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55 Cards in this Set
- Front
- Back
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Common side effects of chemotherapy and radiation
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Bone marrow suppression (what labs should we pay attention to???????????????)
Fatigue and muscle weakness (think about nursing implications!!!!!!!!!!!) GI disturbances (Nutrition implications!!!!!!!!!) Nausea, vomiting, diarrhea, constipation Integumentary and mucosal reactions (Nutrition and body image!!!!!!!!!) Stomatitis, hair loss Pulmonary effects Pulmonary fibrosis & pneumonitis Reproductive effects Cardiac effects Arrhythmias, CHF, Cardiac toxicity |
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Hgb
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used to determine the severity of anemia
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mild anemia
moderate anemia severe anemia |
10-14g/dl
6-10g/dl <6 g/dl |
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mild anemia sxs
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May exist without symptoms
Possible symptoms Palpitations, exertional dyspnea, diaphoresis |
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Moderate anemia
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Increased cardiopulmonary symptoms
Dyspnea experienced at rest or during activity Fatigue |
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severe anemia
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Integument
Pallor ↓ Hemoglobin ↓ Blood flow to the skin Jaundice Hemolysis of of RBCs ↑ Concentration of serum bilirubin Pruritus ↑ Serum and skin bile salt concentrations severe Severe = Hb <6 g/dl Pulmonary Tachypnea Orthophea Dyspnea at rest Neurologic Headache Vertigo Irritability Depression Gastrointestinal (GI) Anorexia Sore mouth Musculoskeletal Bone pain General Lethargy Fatigue Sensitivity to hot and cold |
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Iron-Deficiency Anemia Clinical Manifestations
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Pallor is the most common finding
Ear lobes, palms, and conjuctiva Glossitis is the second most common Inflammation of the tongue Pica Dizziness Fatigue shortness of breath |
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Cobalamin Deficiency Clinical Manifestations
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Sore tongue
Anorexia Nausea Vomiting Abdominal pain Neuromuscular manifestations Weakness Paresthesias of the feet and hands ↓ Vibratory and position senses Ataxia (gross lack of coordination of muscle movement) Muscle weakness Impaired thought process |
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Sickle Cell Disease Clinical Manifestations
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Typical patient is asymptomatic except during sickling episodes
Symptoms can be (see fig 31-4 next page) Pain and joint swelling Pallor of mucous membranes Fatigue Jaundice Irritability |
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Hemophilia Clinical Manifestations
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Prolonged bleeding from small cuts or injuries
Delay of onset of bleeding after injury subQ hematomas GI bleeding Hematuria Pain due to compression of hematomas Hemarthrosis (joint bleeding and swelling |
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DIC Clinical Manifestations
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Nervous system
Vission changes Dizziness Headache Irritability Anxiety Confusion seizures Integumentary ↓ skin temp Pallor Gums bleeding Hematomas GI Abdominal pain Abdominal dissention Blood in stool Respiratory Dyspnea Tachypnea Orthopnea Decreased breath sounds Chest pain Cardiovascular Decreased pulses Decreased capillary refill time Tachycardia Venous dissention Genitouinary Hematuria oliguria Musculoskeletal Joint pain Bone pain weakness |
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Types of Angina:Chronic Stable Angina
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Intermittent chest pain that occurs over a long period with the same pattern of onset, duration, and intensity of symptoms
Pain usually lasts 3 to 5 minutes Subsides when the precipitating factor is relieved Pain at rest is unusual ECG reveals ST segment depression |
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Types of Angina:Prinzmetal’s Angina
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Occurs at rest usually in response to spasm of major coronary artery
Seen in patients with a history of migraine headaches and Raynaud’s phenomenon Spasm may occur in the absence of CAD When spasm occurs Chest pain Marked, transient ST segment elevation May occur during REM sleep May be relieved by moderate exercise |
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Types of Angina Chronic Stable Angina
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Intermittent chest pain that occurs over a long period with the same pattern of onset, duration, and intensity of symptoms
Pain usually lasts 3 to 5 minutes Subsides when the precipitating factor is relieved Pain at rest is unusual ECG reveals ST segment depression |
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Clinical Manifestations of ACS Unstable Angina
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Unstable angina
New in onset Occurs at rest Has a worsening pattern UA is unpredictable and represents a medical emergency |
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Clinical Manifestations of ACS Myocardial Infarction (MI) #1
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Result of sustained ischemia (>20 minutes), causing irreversible myocardial cell death (necrosis)
Necrosis of entire thickness of myocardium takes 4 to 6 hours The degree of altered function depends on the area of the heart involved and the size of the infarct Contractile function of the heart is disrupted in areas of myocardial necrosis Most MIs involve the left ventricle (LV) |
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Clinical Manifestations of ACS MI #2
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Fear and anxiety
Dyspnea Sympathetic nervous system stimulation results in Release of glycogen Diaphoresis Vasoconstriction of peripheral blood vessels Skin: ashen, clammy, and/or cool to touch |
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Clinical Manifestations of ACS MI #3
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Pain
Total occlusion → anaerobic metabolism and lactic acid accumulation → severe, immobilizing chest pain not relieved by rest, position change, or nitrate administration Described as heaviness, constriction, tightness, burning, pressure, or crushing Common locations: substernal, retrosternal, or epigastric areas; pain may radiate |
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Clinical Manifestations of ACS MI #4
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Cardiovascular
Initially, ↑ HR and BP, then ↓ BP (secondary to ↓ in CO) Crackles Jugular venous distention Abnormal heart sounds S3 or S 4 New murmur Nausea and vomiting Can result from reflex stimulation of the vomiting center by the severe pain Fever Systemic manifestation of the inflammatory process caused by cell death |
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Sudden Cardiac Death : risk factors
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Primary risk factors
Left ventricular dysfunction (EF 30%) Ventricular dysrhythmias following MI Other risk factors Male gender (especially African American men) Family history of premature atherosclerosis Tobacco use Diabetes mellitus Hypercholesterolemia Hypertension Cardiomyopathy |
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Hypertension Clinical Manifestations
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Fatigue, reduced activity tolerance
Dizziness Palpitations, angina Headaches Weight gain Edema Muscle cramps Blurred vision Nocturia Dyspnea |
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Hypertensive Crisis: s&sxs
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Severe, abrupt increase in DBP (defined as >140 mm Hg)
Rate of increase in BP is more important than the absolute value (think trends) Often occurs in patients with a history of HTN who have failed to comply with medications or who have been undermedicated |
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Heart Failure Presenting signs
LEFT |
Alternating pulse strength
Tachycardia Decrease in SaO2 & PaO2 Crackles S3 and S4 heart sounds (gallop rhythm) Restlessness and confusion Cyanosis Tachypnea Pleural effusion (fluid between lung and chest wall) |
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Heart Failure Presenting signs
RIGHT |
Murmurs
JVD (jugular venous distention) above clavicle when in sitting at 45 degree angle Edema Weight gain (Sudden weight gain of >3 lb (1.4 kg) in 2 days may indicate an exacerbation of HF) Tachycardia Hepatomegaly |
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Heart Failure Presenting symptoms RIGHT
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Weakness and Fatigue
Anxiety an depression Dependent bilateral edema Right upper quadrant discomfort Nausea GI bloating |
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Heart Failure Presenting symptoms: LEFT
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Weakness fatigue
Anxiety and depression Dyspnea on exertion Orthopnea (number of pillows) Paroxymal nocturnal dyspnea (nightime attacks of breathlessness) Nocturia Dry hacking cough |
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Peripheral Arterial Disease Manifestations
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PAD—intermittent claudication
Ischemic muscle ache or pain that is precipitated by a constant level of exercise Resolves within 10 minutes or less with rest Reproducible Shooting or burning pain in extremity Present near ulcerated areas Produces loss of pressure and deep pain sensations Injuries often go unnoticed by patient |
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Peripheral Arterial Disease Manifestations
#2 |
Thin, cool, shiny, and taut skin
Loss of hair on the lower legs Diminished or absent pedal, popliteal, or femoral pulses Pallor Reactive hyperemia (increased blood flow after ischemia) Pain at rest Occurs in the forefoot or toes and is aggravated by limb elevation Occurs from insufficient blood flow Occurs more often at night |
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Aortic Aneurysm Manifestations:
THORACIC |
Often asymptomatic with first sign being rupture
Main have pain in back, neck, substernal area when lying supine May have dyphagia and dyspnea, stridor or cough when pressing on esophagus or largngeal nerve |
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Aortic Aneurysm Manifestations:
ABDOMINAL |
“heartbeat” in abdomen when lying down
Pulsating abdominal mass Abdominal or lumbar pain Claudication Cool or cyanotic extremities Systolic bruit may be heard |
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Aortic Aneurysm Manifestations: DISSECTING
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Sudden/severe/persistent “ripping” pain in anterior chest
Pain may extend to shoulder or abdomen Pallor and sweating Tachycardia May have elevated BP and you may get different reading in the other arm Syncope Paralysis of lower extremities |
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Buerger’s Disease sxs
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Bluish cast to toe or finger
“coldness” in affected limb Nerve inflammation → severe pain Blocked blood vessels → claudication as seen in PAD with accompanying symptoms Ischemic ulcers and gangrene are common complications |
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Buerger’s Disease
nursing care |
Nursing care
Smoking cessation Vasodilators calcium channel blockers for vasospasms Monitor and treat pain Provide emotional support |
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Raynaud’s Disease Manifestations
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Triphasic color change after attack is triggered
Pallor Cyanosis Rubor Pain Skin thickening and nails become brittle |
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Raynaud’s Disease
nursing care |
Keep hands warm (where gloves in cool environments)
Avoid stressful situations Dissection of nerve fibers that allows vasoconstriction to relieve symptoms Analgesics for pain Vasodilators Calcium channel blockers for vasospams |
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Thrombophlebitis Manifestations:
superficial |
Palpable cordlike vein
Surrounding area warm, red, and tender Edema Arms (mostly like caused by IVs) Legs (most likely a result of varicose veins |
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Thrombophlebitis Manifestations:
deep |
Edema (location depends on what vein is occluded)
Pain Warm skin Homan’s sign (pain on dorsiflexion of foot) |
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PULMONARY EMBOLISM
SXS |
Pink tinged sputum
Tachypnea Tachycardia SOB Chest pain Apprehension (feeling of impending doom) |
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Venous Insufficiency: manifestations
general |
Edema of lower legs may extend to knees
Discoloration of skin (thick brown skin around ankles and feet) Venous stasis ulcers |
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Venous Insufficiency: manifestations:
ARTERIAL |
Skin is Pale
Minimal to no edema Nails thick and brittle Pain worse with elevation and exercise or even at rest Pulses decreased or absence Extremity temperature cool Ulcers dry and necrotic |
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venous insufficiency:
VENOUS |
Skin is ruddy cyanotic if dependent
Edema is present Nails are normal Pain is better with elevation and may increase throughout day Pulses normal Extremity temp is warm Ulcers are moist |
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Infective Endocarditis : clin manifestations for BOTH acute and subacute
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+ blood cultures
New cardiac murmur Heart failure Embolic complications Roth spots (retinal hemorrhage) Splinter hemorrhages tiny lines that run vertically under nails Embolic complications Petechiae Osler’s nodes painful subcutaneous lesions in the distal fingers or toes Janeway’s lesions (painless hemorrhagic lesions on the palms and soles) |
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Infective Endocarditis : clin manifestations
ACUTE |
Spiking fever and chills
Signs of heart failure WBC elevation Weakness |
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Infective Endocarditis : clin manifestations
SUBACUTE |
Fever of unknown origin
Cough Dyspnea Anorexia Malaise Normal WBC Anemia Elevated ESR Clubbing of fingers |
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Pericarditis Manifestations:
acute |
Substernal pain radiating to the neck (sounds like angina!)
Dyspnea Friction rub (scratchy high pitched sound on auscultation) Elevated WBC Fever/Malaise ECG changes include ST and T wave elevations followed by inverted T waves when ST returns |
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Pericarditis Manifestations: chronic
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Increasing dyspnea
Fatigue leading to progressive signs of heart failure |
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Mitral Valve Stenosis: sxs
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Dyspnea
Occasionally accompanied by hemoptysis Primary symptom because of reduced lung compliance Palpitations from atrial fibrillation Fatigue Accentuated first heart sound (S1) Low-pitched, rumbling diastolic murmur Hoarseness Chest pain Seizures Stroke |
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Mitral Valve Regurgitation:
SXS |
Asymptomatic for years until development of some degree of left ventricular failure
Acute: Thready peripheral pulses and cool, clammy extremities Initial symptoms include Weakness Fatigue Palpitations Dyspnea that gradually progresses to orthopnea, paroxysmal nocturnal dyspnea, and peripheral edema Brisk carotid pulses Auscultatory findings of accentuated left ventricular filling leading to audible S3 Murmur is loud pansystolic or holosystolic |
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Potassium: normal value
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3.5-5.0
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Calcium: norm value
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8.4-10.2
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NA sodium norm value
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135-145
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Mg+ magnesium norm value
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2.5-4.5
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Fe IRON norm value
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65 - 150 mcg/dL
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Chloride normal value
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95 - 107
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RBC normal value
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4.6-5.5
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