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58 Cards in this Set

  • Front
  • Back
S&S of Pneumothorax
-Ipsilateral (same side) chest pain
-Increased respiratory rate
-Dyspnea
-Increased heart rate
-Asymmetrical heart movement
-Hyperresonant upon percussion
-Decreased breath sounds
Immediate treatment of Pneumothorax
Chest Tube
S&S of Acute Onset Asthma
-Wheezing
-SOB
-Dyspnea
-Chest tightness
-Mucus production
-Coughing
-Use of accessory muscles
Immediate treatment of Asthma (quick relief)
<b>Emergency Treatment: EPInephrine</b> causes: bronchodilation, increased RR, increased HR, increased BP
<b>Bronchodilators</b>
-short-acting beta-adrenergic agonists
-Anticholinergics
-Corticosteroids
Ipratropium (Atrovent)
<b>Class, Uses, Actions, Contraindications</b>
<b>Ipratropium (Atrovent)</b>
<b>Class:</b> inhaled anticholinergic
<b>Action:</b> block muscarinic receptors on bronchi resulting in bronchodilation
<b>Uses:</b> to relieve bronchospasm associated with COPD & allergen-induced & exercise-induced asthma
<b>Contraindications:</b>
-peanut allergy
-narrow-angle glaucoma
-benign prostatic hypertrophy (due to anticholinergic effects)
Albuterol (Proventil)
<b>Class, Uses, Actions, Contraindications</b>
<b>Albuterol (Ipratropium)</b>

<b>Class:</b> Beta-2 Adrenergic Agonist

<b>Action:</b> selectively activate the beta-2 receptors in the bronchial smooth muscle resulting in bronchodilation
~Bronchospasm is relieved
~Histamine release is inhibited
~Ciliary motility is increased

<b>Uses:</b> to prevent asthma attack, tx for ongoing asthma attacks, long-term control of asthma

<b>Contraindications:</b>
-Tachydysrhythmias
-Caution in clients with diabetes, hyperthyroidism, heart disease, hypertension, & angina
Theophylline (Theolair)
<b>Class, Uses, Actions, Contraindications</b>
<b>Theophylline (Theolair)</b>
<b>Class:</b> methylxanthines
<b>Action:</b> relaxes bronchial smooth muscle resulting in bronchodilation
<b>Uses:</b> long-term control of chronic asthma
<b>Contraindications:</b>
-Caution in clients with heart disease, hypertension, liver & renal dysfunction, & diabetes
-Caution in children & older adults
<b>Do not stop or start smoking while taking theophylline. Decreases clearance</b>
Acetylcysteine (Mucomyst)
<b>Class, Uses, Actions, Contraindications</b>
<b>Acetylcysteine (Mucomyst)</b>
<b>Class:</b> Mucolytic
<b>Action:</b> enhance the flow of secretion in the respiratory passages
<b>Uses:</b> acute & chronic COPD, cystic fibrosis, antidote for acetaminophen poisoning
<b>Contraindications:</b>
-Not to be used in clients at risk for GI hemorrhage
-Caution in clients with PUD, esophageal varicies, & severe liver disease
Phenylephrine
<b>Class, Uses, Actions, Contraindications</b>
<b>Phenylephrine</b>
<b>Class:</b> Decongestant
<b>Action:</b> stimulate alpha-1 adrenergic receptors causing reduction in the inflammation of the nasal membranes
<b>Uses:</b> allergic rhinitis by relieving nasal stuffiness, decongestant for clients with sinusitis & the common cold
<b>Contraindications:</b>
-clients with chronic rhinitis
-Caution in clients with coronary artery disease & HTN
Reactive Airway Disease
<b>Patho, S&S, Tx</b>
<b>Reactive Airway Disease (RAD)</b>
-an asthma-like syndrome that developed after a single exposure to high levels of an irritating vapor, fume, or smoke.
<b>S&S:</b>
-SOB
-Chest tightness
-Wheezing
<b>Tx:</b> Bronchodilators
Chronic Obstructive Pulmonary Disease (COPD)
<b>Patho, & Tx</b>
<b>COPD</b>
-a group of respiratory disorders including: <b>Chronic Bronchitis & Emphysema</b> characterized by chronic and recurrent obstruction of airflow in pulmonary airways
-Bronchial-wall hypersecretion of mucus causes obstruction of airflow and mismatch of ventilation & perfusion
<b>Tx:</b> Albuterol (Proventil)
Bodies response to Respiratory Hypoxemia
-Hypoxemia
-Hypercapnea <b>(increased PaCO2)</b>
-Cyanosis
-Tachypnea (fast breathing)
...causes reflex vasoconstriction of the pulmonary vessels which further impairs gas exchange.
<b>If left untreated, Hypoxemia can cause HTN & right-sided heart failure</b>
A patient born with Alpha1 Antitrypsin Deficiency is likely to develop....
<b>Emphysema & COPD</b>
Alpha1 antitrypsin deficiency (AATD) can cause lung disease in adults and liver disease in adults & children.
-Alpha1 antitrypsin: an enzyme that protects the lungs from injury
<b>Clients with AATD increase their risk of developing Emphysema & COPD if they are smokers!</b>
Consistent use of nasal decongestant sprays can cause...
<b>Rebound Congestion</b>
Often confused with "nasal spray addiction".
Persistent use of nasal decongestants cause the nasal membranes to become "tolerant"--or less responsive to the effects of the medication. As a result, you must use more of the medication to have an effect or your congestion may worsen if you stop the medication (rebound congestion). <b>Reversible</b>
-Stop using for several weeks to reduce tolerance.
Treatment for non-productive cough include:
Expectorants: <b>Guaifenesin</b>
-Action: <b>Liquify & loosen secretions</b>
Antitussives: <b>Dextromethorphan</b>
-Action: <b>Control non-productive cough</b>
What medication class should not be used in an Asthmatic Patient?
<b>Beta Blockers</b>
They cause bronchoconstriction!
What is the role of Nitric Oxide in the vascular endothelium?
Nitric oxide is important to the regulation of blood flow.

Effects of NO:
-Direct vasodilation
-Indirect vasodilation by inhibiting Angiotensin II
-Anti-thrombotic
-Anti-inflammatory
-Antiproliferative
If production of Nitric Oxide is impaired or its bioavailablity is reduced, what can result?
-Vasoconstriction <b>(coronary vasospasm, elevated systemic vascular resistance, HTN)</b>
-Thrombosis due to platelet aggregation & adhesion to vascular endothelium
-Inflammation due to upregulation of leukocyte & endothelial adhesion molecules
-Vascular hypertrophy & stenosis
Disease conditions associated with abnormal Nitric Oxide production and availability:
-<b>HTN</b>
-Obestiy
-Dyslipidemias (hypercholesterolemia & hypertriglyceridemia)
-Diabetes (type I & II)
-<b>Heart Failure</b>
-<b>Atherosclerosis</b>
-Cigarette smoking
Which side of the heart if failing with (JVD) jugular venous distention?
<b>JVD = Right-Sided Heart Failure</b>
ACE inhibitors act on which body system?
ACE inhibitors act on the renin-angiotensin-aldosterone system
eg. Captopril
S&S of Pulmonary Edema
-Peripheral edema
-Sacral edema
-Pink-frothy sputum
What is the leading cause of death in young athletes?
Hypertrophic Cardiomyopathy
<b>Inotropic</b> medications effect the hearts...
Contraction
<b>Chronotropic</b> medications effects the hearts...
Heart Rate
<b>Dromotropic</b> medications effects the hearts...
Conduction velocity--impulse to contract
(dromo- "speed")
Preload of the Right Ventricle is measured by...
Central Venous Pressure (CVP)
Adverse effects of Phosphodiesterase Inhibitors...
-Hypotension
-Hyperthermia
What class of medications should NOT be used in clients with Left-Heart Failure?
<b>Beta-Blockers</b>
-Can causes further respiratory depression & exacerbate breathing difficulties
Dysrhythmia associated with sudden cardiac death...
<b>Ventricular Fibrillation</b>
Ineffective contraction of the ventricles (fibrillation) occurs when blood flow to the heart muscle is decreased by partial or complete blockage of the coronary artery.
A sudden, severe blockage may lead to MI
S&S of Cardiac Ischemia
-Angina pectoris
-Neck or jaw pain
-Arm pain
-Clammy skin
-SOB
-Nausea & vomiting
S&S of Angina
-Chest pain
-GERD
-No belly pain!
A common symptom of Cardiomyopathy...
Difficulty breathing
Beta-Adrenergic Agonists
<b>DoBUTamine</b>
-Increase HR <b>(+ chronotrope)</b>
-Increase contractility <b>(+ inotrope)</b>
-Increase rate of conduction through the AV node <b>(+ dromotrope)</b>
<b>Tx of Acute CHF</b>
Beta-Adrenergic Blockers
<b>Metoprolol (Lopressor)</b>
-Decrease HR <b>(- chronotrope)</b>
-Decrease contractility <b>(-inotrope)</b>
-Decrease rate of conduction though the AV node <b>(- dromotrope)</b>

<b>Tx of Chronic CHF</b>
Cardiac Glycosides
<b>Digoxin</b>
- Increase contractility <b>(+ inotrope)</b>
-Decrease HR <b>(- chronotrope)</b>
<b>Tx of HF & A-Fib</b>
Medications used for CHF & their effects...
<b>Vasodilators: ACE inhibitors & nitrates</b>
-Decrease workload of overworked cardiac muscle by <b>reducing afterload</b>
<b>Diuretics</b>
-Decrease blood volume, which decreases venous return & BP <b>reducing preload</b>
<b>Beta-Adrenergic Agonists</b>
-Stimulate the beta-receptors in the sympathetic nervous system, increasing calcium flow into the myocardial cells and causing <b>increased contraction</b>
<b>Beta-Adrenergic Blockers</b>
-Reduces myocardial stress of <b>prolonged SNS activation</b>
Phosphodiesterase Inhibitors
<b>Class, Action, Uses, Contraindications</b>
<b>Phosphodiesterase inhibitors</b>
-Class: <b>Cardiotonic (inotropic) agent</b>
<b>Milrinone (Primacor):</b> short-term management of CHF in patients who are receiving digoxin & diuretics.
-Action: <b>blocks the enzyme phosphodiesterase</b>, leading to an increase in myocardial cell adenosine monophosphate (cAMP), which <b>increases calcium levels in the cell</b>, causing stronger contraction & prolonged response to sympathetic stimulation
-Uses: <b>short-term Tx of CHF in patients unresponsive to digitalis, diuretics, & vasodilators</b>
S&S of Kawasaki Disease
-Fever
-Viral rash on stomach, chest, & genitals
-Severely red eyes
-Dry, cracked lips
-Swollen tongue
-White coating on tongue
-Swollen palms of hands and soles of feet
<b>Most often effects children <5yrs</b>
Pericarditis
Inflammation of pericardium that can result from cardiomyopathy
Angiotensin II Receptor Blockers (ARBs)
<b>ARBs</b> (-sartan)
<b>Action:</b> selectively bind with angiotensin II receptor sites in vascular smooth muscle & the adrenal gland to <b>block vasoconstriction & the release of aldosterone</b>
<b>Uses:</b> HTN, CHF, slows progression of renal disease in pts with HTN & type 2 diabetes
<b>Contraindications:</b>
-renal artery stenosis/dysfunction
-pregnancy 2nd & 3rd trimester fetal injury
Angiotensin-Converting Enzyme (ACE) Inhibitors
<b>ACE (-pril)</b>
<b>Action:</b> block the production of angiotensin II to cause: <b>vasodilation and excretion of sodium & water</b>
<b>Uses:</b> Heart failure, HTN, MI, diabetic & nondiabetic nephropathy
What is the correlation between COX-2 enzyme & asthma?
Some people suffer from asthma & rhinitis attacks in response to <b>aspirin & NSAIDs</b>
NSAIDs effect on COX-2 Enzymes
NSAIDs inhibit prostaglandin synthesis of COX-1 & COX-2.
-COX2 is active at sites of trauma or injury
-NSAIDs block inflammation before all of the S&S can develop
-NSAIDs is a COX-2 inhibitor
-<b>COX-2 inhibitors block the inflammatory action</b>
What conditions cause Disseminated Intravascular Coagulation (DIC)?
<b>Widespread coagulation and bleeding in the vascular compartment</b>
Clinical conditions that may cause DIC include:
-<b>Obstetric disorders</b> (account for 50% of cases)
-Massive trauma
-<b>Shock</b>
-Infections
-Malignant disease (including Leukemia)
What conditions cause Idiopathic Thrombocytopenic Prupura (ITP)?
<b>Widespread platelet thrombi in arterioles & capillaries of the heart, brain, & kidneys; thrombocytopenia; erythrocyte fragmentation causing hemolytic anemia and jaundice</b>
ITP syndrome is occasionally precipitated by:
-<b>Estrogen use</b>
-Pregnancy
-Drugs
-Infections associated with HIV
What organ clears old RBCs in the body?
Spleen
Dark, cola-colored urine is due in part by what part of RBCs?
Iron
Tx of Pernicious Anemia
Pernicious anemia is a form of megaloblastic anemia due to vitamin B-12 deficiency due to impaired absorption.
<b>Tx: life-long parenteral administration of Vit. B-12</b> B-12 cannot be absorbed orally
Ferrous Sulfate (Feosol)
<b>Class, Action, Uses, Side Effects/Adverse Effects</b>
<b>Ferrous Sulfate (Feosol)</b>
<b>Class:</b> Iron Preparation
<b>Action:</b> provide the iron needed for RBC production
<b>Uses:</b> Tx & prevention of Iron deficiency anemia
<b>Side Effects/Adverse Effects:</b>
-GI distress: nausea, constipation, heartburn
-Teeth staining
-Anaphylaxis risk with parenteral administration
What puts you at risk for Anemia?
-Women in their childbearing years
-Pregnancy
-Heavy menstrual periods
-Low-iron diet
-Chronic blood loss
WBCs that are mobilized for allergic response....
<b>Lymphocytes:</b> 20-30% of WBCs.
-Move from blood to tissue
-Function in lymph nodes or spleen to defend against foreign microbes
<b>Monocytes:</b> 3-8% of WBCs.
-Last for months of years
-Engulf foreign material
-Activate lymphocytes by presenting antigen to T-cells (immune response)
What are the types of WBC disorders & what precautions should be in place for these patients?
<b>WBC Disorders:</b>
-Chronic lymphocytic leukemia (CLL)
-Chronic myelogenous leukemia (CML)
-Acute lymphocytic leukemia (ALL)
-Acute myelogenous leukemia (AML)
<b>Precautions:</b>
-Infection protection
-Bleeding precautions
-Energy management
What is Agranulocytosis?
Inadequate amounts of white blood cells called <b>neutrophils or granulocytes</b>.
<b>Causes:</b>
-Bone marrow producing insufficient amounts of neutrophils
-When WBCs are destroyed faster than produced
<b>Patients with Agranulocytosis are more prone to infection</b>
Epoetin alfa (Epogen)
<b>Class, Action, Uses, Contraindications</b>
<b>Epoetin alfa (Epogen)</b>
<b>Class:</b> Hematopoietic Growth Factor
<b>Action:</b> act on the bone marrow to increase production of RBCs
<b>Uses:</b>
-Anemia in chronic renal failure
-Chemotherapy-induced anemia
<b>Contraindications:</b>
-Clients with uncontrolled HTN
-Caution in clients with cancers of the bone marrow
Dextromethorphan
<b>Class, Action, Uses, Contraindications</b>
<b>Dextromethorphan</b>
<b>Class:</b> Antitussive
<b>Action:</b> acts directly on medullary cough center of the brain to depress the cough reflex
<b/>Uses: control of non-productive cough</b>
<b>Contraindications:</b>
-<b>Do NOT use on post-op patients or those with head injury</b>
What are the risk factors related to lab work with lipids?
Lipid transport in the body:
-dietary lipids absorbed by chylomicrons
-adipose & muscle cells take up lipids from chylomicrons
-chylomicrons remnants are intermediate density lipoproteins
-IDLs become LDL's (bad cholesterol)
-LDL's deliver fat to liver
-Some LDL's are taken by scavenger cells, macrophages
S&S of Venous Insufficiency
<b>Venous Insufficiency</b>
-Stasis dermatitis (brown discoloration of ankles & calfs)
-Edema
-Ulcers
-Shiny skin
-No hair