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174 Cards in this Set
- Front
- Back
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Aortic Aneurysms causes: (5) |
1. degenerative 2. congenital 3. mechanical (trauma) 4. inflammatory 5. infectious |
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Thoracic aortic aneurysm clinical manifestations |
- deep, diffuse chest pain (ripping) -hoarseness -dysphagia -distended neck vein -edema of head and arma |
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abdominal aortic aneurysm clinical manifestations |
-pulsative mass in periumbilical area -audible bruit -pain (abdominal or back) -discomfort with or w/out alteration of bowel movement |
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what is Blue toe syndrome |
-a complication of aortic aneurysm -poor perusion to lower extremities |
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what size aneurysm needs repair? |
>5.5 cm |
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what is Intraabdominal hypertension (IAH) |
-complication of aortic aneurysm repair -can cause abdominal compartment syndrome -reduced blood flow to viscera -end organ perfusion impaired -monitor abdomen size! |
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how do we monitor for graft patency? |
-check renal perfusion by monitor urinary output |
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valves on R side of heart: |
-pulmonic and tricuspid |
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valves on L side of heart |
-aortic and mitral |
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which type of valvular disease is most commonly caused by rheumatic heart disease?
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-mitral valve stenosis |
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mitral valve stenosis |
-problem when valve is open -cant get all the blood from L atria to L ventricle due to narrowing of valve -causes pulmonary issues -may cause atrial flutter and afib |
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Mitral valve stenosis CM: |
-PRIMARY: exertional dyspnea -loud S1 with diastolic murmur -fatigue -palpitations -hoarseness and hemoptysis -chest pain, seizures, and stroke |
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what type of murmur is found in mitral valve stenosis |
-problem is when valve is open so it is diastolic |
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Mitral valve regurgitation |
-problem when valve is closed -causes backward flow into atrium when ventricle contracts |
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mitral valve regurgitation CM |
Acute: -weak, thready peripheral pulses-cool, clammy extremities Chronic: -asymptomatic at first -weakness, fatigue, palpitations, progressive dyspnea -peripheral edema, S3, and systolic murmur |
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What kind of murmur is heard in mitral valve regurgitation? |
-systolic murmur |
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Mitral Valve Prolapse |
-prolapsed back into left atrium b/c of connective tissue disorders or cause unknown -causes mitral regurgitation -usually benign with valve still closing effectively |
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Mitral Valve prolapse CM: |
-most are asymptomatic for life -only 10% have symptoms -systolic murmur d/t regurgitation |
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Aortic Valve Stenosis |
-issue when valve is open -blood is not fully emptying from ventricle into aorta -causes decreased CO, pulmonary HTN, and L sided HF |
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Aortic valve stenosis CM |
-angina, syncope, exertional dyspnea -normal to soft S1 -diminished or absent S2 -systolic murmur -prominent S4 |
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what type of murmur is heard in aortic valve stenosis? |
-systolic murmur |
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Aortic valve regurgitation |
-problem when valve closes -backward flow of blood from ascending aorta into left ventricle -can cause left ventricular dilation and hypertrophy -lowers myocardial contractility -causes pulmonary HTN, and R ventricular failure |
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Aortic valve regurgitation CM |
Acute: -severe dyspnea, chest pain, hypotension, cardiogenic shock Chronic: -may be asymptomatic for years -exertional dyspnea, orthopnea, paroxysmal dypnea, angina, hard pulse -soft or absent S1 -S3 and S4 with diastolic murmur |
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Which type of murmur is heard in aortic valve regurgitation |
-diastolic murmur |
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Tricuspid valve Stenosis |
-occurs in pts with RF and IV drug abuse -R atrial enlargement and higher systemic venous pressure |
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Tricuspid valve stenosis CM |
-peripheral edema -ascites -hepatomegaly -diastolic murmur |
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which type of murmur is heard in tricuspid valve stenosis |
diastolic murmur |
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Pulmonic valve stenosis |
-almost always congenital -causes right ventricular HTN and hypertrophy |
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Pulmonic valve stenosis CM |
-fatigue -loud systolic murmur |
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what type of murmur is heard in pulmonic valve stenosis? |
-systolic |
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Conservative management of Valvular heart disease |
-prophylactiv antibiotic therapy -HF drugs -sodium restriction -anticoagulation therapy -antidysrhythmic drugs |
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PTT |
-for heparin -check after 6 hours |
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INR therapeutic level |
2.2 - 3.5 |
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PTT therapeutic level |
60 - 70 |
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Heparin drips nursing implications |
-check platelett levels every 2-3 days for thrombocytopenia -tx is argatropine |
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2 most common PO antidysrhythmic drugs |
-amiondarone -diltiazem |
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Percutaneous transluminal balloon valvuloplasty |
-used in stenosis -balloon-tipped catheter inserted via femoral artery |
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Valve repair |
-surgical procedure of choice -lower mortality -may not restore full function |
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Valve repair |
-commissurotomy (stenosed valve) - closed, open(more common) -Valvuloplasty (regurgitating valve) - minimally invasive, open -annuloplasty - sutures by adding cosmetic ring but needs anticoagulation therapy |
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how much fluid should be in the pleural space? |
-5-15 ml |
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what does pleural effusion result from? |
-pressure changes -changes in permeability -lymphatic flow obstruction |
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transudative pleural effusion |
-extrinsic -HF, liver disease, renal disease |
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How does liver failure cause pleural effusion |
-body lacks albumin which drops oncotic pressure -causes liquid to come out of lung cells into pleural space |
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how does HF and Kidney failure cause pleural effusion |
-increases hydrostatic pressure which causes fluid build up and pushes fluid out into pleural space |
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Exudative pleural effusion |
-intrinsic -caused by infections and malignancies and autoimmune conditions |
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How does exudative pleural effusion happen? |
-pt will be high in protein which causes inflammation causing increase in cells permeability -makes proteins leak into pleural space -oncotic pressure attracts fluid due to extra protein |
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pleurisy |
-inflammation of pleura |
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causes of pleurisy |
-infectious diseases -chest trauma -medications -neoplasms -autoimmune disorders |
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pleural friction rub |
-present in pleurisy -pain on inhalation -can be auscultated on inspiration and exhalation -pt will breath shallow and quickly |
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empyema |
-purulent (infected) fluid in pleural space |
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epyema CM |
-same as pleural effusion except since there is infection there will be: -fever, weight loss, night sweats |
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epyema causes |
-Tb, pneumonia, lung abcess, and surgical wounds |
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epyea treatment |
-chest tube -antibiotics |
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epyema complications |
-fibrothorax: accumulation of fibrous tissue in pleural space -doesn't allow lung expansion -surgery to extract fibrous tissue |
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pleural effusion CM |
-SOB, chest pain, dry cough, dyspnea, unequal chest expansion, decreased movement on affected side, diminished breath sounds, dullness to percusson |
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Pleural effusion interventions |
-thoracentesis -chemical pleurodesis -treat underlying cause |
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pneumothorax |
-positive air in pleural space -causes partial or complete lung collapse |
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types of pneumothorax |
open: penetration into chest wall closed: chest wall is intact, but something is causing lung to leak air (lung trauma) |
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pneumothorax interventions |
-may not need to be treated -thoracentesis -chest tube with drainage |
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spontaneous pneumothorax |
-usually occurs from rupture of small blebs in lung apex -can be congenital or from COPD -pushes lung to unaffected side |
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Latrogenic pneumothorax |
-caused by a medical procedure -most commonly lungbiopsy |
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Traumatic pneumothorax |
-open (penetrating) or closed (non-penetrating) -air enters pleural cavity and can't escape -can be fatal -needle decompression then chest tube with drainage for treatment |
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hemothorax |
-in conjunction w/a pneumothorax; it is called a hemopneumothorax -causes SOB, decreased breath sounds, unequal chest expansion -fluid replacement, blood perfusions, and chest decompression for treatment |
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Chylothorax |
-lymphatic fluid in pleural space -traumatic or malignant disruption of thoracic duct -intervention: chest tube |
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when is nitro used cautiously in valvular disease? |
-aortic stenosis |
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Which hernia is a pseudohernia? |
umbillical hernia -intestine from abdominal wall goes into umilicus -skin will protrude out to form a pseudo cavity |
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what is a hiatal hernia? |
-portion of the stomach goes through an opening in the diaphragm and goes into the esophagus |
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sliding hiatal hernia |
-slides into thoracic cavity in supine position -goes into dependent body part |
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paraesophageol rolling hernia |
-fundus of stomach rolls through diaphragm forming a pocket alongside the esophagus |
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Hiatal hernia CM? |
-heartburn -severe burning pain when bending over -dysphagia |
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protonix |
-PPI for hiatal hernia |
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nexium |
-ppi for hiatal hernia |
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prevacid |
-ppi for hiatal hernia |
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tagamet |
H2 receptor blocker for haital hernia |
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zantac |
h2 receptor blocker for hiatal hernia |
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pepcid |
h2 receptor blocker for hiatal hernia |
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bethanechol |
cholinergic used in hiatal hernia -increases gastric emptying to increase LES pressure |
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Reglin |
prokinetic-motility enhacer used in hiatal hernia -promotes gastric emptying and promotes peptin |
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Drugs to use in hiatal hernias |
-h2 receptor blocker -ppi -chilinergic -prokinetic-motility enhancers |
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diagnostic studies for hiatal hernias |
-barium swallow -endoscopic visualization of lower esophagus -upper GI endoscopy -motility studies |
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what does a barium swallow tell us? |
-shows protrusion of gastric mucosa through esophageal hiatus |
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what does an endoscopic visualization tell us? |
-shows mucosal abnormalities or any inflammation |
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surgical interventions for hiatal hernia |
-reduction of stomach back into abdomen -herniotomy -herniorraphy -gastropexy |
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possible complications of surgery for hiatal hernias |
-GERD -esophagitis -hemorrhage from erosion -esophageal stenosis -ulcers in herniated portion of stomach -hernia strangulation -regurgitation with tracheal aspiration -gastritis |
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what happens if inflammation of the gastric mucosa occurs as a complication of hiatal hernia surgery |
-when the mucous membrane is compromised, irriation occurs -inflammation results and erosive effects set in -edema results from the inflamation -can cause gastritis |
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acute gastritis treatment |
-eliminating the cause -allow for rest -give fluids -rarely, NG to monitor bleeding and get rid of gastric contents -NG tube lavage |
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Chronic gastritis is caused by: |
-Stress (type A personalitites) releases endorphins which increase gastric secretions -drugs & alcohol -H. Pylori -pernicious anemia (decrease O2 in blood breaks down mucous membrane) |
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NSAIDs related gastritis risk factors |
-female ->60 -history of ulcer disease -concomitant use of anticoagulants, other NSAIDs, corticosteroids -having a chronic debilitating disorder |
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Gastritis risk factors |
-NSAIDs -alcohol -spicy foods -H. Pylori -autoimmune metaplastic atrophic gastritis |
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what is metaplastic atrophic gastritis |
-an immune response against parietal cells |
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Acute gastritis CM: |
-anorexia, N/V -epigastric tenderness -feelings of fullness |
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Chronic gastritis CM: |
-acute gastritis symptoms -loss of parietal cells -loss of intrinsic factor -loss of absorption of cobalamin -pernicious anemia |
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Diagnostic studies for gastritis |
-hx of drugs or alcohol use -endoscopic exams with biopsy -H. pylori breath, serum, stool, and urine tests -stool for occult blood -serum for anemia or lack of IF -serum for antibodies to parietal cells and IF |
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What is needed for definitive diagnosis of gastritis |
-edoscopic exam with biopsy |
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what is the name of a positive stool occult test? |
-melena |
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Peptic Ulcer Disease process |
-erosion of the GI mucosa from digestive action of HCl acid and pepsin -acute ulceration -then exposed to muscle wall which can cause chronic ulceration |
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what is a Physiologic stress ulcer caused by |
-decrease in O2 -dehydration -surgery -burns -anxiety -heartburn |
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how does dehydration cause physiologic stress ulcers |
-dehydraton drops blood volume which drops hydrostatic pressure which drops oxygenation |
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how does surgery cause physiological stress ulcers |
-surgery can cause a drop in blood volume which decreases hydrostatic pressure which decreases oxygenation |
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how do burns cause physiologic stress ulcers |
-fluid sequestration. -burns pull fluid from vasculature into interstitial spaces (blister) -massive fluid shift causes drop in BP which drops oxygenation |
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how can anxiety cause a physiologic stress ulcer |
-increases gastric acid secreation which decreases O2 supply to gastric mucosa membrane |
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how can heartburn cause physiologic stress ulcers |
-increased gastric motility and secretion |
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Clinical manifestations of PUD |
-may have no pain at first because mucous membrane has less nerve endnigs -erosion will slowly cause gastritis and burning and cramp like pain -back pain (especially in posterior duodenal ulcers) |
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PUD complications |
-Hemorrhage -Perforation -Gastric outlet obstruction |
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What is gastric outlet obstruction |
-scar tissue decreases lumen size in duodenum -decreases gastric emptying and can cause vomiting |
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PUD treatment |
-rest to decrease stress and anxiety -bland diet -no smoking or NSAIDs -medications -small frequent meals w/less gastric irritants |
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What types of drugs are used to treat/manage PUD |
-H2r blockers -PPI -antibiotics (H. Pylori) -antacid -anticholenergic -cytoprotective drugs |
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How do cytoprotective drugs work? |
-coats the lining so that the mucous membrane will be less acted upon by HCl in gastritis |
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cipralfate |
cytoprotective drug for PUD |
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parafate |
cytoprotective drug for PUD |
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which medications are like "horse pills" |
cipralfate and parafate -add water to soften |
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Conditions associated with TB |
-malnutrition -overcrowding -substandard housing -inadequate health care -poverty***** |
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Risk factors of TB |
-contact with infected person -immunocopromisation -substance abuse -preexisting medical condition -immigration |
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what is attenuation |
-process of killing a microorganism -maintains its character but lowers its virulence |
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pathophysiology of TB: part 1 |
-pt inhales M. tuberculosis bacilli -infection of the tracheobroncheal tree -bacilli multiplies in the alveoli -transport to other body parts by lymph/blood -inflammatory process -neutrophils/macrophage engulf bacteria |
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pathophsyiology of TB: part 2 |
-accumulation of exudate in the lung/lobe -granulomas formation -transformation to a fibrous mass (Gohn) -formation of cheesy mass and lobe cavitation -tissue necrosis -calcification and formation of collagen scar -bacteria becomes dormant |
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How does tissue necrosis occur in TB |
-the body with try to contain the granulomas, but once it hardens, it weighs more and pushes on the alveoli -alveoli rest on bleed vessels which obliterates circulation -O2 deprivation occurs in lung tissue causing necrosis |
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What part of TB disease process can be seen on an xray |
-when the calcification of tissue forms a collagen scar |
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TB CM: |
-low grade fever -cough -night sweats -fatigue -weight loss |
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TB diagnostic findings/tests |
-H&P -TB skin test -X-ray -AFB smear -sputum culture/sensitivity |
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Ultimate diagnostic test for TB |
-sputum test for acid fast bacilli (AFB) -rod shaped bacteria shown on acid fast test is very definitive |
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what is needed to lift airborne precautions |
-3 negative AFB |
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TB Management |
-chemo therapeutic agent fr 6-12 mos -multiple drug therapy |
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INH |
TB drug -SE: hepatitis, asymptomatic elevation of ALT and AST -monitor liver function monthly |
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Rifampin |
TB drug -SE: hepatitis, thrombocytopenia, orange discoloration of bodily fluid, red urine |
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Pyrazinamide |
TB drug -SE: hepatitis, arthralgias, hyperuricemia |
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Ethambutol |
TB drug -SE: ocular toxicity, monitor visual acuity an color discrimination regularly |
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How can you promote respiratory toileting? |
-postural drainage -C&DB -suctioning -expectorants -hydration -ambulation -humidifier |
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BCG |
-vaccine for TB -not used in USA |
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what is MLT |
-minimal leak technique in tracheostomy care -inflate balloon with 10 cc air -drop 0.1 so it isn't over inflated |
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First tube change in a tracheostomy? |
-after 7 days -performed by MD |
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IBD age range? |
-teens to early adulthood -peak in 50's - 60's |
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Diverticulosis population |
->40 y/o -western, industrialized populations -rarely vegetarians |
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Diverticulosis risk factors |
-low fiber -high refined carbohydrate consumption ex. crackers, pretzels |
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diverticulum |
-saccular dilation or outpouching of mucosa through the circular smooth muscle of intestinal wall |
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Diverticulitis |
-inflammation of diverticulum |
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Diverticulosis |
-non-inflamed diverticula |
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diverticula location |
-can be anywhere in the body but most commonly in large intestine -specifically left colon, descending colon, and sigmoid colon -sigmoid b/c it is next to rectum. constipation will cause increased pressure which causes protrusions of diverticula |
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Divertuiculosis symptoms |
-usually asymptomati -possible cramping, bloating, constipation -less than 20% progress to diverticulitis |
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Diverticulitis disease process |
-the pockets get created by diverticula get trapped with feces -bacteria increases and pressure increases -causes inflammation, erosion, and infection |
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diverticulitis CM |
-acute crampy pain on LLQ relieved by flatus or bowel movement -tenderness to touch -systemic symptoms of infection (N/V, constipation, diarrhea, fever w/ or w/out hills, glucocytosis) -increase in WBC -alternating diarrhea and constipation |
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Complications of Diverticulitis |
-perforation -blockage -bleeding -abscess -peritonitis -fistula |
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What happens during perforation in diverticulitis |
-pus leaks out of the colon and causes pericarditis |
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what happens during blockage in diverticulitis |
-from repeated bouts of diverticulitis -colon wall gets scarred -causes partial or full blockage -needs surgical repair |
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what happens with an abscess in diverticulitis |
-localized collections of pus cause swelling and tissue destruction -usually localized to one spot -can be treated with antibiotics and bowel rest -may need to be drained |
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what happens with pertonitis in diverticulitis |
-inflammation of cavity and its organs -requires surgery to clean out abdomen and possible removal of diseased colon -anastomosis (colostomy) may be done and then a couple months later repeated between colon and the removed portion in order to allow bowel to heal |
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what happens with fistulas in diverticulitis |
-abnormal connection b/w two organs
-2 infected tissues will come together and heal attached to each other -can be b/w colon and bladder, intestines, uterus, skin, or vagina |
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Diverticulitis diagnostic tests |
-H&P -Occult blood -CBC -abdominal xray ct-scan w/oral or IV contrast -sigmoidoscopy; coloscopy |
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how can you prevent diverticulitis |
-high fiber diet -exercise -possibly nuts and seeds |
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Acute diverticulitis treatment |
-bowel rest -home w/oral antibiotics, clear liquids -possible hospitalization (NPO, bed res, fluids, antibiotics) then move to oral fluids and antibiotics -observe for complications |
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Surgical interventions for diverticulitis |
-reserved for last ditch effot -remove diseased portion of colon -create colostomy to allow bowel rest -reconnect after bowl has healed |
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patient education needs in diverticulitis |
-disease process -fiber and laxatives -fluids -weight management -exercise |
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Ulcerative Colitis |
-characterized by inflammation and ulceration of the colon and rectum -colon may become hyperemic ad edematous -may develop abscess and ulceration |
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UC CM: |
-bloody diarrhea** -4.5 bm/day up to 10-20 bm/day (severe) -cramping LLQ pain |
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Severe UC CM: |
-fever, malaise, anorexia, wt loss -anemia and tachycardia -dehydration and -e loss -colonic dilation |
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What is the priority in UC |
-nutritional and maintaining fluid and -e balance |
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Crohn's Disease |
-unknown cause -discontinuous skip lesions -inflammation of segments of the GI tract |
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Most commonly seen areas affected in Crohn's |
-terminal ileum, jejunun, and colon |
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Drugs used for Crohn's |
-sulfasalazine, corticosteroids, and flagyl -dr tan |
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Crohn's CM:
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-diarhhea -fatigue -RLQ pain -wt loss/malnutrition -dehydration -fever -1/3 will have abscesses and fistula -UTI |
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Why are fistulas and abscesses more common in Crohn's |
-b/c it has full thickness affect on wall |
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IBD treatment |
-rest -control inflammation and infection -correct malnutrition and -e balance -alleviate stress -symptomatic relief -blood transfusions -watch for dehydration -smoking cessation |
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What nutritional therapy would be used in IBD |
-low fat -low residue -high calorie -high protein -high vitamin (crohn's) |
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Diagnostic tests for IBD |
-Double contrast barium enema -cat scans and MRIs -colonoscopy and sigmoidoscopy |
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IBS drug therapy |
-sedative -antidiarheals* -aminosalicylates -antimicrobial -corticosteroids -immunosuppressants -biologic and targeted therapy |
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Preferred first line treatment for IBD? |
-Aminosalicylates with antimicrobials
-take for at least a year |
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5ASA |
-decreases inflammation in IBD -given with sulfasalazine in order to reach problem area |
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3 drugs for UC |
olsalazine, mesalamine, and balsalazide |
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what do we monitor when using immunosuppressants in IBD |
-CBC due to depressed T cell function and depressed bone marrow -watch for anemia as a side effect |
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ciprofoxan |
antimicrobial used for IBD |
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Tromodazole |
antimicrobial used for IBD |
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Higher risk of infection in IBD drugs for which class? |
-biologic and targeted therapy |
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Total colectomy with ileoanal reservoir |
-used in UC -2 step procedure 8-12 week apart -1st, they create an ileostomy and leave it open -next they create a reservoir -3-6 months until effective -results in fewer bowel movements |
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Total protocolectomy with permanent ileostomy |
-considered curative in UC -removes colon, rectum, and closes the anus -permanent ileostomy is created |
