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108 Cards in this Set

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CBC
identifies the total # of WBC and RBC, the platelet cont and the H&H
thrombocytopenia
low platelet count
TEE
transesophageal echocardiography
SPECT
single photon emission computed tomography
TRUE/FALSE When a spect procedure is performed the pt hand is held above the head for 30 45 minutes
TRUE
depolarization
electrical stimulation- (mechanical contraction is called systole)
repolarization
electrical relaxation (mechanical relaxation is called diastole0
What influences the heart rate
the autonomic nervous system- consisting of the tympathetic and parasympathetic fibers
sympathetic nerve fibers aka
adrenergic fibers
What system increases the heart rate
stimulation of the sympathetic system
What reduces the heart rate (system)
the parasympathetic
P wave on the ECG
The P wave is the electrical signature of the current that causes atrial contraction. Both the left and right atria contract simultaneously.
QRS representation on the ECG
ventricular muscle depolarization -The QRS complex corresponds to the current that causes contraction of the L & R ventricles
T Wave on the ECG
represents ventricular muscle repolarization (resting state)
how to obtain HR from a rhythm strip
count boxes in the RR interval divide that number into 1500
What rhythm is the RR interval checking
the ventricular rhythm
What rhythm is the PP interval checking
the atrial rhythm
junctional rhythm
when the AV node instead of the AV node becomes the pacemaker of the heart
no P waves on the ECG
supraventricular tacky cardia
3rd degree AV block
occurs when no atrial impulse is conducted through the AV node. In 3rd degree AV block 2 impulses stumulate the heart, one stimulate the ventricles and one the atria
purpose of pacemakers
used when medications does not help with bradycardia and some tachycardia
cardiac tamponade
medical emergency condition where liquid accumulates in the pericardium in a relatively short time. The elevated pericardial pressure prevents proper filling of heart cavities. Instead of reducing the filling of both ventricles equally, the septum of the heart will bend into either the left or right ventricle. The end result is low stroke volume, shock and often death
most common complication of pacemaker insertion
dislodgment of the pacing electrodes. Minimizing pt activity helps with prevents this complications
True/False a pacemaker is senstivie to magnetic fields
True, should not be exposed to these fields for more than a few seconds, avoid welding or chain saws, no gasoline powered tools, carry medical alert especially in airports inorder to be hand searched.
potential complications of insertion of pacemaker
decreased cardiac output
difference between cardioversion and defibrillation
cardioversion is a planned procedure, defibrillation is an emergency procedure
cardioversion
involves the delivery of a timed electrical current to terminate a tachydysrhythmia.
defibrillation
used in an emergency situation as the treatment of choice for V-Fib and pulseless VT
a successful cardioversion would indicate
conversion to sinus rhythm, adequate peripheral pulses and adequate blood pressure
implantable cardioverter defibrillator(ICD)
device that detects and terminates life-threatening episodes of VT or V-fib in high risk patients
Electrophysiological studies
used to evaluate and treat vaious dysrhythmias that have caused cardiac arrest or signigicant symptoms
Ablation
Ablation is defined as the removal of material from the surface of an object by vaporization, chipping, or other erosive processes
endocardial isolation
involves making a n incision into the endocardium that separates the aea where the dysrhythmia originates from the surrounding endocardium. The edges of the incision are then sutured together. The incision and its resulting scar tissue prevent the dysrhythmia from affecting the whole heart.
endocardial resection
the origin of the dysrhythmia is identified and that area of the ndocardium is peeled away. No reconstrucion or repair is necessary
catheter ablation therapy
destroys specific cells thar are the cause of central conduction method of a tachydysrhythmia. (performed after an EP study)
Toxemia
Bacteremia (Bacteræmia in British English, also known as blood poisoning or toxemia) is the presence of bacteria in the blood.
Atherosclerosis
Atherosclerosis is a disease affecting the arterial blood vessel. It is commonly referred to as a "hardening" or "furring" of the arteries. It is caused by the formation of multiple plaques within the arteries.
Arteriosclerosis
hardening that affects the small arterioles
What drug is contraindicated in myocarditis?
NSAIDs
What are the effects of digitalis on pts with myocardits?
they are vey sensitive and may experience digitalis toxicity, which manifests with dysrhythmias, anorexia, nausea, vomiting, headache and malaise
cardiac tamponade
accumulation of fluid in the pericardium. This is an emergency situation.
How to distinguish a pericardial friction from a pleural friction rub?
if a pt is asked to hold their breath a pericardial friction rub will continue
pericardial friction rub
a pericardial friction rub occurs when the pericardial surfaces lose their lubricating fluid b/c/o inflammation. The rub is audible on auscultation and is synchronous with the heartbeat.
cardiac output
the amount of blood pumped in one minute
stroke volume
the amount of blood pumped out of the ventricle with each contraction
cardiac output equation
CO=HR x SV
Left Bundle branch block (LBBB)
LBBB occurs when electrical impulse which normally depolorizes the R & L bundle branches at the same time, depolarizes the R BB and not the L BB
What do you monitor when giving ace inhibitors
hyponatremia, hypovolemia, hypotension, hyperkalemia
work of ace inhibitors in HF
relieves the signs and symptoms of HF, deceases motality and morbidity rate of HF
Ace inhibitors and aldosterone
promote diuresis, decrease the secretion of aldosterone a hormone that causes kidneys to retain sodium, (k+ sparing)
SE of Ace inhibitors
dry cough, hyperkalemia, cough may indicate angioedema, if so regimen must be stopped
angioedema
is the rapid swelling (edema) of the skin, mucosa and submucosal tissues. Apart from the common form, mediated by allergy, it has been reported as a side effect of some medications, specifically ACE inhibitors.
Hydralazine and Isorbine dinitrate used to treat
HF, and useds when pts are not able to tolerate ACE inhibitors
Most common SE of Beta blockers (Coreg, Lopressor, Toprol, bisopropol)
dizziness, hypotension and brady cardia, may produce exacerbation of HF
Teaching on Beta blockers
symptoms may worsen and may take a few weeks before improvement in cardiac status, meds are titrated slowly
True/false beta blockers are contraindicated in pts with advanced stages of asthma
true
why should NSAIDs be avoided in pts who have HF
they can increase systemic vaxcular resistance and decrease renal perfusion, especially in the elderly.
signs of hypokalemia
weak pulse, faint heart sounds, hypotension, muscle flabbiness, diminished deep tendon reflexes and generalized weakness
signs and symptoms of hyponatremia
apprehension, weakness fatigue, malaise, muscle cramps and twitching and a rapid thready pulse
thready pulse
a scarcely perceptible and commonly rapid pulse that feels like a fine mobile thread under a palpating finger.
noxious stimuli
Potentially injury-causing stimuli (noxious stimuli)
dobutamine
iv med given to pts /c significant L ventricular dysfunction
dobutamine (Dobutrex) action
increase cardiac contractility.
Milrinone (primacor)
inhibitor that delays the release of calcium from intracellular reservoirs and prevents the uptake of extracellular CA+ by the cells
Action of Milrinone (primacor)
promotes vasodilation, decreasingpreload and afterload, reducing the workload of the heart
Nisiritide (Natrecor
indicated in acutley decompensated HF
aplastic anemia
low count on WBC, platelets, and RBC, severe anemia, significant neutropenia, thrombocytopenia
Megaloblastic anemia
Megaloblastic anemia is anemia resulting from a deficiency of vitamin B12 and folic acid
Pernicious anemia
Pernicious anemia refers to a type of autoimmune anemia. Antibodies are directed against intrinsic factor or parietal cells which produce intrinsic factor. Intrinsic factor is required for vitamin B12 absorption, so impaired absorption of vitamin B12 can result. An anemia is a deficiency of the blood cells, but in addition to blood cells, many other cells in the body need vitamin B12, including nerve cells.
myelodysplastic syndromes
The myelodysplastic syndromes (MDS, formerly known as "preleukemia") are a diverse collection of haematological conditions united by ineffective production of blood cells and varying risks of transformation to acute myelogenous leukemia. Anemia requiring chronic blood transfusion is frequently present. Although not a true malignant neoplasm, MDS is nevertheless classified within the hematological neoplasms.
Hemolytic anemia
Hemolytic anemia is anemia due to hemolysis, the abnormal breakdown of red blood cells either in the blood vessels (intravascular hemolysis) or elsewhere in the body (extravascular). It has numerous possible causes, ranging from relatively harmless to life-threatening.
Sickle cell crisis
Sickle-cell disease is a general term for a group of genetic disorders caused by sickle hemoglobin (Hgb S or Hb S). In many forms o/t disease, the RBCs change shape upon deoxygenation b/c/o polymerization o/t abnormal sickle hemoglobin. This process damages the RBC membrane, & can cause the cells to become stuck in blood vessels. This deprives the downstream tissues of O2 & causes ischemia & infarction. The disease is chronic and lifelong. Individuals are most often well, but their lives are punctuated by periodic painful attacks.
alloimmunization
Alloimmunity is a condition in which the body gains immunity, from another individual of the same species, against its own cells. Alloimmunity should not be confused with autoimmunity in which the body's immune system attacks its own cells without being provoked or influenced by substances or cells from another member o/t same species. If either alloimmunity / autoimmunity is directed against (RBCs), the direct Coombs test is positive.

Alloimmunity can occur
in the recipient after transfusions of fluids such as blood or plasma.
in the recipient /p allografts (grafts).
in the fetus after maternal antibodies have passed through the placenta into the fetus, as in haemolytic disease o/t newborn & fetomaternal alloimmune thrombocytopenia.
exchange transfusion
pts own blood is removed and replaced via transfusion
acute chest syndrome
The acute chest syndrome (ACS) in sickle cell disease (SCD) can be defined as:
a new infiltrate on chest x-ray associated with one or more NEW symptoms: fever, cough, sputum production, dyspnea, or hypoxia.
avascular necrosis
Avascular necrosis is a disease resulting from the temporary or permanent loss of the blood supply to the bones. Without blood, the bone tissue dies and causes the bone to collapse. If the process involves the bones near a joint, it often leads to collapse of the joint surface. This disease also is known as osteonecrosis, aseptic (bone) necrosis, and ischemic bone necrosis.
Thallassemia
Thalassemia aka "Cooley's anemia", is an inherited disease of the red blood cells. In thalassemia, the genetic defect results in reduced rate of synthesis of normal globin chains(c.f. hemoglobinopathy which is a structural change in a globin chain leading to instability or abnormal oxygen transport). The blood cells are vulnerable to mechanical injury and die easily. To survive, many people /c thalassemia need blood transfusions at regular intervals.
Glucose-6-phosphate dehydrogenase (G6PD)
Glucose-6-phosphate dehydrogenase (G6PD) deficiency is an X-linked recessive hereditary disease featuring nonimmune hemolytic anemia in response to a number of causes. The classic allergy to consumption of broad beans has led to the commonly used term favism, derived from the Italian name of the broad bean (fava).
Glucose-6-phosphate dehydrogenase (G6PD) aka
favism (allergy to broad beans
Hereditary spherocytosis
Hereditary spherocytosis is a genetically-transmitted form of spherocytosis, an auto-hemolytic anemia characterized by the production of red blood cells that are sphere-shaped rather than donut-shaped, and therefore more prone to hemolysis.
Principal treatment for Hereditary spherocytosis
spleen removal
Autoimmune hemolytic anemia
Autoimmune hemolytic anemia (AIHA) is a type of hemolytic anemia where the body's immune system attacks its own red blood cells (RBCs), leading to their destruction (hemolysis).
polycythemia
increased RBCs
clinical manifestations of polycythemia vera
ruddy complexion, splenomegaly, increased blood volume evidenced by HA, dizziness, tinnitus, fatigue, paresthesias and blurred vision/ increased blood viscosity evidenced by angina, claudiction, dyspnea and thrombophlebitis
omplications of polycythemia vera
risk for thromboses resulting in CVA or MI
leukopenia
fewer WBCs
leukocytosis
increaased WBCs
leukemia
proliferation of wbcs in the bone marrow
thrombocytopenia
low platelet count
chronic myeloid leukemia
mutation in the myeloid stem cell
clinical manifestations of chronic myeloid leukemia
elevated WBC count exceeding 100,000
ALL) Acute lymphocytic leukemia
uncontrolled proliferation of immature cells (lymphoblasts) derived from lymphoid stem cell
Acute Lymphocytic leukemia most commonly found in
young children, mainly boys peak incidence at 4 years old
what if the most common form of leukemia in the US
Chronic lymphocytic leukemia
lymphadenopathy
Lymphadenopathy is swelling of one or more lymph nodes. It is a recognised sx of many diseases, which include:
reactive: acute infection (e.g. bacterial, or viral), or chronic infections (tuberculous lymphadenitis, cat-scratch disease). When the infection is of the lymph nodes themselves, it is called lymphadenitis, but when the infection is of the lymph channels, it is called lymphangitis.
tumoral: Hodgkin lymphoma, non-Hodgkin lymphoma, metastasis unknown etiology: sarcoidosis.
What is the classical sign of multiple myeloma
bone pain usually in the back or ribs, increases with movement and decreases with rest
Nurse alert and bone pain
any elderly patient whose chief complaint is back pain and who has elevated total protein level, should be evaluated for possible myeloma
hyperhomocystinemia
increased plasma of homocystine, results from nutritional deficiency of folic acid and b6 and b13. Increased risk for thrombosis
Antithrombin III deficiency
ability to inhibit thrombin and certain coagulation factors. can cause DVTs
Protein C deficiency
inhibits coagulation, when deficient causes DVTs
Thrombophilia
Thrombophilia is the propensity to develop thrombosis (blood clots) due to an abnormality in the system of coagulation.
Febrile non-hemolytic transfusion reaction.
This is the most common adverse reaction to a blood transfusion. Symptoms include fever and dyspnea 1 to 6 hours after receiving the transfusion. Such reactions are clinically benign, causing no lasting side effects or problems, but are unpleasant for the patient.
signs of circulatory overload
dyspnea, orthopnea, tachycardia, and sudden anxiety, Neck vein distention, crackles at the base of the lungs, and rise in blood pressure can occur
Treatment of circulatory overload in pts
if fluid overload is mild, the tranfusion can often be continued after slowing the rate of infusion and administerin diuretics, if severe, the pt is placed in an upright position and the feet in a dependent position, the transfusion us dusccibtubyed abd tge MD notified
sign of bacterial contamination of transfusion
fever, chills and hypotension
A vasopressor is
a drug used to constrict the arteries and increase blood pressure. These agents include dobutamine, dopamine, epinephrine, isoproterenol, norepinephrine, phenylephrine and ephedrine. They are most commonly used in intensive-care and post-operative hospital settings for patients with critical hypotension (low blood pressure).
Transfusion related lung injury
idiosyncratic reaction that occurs in fewer than 1 in 5000 transfusions
Management for transfusion reactions
In a transfusion reaction, stop the transfusion, assess the pt carefully, notify the physician, notify the blood bank, send container and tubing to blood bank