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VN149 Midterm 1
Question | Answer |
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HEMATOLOGY | study of blood ant its components |
HEMATOLOGY- COMPLETE BLOOD COUNT (CBC) | info about the state of health or presence of illness |
HEMATOLOGY- HEMATOCRIT | the separation of blood and the amount of blood cells in relation to the amount of plasma |
HEMATOLOGY- HEMOGLOBIN | capacity of blood to transport oxygen from lungs to tissues |
HEMATOLOGY- PLATELETS | essential to blood clotting |
normal platelet | 150,000 to 350,000. if low platelet, difficulty clotting. Look for s/s of bleeding |
ERYTHROCYTE SEDIMENTATION RATE (ESR) | looks at how long RBC to settle out of unclotted blood with in an hr. |
HEMATOLOGY - FYI | during infection, the |
BLOOD CHEMISTRY TESTS - post | fasting between 8-12 hrs prior to test |
BLOOD CHEMISTRY TESTS | to detect changes in biochemical reaction in the body and determine a diagnosis. |
BLOOD CHEMISTRY TESTS - BLOOD GLUCOSE TEST | essential in the diagnosis and control of diabetes |
BLOOD CHEMISTRY TESTS- BILIRUBIN, ALANINE AMINOTRANSFERASE (ALT) & ALKALINE PHOSPHATASE (ALP) | used to measure liver function |
BLOOD CHEMISTRY TESTS - BLOOD UREA NITROGEN (BUN) & CREATININE LEVELS | important indicators of kidney functions |
BLOOD CHEMISTRY TESTS - LACTATE DEHYDROGENASE (LDH), CREATININE KINASE (CK), & ASPARTATE AMINOTRANSFERASE (AST) | detect damage to striated and heart muscle |
BLOOD GLUCOSE | glucometer. Commonly performed at the bedside or in physician's ofc by nurse. Guides insulin theraphy for diabetics. Requires fingerstick to obtain capillary blood. |
BLOOD GLUCOSE - FYI | hold hand down (gravity). Wash hand with warm water if they are cold. Hosp - uses alcohol and waits for alcohol to dry. |
SEROLOGY TESTS | based on analysis on serum (clear part of blood). Used to diagnose both viral and bactrerial diseases or determine antibody levels for: DYSENTERY, RHEUMATIC FEVER, TYPHOID, INFLUENZA, RUBELLA AND SYPHILLIS |
SEROLOGY TESTS | used to determine titers in response to vaccines. Blood typing and identification of blood factors may also be carried out in the serology section in the lab. |
SEROLOGY TESTS - RADIOIMMUNOASSAYS | detect minute particles of protein in the blood. |
SEROLOGY TESTS - FYI | restrict food & fluid intake. If they have more fluid, it dilutes it so test is not accurate |
BACTERIOLOGY | blood, urine, feces, wound drainage & other body fluids or tissues cultured to identify the disease - causing organism. ASEPTIC TECHNIQUE must be maintained when collecting specimen for culture & sensitivity |
HISTOLOGY & CYTOLOGY TEST | the study of tissues and cells. Detect carcinogenic, metabolic, vascular & other changes. |
ULTRASONOGRAPHY | records the reflection of wound wave directed into the tissues. Used to diagnose pathologic conditions of uterus, ovaries, prostate, heart, liver, kidneys, pancreas, gallbladder, lymph nodes, thyroid, eyes, and peripheral blood vessels. |
ULTRASONOGRAPHY - FYI | often used in conjuction with nuclear medicine scans. Can be used for PICC lines for men's bicep to visualize vein |
RADIOLOGY PROCEDURES - XRAY | most common. Produces image of the denser tissues by passing rays through the part to expose a film. |
RADIOLOGY PROCEDURES - FLUOROSCOPY | examines movement. Xrays passed through the body part and projected on a flourescent screen |
RADIOLOGY PROCEDURES - CINERADIOGRAPHY | adding a video camera to the fluoroscope equipment and making a photographic record of the procedure |
RADIONUCLIDE SCANS - NI | double flush toilets. Linens - biohazard bins. Contraindicated with pregnant women |
RADIONUCLIDE SCANS | various organs&soft tissues of body attract & concentrate certain radionuclides. Radioactive substance is injected into vein. After organ being scanned absorbs the substance, radioactivity scanner (scintillator) is passed over area where organ is located |
IVP (INTRAVENOUS PYELOGRAM) | requires informed consent. Ask for iodine allergy |
ARTHOGRAM | joints |
MYELOGRAM | muscles |
COMPUTED TOMOGRAPHY (CT) SCAN | not required consent but if they add contrast, need consent |
COMPUTED TOMOGRAPHY | it takes about 10-45 mins. |
COMPUTED ANGIOGRAPHY | looks at blood flow |
COMPUTED TOMOGRAPHY | computer enhances xray and allows examination of horizontal sections of the body at various angles to define tissue density |
MAGNETIC RESONANCE IMAGING (MRI) | noninvasive method of differentiating normal fr abnormal tissue in body. Commonly used for brain, knee joint, spine & spinal cord & abd organs. Pts w metal devices implanted in body cannot undergo procedure bec the machine emits a strong magnetic field |
CARDIOPULMONARY STUDIES - EKG/ECG | diagnoses heart rhythms and heart diseasel measures electrical activity of the heart. Consists of waves and lines that represent the electrical activity during the cardiac cycle. P waves, QRS complex and T wave |
CARDIOPULMONARY STUDIES - CARDICA CATHETERIZATION | determines the function of heart, valves and coronary circulation. Readings taken of oxygen concentration at different sites, of pressure in different heart chambers, and cardiac output. |
CARDIOPULMONARY STUDIES - CARDICA CATHETERIZATION | abnormal blood flow through the heart and the coronary vessels can be detected. A surgical procedure using surgical aseptic technics. |
CARDIOPULMONARY STUDIES - CARDICA CATHETERIZATION - NI | pt teaching must be done. Signed consent. NPO at least 6 hours prior. Pre meds taken. AFTER: pressure on site (sand bag). Bed rest. Check for bleeding. |
CARDIOPULMONARY STUDIES - ANGIOGRAPHY AND ARTERIOGRAPHY | locate lessions, occluded vessels, tumors & malformed blood vessels. Contrast medium injected into artery & xrays taken of the dye spreading thorugh the vessels. Used to diagnose problems in arteries anywhere in body: heart, neck, brain or extremities |
CARDIOPULMONARY STUDIES - TREADMILL STRESS TEST | measures the cardiac heart rate and blood pressure response to clinically controlled active exercise. Used to diagnose heart capacity, to guide convalescense from a myocardidal infarction, & to determine response to medical treatment. |
CARDIOPULMONARY STUDIES - TREADMILL STRESS TEST | while having heart action continuosly monitored by ECG, the pt walks on a treatmill, pedals a stationary bicycle, or climbs a set of stairs. PTS SHOULD AVOID: MILK PRODUCTS, CAFFEINE, SMOKING 6 HRS PRIOR. CAN HAVE LIGHT MEAL 2 HRS PRIOR |
CARDIOPULMONARY STUDIES - PULMONARY FUNCTION TEST (PFT) | provides information about respiratory function, lung capacity and diffusion of gases. Spirometers and other breathing devices may be used. No special preparation is required. |
REQUIRES CONSENT | all invasive tests requiring injection of a medium . Tests requiring premeds or sedation. |
TYPES OF HTN | PRIMARY & SECONDARY |
PRIMARY HTN | 90% to 95% of all cases of htn. Its cause is unknown. |
SECONDARY HTN | caused by UNDERLYING FACTORS, such as kidney disease, certain arterial conditions, some drugs and occasionally pregnancy. It is less common than primary HTN. |
NORMAL BP | SYSTOLIC <120 mm Hg; DIASTOLIC <80 mm Hg |
PREHYPERTENSION | systolic pressures between 120 and 139; diastolic pressures between 80 and 89 |
CARDIAC OUTPUT | the volume of blood pumped by the heart in a specific period (usually 1 min). Determined by strength, rate and rhythm of the contraction of the left ventricle and the blood volume. |
PERIPHERAL VASCULAR RESISTANCE | force in blood vessels that left ventricle must overcome to eject blood fromheart. Resistance to blood flow determined by diamter of blood vessels & blood viscosity (thickness). Increased peripheral vascular resistance:most prominent characteristic of htn |
NOREPINEPHRINE & EPINEPHRINE (catecholamines) | vasoconstrictors: cause blood vessels to constrict, making diameter smaller. |
NOREPINEPHRINE | increases peripheral vascular resistance and raises bp. |
EPINEPHRINE | constricts blood vessels and increases the force of cardiac contraction, causing bp to rise. |
CAUSE OF HTN | vasoconstriction, cardiac stimulation, and retention of fluid. |
AGE RELATED CHANGES AFFECTING BP | atherosclerotic changes reduce the elasticity of the arteries & PULSE PRESSURE |
AGE RELATED CHANGES AFFECTING BP- atherosclerotic changes reduce the elasticity of the arteries | causes decrease in cardiac output and increase in peripheral vascular resistance. |
AGE RELATED CHANGES AFFECTING BP - PULSE PRESSURE | the difference between the systolic and diastolic pressure. It widens in response to a decreased ability of the aorta to distend. |
PRIMARY (ESSENTIAL) HTN - risk factors | dyslipidemia, atherosclerosis, diabetes mellitus, tobacco use, age >55 yrs for men & <65 yrs for women, family history, sedentary lifestyle and obesity |
PRIMARY (ESSENTIAL) HTN - signs and symptoms | occipital headaches that are severe on arising, lightheadedness, epistaxis (nosebleed). If HTN has damaged blood vessels in the heart, kidneys, eyes or brain, pt may have symptoms of impaired function of those organs |
COMPLICATIONS - HEART | coronary artery disease develops in pts with htn two to three times more frequently than in people with normal bp |
COMPLICATIONS - KIDNEYS | narrowing of the renal arteries may decrease renal function and lead to chronic renal failure |
COMPLICATIONS - BRAIN | prolonged htn constricts and damages cerebral arteries, putting pt at risk for transient ischemic attacks and cerebrovascular accidents. |
COMPLICATIONS - EYES | damage to eyes may include narrowing of the retinal arterioles, retinal hemorrhages, and papilledemia; may lead to blindness |
DIAGNOSTIC TESTS AND PROCEDURES FOR HTN | confirmed by repeated findings of ave pressures =< 140/90. ambulatory bp monitors. Data-pt's lifestyle, other cardiovascular risk factors & medical diagnostics. EKG. Blood studies -glucose, hematocrit, K, Ca, creatinin, lipid profile. chest radiograph |
MEDICAL TREATMENT FOR HTN | lifestyle mods: wt reduction, smoking cessation, sodium and alcohol restriction, exercise and relaxation techniques |
MEDICAL TREATMENT FOR HTN- pharm therapy | specific antiHTN drugs: diuretics, beta adrenergic receptor blockers, ca antagonists, ACE inhibitors, Angiotensin II receptor antagonists, central adrenergic blockers, alpha-adrenergic receptor blockers, direct vasodilators. |
SECONDARY HTN - causes | renal disease, excess excretion of adrenal hormones, narrowing of the aorta, increased intracranial pressure, some drugs such as vasoconstrictors |
THERAPEUTIC REGIMEN MGMT | diet therapy goals, exercise, stress mgmt, drug therapy |
RISK FOR INJURY - orthostatic hypotension | sudden drop in systolic bp, usually 20 mm Hg, when going from lying or sitting to a standing position. Monitor for lightheadedness, dizziness, syncope. |
RISK FOR INJURY - sedation | advise if drowsiness is likely so activities requiring alertness can be avoided during times of peak drug effect. Taking meds at bedtime promote sleep |
RISK FOR INJURY - ineffective coping | if depression a side effect of an antihypertensive, consult physician to substitute another drug |
RISK FOR INJURY - sexual dysfunction | decreased libido, inability to achieve an erection, or delayed ejaculation. Advise physician so an alternative medication or other intervention can be considered. |
OLDER PTS | response to drug therapy mode difficult to predict; side effects are common. |
HYPERTENSIVE EMERGENCIES | a life threatening medical emergency. Severe HA, blurred vision, nausea, restlessness and confusion. Elevated diastolic bp (130mm Hg or more); the heart & resp rates are increased. May result from having stopped taking anti HTN drugs |
HYPERTENSIVE EMERGENCIES - cause | malignant htn, htn encelopathy, eclampsia, pheochromocytoma (adrenal tumor), cerebrovascular accident. |
HYPERTENSIVE EMERGENCIES - medical diagnosis | assessment in ED reveals elevated bp, pulse and resp rate. Retinal hemorrhage or papilledema, or both, observed in the back (fundus) of eye. |
HYPERTENSIVE EMERGENCIES - medical treatment | the goal of drug therapy is to rapidly reduce the pressure to a non-life threatening level & then to bring it slowly within normal range. |
HYPERTENSIVE EMERGENCIES - medical treatment - DIURETICS & POTENT VASODILATORS | Fenoldopam, Nitroglycerin, Diazoxide, Hydralazine, Phentolamine, Labetalol, Nitroprusside |
HYPERTENSIVE EMERGENCIES - medical treatment | an IV line is usually established because many drugs are given by that route. Oral options for the management of HTN crisis include CAPTOPRIL, CLONIDINE, NIFEDIPINE. |
NURSING CARE OF PT IN HTN CRISIS - ASSESSMENT | freq check bp, pulse, resp & level of consciousness. Drugs given in IV requiring continous monitoring & adjustment. Careful record of fluid I&O. nausea & vomiting may indicate an impending seizure or coma |
NURSING CARE OF PT IN HTN CRISIS - INTERVENTIONS | admin prescribed drugs, vs before & after each dose, monitor cardiac & renal function, start & maintain IV therapy, administer oxygen as ordered, comfort the pt |
DIURETICS | furosemide (Lasix) - K depletion. HCTZ (hydrochlorothiazide) - K sparing |
S/S STROKE | dysphasia, slurred speech, face drooping, level of consiousness, aphasia |
TEST FOR HEPARIN | PTT |
TEST FOR WARFARIN/COUMADIN | PT/INR |
ACE1 - antihypertensive | Lisinopril/Vasotec/Aldomet |
BETABLOCKERS | Proponolol |
CALCIUM CHANNEL BLOCKER | Cardizem (diltiazem) |
ANTIHYPERTENSIVES | include beta blockers, diuretics, calcium channel blockers, alpha blockers, anti-adrenergics, vasodilators |
ANTIHYPERTENSIVES - actions | lowers BP by increasing size of blood vessels, increases space to allow blood flow therefore reduces BP |
ANTIHYPERTENSIVES - nursing interventions | perodic BP checks, same arm same position; periodi weights, check skin for patches |
ANTIHYPERTENSIVES - nursing interventions | pts receiving antihypertensive drugs should be cautioned about sudden changes in body position, especially from supine standing bec postural hypotension may occur |
Beta adrenergic blocking agent (ANTIARRHYTHMICS) II | stimulation beta receptors of the heart results in increase of HR. if the stimulation is interrupted or blocked, heart rate decreases. |
Beta adrenergic blocking agent - adverse reactions | bradycardia, dizziness, vertigo, hyperglycemia, N/V, diarrhea, HA, depression |
calcium channel blocker | Ca+ necessary for transmission of nerve impulses. Procardia, Diltazem (cardizem) inhibit movement of Ca+ ions across the cell member |
calcium channel blocker - uses | prevention of anginal pain associated with certain forms of angina; not used to stop anginal pain once it has occurred |
calcium channel blocker - uses | used when pts cannot tolerate beta blockers or nitrate |
calcium channel blocker - adverse reaction | peripheral edema, dizziness, lightheadedness, nausea, dermatitis, skin rash, fever, chills |
dosis of this anticoagulant med are ordered on the basis of measurement of the patient's PT/INR | warfarin (Coumadin) |
INR (International Normalized Ratio) | the higher it is, it's longer it takes for blood to clot |
Heparin | parental only (SC or IV); onset - immediate to 4 hr peak. IV infusion - loading does, PTT checks maintenance does |
where is the heart located? | in the thoracic cavity between the lungs called MEDIASTINUM |
heart has two pumps | 1) forces blood into lungs and the other pushes blood to the rest of the body |
PULMONARY CIRCULATION | the right heart pumps blood to the lungs for oxygenation |
SYSTEMIC CIRCULATION | the left heart pumps blood throughout the rest of the body |
the thich middle layer of the heart and the thickest of all layers. It is composed of cardia muscle tissue | myocardium |
the outermost layer of the heart; it is slinglike | pericardium |
the thin outermost layer of the heart; it continous at the apex of the heart with the inner lining of the pericardium | epicardium |
heart's innermost layer. It is a thin layer composed of simple squamous epithelium over a layer of connective tissue | endocardium |
describe the circulation pathways | 1) arteries 2) arterioles 3) capillaries 4) venules 5) veins |
describe the electrical activity of the heart | 1) (SA) sinoatrial node 2) (ACF) atrial conducting fibers 3) (AV node) atrioventricular node 4) ( BOH) Bundle of His 5) (BB) bundle branches 6) (PF) purkinge fibers |
receives unoxygenated \blood from the superior vena cava and inferior vena cava. | RA right atrium |
receives unoxygenated blood from the right atrium and pumped out to the lungs through the pulmonary artery | RV right ventricle |
the thin walled chamber that receives fresh oxygenated blood from the lungs through the four pulmonary veins | LA left atrium |
receives oxygenated blood from the left atrium and the thickest of all chambers because it has to send blood to the entire body | LV left ventricle |
"what are the four heart valves | TV, BV, RSV and LSV |
tricuspid valve, bicuspid or mitral valve, right semilunar valve and left semilunar valve" | |
what supplies blood to the myocardium | coronary artery |
contraction of the heart muscle | systole |
relaxation of the heart muscle | diastole |
noise closing of the heart valve ; myocardial contraction | lub dupp |
located in the upper posterior wall of the right atrium; it is the pacemaker of the heart; where the electrical signal originates | Sinoatrial node (SA) |
cardio fyi | stimulation of the parasympathetic nerves (vagus) decreases heart rate & conduction velocity |
special conduction tissue located in the interventricular septum; it receives the SLOWED cardiac impulse from the AV node and transmits the impulse | Bundle of HIS |
branches extend into the Purkinge transmitting the cardiac impulse | Bundle branches |
long fibers that extend into the ventricular myocardium; transmit cardiac impulse rapidly through the RV and LV to ensure a strong, simultaneous ventricular contraction | Purkinge Fibers |
number of times the heart beats per minute | heart rate |
controls the accelerator center and the inhibitory center via the autonomic nervous system | medula oblangata |
amount of blood by a ventricle in 1 minute | cardiac output |
the amount of blood pumped by a ventricle per beat; | stroke volume |
average Stroke Volume is | 60 to 80 ml per beat |
subdivision of Systemic Circulation in which the blood from the abdominal digestive organs and spleen circulates through the liver before returning to the heart | hepatic circulation |
what are the functions of purkinge fibers | it transmit electrical signals throughout the ventricles |
how stroke volume (SV) can be changed | can be changed by Starling's law of heart (stretch) and by inotropic effect (nonstretch) |
PRELOAD | amt of blood left in the ventricles at the end of diastole; it is the same as EDV. Increased = stronger force of contraction |
AFTERLOAD | resistance or opposition. Ie left ventricle pumps into aorta, it must push against blood that is already there. |
EJECTION FRACTION | when ventricle contracts it pumps about 67% of its volume (EDV - end diastolic volume); therefore some blood remains in the ventricle. The % of EDV that is pumped. |
INOTROPIC EFFECT | change in myocardial contraction that is not due to stretch |
describe the blood flow in and out of heart and lungs (1) | 1) from superior or inferior vena cava into (RA) right atrium 2) (TV) tricuspid valve 3) (RV) right ventricle 4) (PV) pulmonic semilunar valve 5) (PA) pulmonary artery 6) (PA r or l) Pulmonary arteries right or left |
describe the blood flow in and out of heart and lungs (2) | 7) (PC) pulmonary capillaries 8) (PV) 4 pulmonary veins 9) (LA) left atrium 10) (BV) bicuspid or mitral valve 11) (LV) left ventricle 12) (AOV) aortic semilunar valve 13) Aorta |