Term
|
Definition
| thickening, loss of elasticity and calcification of arterial walls |
|
|
Term
|
Definition
| fat and fibrin deposits that obstruct and harden the arteries |
|
|
Term
|
Definition
| sudden occlusion of an artery by an embolus or thrombus. |
|
|
Term
| 3 Types of Peripheral Artery Disease |
|
Definition
1. involves the aorta and iliac arteries
2. involves aorta, common and external iliac arteries
3. involves the aorta, iliac, femoral, popliteal and tibeal arteries. |
|
|
Term
| Incidence of Peripheral Artery Disease |
|
Definition
Affects people 60-to 70's
More common in men
In women it is more common in A.A. |
|
|
Term
| Risk factors to Peripheral Artery Disease |
|
Definition
Smoking
Hyperlipidemia (high cholesterol)
Diabetes Mellitus |
|
|
Term
| How much of the artery is occluded when people typically manifest symptoms? |
|
Definition
|
|
Term
| What is the lipid that builds up and calcifies over time? |
|
Definition
|
|
Term
| What arteries are commonly affected by Peripheral artery disease? |
|
Definition
femoral
popliteal
anterior/posterior tibial
peroneal
--commonly occurs where the artery splits (biforcation) |
|
|
Term
|
Definition
Arteries bipass a clot
collateral circulation can be increased through exercise |
|
|
Term
| What is the first symptom associated with peripheral artery disease? |
|
Definition
|
|
Term
| Symptoms of Peripheral Artery Disease |
|
Definition
| ischemic pain, intermittent claudication, pallor, hair loss, skin ulceration, loss of muscle mass, cold extremities, diminished or absent pedal pulses, discoloration of the nails |
|
|
Term
| Nursing Care of PT. with peripheral artery disease |
|
Definition
| Teach footcare Exercise to increase collateral circulation avoid constriction underwear/socks avoid leg crossing SMOKING CESSATION medication education No direct heat or cold Elevate extremities to reduce swelling but never above the heart |
|
|
Term
| Medications for Peripheral Artery Disease |
|
Definition
Antiplatelets (prevent thrombus)
Intermittent Claudication Meds. to reduce blood viscocity, improve oxygen to tissue (pentoxifylline)
Antihypertensives to improve perfusion but not constrict vessels |
|
|
Term
| Diagnostics for Peripheral Artery Disease |
|
Definition
Noninvasive: doppler ultrasound, segemental pressure measurements, duplex imaging
Invasive: angiogram/MRA |
|
|
Term
| Invasive Interventions of Peripheral Artery Disease |
|
Definition
Angioplasty: balloon is inserted
Stents: keeps vessel open
Atherectomy catherters: breaks down the occlusion |
|
|
Term
| Surgical Interventions for Peripheral Artery Disease |
|
Definition
Arterial bipass graft
Endarterectomy: remove plaque
Patch graft: open the artery then use a graft to keep it open
Amputation |
|
|
Term
| 3 Main categories of Corticosteriods |
|
Definition
Glucocorticoids: (cortisol) regulate metabolism, increase blood sugar, maintain blood pressure, antiinflammatory
Mineralcorticoids: (aldosterone) regulate Na and K+ and H2O
Androgens: (testoterone, estrogen) growth and development |
|
|
Term
| Cause of Cushing's Syndrome? |
|
Definition
excess of corticosteroids
benign pituitary tumor causing overproduction of ACTH |
|
|
Term
| Nursing Assessment of Excess Mineralcorticoids |
|
Definition
| increased blood pressure, increased sodium, edema, increased H2O retention, decreased potassium, |
|
|
Term
| Nursing Assessment of glucocorticoids |
|
Definition
|
|
Term
| Clinical Manifestations of Cushing's Syndrome |
|
Definition
| emotional disturbance, moon face, osteoporosis, cardiac hypertrophy, buffalo hump, obesity, abdominal striae, amenhorrea, muscle weakness, poor wound healing, gastric ulcers, easy bruising |
|
|
Term
| Diagnostics for Cushing's Syndrome |
|
Definition
H&P
24 hour measuring cortisol
Late night salivory cortisol test
Plamsa cortisol |
|
|
Term
| Nursing Assessment and Management of Cushing's Syndrome |
|
Definition
Educate on steroid use, monitor blood pressure and blood sugar
Monitor for pain r/t osteoporosis
Diet modifications |
|
|
Term
| Treatment of Cushing's Syndrome |
|
Definition
| Treat the cause, taper medications, change dose schedule, surgery to remove the tumor, radiation or chemo |
|
|
Term
| Medications for Cushing's Syndrome |
|
Definition
Aminogluctethimide and Ketonazole: decrease adrenal synthesis to provide short term relief
Miotane: suppresses activity of the the adrenal cortex |
|
|
Term
| Adrenalcortical Insufficiency |
|
Definition
| Primary: destruction of dysfunction of the adrenal cortex (secondary) Also related to tuberculosis, AIDs, tumors, hemorrhage |
|
|
Term
| Primary Addison's Disease |
|
Definition
Adrenalcortical Insufficiency
70% of cases are r/t autoimmune process |
|
|
Term
| Clinical Manifestations of Addison's Disease |
|
Definition
Decreased glucocorticoids, mineralcorticoids and androgens:
fatigue, muscle wasting, loss of appetite, weight loss, nausea, vomiting, diarrhea, "Addison's tan" hypotension, arrhythmias, changes in menstrual cycle, tremors, confusion, hyperpigmentation decreased, blood pressure, decrease sodium, increased potassium |
|
|
Term
| Diagnosis of Adrenalcortical Insufficiency |
|
Definition
H&P
serum cortisol levels remain low after stimulation
Hyponatremia, Hyperkalemia, hypocholremia, hypoglycemia, anemia, elevated BUN, EKG peaked T wave secondary to hyperkalemia era |
|
|
Term
| Treatment of Addison's Disease |
|
Definition
replacement of corticosteroids and mineralcorticoids
Increased Na+ diet |
|
|
Term
|
Definition
Inadequate replacement of corticoid steroids and exposure to a minor illness or stress (physical or emotional)
may be life threatening if untreated |
|
|
Term
| Signs and Symptoms of Addisonian Crisis |
|
Definition
Penetrating pain in the lower back, abdomen and legs
Muscle weakness
Hypotension--leading to vascular collapse and shock
Nausea, vomiting, dehydration
Tachycardia
Hyponatremia, hypoglycemia, hyperkalemia
High Fever
Confusion |
|
|
Term
| management of Addisonian Crisis |
|
Definition
Immediate steroid replacement
IVF of saline and dextrose
Stabilize BP and BG
Monitor BP Q 15 min.
Correct Hyperkalemia
Daily weight
Infection protection
protect from environmental stressors |
|
|
Term
| Nursing Care of Addison's Disease |
|
Definition
Educate on life-long therapy
medication
avoid cold, increased physical activity and emotional stress and supplement with extra medication
emergency travel kit! |
|
|
Term
| Side Effects of Corticosteroid therapy |
|
Definition
risk for infection/delayed healing HTN
risk for osteoporosis r/t hypocalcemia
decreased K+ mood changes/depression |
|
|
Term
|
Definition
Loss of 1500 ml or 25% of volume
Causes: decreased cardiac output, tachycardia, hypotension pallor, decreased urinary output, constriction of peripheral blood vessels to maintain perfusion to vital organs
can lead to hypovolemic shock! |
|
|
Term
|
Definition
| Erosion of GI mucosa from digestive action of HCL acid and pepsin occurring in the duodenum or stomach |
|
|
Term
|
Definition
1. hematemesis
2. Melena
3. hematochezia
4. Occult bleeding |
|
|
Term
|
Definition
-bright red blood that has not been in contact with stomach acid
-coffee ground emesis, dark brown color in grainy appearance that has been in contact with stomach acid |
|
|
Term
|
Definition
black tarry stools indicate slow bleeding from and upper GI source.
-very foul odor, color related to iron |
|
|
Term
|
Definition
|
|
Term
|
Definition
small amount of blood in stool, emesis, gastric secretions, not apparent to the naked eye
-found by guaiac |
|
|
Term
|
Definition
Ulcers in the stomach or duodenum frequently penetrate a blood vessel and cause bleeding.
Chronic ulcers often cause deeper erosion than acute. |
|
|
Term
|
Definition
Chronic esophagitis: r/t H. pylori infection, ETOH, cigarettes, medication, or GERD causing acid reflux/erosion
Mallory-Weiss tear: severe vomiting can cause a tear at the esophagus/stomach junction causing severe bleeding
Esophogeal Varices: 2ndary to cirrhosis, vessels become engorged and increase in pressure from sneezing, coughing, vomiting can rupture and cause sudden massive bleeding |
|
|
Term
| Potential Causes of GI bleeding |
|
Definition
| Drugs either TX or OTC, smoking, genetics, caffeine, chronic H. pylori, stress ulcers after trauma, burns or surgery, systemic disease such as leukemia, gastritis from ETOH or drugs |
|
|
Term
| Diagnostics of GI bleeding |
|
Definition
Labs: CBC, type cross-match, coagulation profile, electrolytes, liver enzymes, ABGs, BUN, H&H stool specimen
Endoscopy
Upper GI series
Noninvasive H. pylori test. |
|
|
Term
| Emergency assessment and treatment for GI bleeding |
|
Definition
Hemodynamic stabilization.
Identify cause/initiate treatment
Resp. Status
Assess for signs of shock, decreased BP, tachycardia, weak/thready pulse, thirst, cool clammy skin, reslessness, I&Os
Bowel sounds |
|
|
Term
| Complications of GI bleed |
|
Definition
| Hemmorrhage: most common complication can be caused by erosion of ulcer through a blood vessel. Perforation: most lethal complication Gastric Outlet Obstruction: narrowing of pylorus related to edema, inflammation or spasms ( long history of ulcer pain, vomiting, weight loss, loud peristalsis, constipation) |
|
|
Term
| Interventions for GI Bleeding |
|
Definition
O2
IV fluid replacement (normal saline and blood products)
Strict I&Os
Gastric Lavage
Usually NPO
NG to low intermittent suction |
|
|
Term
| Treatment for GI Bleeding |
|
Definition
Endoscopy: to coagulate bleeding area
Surgery: if bleeding persists despite other treatment
Balloon Tamponade: direct pressure on bleeding site |
|
|
Term
| Medications for GI bleeding |
|
Definition
Discontinue NSAIDS
Injection therapy: ethanol or epinephrine, sclersosants (ethamolin or scleromate)
Direct Injection or systemic meds for varices: vasopressin (causes vasoconstriction
Combination of Antibiotics to treat H. pylori
Acid Reduction: sandostatin, antacids, Pepcid, antiulcers
Smoking cessation
Nonirritating diet |
|
|
Term
|
Definition
| A chronic, progressive disease of the liver characterized by the destruction and regeneration of hepatic cells resulting in scar tissue that causes loss of function and obstruction of blood flow. |
|
|
Term
|
Definition
7th leading cause of death in 25-64 yr. olds
2X more common in men |
|
|
Term
|
Definition
Alcohol (laennes's cirrhosis)
Posthepatic or post necrotic cirrhosis
Biliary Cirrhosis
Cardiac Cirrhosis |
|
|
Term
| Alcohol induced Cirrhosis |
|
Definition
Alcohol and malnutrition lead to fatty changes in the liver
-may progress to permanent scarring and a shrunken, nodular liver
Most common in: native american men and women, hispanic males and females |
|
|
Term
| Postheptic/Postnecrotic Cirrhosis |
|
Definition
A complication of Hepatits B or C
Autoimmune hepatitis or nonalcoholic fatty liver disease
Causes: liver cell loss, shrunken liver, fibrosis and nodule formation
**numbers rising r/t hepatitis C and obesity epidemic |
|
|
Term
|
Definition
| related to chronic biliary obstruction and infection, results in inflammation, fibrosis, nodules and jaundice as the primary features |
|
|
Term
|
Definition
| caused from long term severe right sided heart failure, decreased cardiac output leads to necrosis and fibrosis of the liver |
|
|
Term
| Early Symptoms of Cirrhosis |
|
Definition
GI disturbances: related to altered carbohydrate, fat and protein metabolism.
Anorexia, change in bowel habits, weight loss, weakness
Abd. Right upper quadrant pain
liver and spleen enlargement |
|
|
Term
| Later Symptoms of Cirrhosis |
|
Definition
changes r/t liver failure and portal hypertension such as:
bleeding, anemia, low WBC and platelet count, jaundice, neuro changes, endocrine disturbances (gynecomastia/infertility) |
|
|
Term
| MAJOR complications of Cirrhosis |
|
Definition
| Portal Hypertension: causes rerouting of blood to vessels in the esophagus, abd., and rectum that can become weak and rupture |
|
|
Term
| Splenomegaly Hematologic problems |
|
Definition
Portal HTN leads to shunting of blood to the spleen.
Splenomegaly (spleen enlargement) increases the removal and destruction of RBC, WBC and platelets
r/t poor diet, folic acid malabsorbtion, and bleeding from varices
results in: anemia, coagulation disorders, thrombocytopenia, leukopenia |
|
|
Term
|
Definition
| build up of protein rich fluid in the abd./peritoneal cavity associated with lfuid shifts |
|
|
Term
|
Definition
Will have ABD. distention, weight gain, signs of dehydration, and hypokalemia
--possible abd. striae and everted umbilicus |
|
|
Term
|
Definition
increased portal pressure leads to collateral circulation resulting in thin walled, enlarged vessels that are a risk for massive hemorrhage.
Decreased clotting, coughing or high roughage food can increase the risk of rupture
***most threatening complication of cirrhosis |
|
|
Term
| Portal systemic encephalopathy |
|
Definition
AKA Hepatic Encephalopathy
protein metabolism disorder causes a rise in blood ammonia levels. Effects brain by causing major neurologic toxicity
r/t amount of protein ingested, breakdown of blood in the intestines, constipation, infection, sedatives, narcotics and anesthetics |
|
|
Term
| Symptoms of Portal Systemic Encephalopathy (hepatic enchalopathy) |
|
Definition
early: change in mental status and personality, yawning, drowsiness, slurred speech, hiccups, poor judgement, agitation, restlessness
Later: confusion, disorientation and incoherence, fruity musty breath, asterixis
**may lead to coma and death |
|
|
Term
|
Definition
renal failure may develop in advanced cirrhosis r/t poor blood flow to the kidneys
may be proceeded by GI bleed and aggressive diuretic therapy
requires dialysis |
|
|
Term
1. Spider Angiomas
2. Palmar Erythema |
|
Definition
1. dilated blood vessels on face and upper body
2. red areas on the palms
**both related to estrogen increase because liver is unable to metabolize steroids |
|
|
Term
| Goals of Caring for Cirrhosis Patients |
|
Definition
Provide holistic care
Involve family
remove causative agent: ETOH, malnutrition, heart failure, bile obstruction, possible transplant
SLOW progression
Reduce complications |
|
|
Term
| Cirrhosis nutrition and fluid management |
|
Definition
high calorie, high protein, sodium restriction, fluid restriction
supplement hepaticaid or parenatal nutrition if needed
vitamins based on lab values
daily weight |
|
|
Term
| Medications for Esophogeal Varices |
|
Definition
beta blockers to prevent bleeding and reduce htn
vitamin K to prevent bleeding
blood products
octreotide: constricts blood vessels
iron and folic acid for anemia |
|
|
Term
| Medications for Portal Systemic Encephalopathy |
|
Definition
Lactulose: decreases ammonia through the bowel to decrease change in LOC
neomycin sulfate: decrease bacterial action on protein
flagyl |
|
|
Term
| Medications for Ascites and Edema |
|
Definition
Diuretics: aldactone/lasix combo
monitor potassium |
|
|
Term
|
Definition
Can begin as early as 4-6 hours after last drink
peak at 24-48 hours then decline or progress to:
delirium tremors usually occur 2-5 days after last drink and last 2-3 days. |
|
|
Term
| Minor Withdrawal Symptoms |
|
Definition
| mild irritability, anxiety, sweating, nausea, insomnia, increased BP and pulse, tremors, hyperexcitabilty, |
|
|
Term
| 4 Characteristics of Major Withdrawal Syndrome |
|
Definition
Gross Tremors
Seizures
Hallucinations
Delirium Tremors: disorientation, hallucinations, paranoia, hyperactivity, may be very combative |
|
|
Term
|
Definition
CAGE: cut down?
annoyed with you?
guilty?
ever drink in the morning to start the day? |
|
|
Term
| Intervention of Alcoholism |
|
Definition
confront with observations
how has it affected friends/family
insist on treatment |
|
|
Term
| Complications of Alcohol abuse |
|
Definition
Wernicke's encephalopathy: inflammatory, hemorrhagic, degenerative condition of the brain related to thiamine deficiency
can be corrected with thiamine supplementation
can lead to korsakoff's psychosis an irreversible form of amnesia |
|
|
Term
| Treatment of Withdrawal: nursing DX |
|
Definition
Risk for injury
disturbed sensory perception
ineffective breathing pattern
risk for other-directed violence |
|
|
Term
| Nursing interventions for Alcohol withdrawal pts. |
|
Definition
| CLOSE monitoring, seizure precautions, avoid supine position if unconscious, prevent injury to self or others, administer meds. (benxodiazapines) |
|
|
Term
| Medications for Alcohol Withdrawal Syndrome |
|
Definition
Benzodiazapines (ativan): reduces CNS stimulation
Antipsychotics: (haldol) to decrease hallucinations
Antiseizure meds: to control seizures
Thiamine: to reduce neuro complications and encephalopathy |
|
|
Term
| Long Term Treatment of Alcohol withdrawal syndrome |
|
Definition
Behavioral therapy
Naltrexone or Acamprosate will block the desired affects of alcohol and/or cravings
Disulfiram: causes an adverse reaction if alcohol is used |
|
|
Term
|
Definition
Cranial Hypertension
>10mmHG (normal 5-10)
transient increases occur with coughing, sneezing or straining
Sustained increased pressure can lead to ischemia and damage to neural tissue |
|
|
Term
|
Definition
| Constant blood flow through vessels constricting or dilating |
|
|
Term
| Cerebral Perfusion Pressure |
|
Definition
ability of the body to supply blood to the brain
(CPP) |
|
|
Term
|
Definition
| MAP (mean arterial pressure) - ICP (intracranial pressure) |
|
|
Term
| Causes of increased Intracranial Pressure |
|
Definition
Mass/lesions/tumor
brain surgery
infection
CVA
toxic or metabolic encephalopathy
Traumatic brain injury
Hydrocephalus
cerebral edema (most common) |
|
|
Term
|
Definition
Vasogenic: extrecellular edema of white matter results from an increase in capillary permeability of cerebral vessels
Cytotoxic: increase in fluid in neurons, glia and endothelial cells as a result of a failure of the sodium/potassium pump. (grey matter) |
|
|
Term
| Clinical Manifestations of Increase ICP |
|
Definition
Change in LOC
**earliest and most important symptom is decrease in consciousness
-confusion
-restlessness
-lethargy
-coma (late)
-Headache, especially with position change
-Pupillary disfunction
-sluggish response to light, first noted on ipsilateral (same side)
-oculomotor dysfunction (6 cardinal fields or gaze, eye movement)
Visual abnormalities
motor impairment
projectile vomiting
altered resp. pattern
increased temp. |
|
|
Term
|
Definition
| Sign of Increased ICP Bradycardia depressed respirations systolic hypertension while diastolic value remains unchanged (widened pulse pressure) --represents brainstem's final effort to maintain cerebral perfusion **impending sign of brainstem herniation and death |
|
|
Term
| Diagnostics of increased ICP |
|
Definition
CT or MRI
Serum Osmolarity
ICP monitoring |
|
|
Term
| Medical Management of increased ICP |
|
Definition
must be treated when it reaches 20mmhg (often before)
--therapy is to reduce the volume of one of the components in the skull
Surgical removal of a mass
placement of an extraventricular drain (EVD, temporary)
Placement of VP shunt (usually permanent)
consistent measurement of pressure |
|
|
Term
| Nursing interventions in prevention secondary brain injury |
|
Definition
Monitor LOC (glasgow)
Assess motor/sensory response
check for babinski's
monitor vitals
maintain patent airway
position HOB at 30-45 degrees to promote drainage
Avoid extreme flexion of the hips and neck
PEEP <20cm H2O
Limit suctioning
Space interventions
Limit stimulation except gentle touch
Maintain BS, fluid electrolytes
family support
treat fever to decrease metabolic activity
nutrition therapy 3 days after injury (TPN or feeding tube) |
|
|
Term
|
Definition
measure eye movement, verbal response, motor response
maximum is 15 less than 8 is considered a coma |
|
|
Term
| Medications for Increase ICP |
|
Definition
Osmotic and Loop diuretics
Corticosteroids
Antipyretics
Antiulcer
Anti HTN
Vasopressors
Anticunvulsants |
|
|
Term
|
Definition
the protrusion of brain tissue from one compartment to another compartment of lower pressure
uncal, central, cingulate, tralcalvarial, upward, tonsillar |
|
|
Term
|
Definition
most common, lateral displacement of the tip of the temporal lobe. puts pressure on cranial nerve 111 and posterior cerebral artery
-Causes ipsilateral pupil dilation |
|
|
Term
|
Definition
| results in downward displacement of the hemispheres, basal ganlgia and diencephalon through the tentorial notch |
|
|
Term
| Cingulate brain herniation |
|
Definition
| one hemisphere shifts laterally forces the cingulate gyrus under the falx cerebri |
|
|
Term
| Manifestations of Brain Herniation |
|
Definition
fixed dilated pupils
deteriorating LOC
cheyne stokes respirations
hemodynamic instability
abnormal posturing |
|
|
Term
| What can increased portal vein pressure cause? |
|
Definition
| Increased portal vein pressure can cause varices, edema, ascites, splenomegaly, hepatic encephalopathy, hepatorenal syndrome |
|
|
Term
|
Definition
ulcer penetrates serosal surface, spilling gastric or duodenal contents into peritoneal cavity
symptoms: sudden dramatic onset of pain, rapid shallow breathing, absent bowel sounds, rigid board-like abd. |
|
|
