Cardiac, GI, Renal, Neuro, Respiratory, Endocrine
Help!
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| What is the pathway of blood flow through the Heart? | show 🗑
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| What is the order of valves in the heart? | show 🗑
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| show | Aortic (R 2nd), Pulmonic (L 2nd), Tricuspid (L 4th), Mitral-Apex-Apical (L 5th)
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| show | 4th and 5th intercostal space (easier to hear if pt is on their L side)
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| show | Laterally
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| What is preload? | show 🗑
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| show | the pressure in aorta and peripheral artery that the L Vent has to pump against to get blood out of heart to body.
Increased BP is added resistance that L Vent has to pump against.
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| If you increase the volume going back to heart (preload) what does that due to workload? | show 🗑
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| show | CHF and PE- if you increase after load this decreases CO and wears out heart muscle.
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| show | SV=HRxSV
-tissue perfusion
-changes dep on bodes needs (if your HR inc then your SV with inc and then your CO will inc)
-HR (if D or I too much CO drop)
-BV (less volume less CO)
-D contractibility (meds, MI, Muscle Dz)
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| What is SV? | show 🗑
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| Left Ventricle equals... | show 🗑
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| show | Decrease (too much pressure to pump against)
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| show | - chest pain, wet lungs, SOB, cold/clammy skin, D UO, D peripheral P
-Bradycardia (D HR) is ok if CO is still functioning well (can't have any of above sx)
-NO CO = PULSELESSNESS/V-Tach/V-Fib
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| show | Decreased BF to myocardium that leads to ischemia or necrosis
-Can be stable (know factors/tx) or unstable (unknown factors/tx)
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| What is ISCHEMIA? | show 🗑
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| show | -Dilation of Veins and Arts (D pre/after which D workload on Heart)
-Dilation of Coronary Art (I BF to heart muscle brings O2 & stops pain)
-1 q 5 min x3 ( if this doesn't work go to ER)
will D BP but should go back up-never leave pt until stabilized
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| show | -Antihypertensive
- slows HR and D contractibility
-D workload which D CO
-Blocks Beta receptors on heart that accept catacholemines (NE, Epi)
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| How do CCB work? | show 🗑
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| Why do ASA's help with ANGINA? | show 🗑
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| show | -NO isometric exercises (no strenuous exercises on test!!)
-NO caffeine/drugs/overeating/smoking (Increases HR)
-wait 2 hrs after eating to exercise
-avoid Temp extremes
-NItro propholaticly (will be dizzy bc D BP, have pt sit down SAFETY)
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| show | -allergic to SHELLFISH/IODINE
-kidney problem (dye is excreted through kidney and could cause renal failure if it can't be excreted)
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| show | Mucomyst (helps protect kidneys)
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| show | FLUSHING (and warmth) in face and METALLIC TASTE
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| show | HEMORRHAGE (rpt pain at puncture site STAT)
-always check 5 P's after
-hold Metformin before and after (48 hrs)
-lay flat in bed (extremity straight for 48 hrs)
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| show | -Decreased BF to myocardium (ischema and necrosis)
-dont have to be doing anything to bring it on
-usually occurs in AM while in REM sleep (I HR/BP/WL)
-Rest and Nitro WONT help
-crushing chest feeling
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| What SX do WOMEN have when having an MI? | show 🗑
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| show | -SOB is #1 (might just faint)
-behavior change =pain
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| What is a SIGN and ELDERLY person is in pain? | show 🗑
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| What does CPK/MB do? | show 🗑
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| show | -Specific to MI damage
-MOST SPECIFIC (can tell if pt delays tx)
-elevates w/in 3-4 hrs and peaks at 3 weeks
-ONLY present when there is MI DAMAGE
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| What does MYOGLOBIN do? | show 🗑
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| show | V-Fib (No CO bc tissue is dead so it can't be perfused)
-DEFIB the V-FIB
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| show | -1st DEFIB
-2nd Epi (vasopressor)
-3rd Amiodorone (antiarrythmic- used when resistant to tx, can be given to prevent 2nd) or Lidocaine (D irritability of heart)
-TOXICITY = ANY NEURO CHANGES
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| Tx of MI? | show 🗑
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| What do FIBRENOLYTICS do? | show 🗑
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| What kind of meds are PLAVIX, INTEGROLIN, REOPRO) | show 🗑
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| What is a CABAG? | show 🗑
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| show | -weight gain
-ankle edema
-SOB
-confusion
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| What is the heart doing when it is REpolarizing? | show 🗑
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| show | -DEspensing Blood
-Heart muscle contracts
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| What is an Epicardial Pace maker? | show 🗑
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| What is a TRANSCUTANEOUS PACEMAKER? | show 🗑
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| show | -wires are placed into heart chamber
-power source is outside body (check batteries)
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| What should you not let you pt do after receiving a pacemaker? | show 🗑
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| What are SX of R side HF? | show 🗑
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| What are SX of L side HF? | show 🗑
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| What is the #1 cause of HF? | show 🗑
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| show | Systolic- heart can't contract and eject blood
Diastolic -heart can't relax and fill
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| What is the #1 cause of PULMONARY HTN? | show 🗑
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| show | Central line w/balloon inserted into R Atrium, R Ventrical. Pulmonary Artery
-helps to determine cause of D CO, used in HF pt
Complications: Air embolism and Pulmonary Infarct
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| show | Blood test to help determine HF (Sensitive Indicator)
-BNP is a peptide that is secreted when vent volume and pressure in heart Increase
-If on Neutracore (vasodilator and diuretic), will need to stop 2 hrs before test (will give false +)
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| What will a CXR show if you are in HF? | show 🗑
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| show | -Decreased HR (gives Vent more time to fill with blood)
- Increases CO by squeezing down on more blood w/stronger contractions
-Increases Kidney perfusion (diuresisng helps get rid of fluid)
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| show | 0.5-2.0
you know it is working when CO increases
Sx: anorexia, N/V (early), weird arrhythmias, vision changes (late)
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| show | -Improved LOC
-skin warm/dry
-clear lungs
-No SOB
-pulses palpable
-Increased UO
-No Chest pain
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| show | K (potassium), DIG TOX
-any electrolyte imbalance while on Dig can cause toxicity but K gives the most problems
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| show | Preload (decreases)
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| show | DIURETICS
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| What does ALDACTONE Decrease? | show 🗑
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| If you have FLUID RETENTION what should you THINK 1st? | show 🗑
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| show | -BB and ACE
-decrease WL on heart
-prevent vasoconstriction (increases CO- keeps blood moving forward)
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| show | K (potassium)
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| show | -canned foods
-processed foods
-OTC meds
-fried foods
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| If a pt is hypoxic, restless, anxious, has a productive cough and pink sputum what would you assume is going on? | show 🗑
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| show | RESTLESS and ANXIOUS
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| How does LASIX work? | show 🗑
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| What is the best position for a pt with PE? | show 🗑
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| What is a Cardiac Tampanade? | show 🗑
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| What is the Hallmark sign of CARDIAC TAMPANADE? | show 🗑
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| FVE does what to CVP and BP? | show 🗑
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| FVd does what to CVP and BP and CO? | show 🗑
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| show | SHOCK (blood not perfusing vital organs)
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| show | Different reading for inspiration and expiration
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| How do you determine pulse pressure? | show 🗑
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| What are the main sx of Arterial disorders? | show 🗑
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| NCLEX MOMENT | show 🗑
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| What is BURGERS DZ? | show 🗑
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| What is RYNODS DZ? | show 🗑
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| What is a Venous problem? | show 🗑
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| show | -green leafy veggies (high in vit K)
-vit K is antidote to Coumadin
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| show | STREP (difference between GN and NS) also cathaterization
- it puts holes in glomerilus and proteins/blood/sediment leaks out into urine (smokey or rust colored)
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| show | -Sore Throat
-HA
-Malaise (retaining toxins so makes you tired)
If it goes to heart it will attack valves (bad bc valves prevent back flow)
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| What does retaining toxins cause? | show 🗑
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| show | -Increased BUN/CRE/SG/BP
-Sediment/blood/pro in UA due to holes strep caused (brown urine)
-Flank pain
-Facial Edema/ FVE
-D UO, I SG
Limit activity bc of fatigue (safety)
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| show | -carbs empty stomach fast
-body breaks them down for energy (increase when you don't want body to break down proteins for energy)
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| show | -malaise
-HA
-N/V
-anorexia
-weight gain
-Decreased UO
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| show | NS you are VERY EDEMATOUS and MASSIVE PROTEINURIA
-hypoalbumnic
-hyperlipidemia
-many things can cause NS unlike GN where step is usually cause
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| What does Albumin do? | show 🗑
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| show | Anasarca
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| What Dz would you assume if pt had sx of: proteinuria, hypoalbumina, edema, hyperlipidemia | show 🗑
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| show | They block aldosterone secretion
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| show | -Decrease Inflammation
Bad: Immunosupressed, Increase Blood Sugar,
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| show | Decrease Protein
-except in Nephrotic Syndrome and Peritoneal Dialysis pt
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| show | Bilateral (bc you can live with one kidney)
-if blood can't get to kidneys or BP is below 90 (can take just 20 min to kill) SHOCK
Causes: enlarged prost, kidney stones, ABX (mycin -nephro toxic), Diabetes, dyes, HTN, edemitous stoma
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| S/S of Renal Failure? | show 🗑
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| show | IN SELECT ALL THE APPLY- its NEVER all 5
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| show | K (potassium)
-if you are putting out a lot of Urine then you are losing a lot of K
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| What are the 2 phases of Renal Failure? | show 🗑
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| show | Machine is glumerolis
-3-4x/wk
-given anticoag (Hep) stays in sys 4-6 hrs (no surf for this time)
-unstable Heart can't do hemodialysis
-HOLD (lisinopril, Nitro, ABX, vit, pepsid)
-need IV access (permanent)
Feel the thrill
300-800 ml/min
-
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| Peritoneal Dialysis | show 🗑
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| S/S of Peritonitis | show 🗑
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| show | Avoid answers with Always/total/all - too specific
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| show | Continious Dialysis
-Done in ICU
-never more than 80ml of blood out of body at one time
-no drastic fluid shifts (unlike hemodyalysis)
-less stress on Cardiac system
-used for pt w/ acute RF and acute cardiac status
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| What is CAPD? | show 🗑
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| What is CCPD? | show 🗑
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| show | Peritonitis (inflammation of the peritoneum)
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| What type of fluid is used in peritoneal dialysis? | show 🗑
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| What is the exception to diet in Dialysis Pts? | show 🗑
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| show | Kidney Stones
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| If someone was having pain, N/V, Inc WBC, hematuria (RBC in urine) what they have? | show 🗑
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| What happens when there is air/blood/exudate in the pleural space? | show 🗑
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| show | Needle put into the pleural space to remove whatever is in there
-positioning; lay on unaffected side at 45 degree or sit on edge of bed bend over chair, no coughing or deep breaths, need to be very still
Rsk: FVD since fluid is being removed
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| show | To restore vacuum pressure in the pleural space by removing air/particles in a 1 way system until lung is healed.
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| How many mL can a CDU hold? | show 🗑
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| What is the 1st chamber of the CDU for? | show 🗑
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| show | H2O seal chamber-INTERMIT BUBBLING=patent
-Drainage stays in 1st chamber and the air goes to 2nd chamber
-Fluctuation with Respiration (stops=kinks or lung re-expanded)
-filled with 2cm of water
-BAD: continuous bubbling (air in system, tell MD)
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| show | Suction Control- CONTINUOUS BUBBLING
-allows air to vent out
-contolls Amt of suction need to pull fluid/air out
-20cm of sterile H2O (max const no matter how much wall suction)
-if dry suction no H2O = no bubbling
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| show | Below
-if higher the drainage will go back into the pt
-DONT DELEGATE THIS TEACHING
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| If MD has you clamp a chest tube can you leave them while this is clamped? | show 🗑
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| What is a Hemothorax/Pneomothorax? | show 🗑
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| show | -SOB
-Inc HR
-diminished breath sounds on affected side
-less movement on affected side
-chest pain
-cough
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| What is subcutaneous emphysema? | show 🗑
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| show | Pressure has built up in pleural space = COLLAPSED LUNG
-pressure pushes everything to opposite side
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| show | -absent breath sounds on affected side
-asymmetry of thorax
-trachia will be off center
-Resp Distress
-MEDICAL EMERGENCY (Dec CO)
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| What is an Open Pneumothorax/Sucking Chest wound? | show 🗑
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| If someone had a fracture of their ribs or sternum what S/S would you expect to see? | show 🗑
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| What type of medicine would you NOT want to administer for pain in a pt w/ fractured ribs or sternum? | show 🗑
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| Intussusception | show 🗑
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| Hirschprung's | show 🗑
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| TEF | show 🗑
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| show | Regurgitation of gastric content into esophagus
Tx of infants: small frequent feeding w/ thick rice cereal, H2, PPI
Positioning: upright w/ feedings and at night, elevate prone to inc stomach emptying
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| Esophageal Estria | show 🗑
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| show | Sphincter at base of stomach connecting to SI
Sx: PROJECTILE V after eating, irritability, hunger, abd distention
Dx: olive shaped mass by umbilicus, ripple in abd (stomach trying to push content through small opening
Tx: hydration and surg
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| show | Genetic malabsorption disorder, intestinal intolerance to gluten
Tx: NO GLUTEN (B-barley, R-Rye, O-oats, W-wheat)
-GOOD (R-rice, C-corn, S-soy) and millitt
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| Enurisis | show 🗑
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| show | Both or one testes fails to decend through inguenal canal
Tx: surgical correction may be necessary , no vigorous activity for 2 wks after
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| Episadis | show 🗑
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| Hypospadias | show 🗑
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| Where to look for JAUNDICE in CHILDREN | show 🗑
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| Encopresis | show 🗑
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| PKU | show 🗑
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| show | No protective membrane covering bowel
-Rsk for infection
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| show | Sx: RLQ pain
Tx: NO HEAT, Surg, NPO and IV ABX
-position fetal
-RLQ sudden relief = BURST
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| show | BRAT
(Bananas, Rice, Applesauce, Toast) and carrots
NO DAIRY
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| show | -Hepatomegly
-dark frothy urine
-jaundice
-RUQ pain
-Stool clay colored
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| What are some Sx of LACTOSE INTOLERANCE? | show 🗑
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| show | Multiple Rib Fractures
Sx: pain, paradoxical breathing (outward E), dyspnea, cyanosis, Increased P
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| show | -PEP (INVASIVE)
-CPAP/BiPAP (NON-INVASIVE)
-pt must breath on own
POSITIVE INSPIRATORY PRESSURE
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| show | Continuious Airway pressure
-delivers constant pressure during I and E
-non invasve (nasal cannula or face mask)
-used for fail chest and obstructive sleep apnea
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| show | Bilevel Positive Airway Pressure
-used to wean pt from ventilation and acute reps failure (COPD,sleep apnea, HF) and Flail Chest
-excerts different levels of pressure along with O2
-pt must be able to breath spontaneously and co-operate w/support
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| show | Positive pressure that is expelled to keep avoli open
-puts pressure down thorax which expands chest wall and realigns ribs
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| show | Bilateral Lung sounds
-q 2 hrs
-you are putting pressure into thorax so you could pop a lung (pneomothorax)
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| show | Cause: dehydration, venous stasus (prolonged immobilization/surg), clotting disorder, heart arrythmias
-cause blood to get thick and goes to lungs
Sx: #1 HYPOXIA, R side heart failure and pulmonary HTN, coughing up blood, sharp chest pain
Dx: VQ scan
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| What are some MEDS for PE? | show 🗑
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| show | YES
-as you tapper off Heparin, you increase Coumadin which you are sent home on
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| show | -Increase the breakdown of fat and protein
-Decrease Cerebral Edema (decreases ICP)
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| show | Pulse Pressure will widen with Increased ICP
-VS changes are a late sign of problem
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| show | Systolic-Diastolic
(normally around 40, the wider the gap = Increased ICP
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| If a patient has a head injury and starts complaining about a HA what would you assume? | show 🗑
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| What is Occulosufalic Reflex? | show 🗑
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| show | Assesses brain stem fxn
-irrigates ear with 50ml of cool water
-eyes move toward water then back to midline
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| CT Scan | show 🗑
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| MRI | show 🗑
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| show | -DYE
-xray of cerebral circulation
-goes through femoral art (like heart cath)
Pre: Hydrated
Post: BR 4-6hrs, check LOC since dye in brain, 1 side weakness/paralysis, compare baseline vs
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| show | -WARMTH IN FACE
-METALLIC TASTE
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| show | Records electrical activity
-helps dx SEIZURES
NOT NPO this would Dec BS in brain
HOLD:
sedatives-D brain activity
caffiene -I brain activity
Enviroment must be quiet bc machine picks up stimuli
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| show | -Done in 3rd or 4th sub arachnid space
-gets CSF to analyze
Post: lie flat or prone for 2 hrs to decrease pressure), give fluids
Complication: most common HA, I pain when sitting up, brain herniation (know I ICP -procedure contraindicated)
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| show | -Fever
-Chills
+ Brudinski/Kernigs
-V
-nuchal rigidity (STIFF NECK)
-LIGHT HURTS EYES
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| show | Lumbar Puncture
-puncture creates opening for pressure to release and causes brain matter to get sucked down foramen magnum
-ICP BOTTOMS OUT, 99% Fatal
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| What is Cushing Triad and what does it indicate? | show 🗑
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| What are SX of Increased ICP? | show 🗑
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| What is a Concussion? | show 🗑
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| show | Brain is bruised
-unconscious for longer than a few seconds
-possible surface hemorrhage
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| What Electrolyte are all these foods high in and are they acidic or alkaline: Grains, Fruits, Veggies? | show 🗑
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| Are salty foods alkaline or acidic? | show 🗑
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| show | Hypovolemic and Hypotensive
-Less volume= less pressure
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| show | Dehydrated
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| show | Bledding
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| show | -WBC
-lipase/amylase
-SGOT
-PTT
H/H is LOW
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| What Electrolyte do all Proteins have? | show 🗑
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| What follows GLUCOSE? | show 🗑
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| What are the blood tests that are done for MI and which is the most specific? | show 🗑
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| What position do you want to put a pt in post THR? | show 🗑
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| show | A Seizure
-can occur to Decreased B/P postpartum
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| show | It Increases
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| show | -Contact Precations (NO pregnant or contact lens RN)
-Sx are like a really bad cold
-Contagious
-Can lead to PNA
-Rsk for getting worse (less than 6 mo, heart or lung prob, older than 65, immunocompromised)
-Tx: Ribovirin
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| What is Dumping Syndrome? | show 🗑
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| Can you keep a COPD pt and a negative pressure room pt together? | show 🗑
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| What are Kussmal Respirations | show 🗑
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| CHF patho | show 🗑
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