150

Systole

Back 150

- Increased ventricular pressure
- AV valves close
- Semilunar valves open
- Blood injected into pulmonary artery and aorta
- AV and PV close

Front 151

Diastole

Back 151

- Ventricles relax
- AV valves open
- Blood flows into atria/ventricles
- Atria contracts

Front 152

Cardiac conduction system

Back 152

SA Node, AV node, Bundle of his, Bundle branches, Purkinje fibers

Front 153

Cardiac output

Back 153

The volume of blood being pumped by the heart in the time interval of a minute
- HR x SV

Front 154

Stroke Volume

Back 154

The amount of blood pumped by each ventricle with each heart beat ( avg 80 in adults at rest)

Front 155

Preload

Back 155

- Describes the degree of stretch of the cardiac muscle fibers at the end of diastole

Front 156

Afterload

Back 156

The pressure the ventricular myocardium must overcome to eject blood during systole

Front 157

Ejection fraction

Back 157

% of the end-diastolic volume ejected with each contraction (60-70%)

Front 158

Peripheral vascular occlusive disease

Back 158

- Blockages in the vasculature of the extremities

Front 159

Peripheral vascular occlusive disease symptoms

Back 159

Claudication (pain, weakness, numbness, cramping)
Sores, wounds or ulcers heal slowly
Change in color or temperature
Diminished hair or nail growth

Front 160

Peripheral vascular occlusive disease causes

Back 160

- Smoking
- Diabetes
- Dyslipidemia
- Hypertension

Front 161

Peripheral vascular occlusive disease diagnosis

Back 161

When BP readings in ankles are lower then in the arms
CT scan

Front 162

Peripheral vascular occlusive disease treatment

Back 162

- Stop smoking
- Management of diabetes
- Mangement of hypertension & cholesterol
- Antiplatelet drugs
- regular exercise

Front 163

Pulmonary emboli

Back 163

A blockage of the main artery of the lung or one of its branches by a substance that has travelled from elsewhere in the body through the bloodstream

Front 164

Pulmonary emboli symptoms

Back 164

SOB
Rapid breathing
Chest pain
Cough/coughing up blood

Front 165

Pulmonary emboli treatment

Back 165

Anticoagulation
Thrombolysis

Front 166

Deep vein thrombosis

Back 166

A blood clot in a deep vein

Front 167

Deep vein thrombosis symptoms

Back 167

Pain & tenderness in the leg
Swelling
Warmth
Redness or discoloration
Distention of surface veins

Front 168

Deep vein thrombosis Prevention

Back 168

Surgery patients
- early ambulation
- mechanical prophylaxis
- low dose unfractioned heparin
Hospital patients
- anticoagulation
- mechanical prophylaxis
Travelers
- frequent walking
- calf exercises
- aisle seating in airplanes

Front 169

Congestive heart failure

Back 169

A cardiovascular condition in which the heart is unable to pump an adequate amount of blood to meet the metabolic needs of the body's tissues

Front 170

Congestive heart failure compensatory mechanism

Back 170

- Increase HR
- Increase SV
- Arterial vasoconstriction
- NA & H20 retention
- Myocardial hypertrophy
Overtime, compensatory mechanisms make it worse

Front 171

Pulmonary edema

Back 171

- Fluid accumulation in the air spaces and parenchyma of the lungs
- Leads to impaired gas exchange and may cause respiratory failure

Front 172

Pulmonary edema symptoms

Back 172

Difficulty breathing
Coughing up blood
Pale Skin
Excessive sweating

Front 173

Metabolic syndrome

Back 173

A combination of medical disorders that increase the risk of developing cardiovascular disease and diabetes

Front 174

Metabolic syndrome signs

Back 174

Fasting hyperglycemia
High blood pressure
Central obesity
Decreased HDL cholesterol
Elevated triglycerides

Front 175

Respiration

Back 175

- O2 concentration in blood with in the capillaries of the lungs is lower than in the alveoli
- Concentration gradient leads to O2 diffusion from alveoli to blood
- CO2 which has a high concentration in the blood than in the alveoli diffuses frmo the blood into the alveoli

Front 176

Ventilation

Back 176

Movement of air in and out of the airwayds

Front 177

PaO2

Back 177

80-100

Front 178

PaCO2

Back 178

34-45

Front 179

Pneumonia assessment

Back 179

Dull percussion sounds
Consolidated breath sounds

Front 180

Pneumonia treatment

Back 180

Medication
Hospital admission
Plenty of rest
Plenty of fluids

Front 181

Pneumonia symptoms

Back 181

Fever
Cough
SOB
sweating
shaking; chills
headache
fatigue

Front 182

Pneumonia interventions

Back 182

Maintain patent airway
Monitor I & O
Auscultate breath sounds every 4 hours at least
Monitor patients ABG levels

Front 183

Pneumonia complications

Back 183

Bacteria in bloodstream
Septic shock
Fluid accumulation around lungs
Lung abscess
Acute respiratory distress syndrome

Front 184

Pneumothorax pathophysiology

Back 184

- Partial or complete collapse of the lung due to positive pressure in the pleural space
- Occurs when air gets into pleural space
- May occur from trauma or spontaneously

Front 185

Pneumothorax management

Back 185

-Aspiraton
Putting a needle in the chest cavity to remove extra air
- Chest tube
Connected to a one-way valve system that allows air to escape but not re-enter the chest
- Pleurodesis & surgery
Obliterates the plerual space and attaches the lung to the chest wall

Front 186

Pneumothorax symptoms

Back 186

Chest pain
Mild breathlessness
Tension pneumothorax : increased HR, rapid breathing, respiratory distress

Front 187

Cor pulmonale physiology

Back 187

-Enlargement of the right ventricle of the heart as a response to increased resistance or high blood pressure in the lung
- Pulmonary vasoconstriction, increased blood viscosity, pulmonary hypertension

Front 188

Cor pulmonale causes

Back 188

COPD
Pulmonary hypertension
Asthma
Pulmonary embolism
Loss of lung tissue

Front 189

Cor pulmonale symptoms

Back 189

Shortness of breath
Wheezing
Chronic wet cough
Swelling of abdomen with fluid, ankles, and feet

Front 190

Cor pulmonalecomplications

Back 190

- Blood backs up into the sytemic venous system
- Congestion in the liver leads to hypoxia and fatty changes of the peripheral hepatocytes

Front 191

Pleural effusion pathophysiology

Back 191

Abnormal accumulation of fluid in the pleural space
Usually secondary to other diseases

Front 192

Pleural effusion causes

Back 192

Transudative : Left ventricular failure & cirrhosis
Exudative: Bacterial pneumonia, cancer, viral infection, & pulmonary embolism

Front 193

Pleural effusion treatment

Back 193

Intercostal drain
Pleural catheter
Drainage catheter

Front 194

COPD pathophysiology

Back 194

Disease state in which air flow is obstructed by emphysema, chronic bronchitis or both

Front 195

COPD cause

Back 195

Smoking
occupational exposures
Air pollution
Genetics
Autoimmune disease

Front 196

COPD Management

Back 196

Bronchodilators
B2 agonist
Anticholinergics
Corticosteroids

Front 197

COPD symptoms

Back 197

Dyspnea
Rhonchi
Airflow limitation
SOB

Front 198

Emphysema pathophysiology

Back 198

- Impaired gas exchange results form destruction of the walls of over distended alveoli
- Increases the work of breathing because the hyper inflated lungs cause the diaphragm to flatten

Front 199

Emphysema causes

Back 199

Smoking
Air pollution
Second-hang smoke
Chemicals and toxins

Front 200

Emphysema management

Back 200

Stop smoking
Avoid all exposure to smoke & lung irritans
Pulmonary rehab
Medications

Front 201

Emphysema symptoms

Back 201

Shortness of breath
barrel chest
Leaning forward to help breath

Front 202

Chronic bronchitis pathophysiology

Back 202

Excessive accumulation of mucous and secretions block the airway
Gas exchange is hindered
Mucous medium allows for frequent infections
Leads to decreased PaO2, Hypoxemia, Increased PaCO2, repsiratory acidosis

Front 203

Chronic bronchitis symptoms

Back 203

Cough
SOB
wheezing
Occasionally chest pains, fever, fatigue

Front 204

Albuterol use

Back 204

Bronchodilator to control and prevent reversible airway obstruction caused by asthma or COPD

Front 205

Albuterol side effects

Back 205

nervousness
restlessness
tremor

Front 206

Albuterol assess

Back 206

Assess lung sounds pulse and blood pressure before administration and during peak of medication

Not amount, color, and character of sputum produced

Front 207

Atrovent use

Back 207

maintenance therapy of reversible airway obstruction due to COPD including chronic bronchitis and emphysema

Front 208

Atrovent side effects

Back 208

Bronchospasm
Cough
hypotension
palpitations

Front 209

Fluticasone to use

Back 209

-Instruct patient in the proper use of the metered-dose inhaler
- Most inhalers require priming before first use
- Shake inhaler well
- Exhale completely, and then close lips firmly around mouthpiece
- While breathing in deeply and slowly, press down on canister
- Hold breath for as long as possible to ensure deep instillation of medicine
- Allow 1-2 min between inhalations

Front 210

Vancomycin

Back 210

Antibiotic.
Used for resistant bacteria

Front 211

Vancomycin given

Back 211

Given IV every 12 hours over 60-90 minutes

Front 212

Vancomycin - Rapid IV infusion

Back 212

- Rapid IV infusion leads to red neck syndrome with hypotension, flushing, erthematous rach on face and upper body

Front 213

Vancomycin side effects

Back 213

Ototoxicity
Nephrotoxicity

Front 214

Vancomycin monitor

Back 214

- blood levels to prevent toxicity
- Assess hearing : affects CN VIII
- Monitor I & O

Front 215

Hematacrit

Back 215

Male 41-50%
Female 36-44%

Front 216

Pneumovax

Back 216

Pneumonia vaccine

Front 217

Isoniazid (INH) uses

Back 217

Antituberculosis agent.
Given orally, daily

Front 218

Isoniazid (INH) Side effects

Back 218

Peripheral neuropathy
parathesias
hepatotoxicity

Front 219

Isoniazid (INH) risks

Back 219

ETOH increase risks
Take on an empty stomach
Vit B6 can decrease neuropathies

Front 220

Isoniazid (INH) watch

Back 220

Liver enzymes need to be monitors
Look for signs of liver toxicity: dark urine, jaundice, clay colored stool

Front 221

Rifampin

Back 221

Antituberculosis agent, antileprosy agent
Given orally QD

Front 222

Rifampin side effects

Back 222

GI distress
Elevated liver function tests

Front 223

Rifampin how to take

Back 223

Take on an empty stomach
Check liver enzymes periodically

Front 224

Rifampin watch

Back 224

Drug will cause body fluids to be red-orange
Decreases effectiveness of oral contraceptives

Front 225

Ceftriaxone

Back 225

Cepholosporin antibiotic
Used to treat lower respiratory tract infections

Front 226

Ceftriaxone side effects

Back 226

Diarrhea
Nausea
Vomiting
Cholelithasis

Front 227

Ceftriaxone assess

Back 227

-Assess for infection (vital signs, appearance of wound, sputum, urine, and stool, wbc)
- Obtain a history to determine previous use of and reactions to penicillins of cephalosporins
- persons with a negative history of penicillin sensitivity may still have an allergic response

Front 228

Thoracentesis

Back 228

An invasive procedure to remove fluid or air form the pleural space for diagnostic or therapeutic purposes