Medsurg 3

Front 1

List the chambers/valves of the heart that blood flows through in order, beginning with the inferior & superior vena cava. (14)

Back 1

inferior & superior vena cava

right atrium

tricuspid valve

right ventricle

pulmonic valves

pulmonary artery

lungs

pulmonary veins

left atrium

bicuspid (mitral) valve

left ventricle

aorta valve

aorta

all parts of body

Front 2

What are the 2 atrioventricular (AV) and 2 semilunar (SL) valves?

Back 2

AV: tricuspid and bicuspid (mitral)

SL: pulmonic and aortic

Front 3

Name the 2 main arteries of the heart.

Back 3

left coronary artery

right coronary artery

Front 4

Name the 3 parts of left coronary artery and which part of the heart they each perfuse.

Back 4

left main coronary artery - does not perfuse anything directly but divides to form the next 2 arteries listed...

left anterior descending artery (LAD) - anterior wall of heart

left circumflex artery - left lateral wall of heart

Front 5

Which part of the heart is also known as "the widowmaker" and why?

Back 5

LAD bc there is only a 5 minute window to treat any malfunction of this artery before death is imminent

Front 6

Name the 2 parts of the right coronary artery and what part of the heart they perfuse.

Back 6

right main coronary artery - inferior wall of heart

posterior descending artery - posterior wall

Front 7

What do the coronary veins do?

Back 7

drain blood from coronary sinus which then empties into the right atrium

Front 8

What are the 3 layers of the heart wall from outermost part of heart to innermost?

Back 8

epicardium

myocardium

endocardium

Front 9

Describe what the myocardium is made up of and its function.

Back 9

specialized cardiac muscle cells (called myofibrils)

physical pumping of heart

Front 10

Describe the pericardium and its function.

Back 10

layered sac with fluid in between the layers

protects and helps stabilize heart

Front 11

What pericarditis?

Back 11

inflammation of the pericardium

Front 12

What valves close during the S1-lubb & S2-dubb sounds (hint: they are different)?

Back 12

S1: AV valves close

S2: SL valves

Front 13

What valves cause the split S2 sound?

Back 13

SL valves not closing together

Front 14

What causes a murmur (swishing sound)?

Back 14

any valve not closing fully

(swishing of blood back up into where it was coming from is what is heard)

Front 15

Describe, in order, the path that electrical impulses travel in the conduction system of the heart? (4)

Back 15

SA node

AV node

right & left Bundle of His

Purkinjie fibers

Front 16

Where is the SA node located and what is also known as?

Back 16

right atrium

pacemaker of heart

Front 17

How many electrical impulses does the SA node begin per minute (correlates with normal heart rate)?

Back 17

60-100

Front 18

What acts as a TEMPORARY backup if the SA node is not functioning and how long will it last?

Back 18

AV node

a few days

Front 19

How many electrical impulses does the AV node begin per minute?

Back 19

40-60

Front 20

What takes over if the SA and AV nodes fail and how long will it last?

Back 20

nodal cells

minutes-hours, depends

Front 21

How many electrical impulses do the nodal cells begin per minute?

Back 21

30-40

Front 22

Where are the nodal cells found?

Back 22

in ventricles near purkinjie fibers

Front 23

What is the amount of blood pumped by the ventricles and what is the normal volume (L/min)?

Back 23

cardiac output

5L/min

Front 24

What is the amount of blood ejected with each heartbeat and what is the normal volume (ml/beat)?

Back 24

stroke volume

70ml/beat

Front 25

What is the term for amount of cardiac muscle fiber "stretch" that exists at the end of diastole, just before contraction of the ventricles and what is this also known as?

Back 25

preload

LVEDP, left ventricular end diastolic pressure

Front 26

What is the term for force the ventricles must overcome to eject their blood volume?

Back 26

afterload

Front 27

What is the term for capability of the cardiac muscle fibers to contract (how hard the muscle is pumping)?

Back 27

contractility

Front 28

What is preload directly proportional to (2)?

Back 28

stroke volume

contractility

Front 29

What is preload inversely proportional to (1)?

Back 29

afterload

Front 30

What does dehydration do to preload and stroke volume (directly proportional)?

Back 30

decreases both

Front 31

What does anxiety do to afterload and preload (inversely proportional)?

Back 31

lowers preload

raises afterload

Front 32

When the ventricles contract, does they completely empty?

Back 32

no, some blood remains

Front 33

What is the term for the percentage of blood that is ejected from the ventricles and what is the normal range (%)?

Back 33

ejection fraction

55-65%

Front 34

What ejection fraction (%) would be a definitive diagnosis for heart failure?

Back 34

<40%

Front 35

What are the areas to assess during the interview when suspecting/treating a cardiovascular disorder (CVD)? (10)

Back 35

medication

nutrition

elimination

activity

sleep

self-perception and concept

roles/relationships

sexuality/reproduction

coping

prevention

Front 36

What symptom would indicate acute coronary syndrome (ACS), disrhythmias, valvular heart disease or angina pectoris?

Back 36

chest pain

Front 37

What symptom would indicate ACS, valvular heart disease, cardiogenic shock or heart failure?

Back 37

SOB/dyspnea

Front 38

What disease would peripheral edema, weight gain, abdominal distension due to enlarged speel and liver, ascites indicate?

Back 38

heart failure

Front 39

What symptom would be an early warning sign of ACS, valvular heart disease or heart failure?

Back 39

vital fatigue/exhaustion

Front 40

What symptom would indicate ACS, valvular disease,ventricular aneurysms?

Back 40

palpitations

Front 41

What 3 symptoms would indicate dysrhythmias, cardiogenic shock, cerebrovascular disorders, hypotension, postural hypotension (easy one)?

Back 41

dizziness

syncope

LOC changes

Front 42

What would the nurse assess in the physical assessment when suspecting/treating a CVD (4)?

Back 42

general appearance

LOC

skin

extremeties for edema, cap refill

Front 43

In what 2 positions would the nurse want the patient in to check BP when suspecting/treating a CVD and why?

Back 43

sitting

standing

to check for postural hypotension

Front 44

What 3 places should the pulse be checked when suspecting/treating CVD?

Back 44

apical

radial

pedal

Front 45

When a murmur is heard, what 4 things should be assessed about that murmur?

Back 45

location

timing

presence during diastole/systole

intensity

Front 46

What is the grading scale for murmurs and what does each digit represent?

Back 46

1-barely heard, hard to hear without special training

2-soft, can only hear with experience

3-anyone can hear

4-loud, associated with thrill

5,6-really loud, can heart without stethoscope

Front 47

What are the 5 most common terms we students should be familiar with when talking about location of heart sounds?

(ICS location listed for each, but Jennings mentioned we are not required to know those)

Back 47

aortic area (2nd ICS, right of sternum)

pulmonic area (2nd ICS, left of sternum)

Erb's point (3rd ICS, left of sternum)

tricuspid area (4-5th ICS, left of sternum

point of maximum impact (PMI) (5th ICS, midclavicular line)

Front 48

What does a chest x-ray indicate about the heart?

Back 48

size

Front 49

What does an ECG indicatae about the heart?

Back 49

electrical activity

Front 50

How is a cardiac stress test performed?

Back 50

give meds to stress heart OR exercise to stress heart

Front 51

It is imperative that the patient not consume ___ or ____ prior to a cardiac induced stress test.

Back 51

stimulants (caffeine)

anything that would slow heart (beta blockers)

Front 52

What is a transthoracic echocardiagram (TTE) used to observe?

Back 52

heart size

look through chest wall

Front 53

What is a transesophageal echocardiogram (TEE) used to observe?

Back 53

heart size and structure formation

Front 54

What are 2 things to remember about the transesophageal echo (TEE)?

Back 54

trachea will be numbed

pt must be NPO before procedure and after until gag reflex comes back

Front 55

What makes a CT scan or MRI a more detailed test than others (TTE, TEE, chest xray) that allow us to visualize the heart?

Back 55

it shows the crossections of the heart

Front 56

Why are MRIs not used as often as they used to be? (2)

Back 56

any movement -at all- messes up the pictures.

absolutely no metal anywhere near the MRI (impants, name badges)

Front 57

How long must a patient be NPO before a cardiac catheterization?

Back 57

8-12 hours

Front 58

What are the 4 reasons a cardiac catheterization is used?

Back 58

measures cardiac chamber pressures

assess patency of coronary arteries

determine if patient needs CABG

used for stent placement

Front 59

How long must a patient remain on bedrest after a venous and arterial cardiac catheterization (hint: they're different)?

Back 59

venous 4-6 hours

arterial 6-8 hours

Front 60

Why is leg rest so important after a cardiac catheterization?

Back 60

moving the legs could break up clot forming at entry site and start bleeding

Front 61

Describe a balloon angioplasty procedure. (extremely brief)

Back 61

balloon inserted through cardiac cath to where blockage is located

balloon inflated to break up blockages

Front 62

What is a balloon angioplasty used to do?

Back 62

break up blockages

Front 63

When is a coronary artery bypass graft (CABG) done?

Back 63

when a coronary artery is COMPLETELY blocked.

Front 64

After a cardiac catheterization, if the dressing over entry site is saturated, what should the nurse do?

Back 64

apply clean dressing on top and notify doctor

Front 65

What must be done to the vessels during a CABG?

Back 65

they must be completely replaced

Front 66

What is commonly used to replace a cardiac artery in a CABG?

Back 66

safenous vein from pt's own leg

Front 67

What are the 4 lab values used to determine whether or not an MI has occured?

Back 67

CK-MB

LDS

Troponin

Myoglobin

Front 68

What is CK-MB (creatinine-kinase myofibrils)?

Back 68

enzyme found mainly in cardiac cells

Front 69

CK-MB (creatinine-kinase myofibrils) in MI (rise, peak and return to normal, hours)

Back 69

rise - 4-8 hours

peak - 24 hours

normal - 3-4 days

Front 70

What is LDH (lactic dehydrogenase)?

Back 70

enzyme found in body made of 2 types, LDH1 and LDH 2

Front 71

LDH in MI (__ > __)

Back 71

LDH1 > LDH2

Front 72

What is troponin?

Back 72

proteins found only in cardiac muscle

Front 73

describe Troponin level changes during an MI

Back 73

increases for 1-3 hours

elevated for 1-3 weeks

Front 74

Myoglobin in MI (increases, return to normal, hours)

Back 74

increases within 1-3 hours

return to normal -12 hours

Front 75

What 2 other diseases can elevated myoglobin be found in?

Back 75

renal disease

musculoskeletal disease

Front 76

What is the gold standard for MI?

Back 76

Troponin

Front 77

What are the 2 lab values used to gather a lipid profile?

Back 77

LDL

HDL

Front 78

Why are the lipid profile norms different for patients with coronary artery and heart disease?

Back 78

because people with those disorders have to be very controlled due to damaged arteries and veins (usually atherosclerosis)

Front 79

Normal HDL value (men and women)

coronary artery disease/heart disease HDL value

Back 79

normal - males, 35-70 mg/dl
females, 35-85 mg/dl

CAD >40

Front 80

Normal LDL value

coronary artery disease/heart disease LDL value

Back 80

normal <160 mg/dl

CAD <100 mg/dl

Front 81

What is BNP (brain naturetic peptide)

Back 81

a neurohormone that helps regulate BP and fluid volume

Front 82

What is the BNP used to indicate?

Back 82

heart failure

Front 83

What BNP value indicates heart failure (pg/ml)?

Back 83

>100pg/ml

Front 84

What is CRP (C-reactive protein)?

Back 84

protein produced by liver in response to systemic inflammation thought to play a role in athersclerosis

Front 85

normal CRP

value that indicates risk for cardiovascular disorder

Back 85

normal <1mg/dl

CVD risk >3mg/dl

Front 86

What is homocysteine?

Back 86

amino acid that correlates with a high risk of cardiovascular and peripheral disease and stroke

Front 87

optimal homocysteine

borderline homocysteine

high risk homocysteine

Back 87

optimal: <12umol/L

borderline: 12-15 umol/L

high risk: >15 umol/L

Front 88

What is the most prevalent type of cardiovascular disease in adults?

Back 88

coronary artery disease (CAD)

Front 89

What is the most common cause of CAD?

Back 89

atherosclerosis

Front 90

What is CAD?

Back 90

lipid or fibrous tissue that causes decreases in blood flow to the myocardium of the heart and cause blockages through the coronary arteries

Front 91

What are the nonmodifiable risk factors for CAD?

Back 91

family history

increasing age

males

race

Front 92

What are the modifiable risk factors for CAD?

Back 92

hyperlipidemia

HTN

cigarette smoking

diabetes

obseity (especially abdominal fat)

physical inactivity

Front 93

What should the A1C be for a diabetic?

Back 93

<7

Front 94

What is the cure for CAD?

Back 94

there isn't one.

once you have it, you've got it forever

Front 95

What medications are used to control cholesterol?

Back 95

statins

nicotinic acids

bile acid sequestraints

Front 96

What medications are used to control BP?

Back 96

ACE

ARB

BB

Front 97

What medications are used to control diabetes?

Back 97

oral hypoglycemics

insulin

Front 98

Why are stents placed in patients?

Back 98

to prevent vessel collapse.

Front 99

Why are patients placed on anticoagulant medications after placement of a cardiac stent?

Back 99

to prevent blood from sticking to stent while endothelial cells grow around it

Front 100

What is the term for a clinical syndrome usually characterized by episodes of pain in the anterior chest due to insufficient blood flow resulting in decreased oxygen supply when there are increased myocardial oxygen demands?

Back 100

angina

Front 101

What are the clinical manifestations of angina (8)?

Back 101

pain that may radiate to other areas

weakness/numbess

SOB

anxiety

pallor

diaphoresis

dizziness

n&v

Front 102

Are there any lab changes when a patient suffers from anginal attacks?

Back 102

nope

Front 103

What can be used to verify an anginal attack has occured? (2)

Back 103

EKG

family history

Front 104

What is the goal of treatment of angina?

Back 104

decrease oxygen demand and increase oxygen supply to heart

Front 105

As a nurse, when you have a patient complain of chest pain, what should you do? (3)

Back 105

administer 2L oxygen

call doctor

call respiratory

Front 106

When a patient is experiencing frequent episodes of angina, what should the nurse suspect?

Back 106

that blockages may be forming in the heart

Front 107

To check for blockages when a patient is experiencing frequent episodes of angina, what 2 procedures can be performed?

Back 107

percutaneous transluminal coronary angioplasty (PTCA)

CABG

Front 108

What is the most common medication administered for episodes of angina and what is the recommended dosing?

Back 108

sublingual nitroglycerin (SL NTG)

1 tab sublingually every 5 minutes for up to 3 doses

if no relief after 3 doses, call 911.

Front 109

In what forms is nitroglycerin available?

Back 109

SL

spray

patch

paste (applied to chest)

Front 110

What are 3 other medications used to treat angina in adjunct to nitroglycerin and how do they work to relieve angina?

Back 110

BB - decrease oxygen consumption

CCB - decrease oxygen demands

aspirin - prevent clots and keep vessels open

Front 111

What is nitroglycerin?

Back 111

a vasodilator

Front 112

HORRIBLE definition: An area of the myocardium is permanently destroyed caused by reduced blood flow in a coronary artery due to rupture or an atherosclerotic plaque that occluded the artery by a thrombus.

What's the term for this?

Back 112

myocardial infarction

Front 113

What is the diagnostic test performed for an MI and what will the abnormal findings be?

Back 113

ECG

abnormal Q wave

Front 114

What is a STEMI and a NSTEMI?

Back 114

STEMI-sudden thrombotic occlusion of coronary artery

NSTEMI- unstable plaque causing platelet aggregation leads to occlusion of coronary artery

Front 115

What is the difference in the ACG for a STEMI and a NSTEMI?

Back 115

STEMI- ST elevation

NSTEMI- no ST elevation

Front 116

What is the goal of treatment for an MI? (3)

Back 116

to minimize myocardial damage

to preserve myocardial function

to prevent complications

Front 117

What can used to treat an MI? (4)

Back 117

angioplasty (PTCA)

CABG (when multiple vessels blocked)

thrombolytics only when pt not candidate for angioplasty or CABG

meds

Front 118

What is the window for treatment of MI with thrombolytics and why?

Back 118

must use within 3-6 hours and no later due to bleeding risk

Front 119

What meds is a patient normally on while in the hospital waiting on results of diagnostic tests for an MI? (4)

Back 119

aspirin

NTG

morphine (reduces preload and afterload, pain and anxiety)

IV beta-blocker (reduces HR, shown to decrease incidence of future events when given in acute events)

Front 120

HWat is the term for a heart muscle disease associated with cardiac dysfunction and is classified according to the structure and functional abnormality of the heart muscle?

Back 120

cardiomyopathy

Front 121

What are the 3 types of cardiomyopathy?

Back 121

dilated

hypertropic

restrictive

Front 122

What is dilated cardiomyopathy?

Back 122

dilated ventricles with weakend muscular walls

Front 123

What is hypertropic cardiomyopathy?

Back 123

ventricles and muscles dilate assymmetrically

Front 124

What is restrictive cardiomyopathy?

Back 124

no ventriclar stretch that impaires diastolic filling

Front 125

What do all myopathies result in?

Back 125

impaired CO that can lead to heart failure

Front 126

Which cardiomyopathy is autosomal dominant and thus requires frequent ECGs?

Back 126

hypertropic

Front 127

What are the clinical manifestations of cardiomyopathy?

Back 127

the same as in heart failure

syncopy, fluid retention, dyspnea, cough, fatigue...

Front 128

What are the diagnostic tests that can be used to determine cardiomyopathy?

Back 128

ECG

CXR

TEE, TTE

Front 129

What medications/diet restrictions/lifestyle changes are used to treat cardiomyopathies?

Back 129

(same as in heart failure)

beta blockers

vasodilators

low salt diet, fluid limi, exercise, rest

Front 130

What is nonsurgical septal reduction therapy?

Back 130

ethanol is injected into septal cells to kill excess cells and decrease size of heart.

Front 131

When would nonsurgical septal reduction therapy be used?

Back 131

When septum in between ventricles is enlarged.

Front 132

Describe what the surgery would do in the event of an enlarged septum?

Back 132

cut out extra myocardium in septum

Front 133

What is the cure for an enlarged septum?

Back 133

heart transplant

Front 134

In a patient who receives a heart transplant, is there a sympathetic connetion with the implanted heart?

Back 134

no

Front 135

What are 3 infectious cardiac diseases and which is most severe?

Back 135

endocarditis - most severe

myocarditis

pericarditis

Front 136

What are 2 types of endocarditis and whom are they common in?

Back 136

rheumatic endocarditis - children

infective endocarditis - ppl with valve defets/replacements

Front 137

What can lead to rhuematic endocarditis?

Back 137

untreated or insufficiently treated strep (Group A betahemolytic strep)

Front 138

What is endocarditis?

Back 138

a microbial infetion of the endothelial surface of the heart

Front 139

What are the clinical manifestations of endocartidits (either type)?

Back 139

fever

heart murmur

Osler nodes

Janeway lesions

Roth spots

Front 140

What are Osler nodes (endocarditis)?

Back 140

painful nodues on fingers and toe pads

Front 141

What are Janeway lesions (endocarditis)?

Back 141

super small bruises/macules on palms of hands and soles of feet

Front 142

What are Roth Spots (endocarditis)?

Back 142

small hemorrhages in retinal seen with ophthalmoscope

Front 143

What are the diagnostic tests use to determine endocarditis?

Back 143

blood cultures

elevated WBC

TTE, TEE

Front 144

What is the prophylactic treatment of endocarditis in patients with valve replacements?

Back 144

antibiotics before any type of procedure (i.e. dentist appointments)

Front 145

What is the treatment of endocarditis?

Back 145

IV antibiotics that can be outpatient or via home health

Front 146

When is surgical treament done in endocarditis?

Back 146

if the valve must be replaced again due to the infection

Front 147

What is myocarditis?

Back 147

NOT SERIOUS

an inflammatory process involving the myocardium that is usually viral (but can be fungal or parasitic)

Front 148

What are the clinical manifestations of myocarditis?

Back 148

depends on type of infection and extent of damage

can be completely asymptomatic to trouble breathing

Front 149

What are the symptoms similar to in viral myocarditis?

Back 149

flu-like

Front 150

Biopsies are used to diagnose endocarditis if...

Back 150

an infection has spread somewhere other than the heart.

(basically, you don't biopsy someone's heart)

Front 151

What is the prophylactic treatment of myocarditis?

Back 151

immunizations

Front 152

What is the treatment of myocarditis?

Back 152

bedrest, let body heal on its own

NSAIDS as things improve (never in acute phase)

Front 153

When are antibiotics used to treat myocarditis?

Back 153

if cause is determined (but it's usually not)

Front 154

What is pericarditis?

Back 154

NOT SERIOUS

inflammation of the pericardium that can be primary or secondary to major surgery

Front 155

What are the clinical manifestations of pericarditis? (4)

Back 155

pleural friction rub

increased WBC

elevated ESR (erythrocyte sedimentation rate) or CRP (c-reactive protein)

nonproductive cough with pain

Front 156

What are the diagnostic tests for pericarditis? (3)

Back 156

ECG

TEE, TTE

CT scan

Front 157

What is the treatment for pericarditis?

Back 157

bedrest, let body heal on its own

analgesics, NSAIDS for pain

if needed, pericardiocentesis

Front 158

When is a pericardiocentesis performed in primary and secondary (hint: they're different reasons)?

Back 158

primary - to relieve symptoms

secondary - to culture fluid to determine primary cause

Front 159

What is the inability of the heart to pump sufficient amounts of blood to meet the needs of the tissues for oxygen and nutrients?

Back 159

heart failure

Front 160

What are the 4 types of heart failure?

Back 160

right sided

left sided

diastolic

systolic

Front 161

Which 2 types of heart failure are the most common and can they occur at the same time?

Back 161

right and left

yes

Front 162

What are the clinical manifestations of left sided heart failure? (6)

Back 162

dysnpea

SOB with activity and when lying flat

paroxysmal nocturnal dyspean (PND)

adventitious lung sounds

cough

fatigue

Front 163

What are the clinical manifestations or right sided heart failure? (6)

Back 163

peripheral edema

hepatomegaly

ascites

anorexia/weight gain

nauea

weakness

Front 164

What are the diagnostic tests used to determine heart failure?

Back 164

TEE, TTE

chest xray

ECG

lab tests

Front 165

The TEE and TTE are generally used to look at the heart in a crossectional manner. In the instance of heart failure, what are the TTE and TEE used to measure?

Back 165

ejection fraction

Front 166

What lab test is indicative of heart failure?

Back 166

BNP

Front 167

What is the goal of treatment in heart failure? (3)

Back 167

to relieve patient symptoms

to improve functional status, quality of life

to extend survival

Front 168

What are the medications used to treat heart failure?

Back 168

(anything to decrease demand and improve contractility)

ACE

ARBS

diuretics

digoxin

IV drops of these things in an acute exacerbation while in ICU

Front 169

Besides medications, what are 4 other treatments for heart failure?

Back 169

lifestyle recommendations

oxygen

PTCA

implantable defibrillators

Front 170

What is the cure for heart failure?

Back 170

heart transplant

Front 171

What do implantable defibrillators do?

Back 171

improve SA node firing by firing in its place when it malfunctions

Front 172

What is an abnormal accumulation of fluid in the lungs, intersitial spaces and alveoli?

Back 172

acute heart failure

AKA

pulmonary edema

Front 173

What is the onset like for acute heart failure (pulmonary edema)?

Back 173

very, very quick

Front 174

What are the clinical manifestations of acute heart failure (pulmonary edema)? (8)

Back 174

pink frothy sputtum ;-)

restlessness, anxiety

sudden breathlessness/sense of suffocation

cyanotic nail beds

ashen skin

weak, rapid pulse

decreased oxygen sats

feeling of being "full"

Front 175

What are the diagnostic treatments for acute heart failure (pulmonary edema)

Back 175

chest xray

physical exam

Front 176

What are the treatments for acute heart failure (pulmonary edema) (4)?

Back 176

upright positioning with feet depedent (to decrease venous return and allow heart to rest)

oxygen

morphine

other meds (only in ICU)

Front 177

What meds are administered to a patient in acute heart failure while in the ICU? (4)

Back 177

diuretics

dobutamine

primacor

natrecor

Front 178

What are 2 other causes of acute heart failure that are not directly related to the heart itself?

Back 178

renal failure

oncologic conditions

Front 179

What is the term to describe when decreased cardiac output leads to inadequate perfusion and initiation of shock syndrome?

Back 179

cardiogenic shock

Front 180

What are the clinical manifestations of cardiogenic shock? (4)

Back 180

pain r/t angina

dysrhythmias

fatigue

feelings of doom

Front 181

What is the goal of treatment in cardiogenic shock?(4)

Back 181

to correcy underlying problem

to reduce furher demand on heart

to improve oxygenation

to restore tissue perfusion

Front 182

What 4 things should the nurse do for a patient in cardiogenic shock?

Back 182

monitor hemodynamic status

administer iv fluids/meds (NTG)

enhance safety and comfort

Front 183

In patients with heart problems, what should the nurse always be vigilant for doing?

Back 183

identifying patients at risk for cardiogenic shock as early as possible

Front 184

What order do you carry out the abdominal assessment? (4)

Back 184

Inspection

Auscultation

Palpation

Percussion

Front 185

Why do you have to do an abdominal is a certain order?

Back 185

percussion and palpation may alter sounds

Front 186

Define Normal auscultation, hypoactive sounds and hyperactive sounds

Back 186

Normal auscultation is noise every 20sec;

hypo is one sound in 2 min;

hyperactive is constant sound (5 or 6 in 30secs)

Front 187

What is the difference between light and deep palpation? (i.e. what are you checking for in each)

Back 187

light = tenderness

deep = masses

Front 188

define actinic cheilitis

Back 188

cracking of the lips, esp in the corners

Front 189

define leukplakia

Back 189

white patches on insides of cheeks

Front 190

define Candidiasis

Back 190

thrush=yeast infection produces white coating in mouth and tongue

Front 191

define Karposi’s sarcoma

Back 191

oral cancer most commonly associated with HIV pts

Front 192

difference bw/ gingivitis and periodontitis

Back 192

Gingivits- gums grow over teeth, inflamed

Periodontitis- gums recede from teeth

Front 193

Opening in diaphragm through which the esophagus passes becomes enlarged and part of the upper stomach moves up and down into the lower portion of the thorax.

Back 193

hiatal hernia

Front 194

management of Hiatal hernia

Back 194

Frequent, small feedings that pass easily through esophagus

Advise not to recline for 1 hour after eating

Elevate Head Of Bed (HOB) 4-8 inches to prevent hernia from sliding upward

Front 195

When would surgical intervention be used for a Hiatal Hernia?

Back 195

if home care isn't working

Front 196

disorder characterized by: Back flow of gastric contents or duodenal contents into the esophagus (sphincter is incompetent and doesn’t stay closed)

Back 196

Gastro-esophageal Reflux Disease (GERD)

Front 197

How is GERD diagnosed? (3)

Back 197

endoscopy, barium swallow, pH probe

Front 198

How barium swallow is a diagnostic tool:

Back 198

pictures show if barium comes back up

Front 199

explain pH probe

Back 199

probe inserted through nose, measures pH for 12-36 hrs to determine if anything is coming up

Front 200

Management of GERD

Back 200

Elevate HOB

Avoid aggravating foods

Antacids,

Nissan fundoplication

Front 201

What is a Nissan fundoplication?

Back 201

they surgically wrap the upper part of the stomach around the esophagus so that it acts like sphincter and doesn’t allow things to come back up

Front 202

What age group is a Nissan fundoplication more commonly done on?

Back 202

babies

Front 203

Define Barrett's Esophagus

Back 203

Lining of esophageal mucosa becomes damaged by stomach acid over time

Front 204

What condition is Barrett's Esophagus typically seen in conjunction with, and what can it be a precursor to?

Back 204

GERDS

precursor to esophageal cancer

Front 205

What is a common GI problem characterized by inflammation of the stomach that can be acute or chronic?

Back 205

Gastritis

Front 206

Causes of acute gastritis (6)

Back 206

dietary indiscretion

medications,

alcohol,

bile reflux, and

radiation therapy.

Ingestion of strong acid or alkali (may cause serious complications).

Front 207

What is acute gastritis usually caused by?

Back 207

dietary indiscretion

Front 208

What is chronic gastritis usually caused by?

Back 208

prolonged inflammation due to benign or malignant ulcers of the stomach or by Helicobacter pylori.

Front 209

What are the other 6 causes of chronic gastritis?

Back 209

some autoimmune diseases,

dietary factors,

medications,

alcohol,

smoking, or

chronic reflux of pancreatic secretions or bile.

Front 210

S/S of acute gastritis (5)

Back 210

abdominal discomfort,

headache,

lassitude (lack of energy),

nausea, vomiting,

hiccuping.

Front 211

S/S of chronic gastritis (7)

Back 211

epigastric discomfort,

anorexia,

heartburn after eating,

belching,

sour taste in the mouth,

nausea and vomiting,

intolerance of some foods.

Front 212

What may some patients with chronic gastritis have a deficiency of over time, and why?

Back 212

Vitamin B12 deficiency, due to malabsorption

Front 213

How is gastritis usually diagnosed?

Back 213

UGI X-ray or endoscopy and biopsy.

Front 214

What levels of hydrochloric acid may gastritis be associated with?

Back 214

achlorhydria, hypochlorhydria, or hyperchloryhydria

Front 215

medical management of acute gastritis

Back 215

refrain from alcohol and food until symptoms subside,

begin with bland non-irritating diet and advance as tolerated.

usually resolves in 1-2 days

Front 216

What is the management of acute gastritis if caused by ingestion of strong acids or alkalis?

Back 216

dilute and neutralize offending agent

(ie antacids if acidic or lemon juice if alkaline)

Front 217

What is the medical management of chronic gastritis?

Back 217

modify diet,

promote rest,

reduce stress,

avoidance of alcohol and NSAIDS,

treatment of H.pylori if indicated

Front 218

nursing management of gastritis (5)

Back 218

Reduce Anxiety

Promote Optimal Nutrition

Promote Fluid Balance

Relieve Pain

Education

Front 219

Disease in which Erosion of a mucous membrane forms an excavation in the stomach, pylorus, duodenum, or esophagus

Back 219

peptic ulcer disease (PUD)

Front 220

What is PUD associated with (i.e. cause)?

Back 220

H. pylori

(not too much stress like previously thought)

Front 221

Risk factors for PUD (6)

Back 221

excessive secretion of stomach acid,

dietary factors,

chronic use of NSAIDs,

alcohol,

smoking, and

familial tendency.

Front 222

manifestations of PUD (3)

Back 222

dull gnawing pain or burning in the mid-epigastrium;

heartburn and

vomiting

Front 223

Why might anorexia form due to PUD?

Back 223

because pain is at its worse after eating (postprandial)

Front 224

treatments for PUD (3)

Back 224

meds (antibiotics to clear up H. pylori)

lifestyle changes

surgery if it's perforated / penetrating

Front 225

What is the difference between a perforated and penetrating ulcer?

Back 225

perforated=open to abdominal cavity

penetrating=eroded into other organ

Front 226

WHat does IBS result from?

Back 226

functional disorder of intestinal mobility

Front 227

How is IBS diagnosed?

Back 227

after excluding other disorders (takes time to diagnose)

Front 228

What is the criteria necessary for diagnosis?

Back 228

Recurrent abd pain or discomfort for at least 3 days a month in the past 3 months and

2 or more of the following:
improvement of pain with defecation,
onset associated with change in frequency of stool,
onset associated with change in appearance (form) of stool

Front 229

How do the s/s of IBS manifest?

Back 229

Wide variability in symptom presentation, range in intensity and duration from mild and infrequent to severe and continuous

Front 230

What are the primary symptoms of IBS? (4)

Back 230

alteration in bowel pattern: constipation, diarrhea, or combo

Pain,

bloating, and

abdominal distention may be present.

Front 231

nursing management for IBS (4)

Back 231

good dietary habits,

avoidance of triggers

Eat at regular times,

chew food slowly and thoroughly

Front 232

What is the medical management of IBS aimed at? (3)

Back 232

relieving abdominal pain,

controlling the diarrhea or constipation, and

reducing stress

Front 233

What are the medical managements of IBS? (4)

Back 233

Try to identify foods that are irritants (food diary)

High Fiber Diet

Exercise and Stress Reduction

Medications

Front 234

What are the 3 types of meds that may be prescribed with IBS and what they do.

Back 234

antidepressants to increase serotonin to help with motility

antispasmotics/anti-cholernergic to help with cramping and help with pain

Front 235

definition of diarrhea

Back 235

Increased frequency of bowel movements( 3+/day)

Increased amount of stool (200g/day)

Altered consistency of stools (increased liquidity)

Front 236

manifestations of diarrhea (5)

Back 236

Abdominal cramps,

distention,

intestinal rumbling,

anorexia,

thirst

Front 237

If the cause of diarrhea is not obvious, what are the diagnostic tools used? (5)

Back 237

CBC,

metabolic profile (for electrolytes),

stool sample

endoscopy

barium enema

Front 238

What are you checking for the stool sample in a pt with diarrhea? (6)

Back 238

infectious or parasitic organisms,

bacterial toxins,

blood,

fat,

electrolytes, and

WBCs

Front 239

What is the most commonly identified agent in antibiotic associated diarrhea?

(prolonged use of antibiotics kills the good bacteria, so what takes over?)

Back 239

Clostridium Difficile (C-Diff)

Front 240

What 3 things is the management of diarrhea directed towards?

Back 240

controlling symptoms,

preventing complications, and

eliminating or treating underlying disease

Front 241

3 types of meds that may be given to a diarrheal patient

Back 241

antibiotics,

anti-inflammatory agents,

anti-diarrheals (Immodium)

Front 242

3 complications that can arise from diarrhea

Back 242

cardiac dysrhythmias

skin break down

hypovolemic shock

Front 243

Why might a patient with diarrhea get cardiac dysrhythmias?

Back 243

if there is significant fluid and electrolyte loss

Front 244

What are the s/s of hypovolemic shock? (6)

Back 244

Urinary output less than 30ml/hr for 2-3 consecutive hours,

muscle weakness,

paresthesia,

hypotension,

anorexia, and

drowsiness with a potassium level of <3.5mEq/L

Front 245

3 definitions for constipation

Back 245

Abnormal infrequency or irregularity of defecation (more than 4 days)

Abnormal hardening of stools that makes their passage difficult and sometimes painful

Decrease in stool volume or retention of stool in the rectum for a prolonged period

Front 246

manifestations of constipation (8)

Back 246

abdominal distention,

pain and pressure,

decreased appetite,

indigestion,

headache,

fatigue,

sensation of incomplete evacuation;

straining at stool

Front 247

ways to diagnose constipation (4)

Back 247

patient's hx, physical exam

barium enema (X-ray of large intestine)

sigmoidoscopy,

KUB

Front 248

What is a KUB?

Back 248

x-ray of kidneys, ureters, bladder

shows bowels and how much stool is in there

Front 249

medical management of constipation

Back 249

Identify underlying cause and aim to prevent recurrence

Medication

Front 250

What are the 5 types of meds can be prescribed to treat

Back 250

bulk forming
lubricant
stimulant
fecal softener
osmotic agent

Front 251

nursing management of constipation (2)

Back 251

Health hx interview focusing on symptoms of constipation

Teaching/Education of
appropriate diet, exercise

Front 252

5 complications caused by constipation

Back 252

hemorrhoids

anal fissures

megacolon

fecal impaction

valsalva maneuver

Front 253

What exactly is a megacolon?

Back 253

so much stool that it backs all the way through the colon, nothing can get through causing the colon to perforate and spill into the abdominal cavity

Front 254

What is the difference between a megacolon and a fecal impaction?

Back 254

Fecal Impaction- stool blocking just an area of the colon instead of the whole area like in a megacolon

Front 255

how does constipation cause a valsalva maneuver, and what can that cause?

Back 255

straining causes you to hold your breath (the maneuver) which causes BP to drop, then goes back up higher than needs to be then normalizes

Front 256

What is the leading cause of acute abdominal surgery in ages 10-30?

Back 256

appendicitis

Front 257

manifestations of appendicitis (7)

Back 257

Epigastric or periumbical pain that progresses to RLQ pain,

N/V,

low grade fever,

loss of appetite,

tenderness at McBurney’s point (middle of RLQ),

rebound tenderness,

possible constipation

Front 258

3 ways to diagnose appendicitis

Back 258

physical exam,

labs, and

imaging studies

Front 259

What 2 lab values change during appendicitis?

Back 259

WBC and platelets elevate

Front 260

medical management of appendicitis

Back 260

Emergent Appendectomy unless perforation has occurred

if perforated…given antibiotics to wipe out bacteria/infection then come back in for appendectomy

Front 261

What are a sac-like herniations of the lining of the bowel that extend through a defect in the muscle layer?

Back 261

diverticulum

or singularly a diverticula

Front 262

definition: multiple diverticula without inflammation not really causing problems (no infection)

Back 262

diverticulosis

Front 263

definition:

Back 263

infection and inflammation of diverticula

Front 264

Risk factors that increases chance of diverticular disease (2)

Back 264

increased age

low fiber diet

Front 265

How is diverticular disease usually diagnosed?

Back 265

colonoscopy

Front 266

manifestations of diverticular disease (5)

Back 266

rabbit pellets

n/v

increase WBC

chills/fever

extreme abdominal pain

Front 267

Acute cases of diverticular disease may require hospitalization, what would treatment include? (3)

Back 267

NPO until symptoms subside, given IV fluids,

antibiotics for 7-10 days,

opioid analgesics/antispasmodics for pain

Front 268

What are the 5 outpatient treatments for diverticular disease?

Back 268

Rest,

analgesics, and antispasmodics

Clear liquid diet until inflammation subsides, then high-fiber, low fat diet

Antibiotics for 7-10 days

Bulk-forming laxatives

Front 269

4 complications that can arise due to diverticular disease (when they bust open)

Back 269

Peritonitis (diverticula bust open and spread bacteria causing an infection called ^),

abscess,

fistulas, and

bleeding

Front 270

What can cause peritonitis?

Back 270

external or internal source (does not randomly occur on it’s own)

Leakage of contents from abdominal organs into abdominal cavity,

Front 271

What's the pathology of peritonitis?

Back 271

Leakage of contents from abdominal organs into abdominal cavity,

bacterial proliferation occurs,

leads to tissue edema and

exudation of fluid.

Front 272

What are the manifestations of peritonitis based on, and what might they be? (4)

Back 272

Based on location and extent of inflammation

fever,

pain,

board like abdomen,

some rebound tenderness

Front 273

3 ways to diagnose peritonitis

Back 273

X-ray,

abdominal Ultra/Sound,

CT scan

Front 274

4 management strategies for peritonitis

Back 274

Supportive tx of symptoms,

antibiotics
fluids,

surgical interventions to repair what has damaged the area causing the infection

Front 275

What are the supportive tx of symptoms to manage peritonitis?

Back 275

pain meds,

NG tube to suction,

antiemetics

Front 276

What is another name for Crohn's disease?

Back 276

Regional Enteritis

Front 277

What is the disease characterized by Subacute and chronic inflammation that extends through all layers of GI tract wall?

Back 277

Crohn's disease

Front 278

Where does Crohn's disease most commonly occur?

Back 278

distal ileum (works from top down)

Front 279

What are 3 complications common in Crohn's disease?

Back 279

Fistulas, Fissures, and Abscesses common

Front 280

What age range is Crohn's disease diagnosed?

Back 280

young

Front 281

How is Crohn's disease diagnosed?

Back 281

endoscopy (usually)

colonoscopy (not common)

Front 282

Whats the pathology of Crohn's Disease?

Back 282

inflammation causes mucosa to thicken, and ulcers appear on the mucosa

making the intestinal walls thicker and fibrotic making lumen in the bowels smaller and then

adhesions occur b/w the loops blocking off the bowel

Front 283

What are the manifestations of Crohn's disease? (7)

Back 283

wt loss

malnutrition

chronic diarrhea

cramp abdominal pains after eating

steatorrhea

fever

n/v

Front 284

Does Crohn's disease have a familial tendency?

Back 284

yes

Front 285

Which chronic inflammatory bowel disease has periods of remissions and exacerbations?

Back 285

both Crohn's and Ulcerative Colitis.

Front 286

What chronic inflammatory bowel disease is described as an ulcerative and inflammatory disease of mucuosal and submucosal layer causing blockage?

Back 286

Ulcerative Colitis (UC)

Front 287

Where does UC most commonly occur?

Back 287

rectum and colon (works its way up)

Front 288

What is a common complication associated with UC?

Back 288

abscesses


(NOT fistulas or fissures)

Front 289

manifestations of UC (3)

Back 289

mucus and puss in stool from shedding of epithelial cells,

diarrhea

LLQ pain

Front 290

how is UC diagnosed?

Back 290

colonoscopy

Front 291

Nutritional therapy for Crohn's or UC (3)

Back 291

Oral Fluids

Low Residue High Protein High
Calorie Diet

Vitamin Replacement

Front 292

3 types of meds that could be prescribed to manage Crohn's or UC and what they are used for

Back 292

Corticosteroids (antiinflammatory) ,

Immunomodulators, alters how body acts to disease / modifies response

Aminosalicylates, reduces inflammation

Front 293

4 surgical management strategies for Crohns or UC

Back 293

Stricturplasty-opens the narrow area of the bowel

Intestinal transplant-

Colectomy-

small bowel resection

Front 294

What 2 surgical management strategies are more for Crohn's patients than UC? Which one is used more for UC?

Back 294

Crohns = intestinal transplant, small bowel resection

UC = colectomy

Front 295

What is the downside to a colectomy?

Back 295

ileostomy for life

Front 296

Characteristics of bowel obstructions (3)

Back 296

mechanical or function

partial or complete

in small or large bowel

Front 297

Where do most bowel obstruction occur, and what are they caused by?

Back 297

small intestine and are caused by adhesions

Front 298

manifestations of small bowel obstruction (5)

Back 298

come on quickly ( 24-48 hrs)

crampy pain that is wave-like and colicky when peristalsis happens.

vomiting (possibly of stool),

dehydration,

abdominal distention.

Front 299

manifestations of large bowel obstructions (7)

Back 299

develop and progress relatively slowly.

constipation that can last for months,

weakness,

weight loss,

anorexia.

Eventually distended abdomen and crampy lower abdominal pain

Front 300

How are bowel obstructions typically diagnosed? (2)

Back 300

x-ray

CT

Front 301

management of bowel obstruction

Back 301

Decompression of bowel through NG tube, if unsuccessful or if obstruction is complete surgical intervention is necessary.

Front 302

2 types of gastric tubes and what they are used for

Back 302

levin and gastic pump

used to remove fluid or gas for decompression

inserted through the nose to the stomach

Front 303

3 types of enteric tubes and what are they used for?

Back 303

gastric, duodenal, jejunal

used to feed

Front 304

term for a tube surgically inserted directly into the stomach for feeding or decompression

Back 304

gastrostomy

Front 305

two types of gastrostomies

Back 305

PEG tube

low profile PEG (used in kids)

Front 306

What type of nutrition regimen is indicated if the patient is unable to ingest/digest adequate oral food or fluids for 7+ days?

Back 306

Parenteral nutrition

Front 307

What does parenteral nutrition provide, and how is it administered?

Back 307

provides nutrients by IV to be absorbed by the blood

given through PICC or Central Line

Front 308

What type of nutrition is given to meet requirements when oral intake is inadequate or not possible and the middle and lower portions of the GI tract are functionally normal?

Back 308

enteral nutrition

Front 309

What are the 4 ways to administer enteral nutrition?

Back 309

NG

ND

G-Tube

J-tube

Front 310

How many grams a day is considered high fiber?

Back 310

>25g/day

Front 311

How many grams of fiber must a food have before it is considered high fiber?

Back 311

5 g

Front 312

What is a low residue diet?

Back 312

similar to low fiber,

don't eat foods that remains in your intestinal tract and contributes to stool.

Front 313

When would a low residue diet be advised?

Back 313

following abdominal surgery or

during a flare-up of a digestive disorder such as diverticulitis or IBD

Front 314

Why should a low residue diet only be used for a short time?

Back 314

because it cannot provide all the nutrients necessary for staying healthy.

Front 315

Describe the difference in location and stool characteristics of a colostomy and an ileostomy.

Back 315

Colostomy is opening into large colon
more formed b/c its lower down

Ileostomy is opening into the ileum or small intestine
more liquid because it is higher up and water hasn’t been absorbed yet.