Term
| primary risk factors for HF |
|
Definition
| aging and coronary artery disease (CAD) |
|
|
Term
|
Definition
- endocardium - thin inner lining
- myocardium - muscle
- epicardium - outer layer |
|
|
Term
| fibroserous sac that covers the heart |
|
Definition
|
|
Term
| inside layer of the pericardium |
|
Definition
|
|
Term
| outer layer of the pericardium |
|
Definition
|
|
Term
| how much pericardial fluid lubricates the space between the pericardial layers (pericardial space)? What is it's purpose |
|
Definition
| 10-15 mL; prevent friction between the surfaces as the heart contracts |
|
|
Term
| purpose of the heart valves |
|
Definition
| maintain forward flow of blood |
|
|
Term
| what are they 4 heart valves |
|
Definition
Aortic
pulmonic
mitral
tricuspid |
|
|
Term
| which heart valves are the semilunar valves? what is their purpose? |
|
Definition
| the aortic and pulmonic valves; to keep blood from backflowing into the ventricles after ventricular contraction |
|
|
Term
| conduction system of the heart |
|
Definition
SA node
internodal pathways
AV node
bundle of His
R and L bundle branches
fasicles - left bundle branch
purkinje fibers |
|
|
Term
| right coronary artery (RCA) |
|
Definition
| supplies blood to right atrium, right ventricle and a portion of the posterior wall of the left ventricle |
|
|
Term
|
Definition
| marginal and posterior descending arteries |
|
|
Term
|
Definition
| posterior descending artery - located on the back side of the heart |
|
|
Term
|
Definition
|
|
Term
|
Definition
| posterior MI in left ventricle |
|
|
Term
|
Definition
| left main (LM) - known as the widow maker because a blockage in LM blocks blood to the anterior side of the heart |
|
|
Term
|
Definition
| left anterior descending artery (LAD) nad left circumflex artery |
|
|
Term
| the circumflex coronary artery branches into |
|
Definition
|
|
Term
| the left anterior descending artery branches into |
|
Definition
| left diagonal artery branches |
|
|
Term
| nonmodifiable risk factors for CAD |
|
Definition
- age
- gender
- ethnicity
- family history and genetics |
|
|
Term
| major modifiable risk factors for CAD |
|
Definition
- elevated serum lipid levels
- HTN
- tobacco use
- physical inactivity
- obesity |
|
|
Term
| what lipid levels are associated with risk for CAD? |
|
Definition
| serum cholesterol >200mg/dL or a fasting triglyceride level >150 |
|
|
Term
| contributing modifiable risk factors (CMRF) for CAD |
|
Definition
- diabetes mellitus
- metabolic syndrome - obesity with increased weight circumference, HTN, abnormal serum lipids and elevated fasting glucose
- psychologicl states - type A
- homocystein - produced by the breakdown of dietary protein; B vitamins may lower levels; link to pernicious anemia (b12 deficiency)
- substance abuse |
|
|
Term
|
Definition
| defined as BP >140/90 or 130/80 in patients with DM or kidney disease |
|
|
Term
| what is a reason a younger person might have CAD? |
|
Definition
|
|
Term
| things that can cause chronic endothelium injury |
|
Definition
-HTN
-tobacco use
-hyperhomocysteinemia
-hemodynamic factors
-diabetes
-infections
-immune reactions |
|
|
Term
| process of atherosclerosis formation |
|
Definition
-endothelial injury
-platelets attach to endothelium
-fatty streak
-fibrous plaque
-plaque ruptures
-clot forms |
|
|
Term
| non-invasive diagnostic studies used for heart disease |
|
Definition
| chest xray, 12 lead ECG, Holter/event monitors, stress test, echocardiogram. MRI/Cat Scan (CT), Nuclear scans |
|
|
Term
| invasive diagnostic studies used for heart disease |
|
Definition
| cardiac catheterization, electrophysiology study (EPS), transesophageal echocardiogram |
|
|
Term
| electrophysiology study (EPS) |
|
Definition
| invasive study used to record intracardiac electrical activity using catheters (with multiple electrodes) inserted via the femoral and jugular veins into the right side of the heart. The catheter electrodes record the electrical activity in different cardiac structures. In addition, dysrhythmias can be induced and terminated. |
|
|
Term
| bio-markers for cardiac injury |
|
Definition
-creatine kinase (CK)
-troponin
-lipid profiles |
|
|
Term
|
Definition
| enzyme released in response to cell injury |
|
|
Term
|
Definition
CK-MM - specific to skeletal muscle
CK-BB - specific to brain and nervous tissue
CK-MB - shows myocardial injury |
|
|
Term
|
Definition
normals: males - 55-170 units/L
females - 30-135 units/L
levels rise approximately 6 hours after injury
peak at 18 hours
return to normal in 24-36 hours |
|
|
Term
| when do CK-MB values begin to rise? |
|
Definition
| approximately 6 hours after myocardial injury |
|
|
Term
| when do CK-MB levels peak? |
|
Definition
|
|
Term
| when do CK-MB levels return to normal? |
|
Definition
|
|
Term
| biomarker of choice in diagnosing acute MI |
|
Definition
|
|
Term
| when can troponin levles be detected? |
|
Definition
|
|
Term
| what is the peak for troponin levels |
|
Definition
|
|
Term
| how long do troponin levles stay elevated? |
|
Definition
|
|
Term
| what are the two subtypes of troponin? |
|
Definition
|
|
Term
| normal value of troponin T |
|
Definition
|
|
Term
| normal value of troponin I |
|
Definition
|
|
Term
| healthy cholesterol level |
|
Definition
|
|
Term
| healthy triglyceride level |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
male: >40 mg/dL
female: >50mg/dL |
|
|
Term
|
Definition
male: <100 mg/dL
female: <100 mg/ dL |
|
|
Term
| drug therapy used in long-term cardiovascular disease |
|
Definition
-cholesterol/lipid lowering agents
-antiplatelet therapy
-nitrates
-calcium channel blockers
-beta-adrenergic blockers
-angiotensin-converting enzyme inhibitors (ACE)
-angiotensin receptor blockers (ARB)
-diuretics |
|
|
Term
| cholesterol/lipid lowering agents |
|
Definition
-HMG-CoA reductase inhibitors (statins)
-Niacin (b vitamin)
-fibric acid derivatives
-bile-acid sequestrants
-cholesterol absoprtion inhibitor |
|
|
Term
|
Definition
-aspirin
-coumadin
-plavix/clopidogrel |
|
|
Term
|
Definition
-thiazie
-loop
-potassium sparing
-aldosterone receptor blockers |
|
|
Term
| acute cardiovascular drug therapy |
|
Definition
- MONA
- unfractionated heparins
- low molecular weight heparin
- glycoprotein IIb/IIIa inhibitors
- antidysrhythmic drugs |
|
|
Term
| signs of fluid overload and heart failure can include |
|
Definition
| dyspnea, S3 heart sounds with increased HR, basillar crackles |
|
|
Term
| common side effects of nicotinic acid |
|
Definition
| metallic taste in mouth, flushing, increased feeling of warmth |
|
|
Term
| ACE inhibitors should be started within 24 hours of AMI to reduce the incidence of: |
|
Definition
|
|
Term
| The initial drug recommended at the onset of AMI to reduce platelet aggregation is: |
|
Definition
|
|
Term
| the most sensitive cardiac enzyme to assess myocardial necrosis is |
|
Definition
|
|
Term
| the single most useful test to asses for cardiac structures in evaluating patients with heart failure is the |
|
Definition
|
|
Term
| the most common method of diagnosis pericarditis |
|
Definition
| detection of a pericardial frictional rub |
|
|
Term
| the most common presenting symptom of aortic dissection |
|
Definition
severe chest pain
sharp, sudden, and shifting |
|
|
Term
|
Definition
atherosclerosis
blunt trauma
coronary artery spasm
coronary embolism |
|
|
Term
|
Definition
- decrease preload
- provide pain relief
- reduce platelet aggregation |
|
|
Term
| the ______ nervous system increases blood pressure and heart rate |
|
Definition
|
|
Term
| what is used for detecting cardiomegaly, cardiac positioning, degree of fluid infiltrating the pulmonary space, and other structural changes? |
|
Definition
|
|
Term
| antidysrhytmic drugs classes |
|
Definition
NA channel blockers
Beta Adrenergic Blockers
Potassium channel blockers
calcium channel blockers |
|
|
Term
|
Definition
| clinical manifestation of REVERSIBLE myocardial ischemia, results from an increased demand on the heart or decreased 02 supply |
|
|
Term
|
Definition
| known blockages but controlling pain with medication and limiting activity, patter of pain is predictible, intensity and duration are stable; can progress to USA or AMI |
|
|
Term
| unstable angina (US or USA) |
|
Definition
| new onset of pain; occurs at rest, or if stable pattern has changed; emergency situation - needs to be treated! |
|
|
Term
| Acute coronary syndrome (ACS) |
|
Definition
| encompasses USA, non-stemis (non-ST elevation MI), and stemis (ST elevated MI) |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| 80-90% of AMIs are the result of? |
|
Definition
| thrombus formation in the coronary artery |
|
|
Term
|
Definition
| sustained cardiac ischemia that leads to injury |
|
|
Term
| how long do you have after the onset of AMI before death of heart muscle begins? |
|
Definition
|
|
Term
| how long must cardiac ischemia ensue before the damage encompasses the entire muscular wall? |
|
Definition
|
|
Term
| what is the most common complication of MI? |
|
Definition
|
|
Term
|
Definition
dysrhythmias
heart failure
cardiogenic shock
papillary muscle dysfunction
ventricular anerysm
pericarditis
dressler syndrome |
|
|
Term
|
Definition
| one of the most deadly complications of MI, muscle weakes and balloons out, may rupture |
|
|
Term
| when does ventricular aneurysm normally occur? |
|
Definition
|
|
Term
| how can ventricular aneurysm be diagnosed? |
|
Definition
| cardiac catheterization or echocardiagram |
|
|
Term
|
Definition
| temperature after MI; pericarditis with effusion and temperature |
|
|
Term
| when does Dressler syndrome occur? |
|
Definition
|
|
Term
| what can Dressler syndrome lead to? |
|
Definition
|
|
Term
| medical interventions in patient with ACS/AMI |
|
Definition
- percutaneous coronary intervention (PCI, PTCA)
- surgical revascularization (coronary artery bypass grafting/CABG)
-conservative medical management |
|
|
Term
|
Definition
mental status
LOC
language
memory
cranial nerves
motor
muscle strength
muscle tone |
|
|
Term
| leading causes of traumatic brain injury (TBI) |
|
Definition
| MVC, bicycles, pedestrians, recreational vehicles |
|
|
Term
| primary traumatic brain injuries |
|
Definition
due to impact
-microscopic damaga: concussion, diffuse axonal injury
-contusions |
|
|
Term
| secondary traumatic brain injuries |
|
Definition
due to:
hemorrhage
ischemia
infection
increased intracranial pressure |
|
|
Term
|
Definition
concussion
contusion
subdural hematoma (SDH)
intraventricular bleed
diffuse axonal injury (DAI) |
|
|
Term
|
Definition
open
depressed
linear
comminuted
basilar |
|
|
Term
| normal intracranial pressure |
|
Definition
|
|
Term
| what causes intracranial pressure to increase |
|
Definition
| coughing, vomiting, PEEP, suctioining, ROM exercises, valsalva, position changes, hypercapnia, hypoxia, pain, seizures, hyperthermia, etc. |
|
|
Term
| cerebral perfusion pressure |
|
Definition
| calculate by subtracting the ICP from the MAP; must be maintained at no less than 70mmHg to assure perfusion to the brain |
|
|
Term
| normal cerebral perfusion pressure |
|
Definition
|
|
Term
|
Definition
HTN
bradycardia
irregular respirations |
|
|
Term
| what is the # 1 cause of spinal cord trauma? |
|
Definition
|
|
Term
| spinal cord trauma may result in loss of |
|
Definition
motor function
sensation
reflex activity
vowel/bladder control |
|
|
Term
| who is at the greatest risk for spinal cord injury |
|
Definition
| young adult men between 16-30 years old |
|
|
Term
| most common age for spinal cord injury |
|
Definition
|
|
Term
| diagnostic studies for spinal cord injuries |
|
Definition
-complete spine films
-xrays
-ct scan
-mri |
|
|
Term
| levels of spinal cord injury |
|
Definition
paraparesis
paraplegia
quadriparesis
quadripelgia |
|
|
Term
| mechanisms of spinal cord injury |
|
Definition
hyperflexion
hyperextension
axial loading
excessive rotation |
|
|
Term
|
Definition
-head forced backwards
-pieces of bone may be pulled from cervical vertebrae
-vertebral arteries may be torn, stretched, or pulled causing decreased blood flow to the brain |
|
|
Term
| nursing care of spinal cord injury |
|
Definition
| -assess respiratory -vital signs (orthostatic hypotension) -neurologic status check -pain assessment -prevent complications of immobility -assess bladder/bowel function -monitor nutritonal status -assess psychological status |
|
|
Term
|
Definition
aspirin
plavix/clopidogrel |
|
|
Term
|
Definition
thiazide
loop
potassium sparing
adlosterone receptor blocker |
|
|
Term
|
Definition
morphine
oxygen
nitrates
aspirin |
|
|
Term
| Heparin and Lovenox are ________ drugs |
|
Definition
|
|
Term
| Adenosine can cause a brief period of? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| magnesium is used to treat what dysrhythmia? |
|
Definition
|
|
Term
| what is a contraindication for fibrinolytics? why? |
|
Definition
| history of aneurysm; can cause brain bleed |
|
|
Term
|
Definition
| variant; caused by spasms in coronary arteries -> muscle damage -> AMI |
|
|
Term
| why would a dysrhythmia be a complication of AMI? |
|
Definition
| interruption of blood flow can mess up electrical conduction |
|
|
Term
|
Definition
| inflammation of the pericaridum |
|
|
Term
| when does Dressler syndrome occur? |
|
Definition
|
|
Term
| what route is used for percutatenous coronary intervention |
|
Definition
|
|
Term
| when is surgical revascularization considered for CAD/ACS/MI? |
|
Definition
- previous failed PCI
- multiple vessel disease
- LM coronary artery blockage |
|
|
Term
| PQRST assessment of angina |
|
Definition
Precipiating events
Quality of pain
Radiation of pain, numbness, tingling
Severity of pain - pain scales
Timing |
|
|
Term
| goals for patients with ACS/AM |
|
Definition
- relieve pain
- preservaion of myocaridum (90 minutes)
- immediate and appropriate treatment (accurate assessment)
- effective coping with illness and anxiety
- participation of rehab plan
- reduction of risk factors - dx teaching, diet, weight, activities |
|
|
Term
|
Definition
- sternotomy and cardiopulmonary bypass (surgeon operates on non-beating heart)
- uses periperhal veins or arteries or internal mammary arteries for gradts |
|
|
Term
| minimally invasive direct coronary artery bypass (MIDCAB) |
|
Definition
- may have small incision between the ribs rather than use of sternotomy (traditional incision)
-can reduce cost, length of stay, and morbidity for patient
-typically used when only 1 or 2 anterior coronary arteries are involved |
|
|
Term
|
Definition
- may have genetic link (gene that affects conduction)
- unexpected death resulting from various causes |
|
|
Term
|
Definition
| heritabl cardiac conduction and myocardial disease |
|
|
Term
| lab studies in cardiovascular disease |
|
Definition
- c-reactice protein
- homocysteine
- cardiac natriuretic peptide markers
- serum lipids
- chemistry profiles |
|
|
Term
| an abnormal clinical syndrome involving imparied cardiac pumping and/or filling |
|
Definition
|
|
Term
| what is the most common reason for hospital admission in adults >65 |
|
Definition
|
|
Term
| primary risk factors for heart failure |
|
Definition
aging
coronary artery disease (CAD)
HTN
diabetes
congenital heart defects
pulmonary HTN
cardiomyopathy
hyperthyroidism
valvular disorders
inflammatory diseases of the heart |
|
|
Term
|
Definition
| the amount of blood pumped by each ventricle in 1 minute |
|
|
Term
|
Definition
| stretch of the heart muscle; increased volume -> heart stretches more -> heart pumps more effectively |
|
|
Term
|
Definition
|
|
Term
|
Definition
| the % of end-siastolic blood volume that is ejected during systole, estimates left ventricule systolic function |
|
|
Term
|
Definition
the inability of the heart to pump effectivley
- decreased ejection fraction
- causes: MI and AMI |
|
|
Term
|
Definition
inability of the ventricles to relax and fill during diastole
- may have normal ejection fraction
- causes: chronic HTN |
|
|
Term
| mixed systolic and diastolic heart failure |
|
Definition
the inabilty og the heart to pump and fill normally
- very low ejection fraction (10-15%)
- may be seen in conditions where the ventricles are dilated and stiff; dilated cardiomyopathy |
|
|
Term
|
Definition
|
|
Term
| right-sided heart failure |
|
Definition
| right ventricular failure |
|
|
Term
|
Definition
| right ventricular failure caused by pulmonary disease |
|
|
Term
| compensatory mechanisms with heart failure |
|
Definition
-sympathetic nervous system activation
-neuro-hormonal responses
-ventricular dilatation
-ventricular hypertrophy |
|
|
Term
| what is the least effective compensatory mechanism in heart failure |
|
Definition
| sympathetic nervous system activation |
|
|
Term
| what is the first triggered compensatory response in heart failure |
|
Definition
| sympathetic nervous system |
|
|
Term
| what hormone is released when the sympathetic nervous system is activated? What does this do? |
|
Definition
| catecholamine; increases heart rate |
|
|
Term
| neuro-hormonal response (compensatory mechanisms in heart failure) |
|
Definition
- renin-angiotesnion-aldosterone cascade
- fairly effective compensatory mechanism |
|
|
Term
| what compensatory mechanism in heart failure activates the renin-angiotesnion-aldosterone cascade? |
|
Definition
|
|
Term
|
Definition
| increased stretch -> increased contractility (to an extent); Sterling's Law |
|
|
Term
| counterregulatory mechanisms in heart failure |
|
Definition
natriuretic peptides
nitric oxide |
|
|
Term
| how can ANP and BNP be measured? |
|
Definition
|
|
Term
| atrail natriuretic peptide (ANP) |
|
Definition
|
|
Term
| B-type natriuretic peptide (BNP) |
|
Definition
|
|
Term
|
Definition
hormones produced by the heart that promote venous and arterial vasodilation, decreasing preload and afterload;
inhibit cardiac hypertrophy and have anti-inflammatory effects;
enhance diuresis |
|
|
Term
| when are ANP and BNP released? |
|
Definition
| in response to increased stretch or pressure in the ventricles |
|
|
Term
|
Definition
- released when ANP and BNP are depleted
- also produce vasodilation and decreased afterload |
|
|
Term
| clinical manifestations of chronic heart failure |
|
Definition
*depends on which ventricle is failing, age, and extenet of disease
-fatigue
-dyspnea
-tachycardia
-edema
-nocturia
-skin changes
-behavioral changes
-chest pain
-weight changes (not able to get rid of fluid) |
|
|
Term
| acute decompensated heart failure presents as |
|
Definition
|
|
Term
|
Definition
| SOB when trying to lay flat; how many pillows do you need? |
|
|
Term
| paroxysmal noctural dyspnea |
|
Definition
|
|
Term
| clinical manifestations of acute decompensated heart failure |
|
Definition
*pulmonary edema - life-threatening condition
-severe dyspnea - use of accessory msucles
-rapid RR >30
-coughing
-frothy,blood-tinged sputum
-rales,rhonchi, wheezing |
|
|
Term
| common diagnostic tools for heart failure |
|
Definition
history and physical
12 lead EKG
chest xray
echocardiogram
lab work (BNP)
endomyocardial biopsy
cardiac cath
hemodynamic monitoring |
|
|
Term
| what is the most common lab to detect heart failure |
|
Definition
|
|
Term
|
Definition
<100 pg/ml - heart failure is improbable
100-500 pg/ml more than likely
>500 pg/ml highly probable |
|
|
Term
| drug therapy in acute heart failure |
|
Definition
-diuretics
-vasodilators - IV nitroglycerin, nitroprusside
-morphine - reduces preload and afterload, relaxes patient, decreases 02 demand
-positive inotropes - digitalis, beta adrenergic agonists (dopamine), phophodiesterase inhibitors
-oxygen |
|
|
Term
| drugs for chronic heart failure |
|
Definition
- diuretics (oral rather than IV)
- angiotensin-converting enzyme inhibitors (ACE)
- angiotesnin receptor blockers (ARB)
- vasodilators (nitrates - orally, topically)
- beta adrenergic blockers - lopressor tenormin
- positive inotropes - digitalis
- home oxygen |
|
|
Term
| non-pharmacologic management of heart failure |
|
Definition
- diet education - fluid restriction, DASH diet
- weight management - daily weights
- bi-ventricular pacing
- implantable cardioverter-defibrillaor (ICD)
- intra-aortic balloon pump
- ventricular assist devices (VADs)
- heart transplant |
|
|
Term
| weight gain > _ over a couple of days or > _____/week should be reported |
|
Definition
| 3 lbs in a couple of days or 3-5 lbs/week |
|
|
Term
| what is the overall goal for patients with heart failure? |
|
Definition
| treat the underlying cause and contributing factors, maximize CO, provide treatment to alleviate symptoms, improve ventricular function, improve quality of life, preserve target organ function, and improve mortality and morbidity risks |
|
|
Term
| Core Measures for patient with heart failure |
|
Definition
- % of heart failure patient given discharge instructions
- % of heart failure patients given an evaluation of left ventricular systolic (LVS) function (via echo)
- % of heart failure patients given ACE inhibitor or ARB for left ventricular systolic dysfunction (LVSD)
- % of heart failure patients given smoking cessation advice/counseling |
|
|
Term
| inflammatory disorders of the heart |
|
Definition
- infective ednocarditis
- pericarditis
- myocarditis
- rheumatic heart disease |
|
|
Term
|
Definition
| infection of the ednocardial layer of the heart which is contiguous with heart valves leading to vegetation (growths) of the valves |
|
|
Term
| what do vegetations consist of? |
|
Definition
| firbin, WBC, platelets, and microbes |
|
|
Term
| acute infective endocarditis |
|
Definition
| most often affects individuals with healthy valves and is a rapiduly progressive illness |
|
|
Term
| subacute infective endocarditis |
|
Definition
| affects those with known valvular disease and may progress or extend over a period of months |
|
|
Term
| causative agents of infective endocarditis |
|
Definition
streptococcus viridans
staphylococcus aureus
fungal
viral |
|
|
Term
| clinical manifestations of infective endocarditis |
|
Definition
low grade fever
chills
weakness
arthralgias and myalgias (joint and muscle pain)
vascular manifestations
new or changing murmur
embolization of vegetation |
|
|
Term
| vascular manifestations associated with IE |
|
Definition
splinter hemorrhages - nail bed
olser's nodes - fingers or toes
janeways lesison - palms or soles of feet
roth's spots - retina |
|
|
Term
|
Definition
health hx
blood cultures
new or changed murmur
vegetation or intracardiac mass seen on echocardiogram
*cardiac catheterization for evalutaion of valve function and coronaries when valve replacement is considered |
|
|
Term
|
Definition
-ID and treat agent
-management of s/s of cardiac dysfunction caused by valvular damage
-valve replacement |
|
|
Term
|
Definition
| inflammation or scarring of the pericardial sac |
|
|
Term
| causative agents/events - pericarditis |
|
Definition
viral infection
uremia - not clearing uric acid
AMI
bacterial infection
cardiac surgery
neoplasm - cancer |
|
|
Term
| clinical manifestations of pericarditis |
|
Definition
sharp, pluritic chest pain - worse on inspiration
pericardial friction rub - hallmark finding
dyspnea
wekaness
fatigue
fever |
|
|
Term
| complications of pericarditis |
|
Definition
pleural effusion
cardiac tamponade - EMERGENCY! |
|
|
Term
| hallmark sign of pericarditis |
|
Definition
|
|
Term
| diagnostic testing for pericarditis |
|
Definition
EKG findings - widespread ST elevation in ALL leads
echocardiogram
labs - sedimentation rate, troponin, WBC |
|
|
Term
| what does sedimentation rate measure? |
|
Definition
|
|
Term
| treatment of pericarditis |
|
Definition
pain management
NSAIDs
steroids
treatment of infective agent
pericardiocentesis - drain fluid
pericardial window - removal of pericardial sack |
|
|
Term
|
Definition
| inflammation of the myocardium (muscle) itself |
|
|
Term
| causative agents - myocarditis |
|
Definition
viral infections
autoimmune disorders
idipathic |
|
|
Term
| clinical manifestations of myocarditis |
|
Definition
*range from mild to life-threatening
fever
fatigue
arthralgia/myalgia
pharyngitis
lymphadenopathy
severe cardiac symptoms
sudden cardiac death |
|
|
Term
| diagnostic studies - myocarditis |
|
Definition
EKG
labs may be inclusive
confirmation with endomyocardial biopsy - definitive dx |
|
|
Term
| how do you definitively diagnosis myocarditis? |
|
Definition
|
|
Term
|
Definition
management of cardiac symptoms
treatment of causes if identified |
|
|
Term
|
Definition
stenosis
prolapse
regurgitation |
|
|
Term
|
Definition
|
|
Term
| tricuspid and pulmonic valve disease |
|
Definition
| less common than mitral or aortic valve disease |
|
|
Term
|
Definition
| constriction of narrowing resulting in pressure gradiant across valves |
|
|
Term
|
Definition
rheumatic fever
congenital
rheumatoid arthritis
systemic lupus erythematous
any inflammatory process |
|
|
Term
| what is the most common cause of mitral valve stenosis? |
|
Definition
|
|
Term
|
Definition
congenital
rheumatic fever
effects of aging |
|
|
Term
|
Definition
rheumatic fever
IV drug abuse
previous treatment with a dopamine agonist |
|
|
Term
|
Definition
|
|
Term
|
Definition
| incomplete closure of the leaflets of the valves |
|
|
Term
|
Definition
-AMI affecting papillary muscles or other supporting structures
-rheumatic heart disease
-IE
-mitral valve prolapse |
|
|
Term
|
Definition
-may result from disease of lealets or aortic root
-trauma
-IE
-rheumatic heart disease
-rheumatic conditions (reactive arthritis) |
|
|
Term
| tricuspid/pulmonic regurgitation |
|
Definition
|
|
Term
|
Definition
| an abnormality of the mitral valve leaflets and the papillary muscles or chordae that allows leaflets to prolapse into the left atrium during systole |
|
|
Term
| etiology/pathophysiology of mitral valve prolapse |
|
Definition
-diverse pathogenic mechanisms of the mitral valve
-some connective tissue defects (Marfan's or other conditions that affect collagen) - genetic component |
|
|
Term
| clinical manifestations of valvular disease |
|
Definition
*may range from none to cardiovascular collapse depending on which valve is affected and the severity of the disease
dyspnea
weakness, fatigue
palpitations
chest pain
murmurs
extra or abnormal heart sounds
water hammer pulse in aortic regurgitation |
|
|
Term
| diagnostic studies for valvular disease |
|
Definition
EKG
primarily echocardiogram
cardiac catheterization |
|
|
Term
| management of valvular disease |
|
Definition
- conservative management with medication and diet to control heart failure, treat underlying cause, and manage chest pain associated with valvular disease
- valvuloplasty
- surgical repair ot replacement of the affected valve |
|
|
Term
|
Definition
| balloon inserted across valve that is stenosed and breaks open valve; less invasive than valve replacement |
|
|
Term
|
Definition
| a group of diseases that directly affect the structural or functional ability of the myocardium |
|
|
Term
|
Definition
| etiology unknown; heart muscle is the only portion of the heart involved (no valvular disease) |
|
|
Term
|
Definition
| etiology is known and the CMP is secondary to another disease process (ex HTN) |
|
|
Term
|
Definition
dilated
hypertrophic
restrictive |
|
|
Term
| what is the most common type of CMP |
|
Definition
|
|
Term
|
Definition
| less common than dilated CMP, more common in men, 1/2 cases are hereditary |
|
|
Term
|
Definition
| least common CMP, impaired diastolic filling and stretch, systolic function not affected |
|
|
Term
| nursing management for valvular disease and CMP |
|
Definition
|
|
Term
| acute respiratory failure |
|
Definition
| state of altered gas exchange at room air |
|
|
Term
| acute respiratory failure |
|
Definition
| state of altered gas exchange at room air |
|
|
Term
| diagnositc findings in acute respiratyory failure |
|
Definition
paO2 < 60 mmHg
paCO2 > 45 mmHg
pH < 7.30 |
|
|
Term
| causes of acute respiratory failure |
|
Definition
failure of oxygenation
failure of ventilation
combination of both |
|
|
Term
| reasons for failure of oxygenation |
|
Definition
hypoventilation
intrapulmonary shunting
ventilation perfusion mismatch (VQ mismatch)
diffusion defects
low cardiac output
low hemoglobin level |
|
|
Term
| causes of hypoventilation |
|
Definition
| blockage in airway, neurologic disorders, high altitudes, abdominal or thoracic surgery, morphine, drug overdose, paralytics, hypnotics, CNS depression |
|
|
Term
| ways to prevent hypoventilation |
|
Definition
| monitor LOC, monitor O2 sat, cough, deep breathe, incentive spirometry, splint with pillow |
|
|
Term
|
Definition
| *blood is shunted from the right to the left side of the heart without oxygenation/no gas exchange occurs |
|
|
Term
| causes of intrapulmonary shunting |
|
Definition
atrial/ventricular-septal defects
atelectasis
pneumonia
pulmonary edema |
|
|
Term
|
Definition
|
|
Term
| what is the most common cause of decreased O2? |
|
Definition
|
|
Term
| ventilation perfusion mismatch (VQ) |
|
Definition
| rate of ventilation (v) typically equals the rate of perfusion (Q); ratio of 1; mismatch occurs if either V is decreased or Q is decreased |
|
|
Term
| causes of ventilation perfusion (VQ) mismatch |
|
Definition
pneumonia
COPD
pulmonary embolism (PE)
bronchospasm
atelectasis |
|
|
Term
|
Definition
*diffusion of O2 and CO2 does not occur
-fluid in alveoli
-COPD
-pulmonary fibrosis |
|
|
Term
|
Definition
-hypoventilation (hypercapnia)
-ventilation-perfusion mismatch |
|
|
Term
| assessment for acute respiratory failure |
|
Definition
neurologic
-anxiety, restlessnes, confusion, lethargy leading to coma,
respiratory
-evaluation of gas exchange (ABGs), chest xray, pulse ox, tachypnea initially, increase in tidal volume, use of accessory muscles, with muscle fatigue and compensatory failure respirations decrease and become more shallow
cardiovascular
-HTN and increased HR initially
-with progression: dysrhytmias (PVCs), hypotension, bradycardia, angina, cardiac arrest
-skin color and temperature - cyanosis is a late sign
Nutrition
-key in maintaining respiratory muscle strength
Psychosocial
-anxious when can't breathe |
|
|
Term
| decreasing, shallow respirations |
|
Definition
| Guppy breathing - get ready to intubate! |
|
|
Term
| what dysrhythmias are common with the progression of acute respiratory failure? |
|
Definition
|
|
Term
| Interventions in acute respiratory failure |
|
Definition
Maintain a patent airway
-oral airways (c-shaped) nurses can put in without order
-ETT
-tracheostomy
Optimize O2 delivery
-supplemental O2 - mask
-may require mechanical ventilation
-blood transfusions - low hemoglobin, low cardiac output
-nutritional support
-bronchodilators and corticosteroids - opens airways
Minimzie O2 demand
-hemodynamic monitoring
-provide rest
-reduce fever
-prevent agitation and restlessness
-sedation
-therapeutic paralysis
Treat the Cause
Prevent Complications |
|
|
Term
| acute respiratory distress syndrome |
|
Definition
| non-cardiogenic pulmonary edema |
|
|
Term
|
Definition
|
|
Term
| diagnostic criteria for ARDS |
|
Definition
PaO2/FiO2 ratio <200
bilateral infiltrates seen on chest xray
pulmonary artery wedge pressure < 18 mmHg |
|
|
Term
|
Definition
|
|
Term
|
Definition
| systemic inflammatory response syndrome |
|
|
Term
|
Definition
| dyspnea, tachycardia, hyperventilation, respiratory alkalosis, crackles and rhonchi, increased temperature (inflammmatory response), worsening chext xrays that progress to bilateral white out, increased peak inspiratory pressure on ventilation (air can't go in because lungs aren't compliant), eventual severe hypoxemia |
|
|
Term
|
Definition
treat the cause
oxygenation and ventilation
-generally require intubation
-low tidal volume, low-end inspiratory plateau pressure, nontoxic O2 levels (<60%), and PEEP
comfort - sedation, paralysis
positioning - possible prone
fluid and electrolyte balance
adequate nutrition
psychosocial support |
|
|
Term
| why is sedation almost always indicated for patients with ARDS |
|
Definition
| comfort, allows for rest, adequate ventilation, and reduces anxiety |
|
|
Term
| why is theraputic paralysis sometimes provided for ARDS patients? |
|
Definition
| provides complete control of ventilation by the health care team |
|
|
Term
| when should prone position be considered to facilitate ventilation (ARDS) |
|
Definition
PaO2/FiO2 ratio is <100
other strategies have been exhausted
pulmonary status continues to deteriorate |
|
|
Term
| what should you be careful of if laying a ventilated patient in the prone position |
|
Definition
|
|
Term
| complications of laying a ventilated patient in the prone position |
|
Definition
gastric aspiration
peripheral nerve injury
skin necrosis
eye damage (corneal abrasians) |
|
|
Term
| what is the recommendation for fluid in management in ARDS patients? |
|
Definition
| conservative fluid management |
|
|
Term
| what are other treatment options for ARDS |
|
Definition
inhaled nitric oxide
liquid ventilation
extracorporeal lung assist
surfactant
corticosteroids
vasodilators
anticoagulation mediators |
|
|
Term
| what are essential nursing interventions for ventilated patients? |
|
Definition
-maintain adequate airway
-ensure adequate ventilation
-ensure adequate oxygenation |
|
|
Term
|
Definition
| momvement of O2 and CO2 in and out of alveoli |
|
|
Term
| diffusion of O@ and CO2 occurs at |
|
Definition
|
|
Term
| respiration is stimulated by elevated |
|
Definition
|
|
Term
| what stimulates respirations in COPD patients? |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| amount of effort required to maintain ventilation |
|
|
Term
| when WOB becomes too high |
|
Definition
| respiratory failure will occur |
|
|
Term
|
Definition
|
|
Term
|
Definition
| ease with which lungs can be inflated |
|
|
Term
| what is compliance dependent on? |
|
Definition
|
|
Term
|
Definition
| opposition to gas flow in the airways |
|
|
Term
| what determines airway resistance? |
|
Definition
airway length
airway diameter
flow rate of gases |
|
|
Term
| what can cause a decreased airway diameter? |
|
Definition
small tube (if ventilated)
spasms
mucus |
|
|
Term
|
Definition
| amount of air that goes in and out with each breath |
|
|
Term
| what is normal tidal volume |
|
Definition
|
|
Term
|
Definition
| maximum amount of air inspired over normal tidal volume |
|
|
Term
|
Definition
| maximum amount that can be exhaled over noraml tidal volume |
|
|
Term
|
Definition
| amount of air remaining after forced expiration |
|
|
Term
| what is the normal residual volume |
|
Definition
| 1200 mL - will increase with age |
|
|
Term
|
Definition
IRV + VT + ERV
amount of air that can be exhaled from the point of maximum inhalation |
|
|
Term
|
Definition
VT + IRV
total amount of air that can be taken in |
|
|
Term
| functional residual capacity |
|
Definition
| volume of air in the lungs at the end of normal expiration |
|
|
Term
|
Definition
| the sum of all lung volumes |
|
|
Term
| health history related to ventilation |
|
Definition
tobacco pack per year hx
occupation hx
sputum production
shortness of breath, dyspnea, cough, anorexia, weight loss, and chest pain
oral and inhalant respiratory medicines
OTC drugs
allergies; medication and environmental
last chest xray and TB screen |
|
|
Term
| abnormal breathing patterns |
|
Definition
cheyne-stokes
biots
kussmauls
apneustic |
|
|
Term
|
Definition
| cyclical with apneic periods |
|
|
Term
|
Definition
| cluster breathing; irregular with pauses; NO cycle |
|
|
Term
|
Definition
|
|
Term
|
Definition
| gasping inspirations - GET CRASH CART |
|
|
Term
|
Definition
| partial pressure of oxygen dissolved in arterial blood; decreases as a person ages |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| amount of oxygen bound to hemoglobin |
|
|
Term
|
Definition
|
|
Term
| how is SaO2 frequently measured? |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| how do you ensure accurate readings on the pulse oximetry |
|
Definition
limit movement during measurement
avoid edematous areas
sunlight, fluorescent light, nail polish, artificial nails, and dyes may cause the reading to be lower than actual readings |
|
|
Term
|
Definition
normal tends to be 2-5 less than PaCO2
colorimetric CO2 detector |
|
|
Term
| airway managemnet positioning |
|
Definition
|
|
Term
| devices for airway management |
|
Definition
oral airway
nasopharyngeal airway (trumpet)
endotracheal/nasotracheal intubation |
|
|
Term
| supplies for endotracheal intubation |
|
Definition
right size tube
check balloon on tube for leak
need stylet, goes in ET tube for guidance, then removed
lubricate the tube
laryngoscope and blade
Yonker connected to suction
ET tube holding device |
|
|
Term
| what are the normal sizes for ET tubing |
|
Definition
7.5-8.0 female
8.0-9.0 male
8.0 is most common |
|
|
Term
| patinet preparation and positioning for ET intubation |
|
Definition
sniffing position
premedicate as needed
topical anesthetic/in throat/hurrican spray/may need paralytic if combative
ventilate patient
suction oropharynx as needed |
|
|
Term
| procedure for ET intubation |
|
Definition
intubate within 30 seconds
inflate the balloon (5-10mL)
verify placement |
|
|
Term
|
Definition
|
|
Term
| ways to verify ETT placement |
|
Definition
auscultate epigastric area
auscultate bilateral breath sounds
ETCO2 detector (end title CO2 detector)
esophageal detector device may be an option
chest xray required
secure the tube with the securing device
record cm at the lipline for reference |
|
|
Term
| indications for tracheostomy |
|
Definition
long-term mechanical ventilation
frequent suctioning
to protect airway - ET tube can damage voal cords
bypass an airway obstruction
reduce work of breathing |
|
|
Term
| where is a tracheostomy performed |
|
Definition
| in the OR or bedside (percutaneous) |
|
|
Term
| indications for ET suctioning |
|
Definition
visible secretions
patient continues to cough
rhonchi when listening to airways
high pressures alarming on ventilator
ventilator alarms |
|
|
Term
| conventional versus closed suction |
|
Definition
concentional increases risk for infection when you disconnect tubing;
hyperoxygenate throughout procedure;
avoid normal saline instillation |
|
|
Term
|
Definition
| PaO2 <60mmHg on FiO2 > .50 (being given more than 50% O2) |
|
|
Term
|
Definition
| PCO2 >50mmHg with pH <7.25 |
|
|
Term
| indicators for ventilation |
|
Definition
hypoxemia
hypercapnia
progressive deterioration
-increasing RR
-decreasing Vt
-increased WOB |
|
|
Term
|
Definition
| the amount of O2 being delivered |
|
|
Term
|
Definition
|
|
Term
| normal Vt on ventilator settings |
|
Definition
8-10 mL/kg to low of 4-8 mL/kg
monitor exhaled Vt or EVt
difference should be 50 mL or less |
|
|
Term
| normal respiratory rate for ventilator settings |
|
Definition
| set to mimic normal breathing 14-20 bpm |
|
|
Term
| I:E ratio for ventilator settings |
|
Definition
| nomral 1:2 = expiration is twice as long as inspiration |
|
|
Term
| PEEP for ventilator settings |
|
Definition
- positive airway pressure to mechanically assisted breaths
- normal setting is 5-20cm of water
- keeps airways open at the end of expiration and increases functional residual capacity
- used to decrease the amount of FiO2 needed
- increases intrathoracic pressure - risk for barotrauma and decreases cardiac output |
|
|
Term
| normal PEEP ventilator settings |
|
Definition
|
|
Term
| ventilator settings - sensitivity |
|
Definition
| senses the amount of the patients effort |
|
|
Term
|
Definition
FiO2
Vt
RR
I:E ratio
PEEP
sensitivity
sigh |
|
|
Term
| modes of mechanical ventilation |
|
Definition
volume controlled
-assist/control (A/C)
-synchronized intermittent mandatory ventilation (SIMV)
pressure controlled |
|
|
Term
| volume controlled ventilation |
|
Definition
|
|
Term
| assist/contol ventilation |
|
Definition
-preset number of breaths at preset Vt
-patient may trigger additional breaths
-Vt does not vary
-ventilator performs most of the WOB
-useful in normal respiratory drive but weak or unable to exert WOB
-risk of hyperventilation and respiratory alkalosis |
|
|
Term
| synchronized intermittent mandatory ventillation (SIMV or IMV) |
|
Definition
-preset Vt at a preset respiratory rate
-in between "mandatory" (preset) breaths patient may initiate spontaneous breahts
Vt of spontaneous breaths vary
-helps to prevent respiratory muscle weakness because patient contributes more WOB
-risk of hypoventilation |
|
|
Term
| pressure controlled ventilation |
|
Definition
-ventilator set to allow air flow until a preset pressure is reached
-the Vt is variable
-PIP (peak inspiratory pressure) can be better controlled with this setting
-risk of hypoventilation and respiratory acidosis |
|
|
Term
| what are the two types of pressure controlled ventilation? |
|
Definition
continuous positive airway pressure (CPAP)
and Pressure support (PS) |
|
|
Term
|
Definition
-continous positive airway pressure throughout respiratory cycle to patient who is spontaneously breathing
-similar to PEEP
-can be through ventilator or face mask
-option for patients with sleep apnea |
|
|
Term
| pressure support ventilation |
|
Definition
-the patients spontaneous effort is assisted by a preset amount of positive pressure
- 6-12cm H2O
-decreases WOB with spontaneous breaths
-useful in weaning |
|
|
Term
| troubleshooting ventilator alarms |
|
Definition
NEVER turn alarms off - can silence
manually ventilate if unsure of the problem
nurses cannot make changes to ventilator settings |
|
|
Term
| what is the pressure support ventilator normally set to |
|
Definition
|
|
Term
|
Definition
low volume/pressure
high pressure
apnea |
|
|
Term
| low volume/pressure ventilator alarm |
|
Definition
| means the patient is not receiving preset Vt; fix the cause! |
|
|
Term
| causes for low volume/pressure ventilator alarm |
|
Definition
inadequate spontaneous Vt
disconnection of the circuit from the tube or break in circuit
leak in the balloon of ETT
tube may be out of position |
|
|
Term
| high pressure ventilator alarm |
|
Definition
| will sound if preset pressure limit is exceeded |
|
|
Term
| causes of high pressure ventilator alarm |
|
Definition
secretions and mucus plugs
kinks in the ET tube or tubing
talking
biting ETT |
|
|
Term
|
Definition
| will go off when spontaneous respirations are not detected |
|
|
Term
| complications of ventilation |
|
Definition
right main stem intubation
ETT malposition/extubation
unplanned extubation
tracheal injury
oral and nasal mucosal damage
infection |
|
|
Term
| right main stem intubation |
|
Definition
| no breath sounds on left side - LISTEN! |
|
|
Term
| ETT malposition/extubation |
|
Definition
check lipline
breath sounds |
|
|
Term
| prevention of unplanned extubation |
|
Definition
provide adequate sedation and analgesia
montior intubate patients vigilantly
assess for risks for sel extubation - agitation, suicidal, combative, drug OD
apply restraints/protective devices
adequately secure ET tube
support ventilator tubing
use two staff members when moving/repositioning patient
educate patient/family |
|
|
Term
| tracheal injury (due to intubation) |
|
Definition
-prevent excessive head movement
-routine monitoring of ET cuff/balloon pressure
-keep no higher than 25-30cm H2O |
|
|
Term
|
Definition
head of bed at 30 degrees
awaken daily and assess readiness to wean
stress ucler prophylaxis - protonix
DVT prophylaxis |
|
|
Term
| EBP data for VAP prevention |
|
Definition
elevate HOB 30-45 degrees
Prevent drainage of condensation back to patient
hand hygiene
ETT with subglotic suction capability (hole in ET tube connected to suction)
aspirate secretions from above ETT prior to cuff delation and tube removal
oral hygeine program
non-invasive ventilation when possible |
|
|
Term
|
Definition
-underlying cause for ventilation must be resolved
-hemodynamic stability; with adeqaute cardiac output
-adequate respiratory muscle strength
-adequate oxygenation without a high FiO2 and/or high PEEP
-absence of factors that impair weaning - coma, paralysis
mentally ready
-minimal need for medicines that cause respiratory depression |
|
|
Term
| stopping the weaning process |
|
Definition
-respiratory rate >30 or <8
-low spontaneous Vt
-labored respirations
-use of accessory muscles
-low O2 sat
-HR or BP changes >20% from baseline
-dysrhythmias (PVCs) mutliple or significant
-ST segment elevation
-decreased LOC
-anxiety |
|
|
Term
|
Definition
-family has decided to let patient go
-turn ventilator off
-extubate
-give O2 through nasal cannula at low levels
-comfort measures
-high dose morphine |
|
|
Term
| Glasgow coma scale - head injury classification |
|
Definition
Coma: No eye opening, no ability to follow commands, no word verbalizations (3-8)
Severe Head Injury----GCS score of 8 or less
Moderate Head Injury----GCS score of 9 to 12
Mild Head Injury----GCS score of 13 to 15 |
|
|
Term
| occurs when a blood vessel in the brain bursts or, more commonly, when a blockage develops |
|
Definition
|
|
Term
| signs of a stroke may include |
|
Definition
- Sudden numbness or weakness of the body, especially on one side.
- Sudden vision changes in one or both eyes, or difficulty swallowing.
- Sudden, severe headache with unknown cause.
- Sudden problems with dizziness, walking, or balance.
- Sudden confusion, difficulty speaking or understanding others. |
|
|
Term
| The F.A.S.T. test helps spot symptoms. It stands for: |
|
Definition
Face. Ask for a smile. Does one side droop?
Arms. When raised, does one side drift down?
Speech. Can the person repeat a simple sentence? Does he or she have trouble or slur words?
Time. Time is critical. Call 911 immediately if any symptoms are present. |
|
|
Term
| clot-busting drugs that can curb brain damage, but they have to be used within _____ hours of the initial stroke symptoms |
|
Definition
|
|
Term
| what are the two main types of stroke? |
|
Definition
|
|
Term
| the most common type of stroke |
|
Definition
|
|
Term
| what type of stroke is more likely to be fatal? |
|
Definition
|
|
Term
| Blood flow is temporarily impaired to part of the brain, causing symptoms similar to an actual stroke |
|
Definition
|
|
Term
| Certain chronic conditions increase your risk of stroke. These include: |
|
Definition
High blood pressure
High cholesterol
Diabetes
Obesity |
|
|
Term
| the most common type of stroke |
|
Definition
|
|
Term
| what type of stroke is more likely to be fatal? |
|
Definition
|
|
Term
| Blood flow is temporarily impaired to part of the brain, causing symptoms similar to an actual stroke |
|
Definition
|
|
Term
| Certain chronic conditions increase your risk of stroke. These include: |
|
Definition
High blood pressure
High cholesterol
Diabetes
Obesity |
|
|
Term
| Certain behaviors also increase the risk of stroke: |
|
Definition
smoking
too little exercise
heavy use of alcohol |
|
|
Term
| when a patient is having a stroke what can help doctors determine whether the symptoms are coming from a blocked blood vessel or a bleeding one? |
|
Definition
|
|
Term
| what is the most common type of stroke? |
|
Definition
|
|
Term
| what type of strokes are more fatal? |
|
Definition
|
|
Term
| Hemorrhagic strokes often result from |
|
Definition
| uncontrolled high blood pressure that causes a weakened artery to burst |
|
|
Term
| Certain chronic conditions increase your risk of stroke. These include: |
|
Definition
High blood pressure
High cholesterol
Diabetes
Obesity |
|
|
Term
| Certain behaviors also increase the risk of stroke: |
|
Definition
Smoking
Getting too little exercise
Heavy use of alcohol |
|
|
Term
| A diet high in ___________________ may help lower stroke risk. |
|
Definition
| fruits, vegetables, whole grains, and fish |
|
|
Term
| non-modifiable stroke risk factors |
|
Definition
- age
- family history
- gender
- race |
|
|
Term
| A clot-busting medication is highly effective at dissolving clots and minimizing long-term damage, but it must be given within ____ hours of the onset of symptoms |
|
Definition
|
|
Term
| Treatment for hemorrhagic strokes usually involves |
|
Definition
| attempting to control high blood pressure, bleeding, and brain swelling |
|
|
Term
| Common problems after a stroke include |
|
Definition
| numbness in the arms or legs, difficulty walking, vision problems, trouble swallowing, and problems with speech and comprehension. These problems can be permanent, but many people regain most of their abilities. |
|
|
Term
| People who have had a stroke or TIA can take steps to prevent a recurrence: |
|
Definition
Quit smoking.
Exercise and maintain a healthy weight.
Limit alcohol and salt intake.
Eat a healthier diet with more veggies, fish, and whole grains. |
|
|
Term
|
Definition
| removes plaque from the lining of the carotid arteries and can prevent additional strokes |
|
|
Term
|
Definition
| involves temporarily inserting a catheter into the artery and inflating a tiny balloon to widen the area that is narrowed by plaque. A metal tube, called a stent, can be inserted and left in place to keep the artery open |
|
|
Term
| what are the two types of stroke? |
|
Definition
|
|
Term
| risk factors for stroke are the same as |
|
Definition
|
|
Term
| an ischemica stroke develops when |
|
Definition
| a blood vessle (artery) supplying blood to an area of the brain becomes blocked by a blood clot. The clot may form in the blood vessel (thrombus) or travel from somewhere else in the blood system (embolus) |
|
|
Term
| what is the most common type of stroke in older adults |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| deficits lasting longer than 24 hours |
|
|
Term
| etiology of ischemic stroke |
|
Definition
- larger artery atherosclerosis - plaque, clots, inflammation
- cardioembolic stroke - A-fib
- small artery occlusive disease (lacunar) - diabetes - glucose sticks to vessles, platelets stick and cause clot
- cryptogenic stroke (unknown) |
|
|
Term
| how long without oxygen in the brain before cells begin to die |
|
Definition
|
|
Term
| do brain cells regenerate? |
|
Definition
|
|
Term
| what are some interventions performed in the hospital that can lead to stoke? |
|
Definition
intra-aortic balloon pump, cardiac cath;
Always inform patients of complications of procedures |
|
|
Term
|
Definition
|
|
Term
|
Definition
| increase blood pressure in shock |
|
|
Term
| arterial venous malformation |
|
Definition
| congenital and deep in brain |
|
|
Term
| hemorrhagic stroke - primary etiology |
|
Definition
- intraparenchymal hemorrhage
- ruptured vascular malformations: aneurysms or AVM
vasospasm common
hydrocephalus may occur |
|
|
Term
| secondary etiology - hemorrhagic stroke |
|
Definition
- over anitcoagulation - LMW heparin
- vasopressor medications
- drug abuse - street drugs often increase BP
- coagulopathy - DIC
- |
|
|
Term
| where is the most common place for brain aneurysm? |
|
Definition
| Circle of Willis - at the base of the brain where all of the arteries connect |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| what can occur after an anuerysm? |
|
Definition
cardiac dysrhythmias
free bleeding
vasospasm
hydrocephalus
rebleeding
seizures |
|
|
Term
| when is rebleeding of an aneurysm most likely to occur? |
|
Definition
| 7-10 days after the initial bleed |
|
|
Term
| why is hydrocephalus common after a brain aneurysm? |
|
Definition
CSF can back up due to obstruction
OR
thickening of the subarachnoid space can decrease villi absoprtion of the fluid |
|
|
Term
| seizures that occur within ___ hours of an aneurysm are due to increased ICP |
|
Definition
|
|
Term
| seizures that occur _____ hours after a brain aneurysm are caused by bleeding |
|
Definition
|
|
Term
| when does vasospasm commonly occur after an aneurysm? |
|
Definition
| 3-14 days; not known why; blocks blood flow -> ischemia |
|
|
Term
| classic stroke signs and symptoms |
|
Definition
weakness/numbness on one side of the body
inability to understand what is being said
visual disturbances - blindness in one eye - most common, double vision, blurriness
dizziness
nausea/vomiting due to increased ICP
severe headache - "the worst headache I've ever had" |
|
|
Term
|
Definition
Emergency Dept.
eyewitness description
exact time of onset
critical
neurologic exam
mental status
cranial nerves - optic and occulomotor
reflexes - gag - airway and aspiration
NIH Stroke Scale (NIHSS)
ABCs
Must differentiate occlusive from hemorrhagic
Emergent CT scan without contrast
Onset of symptoms must be established
Other dx tests - 12 lead EKG, labs, MRI, or MRA, chest xray |
|
|
Term
| things needed for a neurologic exam |
|
Definition
rhine and webber
pen light
light touch object
gag reflexes - tongue depressor
something sharp
eye chart |
|
|
Term
| what areas does the NIHSS assess |
|
Definition
LOC
follow commands
facial palsy
motor strength
sensory |
|
|
Term
|
Definition
# is predictive of functionality and outcome
scores range from 0-42
20-42 = severe |
|
|
Term
| a stroke in the ______ may affect the respiratory system leading to ________ |
|
Definition
|
|
Term
| BP parameters in stroke pts |
|
Definition
ischemic - keep BP up to perfuse brain
hemorrhagic - don't increase BP, vasodilators |
|
|
Term
| how do you increase BP in an ischemic stroke pt |
|
Definition
| IV fluid or vasoconstrictors |
|
|
Term
| what is the fluid of choice for stroke pts |
|
Definition
normal saline
*monitor serum sodium levels |
|
|
Term
|
Definition
|
|
Term
| why do you not use contrast with a CT scan for stroke pt? |
|
Definition
| contrast can cause dehydration -> renal failure |
|
|
Term
|
Definition
| magnetic resonance arteriogram |
|
|
Term
| why might a chesy xray be ordered for a suspected stroke? |
|
Definition
| to rule out infection in the lungs |
|
|
Term
|
Definition
|
|
Term
|
Definition
- blood pressure management (maintain systolic BP <220/120 mm Hg)
- gradual BP reduction (prevent extension of infarction)
- control BP prior to thrombolytics (systolic BP < 185/100 mm Hg)
- thrombolytics |
|
|
Term
| thrombolytics given in ischemic stroke |
|
Definition
- only effective if given within 3 hours of onset of symptoms
- rt-PA is used
increased risk of bleeding
- meet a set criteria for TPA |
|
|
Term
| thrombolytics given to patients with ischemic stroke are only effective if given within ___ hours of onset |
|
Definition
|
|
Term
| what is the only clot-busting drug approved for stroke? |
|
Definition
|
|
Term
|
Definition
2 IVS
- TPA
- maintenance fluid, Heparin, etc. |
|
|
Term
| Inclusion criteria for TPA for acute ischemic stroke |
|
Definition
- onset of stroke symptoms <3 hours
- clinical diagnosis of ischemic stroke with a measurable deficit using the NIHSS
- age > 18 years
- CT scan consisten with ischemic stroke or shows NO hemorrhagic stroke |
|
|
Term
|
Definition
| tissue plasminogen activator |
|
|
Term
|
Definition
- suction to prevent aspiration
- elevated HOB to prevent aspiration
- nutrition - no NG tube due to possibility of aspiration; feeding tube needs to go past pyloric sphincter
- neuro checks
- manage blood sugar
- assess skin
- foley
- stool softeners - bowel managements |
|
|
Term
|
Definition
- patients have early symptoms that can progress to stroke
- resolves within 24 hours
- may need carotid enaterectomy |
|
|
Term
| most people who have a TIA experience a stroke within _________ |
|
Definition
|
|
Term
| intraparenchymal hemorrhage |
|
Definition
| bleeding within the cerebral tissue; control of blood pressure is critical |
|
|
Term
| hemorrahgic stroke commonly occurs in |
|
Definition
| the intraparenchymal space or the subarachnoid space |
|
|
Term
|
Definition
|
|
Term
| surgical intervention for SAH |
|
Definition
craniotomy
endovascular intervention - can clip aneursym with metal clip |
|
|
Term
|
Definition
- BP control
- prevention of vasospasm
nimodipine - CCB treats cerebral artery vasospasm
hypervolemia
hypertension - keep BP > 150-160 systolic
dopamine - renal perfusion
dobutamine - Afib or CHF pts
phenylephrine - BP management
Papaverine and angioplasty - direct vasodilator - only used for cerebrovasodilation |
|
|
Term
|
Definition
| direct vasodilator only used for cerebrovasdilation |
|
|
Term
|
Definition
| seizure lasting for more than 30 minutes |
|
|
Term
|
Definition
- abnormal electrical discharge in the brain
- seizures lasing more than 30 min
- common with nonadhearence to medical treatment for seizures
- prolonged seizures deplete energy sores and lead to hypoglycemia, lactic acidosis, and cerebral edema |
|
|
Term
| what are some things that can cause status epilepticus |
|
Definition
| allergies, congenital malformations, decreased O2, head injury, and premature birth |
|
|
Term
| nursing goal of status epilepticus |
|
Definition
|
|
Term
| phases of status epilepticus |
|
Definition
phase 1
- protective mechanisms
- increased metabolism
- massive autonomic activity
- cardiovascular changes
phase 2
- decompensation
- unable to meet demands |
|
|
Term
| nursing interventions for status epilepticus |
|
Definition
- maintain airway and ventilation
- stop seizure activity
- medications IV
Lorazepam (Ativan)
Phenytoin (dilantin) or Fospheytoin
Phenobarbital
Propofol
- maintain therapeutic levels of drugs
- prevent injury
- assess and treat causes
- prevent complications (aspiration, hyperthemia) |
|
|
Term
| why is Dilantin not used to treat seizures once they have begun |
|
Definition
| it takes 20-30 minutes to reach therapeutic levels; used in prevention |
|
|
Term
| what are some common side effects of anti-seizure medications? non-compliance is common! |
|
Definition
lethargy
GI disturbance
gingival hyperplasia
teratogenic |
|
|
Term
|
Definition
- neurologic emergency
- infection of the pia and the arachnoid layers
- CSF |
|
|
Term
| transmission of bacterial meningitis |
|
Definition
- via blood/ sinusitis
- neurosurgical procedures
- skull disruption
- airborne droplets |
|
|
Term
| clinical manifestations of bacterial meningitis |
|
Definition
- headahce
- fever
- vomiting
- nuchal rigidity |
|
|
Term
|
Definition
| pain in the neck when thigh is brought to abdomen; seen in bacterial meningitis |
|
|
Term
|
Definition
| involuntary flexion of the hips when the neck flexes |
|
|
Term
| how is bacterial meningitis diagnosed? |
|
Definition
|
|
Term
| management of bacterial meningitis |
|
Definition
antibiotics
corticosteroids
droplet precautions - private room, mask
- dim lights
- monitor for increased ICP
- seizure precautions |
|
|
Term
|
Definition
| I - olfactory - smell II - optic - vision III - oculomotor - movement of the eyes; pupillary constriction and accommodation IV - trochelear - movement of eyes V - trigeminal - chewing; sensation of scalp, face, and teeth VI - abducens - movement of eyes VII - facial - facial expression; lacrimation, salivation; tase anterior tongue VIII - Auditory - hearing, equilibrium IX - Glossopharyngeal - swallowing; taste posterior tongue; general sensation pharynx X - vagus - swallowing and laryngeal control; parasympathetic function XI - spinal accessory - movement of head and shoulders XII - hypoglossal - movement of tongue |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| oculomotor - movement of eyes; pupillary constriciton and accommodation |
|
|
Term
|
Definition
| trochlear - movement of eyes |
|
|
Term
|
Definition
| trigeminal - chewing; sensation of scalp, face, teeth |
|
|
Term
|
Definition
| abducens - movement of eyes |
|
|
Term
|
Definition
| facial - facial expression; lacrimation, salivation; taste anterior tongue |
|
|
Term
|
Definition
| auditory - hearing (cochlear), equilibrium (vestibular) |
|
|
Term
|
Definition
| glossopharyngeal - swallowing, tase posterior tongue; general sensation pharynx |
|
|
Term
|
Definition
| vagus - swallowing and laryngeal control; parasympathetic function |
|
|
Term
|
Definition
| spinal accessory - movement of head and shoulders |
|
|
Term
|
Definition
| hypoglossal - movement of tongue |
|
|
Term
|
Definition
| conscious thought, abstract thinking, judgment, and initiation of contralateral (opposite side of the body) involuntary motor activity |
|
|
Term
|
Definition
| part of the frontal lobe; motor expressive component of language |
|
|
Term
|
Definition
| sensory functioning, sensory perception, association, and processing of general sensory modalities at a higher level |
|
|
Term
|
Definition
|
|
Term
|
Definition
| part of the parietal lobe; understanding written and social language |
|
|
Term
|
Definition
| visual reception and association |
|
|
Term
|
Definition
mental status
LOC
language
memory
cranial nerves
motor
muscle strength
muscle tone |
|
|
Term
|
Definition
standardized tool used to assess head injury patients
assesses arousal and cognition |
|
|
Term
| GCS < or equal to _____ = severe brain injury |
|
Definition
| 8; intubate, ABGS, extra IV, CT scan |
|
|
Term
| what are some ways to appropriately assess a patient for pain |
|
Definition
orbital rim pressure
pen in nail bed
sternal rub - not frequent; can give skin burn
NO pinching or using sharp objects |
|
|
Term
| how do you score GCS when patient is intubated? |
|
Definition
| use normal system but follow # score with a T to indicate tube |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| coup; due to impact; microscopic damage; concussion, diffuse axonal injury; contusions |
|
|
Term
| anytime you loose consciousness > ___ min you should spend 24 hours in a hospital |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| secondary traumatic brain injuries |
|
Definition
| counter-coup; due to hemorrhage, ischemia, infection, increased ICP |
|
|
Term
| Current recommendations for traumatic brain injuries |
|
Definition
- Children or adolescents who sustain a concussion should always be evaluated by a physician and receive medical clearance before returning to play.
- After a concussion, all athletes should be restricted from physical activity until they are asymptomatic at rest and with exertion. - Physical and cognitive exertion, such as homework, playing video games, using a computer or watching TV may worsen symptoms.
- Symptoms of a concussion usually resolve in 7 to 10 days, but some athletes may take weeks or months to fully recover.
- Neuropsychological testing can provide objective data to athletes and their families, but testing is just one step in the complete management of a sport-related concussion.
- There is no evidence proving the safety or efficacy of any medication in the treatment of a concussion.
- Retirement from contact sports should be considered for an athlete who has sustained multiple concussions, or who has suffered post-concussive symptoms for more than three months. |
|
|
Term
|
Definition
| venous bleed; slow accumulating; can be chronic in old pts who fall; may take a while to see on CT scan |
|
|
Term
| how do you treat subdural hematomas? |
|
Definition
| drill burr holes to relieve pressure |
|
|
Term
|
Definition
| arterial; bleeds quickly; medical emergency; blood leaks every time the heart beats; common under temporal bone; periods of awakeness then periods of unresponsiveness |
|
|
Term
| how is an epidural hematoma treated? |
|
Definition
| medical emergency - operating room - artery clipped or sclerosed! |
|
|
Term
|
Definition
| lots of force; must wait for it to resolve; operating too early can make it worse |
|
|
Term
|
Definition
| diffuse axonal injury - shearing of neurons; can range from insignificant - death |
|
|
Term
| what is the most dangerous type of skull fracture? |
|
Definition
| basilar - base of skull communicates with CSF - INFECTION! |
|
|
Term
| what are two common signs of basilar skull fractures |
|
Definition
battlesign - bruise behind ear
raccoon eyes
otorrhea
rinohrrhea
* DON'T stop the leakage of CSF (can cause infection)
WASH YOUR HANDS |
|
|
Term
|
Definition
|
|
Term
| what is our job as nurse when caring for a patient with increased ICP |
|
Definition
keep ICP at ordered level
spread out movements and activities to allow pt to decrease ICP in between |
|
|
Term
| what is the only method for monitoring ICP as well as draining? |
|
Definition
|
|
Term
| where does the EVD enter the brain |
|
Definition
| left lateral ventricle - where CSF is made |
|
|
Term
| what are ways to measure ICP |
|
Definition
ventriculostomy
intraparenchymal fiber optic catheter
epidural trasnducer
subdural catheter
subdural bolt |
|
|
Term
|
Definition
2(diastolic) + systolic
-----------------------
3 |
|
|
Term
| vasoconstrictors used to maintain MAP |
|
Definition
| neosynephrine and levophed |
|
|
Term
|
Definition
|
|
Term
| CPP should be maintained at no less than ____ mmHg to assure perfusion to the brain |
|
Definition
|
|
Term
| how do you treat a decreased CPP |
|
Definition
| increased blood pressure (vasoconstrictors) and decrease ICP (drain EVD) |
|
|
Term
| what drug is often used to decrease ICP |
|
Definition
|
|
Term
|
Definition
| dehydrates brain; also changes serum osmolality - watch sodium levels |
|
|
Term
| Nursing management for increased ICP |
|
Definition
- HOB @ 30 degress
Neutral body position, minial hip felxion
- check fit of C collar and ETT tube/trach tape - not pressing on carotid - can obstruct blood flow
- optimize MAP and CPP
- maintain serum osmolality between 310 and 315mOsml/L
- keep area quiet and lights low, monitor visitors |
|
|
Term
| medical management of increased ICP |
|
Definition
Decrease metabolic demands
- hyperventilation
- diuretic therapy
- oxygenation
- MAP/BP management |
|
|
Term
| medication used to treat increased ICP |
|
Definition
- diurectics
- steroids - stabilize cell membranes, prevent leaky cells, limit further injuries
-ulcer prevention
- anti-seizure medication - even if not seizing, head injuries are at an increased risk
- pain meds
- sedation
- calcium channel or beta blockers - decrease HR |
|
|
Term
|
Definition
|
|
Term
| brain herniation due to uncontrolled ICP |
|
Definition
Cushings Triad - happens before herniation
- HTN >200/100
- bradycardia
- irregular respirations - can be difficult to see if on ventilator |
|
|
Term
|
Definition
- HTN
- bradycardia
- irregular respirations |
|
|
Term
| Harvard brain death criteria |
|
Definition
Coma - unresponsive
Unresponse to pain
Brain Stem Reflexes - negative
- Pupils, Dolls Eyes (occulocephalic) Cold Calorics (occular vestibular), and Gag Apnea
- no imitation of breaths
-Absence of sedating drugs, electrolyte abnormalities, and hypothermia |
|
|
Term
|
Definition
Harvard criteria +
Any 2 separate physicians 30 min apart, can't be inolved with transplant team |
|
|
Term
| the spinal cord is injured when _______ tear |
|
Definition
|
|
Term
| how can you detect a spinal cord injury? why might this be delayed? |
|
Definition
| CT scan; trauma patients may be on ventilator or C-collar may delay |
|
|
Term
| spinal cord injury may result in loss of: |
|
Definition
motor function
sensation
reflex activity
bowel/bladder control |
|
|
Term
| how might the esophagus be injured in a spinal cord injury? |
|
Definition
| the esophagus may be injured as it scrapes against sharp bone or is pinched between vertebrae |
|
|
Term
| what is the prognosis for life for spinal cord injuries |
|
Definition
| only 5 years less than persons of some age without spinal cord injury |
|
|
Term
| what are some potential problems of spinal cord injuries |
|
Definition
- disruption of individual growth and development
- altered family dynamics
- economic loss
- increase cost of rehabilitation, long-term health care
- skin break down, pneumonia, UTI |
|
|
Term
| when can disabled patients collect disability |
|
Definition
| 365 days after the incident |
|
|
Term
| 90% of patients with spinal cord injuries are discharged from the hospital to |
|
Definition
| home; only 10% are discharged to nursing homes, chronic care facilities, or group homes |
|
|
Term
| primary spinal cord injury |
|
Definition
| initial mechanical disruption of axons as a result of stretch or laceration |
|
|
Term
| secondary spinal cord injury |
|
Definition
| ongoing, progressive damage that occurs after the initial injury - related to EDEMA |
|
|
Term
| initial spinal cord injury |
|
Definition
- 24 hours or less: permanent damage may occur
- edema secondary to inflammatory response is harmful because of lack of space for tissue expansion
- resultant compression of cord and extension of edema above and below injury increases ischemic damage
- extent of neurological damage results from primary injury damage and secondary injury damage
- extent of injury and prognosis for recovery are most accurately determined 72 hours or more after injury |
|
|
Term
| when is extent of injury and prognosis for spinal cord trauma most accurate? |
|
Definition
| 72 hours or more after injury |
|
|
Term
| diagnostic studies for spinal cord injuries |
|
Definition
- complete spine films
- xrays
- CT scan
- MRI |
|
|
Term
| what can CT scans show R/T a spinal cord injury |
|
Definition
- stability of the injury
- location
- degree of bone injury
- soft and neural tissue changes
- degree of spinal canal compromise |
|
|
Term
|
Definition
| used for strain of cervical ligaments; provides comfort, not support or stability |
|
|
Term
|
Definition
| used by EMTs, not patient specific, come in S, M, L sizes; doesn't provide long-term stability |
|
|
Term
|
Definition
| patient specific; sized; provide long-term stability |
|
|
Term
|
Definition
| traction for the cervical spine |
|
|
Term
| types of cervical spine traction |
|
Definition
- Gardner-Wells tongs
- Halo fixation device with jacket |
|
|
Term
|
Definition
- Be aware that the weight of the halo device alters balance.
- Wear loose clothing.
- Bathe in the bathtub or sponge bathe.
- Wash under the lamb's wool liner of the vest to prevent rashes or sores.
- Have someone change the liner if it becomes odorous.
- Use baby powder
- Support the head with a small pillow when sleeping.
- Try to resume usual activities to the extent possible.
- Do not drive, because vision is impaired.
- Keep straws available for drinking fluids.
- Cut meats and other food in small pieces to facilitate chewing and swallowing.
- If going outside in cold temperatures, wrap the pins.
- Have someone clean the pin sites.
- Observe the pin sites daily for redness or drainage.
- Increase fluids and fiber in the diet to prevent constipation.
- Use a position of comfort during sexual activity. |
|
|
Term
|
Definition
anterior cord
posterior cord
brown-sequard
central cord |
|
|
Term
|
Definition
loss of motor function, pain, and temperature
NOT position, vibration, and light touch |
|
|
Term
|
Definition
changes in sensation and position sense
motor intact |
|
|
Term
|
Definition
- loss of pain, temperature, and light touch on opposite side
- loss of motor function and vibration, position, and deep touch sensation on same side as cord damage |
|
|
Term
|
Definition
| Located on or affecting the same side of the body. |
|
|
Term
|
Definition
| Taking place or originating in a corresponding part on an opposite side |
|
|
Term
|
Definition
| loss of motor function is more pronounce in upper extremities than lower |
|
|
Term
| injury above what level of the spinal cord requires ventilator |
|
Definition
|
|
Term
|
Definition
| is a bundle of spinal nerves and spinal nerve roots. The nerves that comprise the cauda equina innervate the pelvic organs and lower limbs to include motor innervation of the hips, knees, ankles, feet, internal anal sphincter and external anal sphincter. In addition, the cauda equina extends to sensory innervation of the perineum and, partially, parasympathetic innervation of the bladder. |
|
|
Term
| axial loading spinal cord injury |
|
Definition
|
|
Term
| excessive rotation spinal cord injury |
|
Definition
|
|
Term
| emergency care of spinal cord injury |
|
Definition
- what was person doing when injury occurred?
- suspect injury to the spinal cord
- immobilize - flat with head in neutral position
- priority is respiratory
- bleeding - often from other bodily injury
- CV - BP, HR
- neurological status - GCS
- sensation
- motor ability
- rectal tone |
|
|
Term
|
Definition
| map of motor and sensory levels in the body used to assess motor and neuro function |
|
|
Term
| immediate post-injury problems (spinal cord trauma) |
|
Definition
- maintaining a patent airway
- adequate ventilation
- adequate circulating blood volume
- preventing extension of cord damage - prevent EDEMA - steroids |
|
|
Term
| cervical injury above level c4 |
|
Definition
- total loss of respiratory muscle function
- mechanical ventilation required |
|
|
Term
| insertion of endotracheal tube |
|
Definition
|
|
Term
|
Definition
| an adjunct to mechanical ventilation that helps decrease the work of breathing |
|
|
Term
| The endotracheal tube must be positioned above the bifurcation of the bronchus, known as the |
|
Definition
|
|
Term
| Lung sounds that are auscultated over most of the lung fields are called _________ sounds. |
|
Definition
|
|
Term
| ___________ is a measure of distensibility, or stretchability, of the lung and chest wall. |
|
Definition
|
|
Term
| One method to assess placement of the endotracheal tube is to mark the tube at the ____ _____. |
|
Definition
|
|
Term
| The volume of a normal breath is termed ________ _________. |
|
Definition
|
|
Term
| Another term for weaning from mechanical ventilation is ______________ |
|
Definition
|
|
Term
| The maximum pressure that occurs during inspiration is called the _________ inspiratory pressure. |
|
Definition
|
|
Term
| Closed-system; method of aspirating secretions while keeping the patient ventilated |
|
Definition
|
|
Term
| Increases functional residual capacity |
|
Definition
|
|
Term
| Method of weaning from mechanical ventilation |
|
Definition
|
|
Term
| Paralyzes the respiratory muscles to facilitate ventilation |
|
Definition
|
|
Term
| Positive pressure ventilation that ensures a preset rate at a preset volume |
|
Definition
| assist/control ventilation |
|
|
Term
| Provides short-term ventilatory support, such as treatment of acute pulmonary edema |
|
Definition
|
|
Term
| An end-tidal CO2 detector assists in verifying |
|
Definition
| endotracheal tube placement |
|
|
Term
| What often occurs when positive end expiratory pressure (PEEP) is used? |
|
Definition
| Cardiac output may decrease. Because PEEP increases intrathoracic pressure, cardiac output may decrease. |
|
|
Term
| breath sound that is coarse, low-pitched characteristics and is usually continuous? |
|
Definition
|
|
Term
| ventilator modes delivers a preset number of breaths at a preset tidal volume. The patient may trigger additional breaths, and the ventilator will deliver an assisted breath at the preset tidal volume |
|
Definition
| assist-control ventilation |
|
|
Term
| mechanical ventilation allows air flow to the lungs until a preset pressure has been reached |
|
Definition
| Pressure-controlled ventilation |
|
|
Term
| Common side effects of nicotinic acid include |
|
Definition
| metallic taste in mouth, flushing, and increased feelings of warmth |
|
|
Term
| Angiotensin-converting enzymes inhibitors (ACE inhibitors) should be started within 24 hours of AMI to reduce the incidence of |
|
Definition
|
|
Term
| The initial drug recommended at the onset of AMI to reduce platelet aggregation is |
|
Definition
|
|
Term
| A target level of low-density lipoprotein for a patient who has a history of AMI is |
|
Definition
|
|
Term
| The ______________ nervous system increases blood pressure and heart rate |
|
Definition
|
|
Term
| The _______ _________ is used for detecting cardiomegaly, cardiac positioning, degree of fluid infiltrating the pulmonary space, and other structural changes. |
|
Definition
|
|
Term
| In educating the potential cardiac patient, the nurse should recommend that the patient strive to keep LDL levels less than ________ mg/dL. |
|
Definition
|
|
Term
| The patient is complaining of chest pain and shortness of breath. The nurse has the patient stop his activity and puts him on oxygen. The goal is to maintain an oxygen saturation above ________% |
|
Definition
|
|
Term
| Patients post surgery for an aortic valve replacement with any combination of fever, chills, night sweats, cough, general malaise, fatigue, new onset heart failure, or musculoskeletal complaints may be demonstrating signs and symptoms of ______________. |
|
Definition
|
|
Term
| a life-threatening complication that may occur after coronary artery bypass surgery |
|
Definition
|
|
Term
| he most common cause of right-sided heart failure is |
|
Definition
|
|
Term
| Collection of blood in the space between the inner table of the skull and the dura causes a(n): |
|
Definition
|
|
Term
| The third leading cause of death in the United States, the most frequent cause of adult disability, and the leading cause of long-term care is |
|
Definition
|
|
Term
| Thrombolytic therapy for acute stroke is most effective if given |
|
Definition
| within 3 hours of onset of symptoms |
|
|
Term
| The subarachnoid space lies between the |
|
Definition
|
|
Term
| Rupture of a cerebral aneurysm is a common cause of cerebral bleeds. These aneurysms typically rupture into which area? |
|
Definition
|
|
Term
| Vasospasm is a narrowing of the arteries adjacent to an aneurysm, resulting in ischemia and infarction of brain tissue if unresolved. The nurse is alert to this potential problem. Which time frame best indicates the greatest risk for vasospasm? |
|
Definition
| 3-14 days following rupture |
|
|
Term
| An ___________ is a congenital abnormality consisting of tangled, dilated vessels the form an abnormal communication between the arterial and venous systems abnormally shunting blood from the arterial system to the venous system. |
|
Definition
| arteriovenous malformation (AVM) |
|
|
Term
| The most common type of stroke is due to |
|
Definition
|
|
Term
|
Definition
| Oculomotor - Eye and upper eyelid movement; papillary constriction and accommodation |
|
|
Term
|
Definition
| Trochlear - Movement of eyes |
|
|
Term
|
Definition
|
|
Term
|
Definition
| Vagus - Sensation around ears and viscera; swallow, cough, and gag; main PNS nerve |
|
|
Term
|
Definition
| Hypoglossal - Tongue movement, swallowing and phonation |
|
|
Term
Blood is supplied to the brain by two
major pairs of arteries |
|
Definition
internal carotid arteries
vertebral arteries |
|
|
Term
If blood flow to brain is totally
interrupted |
|
Definition
- Neurologic metabolism is altered in 30 seconds
- Cellular death occurs in 5 minutes |
|
|
Term
|
Definition
|
|
Term
|
Definition
| microemboli that temporarily block blood flow |
|
|
Term
Transient ischemic attack
(TIA) |
|
Definition
a temporary neurological deficit caused
by ischemia |
|
|
Term
|
Definition
- Antiplatelet drugs are usually the chosen treatment to prevent stroke in
patients who have had a TIA
- Aspirin is the most frequently used
antiplatelet agent
- Surgical interventions for the patient
with TIAs from carotid disease include
Carotid endarterectomy
Angioplasty
Stenting |
|
|
Term
|
Definition
| stasis of blood in the heart |
|
|
Term
|
Definition
| small vessel occlusive disease |
|
|
Term
| ischemic strokes result from |
|
Definition
Inadequate blood flow to the brain from
partial or complete occlusion of an artery |
|
|
Term
|
Definition
|
|
Term
|
Definition
- Result of thrombosis (blood clot)
occluding a cerebral vessel
- Plaque can cause a clot to form which
blocks the passage of blood through
the artery
- Most common cause of stroke
- Extent of stroke depends on rapidity
of onset, size of the lesion & presence
of collateral circulation |
|
|
Term
|
Definition
- Majority of emboli originate in the inside layer of the heart, with plaque breaking off from the endocardium and entering the circulation
- Patient with an embolic stroke commonly
has a rapid occurrence of severe clinical
symptoms |
|
|
Term
| types of hemorrhagic stroke |
|
Definition
intracerebral hemorrhage
ruptured cerebral aneurysm
AVM |
|
|
Term
|
Definition
- Usually caused by uncontrolled HTN
- Escaped blood forms a mass that displaces and compresses brain tissue |
|
|
Term
| ruptured cerebral aneurysm |
|
Definition
- Wall of the artery weakens
- Large arteries at the base of the brain (Circle of Willis)
- Ruptures into subarachnoid space and causes SAH |
|
|
Term
|
Definition
- Congenital abnormality leading to tangled, dilated vessels
- Predisposes the vessels to rupture and hemorrhage, causing SAH or ICH |
|
|
Term
|
Definition
- Weakness or numbness on one side of the
body
- Slurred speech
- Inability to comprehend what is being said
- Visual disturbances
- Dizziness, incoordination, double vision,
vertigo
- Nausea and vomiting
- Severe headache (worst headache of my life) |
|
|
Term
| primary diagnostic test for stroke |
|
Definition
|
|
Term
| stroke diagnostic studies |
|
Definition
- CT should be obtained within
25 minutes and read within 45
minutes of arrival at ER
- CT will differentiate between ischemic & hemorrhagic stroke
- MRI/MRA, carotid doppler ultrasound, transcranial doppler
For cardiac assessment
- Electrocardiogram
- Chest x-ray
- Cardiac enzymes
- Echocardiography
Additional studies
- Complete blood count (CBC)
- Platelets, prothrombin time, partial
thromboplastin time
- Electrolytes, blood glucose
- Renal and hepatic studies
- Lipid profile |
|
|
Term
Recombinant tissue plasminogen
activator |
|
Definition
|
|
Term
|
Definition
- Used to reestablish blood flow through a
blocked artery to prevent cell death to
patients with acute onset of ischemic
stroke symptoms
- Must be administered within 3 hours of
onset of clinical signs of ischemic stroke
- Neuro assessment, VS, I&O, cardiac
monitoring, monitor for bleeding |
|
|
Term
| management of intracerebral hemorrhage |
|
Definition
- Control of BP to prevent continued bleeding
- Determine size and location of bleed
- Possible surgical intervention |
|
|
Term
|
Definition
- Surgery or interventional techniques
- Ventriculostomy to monitor ICP
- Management of BP
- Control of vasospasm |
|
|
Term
|
Definition
|
|
Term
|
Definition
is a loss of comprehension and use of
language |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| Disturbance in the muscular control of speech |
|
|
Term
| ________ ________ is a clot or plug of material that lodges in the pulmonary vasculature and can be life threatening. |
|
Definition
|
|
Term
| Reduced alveolar ventilation is called _____________ and may result from drug overdose or neurological disorders. |
|
Definition
|
|
Term
| Intrapulmonary __________ occurs when unoxygenated blood is returned to the left heart secondary to lung areas that are adequately perfused but not ventilated. |
|
Definition
|
|
Term
| Failure of _____________ is detected by values of PaCO2. |
|
Definition
|
|
Term
| The most severe acute lung injury is called _____ _______ _______ syndrome. |
|
Definition
| acute respiratory distress |
|
|
Term
| PaCO2 decreases by approximately _ mm Hg every decade of life. |
|
Definition
|
|
Term
| Studies have shown that the ____ position can improve oxygenation in ARDS patients. |
|
Definition
|
|
Term
| The three main mechanisms that favor the development of venous thromboembolism, often referred to as Virchow's triad, are |
|
Definition
| (1) venous stasis, or a reduction in blood flow; (2) altered coagulability of blood; and (3) damage to the vessel walls. |
|
|
Term
| Symptoms of early respiratory failure are: |
|
Definition
| irritability and restlessness |
|
|
Term
| Chest pain, hemoptysis, and a low oxygen saturation level are signs and symptoms of |
|
Definition
|
|
Term
| cervical injury below level of c4 |
|
Definition
| diaphragmatic breathing if phrenic nerve is functioning |
|
|
Term
| injury above level t6 greatly decreases |
|
Definition
influence of sympathetic nervous system
- bradycardia
- peripheral vasodilation
- hypotension |
|
|
Term
| what is autonomic dysreflexia storm most often due to |
|
Definition
- fecl impaction
- kinked foley
- clothing too tight |
|
|
Term
| injury above t5 affects GI |
|
Definition
- hypomotility
- paralytic ileus
- gastric distension
- stress ulcers
- intrabdominal bleeding may occur
- neurogenic bladder - less voluntary neurologic control over bowel; decreased sphincter tone |
|
|
Term
|
Definition
| body temperature = room temperature; due to interruption of SNS; decreased ability to sweat or shiver; watch for dehydration in heat and lack of blood flow in cold |
|
|
Term
| nasogastric suctioning may lead to |
|
Definition
|
|
Term
| decreased tissue perfusion may lead to |
|
Definition
|
|
Term
|
Definition
| - severe rapid hypertension, bradycardia - flushing of the face and neck - nasal stuffiness - severe throbbing headache, sweating, nausea - blurred vision |
|
|
Term
| emergency care of autonomic dysreflexia |
|
Definition
- loosen tight clothing
- check foley for kinks and check for bladder distension
- check for bowel impaction
- high fowlers position
- check room temp
- vital signs
- meds - don't solve problem just decrease s/s - nitrates and hydralazine |
|
|
Term
| what medications decrease s/s of autonomic dysreflexia |
|
Definition
|
|
Term
| treatment of spinal cord injury |
|
Definition
nonsurgical
- immobilization
- drug therapy
Surgical
- removal of foreign bodies
- decompressive laminectomy - severing nerve to help with pain
- spinal fusion
- rod insertion |
|
|
Term
| goals for spinal cord injury |
|
Definition
Patient will:
- be free of further injury to spinal cord
- maintain adequate respiratory function
- be free from undetected spinal shock
- maintain fluid and electrolyte balance
- remain free of autonomic dysreflexia (if cervical or high thoracic injury)
- ingest adequate nutrition and fluids
- remain free of urinary tract infections
- remain free of stress ulcers
- be free of pain in paralyzed limbs
- become as independent as possible |
|
|
Term
| what drug if given has greater recovery of neurologic function with early administration (spinal cord injury) |
|
Definition
| methylprednisone - Solu-medrol |
|
|
Term
| how does Solu-medrol work |
|
Definition
improves blood flow
reduces edema
reduces post-traumatic ischemia
improvement of energy balance
restoration of extracellular calcium
improvement in impulse conduction
repression of free fatty acid release |
|
|
Term
| vasopressor agents are used in the acute phase of spinal cord injury to |
|
Definition
| maintain MAP to improve perfusion to spinal cord |
|
|
Term
|
Definition
| put pillow forcefully at abdomen to make cough |
|
|
Term
|
Definition
| transfer or discharge from the CCU can result in physiologic and/or psychological stress for both patients and their families |
|
|
Term
|
Definition
| a match between patient needs and nurse competencies |
|
|
Term
|
Definition
| what outbreak of disease led to the specialty of critical care |
|
|
Term
|
Definition
- requires in-depth assessment
- high intensity therapies and interventions
- contious nursing vigilance
- those at risk for actual or potential life-threatening health problems |
|
|
Term
|
Definition
- collect data
- determine diagnoses
- identify expected outcomes
- develop a plan of care
- implememnt interventions
- evaluate outcomes of interventions |
|
|
Term
| the focus of critical care nursing |
|
Definition
| includes both the patient’s and family’s responses to illness and involves prevention as well as cure |
|
|
Term
| What nurse helped establish critical care units |
|
Definition
| Florence Nightingale in the Crimean War |
|
|
Term
| What was the first modern ICU |
|
Definition
|
|
Term
| Unrelenting sensory stimulation |
|
Definition
| Light, noise, loss of privacy and control, lack of nonclinical physical contact, emotional and physical pain, |
|
|
Term
| Responses are influenced by |
|
Definition
Age
Developmental stage
Prior experience with healthcare environment
Family relationships
Social support
Coping mechanisms
Personal philosophy about life, death, and spirituality |
|
|
Term
| Space and touch preferences |
|
Definition
Asian
Prefer minimal physical contact
Anglo-American
Prefer minimal physical contact
African American
Close personal space
Native American
Minimal spatial boundaries, strive to be one with the universe and surrounding beings
Latino
Comfortable with tactile relationships, touching, and embracing |
|
|
Term
| Families and Social Organization |
|
Definition
Asian
Strong family ties, loyal to elders
Anglo-American
Nuclear family
African American
Large extended family, often female head of household, strong church affiliation
Native American
Strong, extended family, highly respectful of elders and tradition
Latino
Nuclear and extended family, Godparents play an important role |
|
|
Term
|
Definition
Links clinical practice with patient outcomes
Described as: when 2 or more parties work together to achieve an outcome that is greater than that which each could produce if working separately |
|
|
Term
| Patient characteristics of the synergy model |
|
Definition
Resiliency
Vulnerability
Stability
Complexity
Resource Availability
Participation in Care
Participation in Decision Making
Predictability |
|
|
Term
| Nursing competencies of the synergy model |
|
Definition
Clinical Judgment
Advocacy and Moral Agency
Caring Practices
Collaboration
Systems Thinking
Response to Diversity
Facilitation of Learning
Clinical Inquiry |
|
|
Term
|
Definition
| Respect for the individual and the ability of individuals to make decisions with regard to their own health and future |
|
|
Term
|
Definition
| Actions intended to benefit the patients or others |
|
|
Term
|
Definition
| Actions intended not to harm or bring harm to others |
|
|
Term
|
Definition
| Requires that healthcare resources be distributed fairly and equitably |
|
|
Term
|
Definition
| The obligation to tell the truth |
|
|
Term
|
Definition
| The moral duty to be faithful to the commitments that one makes to others |
|
|
Term
|
Definition
| Respect for an individual’s autonomy and the right of individuals to control the information relating to their own health |
|
|
Term
| Three primary elements of informed consent |
|
Definition
Competence or capacity
Voluntariness
Disclosure of information |
|
|
Term
| Informed consent must be given by someone 18 years old or older unless |
|
Definition
The procedure is emergent
If the minor is emancipated if they are:
Self supporting, not living at home, married, pregnant or a parent, in the military, or declared to be emancipated by a court
The statute varies from state to state |
|
|
Term
|
Definition
- Measurement of pressure, flow, and oxygenation within the cardiovascular system
-Includes invasive and noninvasive measurements
-Systemic and pulmonary arterial pressures
-Central venous pressure (CVP)
-Pulmonary artery wedge pressure (PAWP)
- Cardiac output (CO)/cardiac index (CI)
- Stroke volume (SV)/stroke volume index (SVI)
- O2 saturation of arterial blood (SaO2)
- O2 saturation of mixed venous blood (SvO2) |
|
|
Term
|
Definition
| Volume of blood pumped by heart in 1 minute |
|
|
Term
|
Definition
| CO adjusted for body size |
|
|
Term
|
Definition
| Volume ejected with each heartbeat |
|
|
Term
|
Definition
| phase of readiness; heart muscle is relaxed; cardiac cells negatively charged; Na outside the cells, K inside |
|
|
Term
|
Definition
| phase of contraction; the cardiace cells have transmiited an electrical impulse, usually causing the cardiac muscle to contract; cells positively charged K outside the cells and Na inside the cells; when K and Na move in and out it causes an electrical conduction through the surrounding cells |
|
|
Term
|
Definition
| recovery phase; cells in relaxed state; negatively charged |
|
|
Term
|
Definition
| the ability of cardiac cells to initiate or generate an impulse |
|
|
Term
|
Definition
| the ability of the cells to respond to impulse (electrical stimulus) |
|
|
Term
|
Definition
| ability of cardiac cells to transmit an electrical stimulus to other cardiac cells |
|
|
Term
|
Definition
| the ability to respond to impulse by contracting |
|
|
Term
|
Definition
| -SA node
- AV node and atria
- Bundle of His
- Bundle Branches
- Purkinje fibers
- ventricular muscle
[image] |
|
|
Term
| inherent rate of the SA node |
|
Definition
|
|
Term
| inherent rate of the AV node |
|
Definition
|
|
Term
| inherent rate of ventricular muscle |
|
Definition
|
|
Term
|
Definition
| snow over grass, smoke over fire, brown in the middle |
|
|
Term
graph paper
horizontal
1 small square |
|
Definition
|
|
Term
graph paper
horizontal
1 large square |
|
Definition
|
|
Term
graph paper
horizontal
15 large squares |
|
Definition
|
|
Term
graph paper
horizontal
30 large squares |
|
Definition
|
|
Term
graph paper
vertical
1 small square |
|
Definition
| 0.10 millivolt(mv) = 1 millimeter(mm) |
|
|
Term
| how many hash marks would be on a 6 second strip |
|
Definition
|
|
Term
| what is the most common size strip to look at? |
|
Definition
|
|
Term
| no electrical activity is what dysrythmia? |
|
Definition
|
|
Term
|
Definition
| imaginary, straight line that represents absence of electrical activity; everything should always return here |
|
|
Term
|
Definition
| represents depolarization of the left and right atria; usually before the QRS wave |
|
|
Term
|
Definition
- the time of flow of conduction from the atria and the AV node to the beginning of ventricular depolarization
- measured from the beginning of the P wave to the beginning of the next deflection of baseline
- in between lub and dub
- normal PRI = 0.12-0.20 |
|
|
Term
|
Definition
|
|
Term
|
Definition
| conduction disturbance; something causing conduction to take longer to reach the ventricles |
|
|
Term
|
Definition
| ventircular depolarization (contraction) |
|
|
Term
|
Definition
| from the beginning of the Q wave to where the S wave meets baseline |
|
|
Term
| how is the PR interval measured? |
|
Definition
| from the beginning of the P wave to the beginning of the next deflection of baseline |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| how is the ST segment measured? |
|
Definition
| from the end of the S wave to the beginning of the T wave |
|
|
Term
| elevated or depressed ST segments may indicate? |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| ventricular repolarization (ventricles relaxing) |
|
|
Term
| A tall, peaked T wave may indicate? |
|
Definition
| hyperkalemia or new ischemia |
|
|
Term
| A flattened T wave may indicate? |
|
Definition
|
|
Term
| A depressed T wave may indicate? |
|
Definition
| previous cardiac ischemia |
|
|
Term
| why is atrial repolarization not seen on a cardiac strip? |
|
Definition
| because it happens inside the QRS wave; ventricular depolarization is so strong it overrides the atrial repolarization |
|
|
Term
| how do you determine if a rhythm is regular? |
|
Definition
| measure from one P or R wave to another P or R wave; can be done using a caliper or paper |
|
|
Term
|
Definition
|
|
Term
| how is the QT interval measured? |
|
Definition
| from the beginning of the QRS to the end of the T wave |
|
|
Term
| Prolonged QTI usually indicates |
|
Definition
|
|
Term
|
Definition
- P, QRS, & T waves
- measured from the beginning of one P wave to the beginning of the next P wave
- one lub dub |
|
|
Term
| 5 steps to rhythm interpretation |
|
Definition
- rhythm
- rate
- P waves
- PR intervals
- QRS complexes |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| how do you determine heart rate based on a strip? |
|
Definition
| count the # of QRS complexes between the 1st and the 3rd hashmark and multiply by 10 |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| normal range of QRS complex |
|
Definition
|
|
Term
| other names for normal sinus rhythm |
|
Definition
|
|
Term
| what is the only heart rhythm considered to be normal? |
|
Definition
|
|
Term
| don't give digoxin if HR is |
|
Definition
|
|
Term
| What should you do before administering digoxin? |
|
Definition
| listen to the apical pulse for a full minute |
|
|
Term
|
Definition
| SA node still initiates impulse and the impulse follows the normal pathway, it is just slower than normal |
|
|
Term
| when is sinus bradycardia common? |
|
Definition
| sleep, athletes, drugs (digoxin, morphine) |
|
|
Term
|
Definition
|
|
Term
|
Definition
| hypotension, dizziness, syncopy, chest pain |
|
|
Term
| reason for the symptoms of tachycardia |
|
Definition
| the heart is pumping too fast, it is not filling up completely, decreasing the cardiac output which leads to decreased tissue perfusion |
|
|
Term
|
Definition
| SA node initiates impulse, follows normal pathway just more rapid. |
|
|
Term
| causes of sinus tachycarida |
|
Definition
| exercise, pain, fever, hemmorrhage, caffeine, atropine |
|
|
Term
| why is atropine used in surgery? |
|
Definition
|
|
Term
| Premature atrial complex (PAC) |
|
Definition
- atrial impulse originating outside of the SA node
- occurs earlier than the next expected complex
- represents increased atrial irritability
- is counted in rate |
|
|
Term
|
Definition
| when a single irritable site in the atria initiates many rapid electrical impulses; F waves seen (flutter waves); AV node blocks some of them; "saw tooth" baseline |
|
|
Term
| other names for atrial flutter |
|
Definition
|
|
Term
| what can cause atrial flutter? |
|
Definition
| drugs, MI, heart damage, or heart disease |
|
|
Term
| what you see in atrial flutter |
|
Definition
rhythm: can be regular or irregular
rate: atrial rate (250-350); measure QRS to determine ventricular - can be anything
P waves: no P wave; F wave
PRI: none measurable
QRS: <0.12; all the same |
|
|
Term
| what procedure can be done to correct atrial flutter? |
|
Definition
|
|
Term
|
Definition
| increased irritability in all of the cells of the atria which all initiate impulses; not all are sent - some are stopped by the AV node; atria doesn't depolarize - it quivers! wavy baseline |
|
|
Term
| what medication are most patients with atrial fibrillation on? Why? |
|
Definition
| coumadin - blood pools in the atrium, where it can coagulate, forming a clot which can be sent out into the body |
|
|
Term
| what can be done for patients with a new onset of atrial fibrillation? Why can it not be done for old patients? |
|
Definition
| cardioversion (shock) - because this will cause the myocardium to fully contract which can dislodge a clot -> stroke, PE |
|
|
Term
| what is seen on a strip of someone with atrial fibrillation? |
|
Definition
rhythm: irregularly irregular
rate: atrial >350; any ventricular rate
P-waves: indiscernable; wavy baseline
PRI: not measurable
QRS: all look the same; <0.12
* T waves are present! |
|
|
Term
|
Definition
| when the electrical impulse is initiated in the AV node due to failure of the SA node; follows normal conduction pathway but must follow retrograde pattern to depolarize atria |
|
|
Term
| what is seen on a strip of somone with a junctional dysrhythmia? |
|
Definition
rhythm: regular
rate: 40-60 (AV node inherent)
P-wave: abnormal; if present, inverted due to retrograde pattern ormay precede, follow or be within the QRS
PRI: if P wave before QRS <0.12; may not be measurable
QRS: all same; <0.12 |
|
|
Term
|
Definition
rate: <40
* REMEMBER with junctional, AV node is initiating impulse |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| when are temporary pacemakers used? |
|
Definition
| in emergency situations or prior to permanent pacemaker placement |
|
|
Term
| what are the two types of temporary pacemakers? |
|
Definition
| transvenous and transcutaneous |
|
|
Term
|
Definition
| lead wires inserted through the skin into a vein into the right atrium, a shock is delivered through thte lead wires from a generator |
|
|
Term
| things a nurse should be aware of if his/her patient has a transvenous pacemaker |
|
Definition
- avoid static electricity
- Clean daily with soap and water
- can NEVER be removed by a nurse |
|
|
Term
|
Definition
| lead wires connected to pads placed directly on the patient's skin; shock delivered throuh pades |
|
|
Term
| things a nurse should be aware of if his/her patient has a transcutaneous pacemaker |
|
Definition
- ensure proper contact with the skin
- hair removed prior to application
- pads should not touch each other
- follow directions on package or physicians orders
- warn patient before applying pads (cold) and removing
- nurses can remove transcutaneous leads |
|
|
Term
| when is a permanent pacemaker required? |
|
Definition
| when the patients heart can no longer maintain acceptable rate or cardiac output |
|
|
Term
|
Definition
| represents the discharge of electrical impulse from the generator; vertical line on rhythm strip; followed by a P wave if atrial pacer and a QRS complex if ventricular |
|
|
Term
|
Definition
- used only when AC junction (node) and ventricular electrical conduction pathways are functioning
- not commonly used
- single chamber pacemaker |
|
|
Term
|
Definition
- lead wire can be place in left or right ventricle depending on the patient's needs
- QRS complex is usually wider
- single chamber pacemaker |
|
|
Term
|
Definition
- one lead is inserted into the right atria and another inserted into the right ventricle
- generator causes depolarization of the chambers in the normal conduction pathway
- one pacer spike beofre P wave and on before QRS wave |
|
|
Term
| what is the most commonly used pacemaker? |
|
Definition
|
|
Term
|
Definition
- one lead inserted into the right atrium and one in each ventricle
- used to greatly increase cardiac output, because both ventricles are being forced to contract
- generator causes depolarization in normal pathway
- pacer spike beofre P wave and one before QRS complex |
|
|
Term
| other names for the biventricular pacemaker |
|
Definition
| Bi-V pacemaker or sequential biventricular |
|
|
Term
|
Definition
- the ability of the cardiac cells to depolarize in response to an impulse
- should see P wave or QRS complex after spike |
|
|
Term
| what is the only way to determine ventricular depolarization? |
|
Definition
|
|
Term
|
Definition
| determined by the # of pacer spikes followed by a complex |
|
|
Term
|
Definition
| 1 complex for every pacer spike |
|
|
Term
|
Definition
| 7/10 pacer spikes followed by a complex |
|
|
Term
|
Definition
| occurs when a complex does not follow a pacer spike; indicates that impulse has not been conducted |
|
|
Term
| failure to capture may indicate |
|
Definition
| a need for more voltage or the myocaridum is too damaged to conduct an impulse |
|
|
Term
|
Definition
| the % of complexes generated by pacemaker; depends on pacemaker settings |
|
|
Term
|
Definition
| fires only when the patient's heart does not initiate an impulse |
|
|
Term
|
Definition
| pacemaker fires at set rate, see pacer spike before every complex that it is set for |
|
|
Term
| implantable cardioverter defibrillator (ICD) |
|
Definition
- used to treat pacing needs as well as defibrillation as needed - identifies and treats rapid HRs and lethal dysrhythmias
- implanted under skin, slightly larger than normal pacemaker
- lead wires and sensing units placed in appropriate chambers
- ICD will defirbillate unitl heart returns to a normal rhythm or is turned off
- firing represented by a spike |
|
|
Term
| Considerations for pacemakers/ICD |
|
Definition
- do not perform external defibrillation over pacemaker or ICD
- doo not place temporary placement pads over ICD or pacemaker
- teach patients to alert airport authorities
- CANNOT HAVE MRI
- avoid direct blows to pacemaker/ICD
- avoid magnets
- taught to carry information card at all times
- wear medical ID bracelet |
|
|
Term
| premature ventricular complex |
|
Definition
| part of a rhythm; electrical impulse originates below the Bundle of His and ovvurs earlier than the next expected complex; may or may not stimulate atrial depolarization; include PVC in heart rate |
|
|
Term
|
Definition
| originate from single site in ventrical; all beats the same; >0.12 second |
|
|
Term
|
Definition
| impulse originates from different ventricular sites; the complexes look different because they are from different sites; more dangerous - represents increased irritability of ventricles -> can lead to v tach |
|
|
Term
|
Definition
| occurs when the R wave of a PVC falls directly on the T wave of the previous complex; may lead to a lethal dysrhythmia |
|
|
Term
| if a patient has ventricular tachycardia, when do you normally notify the DR? |
|
Definition
| if > 3 or 4 beats of v tach |
|
|
Term
|
Definition
life-threatening dysrhythmia defined by 3 or more PVCs in a row; ventricular fill and empty times are shortened -> decreased cardiac output -> decreased oxygen perfusion
- SHOCKABLE! |
|
|
Term
| what does ventricular tachycardia look like on a strip? |
|
Definition
rhythm: regular
rate: 100-250
p-wave: usually absent
PRI: absent
QRS: >0.12 |
|
|
Term
|
Definition
| life-threatening; resembles v-tach; wave amplitude repeats an increasing and decreasing pattern; shockable; must treat low magnesium after shock to maintain stability |
|
|
Term
| what dysrhythmia is associated with low magnesium |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| letahl- results from multiple ventricular impulses that DO NOT follow a conduction pathway; neither atria nor ventricles depolarize; patient has NO PULSE; no contractions, no cardiac output; SHOCKABLE! |
|
|
Term
| what does ventricular fibrillation look like on a strip? |
|
Definition
rhythm: none to assess
rate: none
p-wave: none
PRI: none
QRS: none, wavy baseline |
|
|
Term
|
Definition
| due to failure of ALL intrinsic pacemakers of the heart; ventricles try but too damaged; what depolarization does occur is not effective; decreased cardiac output; |
|
|
Term
| treatment of idioventricular/agonal dysrhythmias |
|
Definition
chest compressions, epinephrine, atropine
- poor prognosis; nothing to shock
- tombstones |
|
|
Term
|
Definition
| atrial depolarization but a loss of ventricular depolarization; just p waves; no cardiac output; no pulse; |
|
|
Term
| treatment of ventricular standstill |
|
Definition
| compressions, epi, atropine |
|
|
Term
|
Definition
| complete lack of electrical activity; no depolarization; no pulse; NOT shockable; can treat with compressions, epi, and atropine |
|
|
Term
| pulseless electrical activity |
|
Definition
| electrical activity is heart with absence of contraction of myocardium; no depolarization; NO PULSE! |
|
|
Term
| what is the only way to determine PEA |
|
Definition
|
|
Term
| 5 H's that PEA can be caused by |
|
Definition
hypoxia
hypolvolemia
hypo/hyperkalemia
hydrgoen ions (acidosis)
hypothermia |
|
|
Term
| 5 T's that PEA can be caused by |
|
Definition
tablets (overdose)
tamponade (cardiac)
tension pneumothorax
thrombosis (cardiac)
thrombosis (pulmonary) |
|
|
Term
|
Definition
P - pump (compressions)
E - epinephrine
A - atropine
* then treat underlying cause |
|
|
Term
|
Definition
| interference seen on a rhythm strip |
|
|
Term
| things that can cause artifact |
|
Definition
| coughing, moving, ventilator tubing on electrode |
|
|
Term
| ways to prevent/fix artifact |
|
Definition
- ensure proper contact
- make sure gel is not dry
- move ventilator tubing away from leads |
|
|
Term
|
Definition
| amount of blood pumped by the left ventricle in 1 minute |
|
|
Term
|
Definition
|
|
Term
|
Definition
| interference or static seen on the monitor |
|
|
Term
|
Definition
| adhesive pads that are attached to the patient's skin |
|
|
Term
|
Definition
| wires that connect the electrodes to tht emoniotr or telemetry unit, also called lead wires |
|
|
Term
| another name for baseline |
|
Definition
|
|
Term
| negative(inverted) and absent P waves are usually a sign of |
|
Definition
| electrical conduction that is initiated from the AV node |
|
|
Term
| what rate should be the same as the patient's pulse? |
|
Definition
|
|
Term
|
Definition
| Volume of blood within ventricle at end of diastole |
|
|
Term
|
Definition
Forces opposing ventricular ejection
- Systemic arterial pressure
- Resistance offered by aortic valve
- Mass and density of blood to be moved |
|
|
Term
|
Definition
| Strength of ventricular contraction |
|
|
Term
|
Definition
| Measurement of pulmonary capillary pressure; reflects left ventricular end-diastolic pressure /preload under normal conditions |
|
|
Term
|
Definition
| Right ventricular preload or right ventricular end-diastolic pressure under normal conditions, measured in right atrium or in vena cava close to heart |
|
|
Term
|
Definition
| Positioning transducer so zero reference point is at level of atria of heart or phlebostatic axis |
|
|
Term
|
Definition
| Confirms that when pressure within system is zero, monitor reads zero |
|
|
Term
|
Definition
- During initial setup of arterial line
- immediately after insertion of arterial line
- When transducer has been disconnected from pressure cable or pressure cable has been disconnected from monitor
- When accuracy of values is questioned |
|
|
Term
| risks with arterial pressure monitoring |
|
Definition
| Hemorrhage, infection, thrombus formation, neurovascular impairment, loss of limb |
|
|
Term
| Continuous flush irrigation system |
|
Definition
- Delivers 3 to 6 ml of heparinized saline per hour
- Maintains line patency
- Limits thrombus formation
- Assess neurovascular status distal to arterial insertion site hourly |
|
|
Term
| Pulmonary Artery Pressure Monitoring |
|
Definition
- Guides management of patients with complicated cardiac, pulmonary, and intravascular volume problems
- PAWP: Indicator of cardiac function and fluid volume status
- Monitoring PA pressures allows for therapeutic manipulation of preload |
|
|
Term
| PA flow-directed catheter |
|
Definition
- Distal lumen port in PA
- Samples mixed venous blood |
|
|
Term
| Thermistor lumen port near distal tip |
|
Definition
- Monitors core temperature
- Thermodilution method measuring CO |
|
|
Term
| When pulmonary arterial pressure measurements are obtained |
|
Definition
- At end expiration
- PAWP: By inflating balloon with air until PA waveform changes to a PAWP waveform
- Balloon should be inflated slowly and for no more than four respiratory cycles or 8 to 15 seconds |
|
|
Term
| people involved in a code |
|
Definition
Code nurses - primary, secondary, and nursing supervisor
anesthesiologist or nurse anesthetist
respiratory therapist
pharmicist or pharmacy tech
EKG tech
chaplain |
|
|
Term
| a tall peaked T wave may indicate |
|
Definition
|
|
Term
| vagal nerve stimulation results in.. |
|
Definition
|
|
Term
| the sawtooth waveform of atrial flutter is caused by an irritable focus in the.. |
|
Definition
|
|
Term
| atrial fibrilation is characterized by |
|
Definition
| irregular rhythm and no P waves |
|
|
Term
| patient problems noted after discharge from a critical care unit may include: |
|
Definition
| fatigue and poor short-term memory |
|
|
Term
|
Definition
| the susceptibility to actual or potential stressors that may adversely affect the patient |
|
|
Term
|
Definition
| Claims that one has the moral duty to be faithful to commitments made to others |
|
|
Term
| normal cardiac output (CO) |
|
Definition
|
|
Term
| normal central venous pressure (CVP) |
|
Definition
|
|
Term
| normal left atrial pressure (LAP) |
|
Definition
|
|
Term
| normal stroke volume (SV) |
|
Definition
|
|
Term
| normal systemic vascular resistance (SVR) |
|
Definition
|
|
Term
| normal pulmonary artery occlusive pressure (PAOP) |
|
Definition
|
|
Term
|
Definition
| the measurement of pressure, flow, and oxygenation within the cardiac system |
|
|
Term
|
Definition
| measures preload for the right side of the heart |
|
|
Term
|
Definition
|
|
Term
|
Definition
| volume of blood that returns to the heart; volume of blood within ventricle at the end of diastole |
|
|
Term
|
Definition
| pressure; how dilated or constricted arterial system is; forces opposing ventricular ejection |
|
|
Term
| what are some medications given for too much preload |
|
Definition
| Lasix (diuretic), Morphine 10 mg (if patient is ventilated don't worry about breathing issues), in left-sided heart failure Nitrates-dilate venous system, in right sided heart failure - nitroglycerin drip |
|
|
Term
| Sa02 - 02 saturation of arterial blood |
|
Definition
| 02 sat - can be taken by pulse ox, blood gas, or pulmoary artery cath |
|
|
Term
|
Definition
| 02 saturation of mixed venous blood |
|
|
Term
|
Definition
|
|
Term
|
Definition
| measurement of pulmonary capillary pressure; reflects left ventricular end-diastolic pressure/preload under normal conditions |
|
|
Term
| Right atrial pressure (RAP) |
|
Definition
|
|
Term
| normal adult urinary output |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| 4th intercostal space, under arm, mid-chest |
|
|
Term
| continuous arterial pressure monitoring |
|
Definition
| monitors blood pressure and used to draw blood gases |
|
|
Term
| how do you assess for collateral circulation |
|
Definition
Allen's test:
occlude radial artery
close hand
occlude ulnar artery
release hand
then release ulnar |
|
|
Term
| dampened arterial pressure could indicate |
|
Definition
| thrombosis, check the pressure of the bag, flush, and check for kinks |
|
|
Term
| where is an ART line normall inserted? |
|
Definition
brachial, subclavia, or femoral artery
*femoral is not ideal for long-term |
|
|
Term
| what is the only way to measure left heart function |
|
Definition
|
|
Term
|
Definition
| indicator of cardiac function and fluid volume status; monitoring PA pressues allows for therapeutic manipulation of preload |
|
|
Term
| where does the tip of a PA catheter end? |
|
Definition
|
|
Term
| additional lumens on the PA catheter |
|
Definition
-temp
-balloon wedge pressure
-yellow (distal) pressure - can draw blood, NO fluids or medication
- blue or white CVP - can push meds or fluids |
|
|
Term
| Nursing responsibilities during a PA catheter insertion |
|
Definition
-STERILE procedure
-prepare for sterile setting
-get pulmonary artery pressure monitor
-test balloon
-flush tubing
-tell charge nurse
-have crash cart outisde of room
-informed consent
-if patient is alert should be sedated
-towel under should for positioning
-MONITOR PATIENT!
-record tracings as it is being inserted |
|
|
Term
| how long can a PA catheter remain in a patient |
|
Definition
| 1 week - 10 days because of potential damage to heart |
|
|
Term
|
Definition
| jugular venous distension, muffled heart sounds, equalizing pressures |
|
|
Term
| what's the longest the balloon in a PA catheter should be blown up? |
|
Definition
|
|
Term
|
Definition
| reflects balance between oxygenation of arterial blood, tissue, perfusion, and tissue oxygen consumption (VO2) |
|
|
Term
| normal SVO2 in a healthy patient |
|
Definition
|
|
Term
|
Definition
- decreased arterial oxygenation
- low cardiac output
- low HgB level
- increased oxygen consumption or extraction |
|
|
Term
|
Definition
- may indicate clinical improvenment
- worsening clinical condition (sepsis) |
|
|
Term
| drugs that can be given for vtach |
|
Definition
sodium channel blocksers
lidocaine/novacaine |
|
|
Term
| what medications can be squirted down an ET tube |
|
Definition
ALE
atropine - bradycardia
lidocaine - vtach/vfib
epinephrine - hypotension |
|
|
Term
| Complications with PA Catheters |
|
Definition
infection and sepsis
ventricular dysrhythmias
air embolus
catheters cannot be wedged - may need repositioning by DR
pulmonary infarction or PA rupture |
|
|
Term
| when is it difficult to get an SpO2 reading? |
|
Definition
| patients are hypothermic, receiving IV vasopressors, experiencing hypoperfusion |
|
|
Term
| what are the two main goals of inserting an intraaortic balloon pump? |
|
Definition
| increase blood flow and decrease 02 consumption |
|
|
Term
| what artery is the intraaortic balloon pump inserted through? |
|
Definition
|
|
Term
| complications of IABP therapy |
|
Definition
vascular injuries (disloding of plaque, aortic dissection, compromised distal circulation)
thrombus and embolus formation |
|
|
Term
| Ventricular Assit Devices (VADs) |
|
Definition
- can be implanted or positioned externally
- provide R or L ventricle or biventicular support |
|
|
Term
|
Definition
| when a patient is going to live with an internal VAD |
|
|
Term
| what does lactate indicate |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| why is digoxin (an inotropic drug) not used to treat shock patients? |
|
Definition
| it takes to long to reach therapeutic levels |
|
|
Term
|
Definition
| caused by a delay in the conduction of an impulse related to a partial interruption in conduction through the AV junctional area. PR interval is always > 0.20 second |
|
|
Term
| 2nd degree heart block - Type I (Mobitz I, Wenckebach) |
|
Definition
| a progressive heart block where the electrical impulse is interrupted at the AV junction. This interruption becomes longer with each impulse until the interruption completely blocks the conduction of the impulse – seen as PR intervals become longer before each QRS until one is dropped (pattern is repeated) |
|
|
Term
| 2nd degree heart block - Type II (Mobitz II, Classic) |
|
Definition
| caused by an intermittent interruption of impulses near or below the AV junction – occurs suddenly and without warning and completely blocks the conduction – will see a dropped QRS with a uniform P (P to P is usually regular). Can be life-threatening due to increased myocardium irritability |
|
|
Term
|
Definition
| occurs when the electrical impulse is completely blocked between the atria and ventricles – no relationship between P and QRS (ventricles must initiate own impulses and heart is functioning as two separate hearts). Considered a life-threatening dysrhythmia because it may lead to asystole or lethal if severe bradycardia with decreased CO is involved |
|
|
Term
|
Definition
| a delay in conduction of either the right or left bundle branch. This delay in one branch causes late depolarization in the corresponding ventricle leading to two separate ventricular depolarizations – will see rabbit ears on strip due to “detour” of impulse |
|
|
Term
| what can be donated if the donor's hear is still beating? |
|
Definition
heart
lungs
kidneys
pancreas
bowel
multi-visceral |
|
|
Term
| what can be donated if the donor's heart is no longer beating? |
|
Definition
corneas
bone
fascia
tendons
patellar ligaments
cartilage
blood vessels
heart valves
bone marrow |
|
|
Term
|
Definition
- legal determination of death
- determined by two licensed physicians not affiliated with the procurement or transplantation
- determined by clinical exam
- an irreversible cessation of all functions of the entire brain, including the brain stem |
|
|
Term
| one tissue donor can help how many people? |
|
Definition
|
|
Term
| what is the most common type of donor? |
|
Definition
|
|
Term
|
Definition
| the circulating volume is inadequate for the body's needs = the tank is not full |
|
|
Term
| causes of hypovolemic shock |
|
Definition
| external or internal fluid loss |
|
|
Term
| clinical presentation of hypovolemic shock |
|
Definition
INCREASED:
- HR
- RR
- SVR
- Hematocrit
DECREASED
- BP
- U/O
- cool, pale skin
- mentation
- flat neck veins
- CO
- PCSP
- CVP
- Sv02
- Hematocrit |
|
|
Term
| estimating systolic blood pressure |
|
Definition
- radial pulse = 80
- femoral pulse = 70
- carotid pulse = 60 |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| conversion of centigrade to fahrenheit |
|
Definition
|
|
Term
| causes of cardiogenic shock |
|
Definition
- MI
- myocardial contusion
- caridomyopathy
- myocarditis
- severe heart failure
- dysrhytmias
- valvular dysfunction
- ventricular septal rupture |
|
|
Term
| clinical presentation of cardiogenic shock |
|
Definition
INCREASED
-HR
-dysrhythmias
-chest pain
-RR
-CVP
-PCWP
-SVR
- cool, pale skin
DECREASED
-BP
-U/O
-mentation
-LV failure
- pulmonary edema
-RV failure
- CHF
-CO
-Sv02 |
|
|
Term
| managment of cardiogenic shock |
|
Definition
-improve contractility with inotropic agents
-mechanical support
-revascularization
-reduce preload
-reduce afterload
-prevent/treat dysrhythmias |
|
|
Term
| causes of anaphylactic shock |
|
Definition
-food
-drugs
-bites or stings
-chemicals |
|
|
Term
| management of anaphylactic shock |
|
Definition
-remove offending agent
-maintain airway
-epinephrine |
|
|
Term
| causes of neurogenic shock |
|
Definition
-anesthesia
-epidural
-cervical spinal cord injury |
|
|
Term
| what is the most common cause of neurogenic shock? |
|
Definition
| cervical spinal cord injury |
|
|
Term
| management of neurogenic shock |
|
Definition
-eliminate or treat the cause
-maintain MAP
-DVT prophylaxis |
|
|
Term
| management of septic shock |
|
Definition
-good handwashing
-identify source of infection
-meticulous oral and airway care
-meticulous catheter and wound care
-avoid NPO status / enteral feedings only
- antibiotics as indicated
- Xigris remvoed from market in October 2011
-control hyperthermia
-miantain MAP |
|
|
Term
| how long does neurogenic shock last? |
|
Definition
|
|
Term
|
Definition
-decreased reflexes
-loss of sensation
-flaccid paralysis below level of injury
- ~50% of people with acute spinal cord injury experience spinal shock |
|
|
Term
|
Definition
flaccid paralysis
loss of reflex activity below level of lesion/injury
bradycardia
paralytic ileus
hypotension
dyspnea
urinary retention
absence of sweating |
|
|
Term
| when does neurogenic shock develop? |
|
Definition
| 30-60 minutes post injury |
|
|
Term
| how long does spinal shock last? |
|
Definition
|
|
Term
|
Definition
regulation of fluid volume
regulation of electrolyte balance
regulation of acid-base balance
regulation of blood pressure
excretion of nitrogenous waste products
regulation of erythropoiesis
metabolism of vitamin D
synthesis of prostaglandin |
|
|
Term
| sings and symptoms of fluid volume overload |
|
Definition
| hypertension, edema, crackles, neck vein distention, weight gain, increased pulmonary artery pressures, decrease urine output, decreased hematocrit, and presence of an S3 heart sound |
|
|
Term
| an ______ ______ sits on top of each kidney and is responsible for the production of aldosterone, a hormone that influences sodium and water balance |
|
Definition
|
|
Term
| what is the role of the adrenal gland? |
|
Definition
| production of aldosterone |
|
|
Term
|
Definition
| a hormone that influences sodium and water balance |
|
|
Term
| two regions of each kidney |
|
Definition
outer region - cortex
inner region - medulla |
|
|
Term
| the basic functional unit of the kidney |
|
Definition
|
|
Term
| how many nephrons are in each kidney |
|
Definition
|
|
Term
| how does blood enter the kidneys |
|
Definition
|
|
Term
| how does blood reach the glomerulus? how does it leave the glomerulus? |
|
Definition
reaches - afferent arteriole
leaves - efferent arteriole |
|
|
Term
| how does blood exit the kidney |
|
Definition
|
|
Term
|
Definition
| a cluster of minute blood vessels that filter blood |
|
|
Term
|
Definition
regulation of fluid volume
regulation of electrolyte balance
regulation of acid-base balance
regulation of blood pressure
excretion of nitrogenous waste products
regulation of erythropoiesis
metabolism of vitamin D
synthesis of prostaglandin |
|
|
Term
| what is filtered out of the blood as it flows through the glomerulus? |
|
Definition
| water, electrolytes, and waste products |
|
|
Term
| what is a normal glomerular filtration rate (GFR)? |
|
Definition
|
|
Term
| what percentage of filtrate is reabsorbed in the nephron's tubules? |
|
Definition
|
|
Term
|
Definition
| the movement of substances from the filtrate back into the capillaries |
|
|
Term
|
Definition
| movement of substances from the peritubular capillaries into the tubular network |
|
|
Term
| _______ and _________ play a role in water reabsorption in the distal convoluted tubule and collecting duct |
|
Definition
| aldosterone and antidiuretic hormone (ADH) |
|
|
Term
| average urine output per day |
|
Definition
|
|
Term
| the kidneys help to maintain acid-base equilibrium in three ways: |
|
Definition
reabsorbing filtered bicarbonate
producing new bicarbonate
excreting small amounts of hydrogen ions (acid) buffered by phosphates and ammonia |
|
|
Term
| the most important renal physiological change that occurs with aging is |
|
Definition
|
|
Term
| after age __ there is a decline of approximately ____mL/min per decade GFR |
|
Definition
|
|
Term
| why does GFR decrease after age 40 |
|
Definition
| reduction in renal mass, number of glomeruli, and blood flow |
|
|
Term
| sudden decline in GFR resulting in retention of nitrogenous waste products (azotemia) |
|
Definition
|
|
Term
|
Definition
| urine output <400mL in 24 hours |
|
|
Term
|
Definition
| urine output <100 mL in 24 hours |
|
|
Term
three categories of acute renal failure:
classification depends on where the precipitating factor exerts its pathophysiological effect on the kidney |
|
Definition
prerenal
postrenal
intrarenal |
|
|
Term
| signs and symptoms of fluid volume overload |
|
Definition
| HTN, edema, crackles, neck vein distension, weight gain, increased pulmonary artery pressures, decreased urine output, decreased hematocrit, and presence of an S3 heart sound |
|
|
Term
|
Definition
| Donation after cardiac death - a donor that does not meet criteria for brain death |
|
|
Term
| what organs can be removed after cardiac arrest |
|
Definition
| vascular organs - liver, kidney, pancreas |
|
|
Term
| the healthcare professional's role in organ donation |
|
Definition
*identification and referral
call the Alabama Organ center and the Alabama Eye Bank when death has occurred or is imminent
provide information to the Alabama Organ Center and the Alabama Eye Bank
The patient's suitability will be evaluated - enables the requester to answer family questions and prevents asking families that do not have any donation options
family approached about donation as appropriate
*support of the family considering donation
assist with the family approach
should be done by a requester comfortable with donation
approach the next-of-kin and limit the number of people to present
needs to be done in a sensitive manner
separate family approach from the discussion of death
it is the family's right to be approached |
|
|
Term
|
Definition
ensures hospital compliance with federal, state, and Joint Commission requirements
Required by Health and Human services as of August 21, 1998
Ensures that families are approached about donation
decreases the disparity between people waiting and the number of donors |
|
|
Term
|
Definition
*Regulation of:
fluid volume
electrolyte balance
acid-base balance
blood pressure
erythropoesis
excretion of nitrogenous waste products
metabolism of vitamin D
synthesis of prostaglandin (substances that can be synthesized from the phospholipids of cell membranes of most body tissues, including blood cells) |
|
|
Term
|
Definition
| nitrogenous waste in the blood |
|
|
Term
| obstructive renal failure |
|
Definition
|
|
Term
|
Definition
looks at kidneys, ureters, and bladder
shows size, shape, and position of kidneys
may also detect abnormalities such as calculi, hydronephrosis (dilation of the renal pelvis), cysts, or tumors |
|
|
Term
|
Definition
| separation of solutes by differential diffusion through a porous or semipermeable membrane that is placed between two solutions |
|
|
Term
| complications of continuous renal replacement therapy (CRRT) |
|
Definition
electrolyte and acid-base imbalances
fluid imbalances
hypotension
infection
bleeding from disruption of the catheter or system connections
filter clotting
air embolism |
|
|
Term
|
Definition
| a physical injury caused by external force or violence |
|
|
Term
| the classic sign of abdominal injury is? |
|
Definition
|
|
Term
| complications of musculoskeletal injuries |
|
Definition
compartment syndrome
rhabdomyolosis
DVT
fat embolism |
|
|
Term
|
Definition
| a clinical syndrome characterized by inadequate tissue perfusion that results in cellular, metabolic, and hemodynamic derangements |
|
|
Term
|
Definition
| the process undertaken to restore adequate circulating blood volume and therefor tissue perfusion |
|
|
Term
|
Definition
hypovolemic
cardiogenic
distributive
- anaphylactic
- spectic
- neurogenic |
|
|
Term
|
Definition
initiation
compensatory
progressive
refractory |
|
|
Term
| initiation stage of shock |
|
Definition
no obersvable clinical signs
*nurse's index of suspicion must be high |
|
|
Term
| compensatory stage of shock |
|
Definition
- increased HR (except neurogenic)
- narrowed pulse pressure
- rapid breathing - respiratory alkalosis
- thirst
- cool moist skin
- oliguria
- diminished bowel sounds
- restlessness progressing to confusion
- hyperglycemia
- increased urine specific gravity and decreased creatinine clearance |
|
|
Term
| progressive stage of shock |
|
Definition
- dysrhythmias
- hypotension with narrowed pulse pressure
- tachypnea
- cold, clammy skin
- anuria
- absent bowel sounds
- lethargy progressing to coma
- hyperglycemia
- increased BUN, Cr, and K+
- Respiratory and metabolic acidosis |
|
|
Term
| refractory stage of shock |
|
Definition
- life threatening dysrhytmias
- severe hypotension despite vasopressors
- respiratory and metabolic acidosis
- acute respiratory failure
- ARDS
- DIC
- hepatic dysfunction/failure
- renal failure
- myocardial ischemia/infarction/failure
- cerebral ischemia/infarction |
|
|
Term
| important labs associated with shock |
|
Definition
- glucose
- BUN/Cr
- sodium, potassium, chloride
- lactate
- cbc with diff
- billirubin
- ABGs
- cultures |
|
|
Term
|
Definition
- Dobutamine/dobutrex
- Dopamine/intropin
- Norepinephrine/levopher
- Phenylephrine/neosynephrine
- vasopressin
- nitroglycerine
- nitroprusside/nipride
- beta-blockers
- antibiotics |
|
|
Term
|
Definition
| Upheld if persons tell the truth in their communication with others |
|
|
Term
|
Definition
| sudden and rapid loss of renal function which results in the retention of nitrogenous waste products (urea nitrogen and creatinine) in the blood (azotemia) |
|
|
Term
|
Definition
| an increase of urea, nitrogen, and creatinine in the blood |
|
|
Term
|
Definition
|
|
Term
| what percentage of ARF patients have normal or increased urine output |
|
Definition
|
|
Term
|
Definition
| urin is more dilute; these patient usually have fewer complications and recover faster than patients with oliguric ARF |
|
|
Term
| how quick can ARF develop? |
|
Definition
| can develop over hours to days |
|
|
Term
|
Definition
| severe, prolonged hypotension or hypovlemia, exposure to a nephrotoxic agent |
|
|
Term
|
Definition
prerenal
intrarenal
postrenal |
|
|
Term
|
Definition
conditions outside of the kidneys interefere with renal perfusion and lead to decreased glomerular perfusion and filtration
includes fluid volume loss, decreased cardiac output, and vasoconstriction of the renal blood vessels
prolonged or severe situations can lead to more intrarenal permanent damage |
|
|
Term
| common causes of prerenal ARF |
|
Definition
volume depletion - hemorrhage, trauma, surgery, postpartum period, GI loss, diarrhea, nasogastric suctioning, vomiting, renal loss, diuretics, osmotic diuresis, diabetes insipidus, volume shifts, burns, ileus, pancreatitis, periotnitis, hypoalbunemia
vasodilation - sepsis, anaphylaxis, medications (antihypertensives, afterload reducing agents), anesthesia
impaired cardiac performance - heart failure, myocardial infarction, cardiogenic shock, dysrhythmias, pulmonary embolism, positive-pressure ventilation, pericardial tamponade
miscellaneous - ACE inhibitors in renal artery stenosis, inhibition of prostaglandins by nonsteroidal anti-inflammatory drug use during renal hypoperfusion, renal vasoconstriction, norepinephrine, ergotamine, hypercalcemia |
|
|
Term
|
Definition
conditions that cause direct damage to the kidney
primarily caused by prolonged ischemia, exposure to nephrotoxins, hemoglobin released from hemolyzed RBCs or myoglobin released from necrotic muscle cells - cells can clog in vessels and cause damage
lupus and glomerulonephritis may also cause intrarenal failure |
|
|
Term
| what two disease processes often cause intrarenal failure? |
|
Definition
| lupus or glomerulonephritis |
|
|
Term
| acute tubular necrosis (ATN) |
|
Definition
| condition which occurs after prolonged ischemia or nephrotoxic agents, or a combination of the two |
|
|
Term
|
Definition
| prolonged ischemia, exposure to nephrotoxic agents, or a combination of the two |
|
|
Term
|
Definition
| results when the ischemia overwhelms the normal autoregulatory defenses of the kidneys and cell death occurs |
|
|
Term
|
Definition
| nephrotoxic agents cause necrosis of tubular epithelial cells which slough off and occlude the tubules |
|
|
Term
| what portions of the renal tubule are most commonly affected by ATN? |
|
Definition
| proximal tubule and ascending limb of the loop of Henle |
|
|
Term
|
Definition
| with treatment, renal function will slowly return with GFR at 70-80% of normal within 1-2 years |
|
|
Term
|
Definition
|
|
Term
| contrast-induced nephropathy |
|
Definition
| an increase in the serum creatinine level within the first 24 hours after administration of radiocontrast; however, levels may rise up to 5 days after the procedure |
|
|
Term
| what happens to urine output in contrast-induce nephropathy |
|
Definition
|
|
Term
| what is the most important risk factor for developing contrast-induced nephropathy? |
|
Definition
| pre-existing reduction in renal function |
|
|
Term
| contrast-induced nephropathy ______develops in patients with ____ renal function problems |
|
Definition
|
|
Term
| Patient with DM are ___times more likely to develop contrast-induced nephropathy than non diabetic patients |
|
Definition
|
|
Term
| postrenal failure is also known as |
|
Definition
| obstructive renal failure |
|
|
Term
|
Definition
obstruction causes increased intratubular pressure resulting in a decrease in GFR and abnormal nephron function
usually resolves rapidly once obstruction is removed |
|
|
Term
| causes of postrenal failure |
|
Definition
BPH
blood clots
tumors
foley catheter obstruction |
|
|
Term
| phases of acute renal failure |
|
Definition
initiating phase
oliguric phase
diuretic phase
recovery phase |
|
|
Term
|
Definition
begins with the precipitating event and continues until oliguria develops
can last for several hours to days
may observe gradual increase in serum BUN and creatinine levels
ARF is potentially reversible during the initiation phase |
|
|
Term
|
Definition
characterized by a urine output of 100-400 mL/24 hours that does not respond to fluid challenges or diuretics
typically lasts 8-15 days but can last for several weeks, especially in older clients or those with pre-existing renal insufficiency
longer time in this phase = the slower the recovery will be and the greater the chance of permanent renal damage is |
|
|
Term
|
Definition
| patient has decreased urine output, bolus patient with fluids to see if urine output will increase |
|
|
Term
| what is normal urine output during oliguric phase |
|
Definition
|
|
Term
| how long does the oliguric phase of ARF usually last? |
|
Definition
|
|
Term
| changes seen in the oliguric phase |
|
Definition
fluid volume excess *be careful with fluid challenges
metabolic acidosis
sodium balance
potassium excess
hematologic disorders
calcium deficit and phosphate excess
waste product accumulation
neurologic disorders |
|
|
Term
|
Definition
often has a prompt onset with urine flow increasing rapidly over a period of several days
diuresis can result in an output of up to 10L/day of dilute urine
usually occurs 2-6 weeks after the onset of oliguric ARF and and continues until the BUN level stops rising
Normal renal tubular function is reestablished at this point |
|
|
Term
|
Definition
client begins to return to normal levels of activity
Renal function may continue to improve for up to 12 months after oliguric ARF began
patient is particularly vulnerable to additional renal injury
renal function may never return to pre-illness levels, but function for a long, healthy life is likely
residual renal insufficiency may be noted through regular monitoring of renal function |
|
|
Term
|
Definition
hyoptension
tachycardia
decreased cardiac output
decreased CVP
lethargy
appearance is similar to patient with heart failure or dehydration |
|
|
Term
|
Definition
oliguria or anuria
edema
HTN
tachycardia
SOB
distended neck veins
elevated CVP (preload)
weight gain
crackles
anorexia
N/v
letahrgy or varying levels of consciousness
EKG changes may also be present due to fluid and electrolyte imbalances |
|
|
Term
|
Definition
oliguria or intermittent anuria
symptoms of uremia
lethargy |
|
|
Term
| what type of ARF is the easiest to trait? |
|
Definition
| postrenal - simply remove the obstruction |
|
|
Term
|
Definition
|
|
Term
|
Definition
serum creatinine
BUN
serum sodium
serum potassium
serum phosphorous
urinalysis |
|
|
Term
|
Definition
gradual increase of 1-2 mg/dL every 24-48 hours
consistently elevated levels indicate decreased renal function |
|
|
Term
|
Definition
often increases by 10-20 mg/dL every 24-48 hours
rate of increase is controled by limiting protein intake which also decreases the rate of onset of systemic symptoms, such as anorexia, n/v |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
may be normal or decreased
patients with renal failure retain sodium (where salt goes, so goes water -so, serum levels seem normal)
with excessive water retention, sodium levels seem decreased due to hemodilution
Limit fluid intake
Avoid excessive sodium intake |
|
|
Term
| why should renal patients avoid salt substitutes? |
|
Definition
| they are high in potassium |
|
|
Term
| what happens to potassium in ARF |
|
Definition
will be increased due to diminished excretion
monitor closely for rapidly increasing levels
EKG changes occur with levels > or equal to 6.5
limit potassium-containing foods
avoid salt substitutes |
|
|
Term
|
Definition
will be increased due to diminished excretion
short-term increases have potential to cause rapid decrease in calcium level and cardiac rhythm disturbances
long-term increases demineralize bones and enhance fracture potential |
|
|
Term
| diagnostic assessment for ARF |
|
Definition
Radiological
- KUB
- renal ultrasoun
Invasive
- IV pyelography
- CT
- renal angiography
- renal scanning
- renal biopsy |
|
|
Term
|
Definition
stands for kidneys, ureters, and bladder
shows size, shape, and position of kidneys
may also detect abnormalities such as calculi, hydronephritis (dilation of the renal pelvis), cysts, or tumors |
|
|
Term
|
Definition
| dilation of the renal pelvis |
|
|
Term
|
Definition
helpful in identifying obstruction
can document the size of the kidneys, which may be helpful in differentiation acute from chronic renal failure |
|
|
Term
|
Definition
early recognition and treatment are essential
prompt replacement of fluids
aggressive treatment of shock
blood transfusions for any blood loss
vasoconstrictors for intense vasodilation
hemodynamic monitoring |
|
|
Term
|
Definition
usually resolved with insertion of an indwelling bladder catheter, either transurethral or suprapubic, or with the removal of a kink in the catheter
ureteral stent may need to be placed if the obstruction is caused by calculi or carcinoma - ureter may have clamped
in other words, REMOVE OCCLUSION! |
|
|
Term
|
Definition
|
|
Term
|
Definition
drug therapy
dietary management
management of fluid and electrolyte imbalances
dialysis or CRRT
Prevention! |
|
|
Term
| what are ways to prevent intrarenal failure |
|
Definition
maintaining adequate hydration
maintaining renal perfusion
monitoring duration, dosage, and combination of all nephrotoxic agents |
|
|
Term
|
Definition
diuretics
dopamine
acetylcysteine (mucomyst)
theophylline
Epoetin Alpha (epogen) |
|
|
Term
|
Definition
used to "shock" kidneys and produce increased urine output
use is controversial
commonly given but little evidence to support any benefit for ARF
may cause excess diuresis and renal hypoperfusion
loop diuretics commonly ordered |
|
|
Term
| what type of diuretics are commonly ordered for ARF |
|
Definition
|
|
Term
| what is a potential complication of using diuretics to treat ARF? |
|
Definition
| excess diuresis -> renal hypoperfusion |
|
|
Term
| dopamine used to treat ARF |
|
Definition
vasoconstrictor
low doses (<5mcg/kg) used to increase urine output (vasodilation effects)
use is controversial
multiple s/e
may actually be detrimental to the patient |
|
|
Term
| Acetylcysteine (mucomyst) to treat ARF |
|
Definition
| an atioxidant used prophylactically in combination with IV fluids to reduce the incidence of contrast-induced acute renal failure |
|
|
Term
| what is mucomyst used for in ARF? |
|
Definition
| to reduce the incidence of contrast-induced ARF - used in combination with IV fluids |
|
|
Term
| Theophylline used in treatment of ARF |
|
Definition
used prophylactically to decrease the risk of contrast-induced ARF
not used much because of numerous side effects |
|
|
Term
| Epoetin Alpha (epogen) - used in treatment of ARF |
|
Definition
used to treat the anemia related to ARF
main side effect is HTN |
|
|
Term
| what is the main side effect of epogen |
|
Definition
|
|
Term
|
Definition
*
UA
skin color, edema, neck vein distension, brusing
dialysis access site
LOC - neurologic issues due to retainment of waste
lung sounds - crackles, fluid volume overload
EKG and other labs |
|
|
Term
| nursing diagnoses for ARF |
|
Definition
excess fluid volume
potential complication: dysrhythmias
risk for infection |
|
|
Term
|
Definition
-complete recovery without any loss of kidney function
-maintain normal fluid and electrolyte balance
-have decreased anxiety
-comply with and understand need for follow-up care; vulnerable to excess kidney damage for up to a year |
|
|
Term
|
Definition
identify high risk populations
control exposure to nephrotoxic agents
prevent prolonged episodes of hypotension and hypovolemia
careful monitoring of I&O and electrolyte imbalance
contrast-dye prophylaxis
if taking nephrotoxic drugs, need regular renal function monitoring |
|
|
Term
| acute intervention for ARF |
|
Definition
-usually changes come on suddenly
important to monitor fluid and electrolyte balance during oliguric and diuretic phases
observing and recording I/O is important
daily weights - retaining fluids
cardiac monitoring
infection control
maintenance of adequate respiratory ventilation (TCDB, ICS, humidifed O2)
skin care/oral care |
|
|
Term
| ambulatory and home care for ARF |
|
Definition
good nutrition, rest, and activity are necessary
high calorie diet
follow-up care and renal function monitoring are necessary
teach them to recognize s/s of recurrent disease
prevention measures emphasized
counseling, social work, psychiatrist/psychologist referral as needed
education on dialysis if necessary = may be done by dialysis nurse |
|
|
Term
| evaluation/expected outcomes for ARF |
|
Definition
regain and maintain normal fluid and electrolyte balance
comply with treatment regimen
experience no infectious complications
complete recovery |
|
|
Term
|
Definition
| separation of solutes by differential diffusion through a porous or semipermeable membrane that is placed between two solutions |
|
|
Term
|
Definition
uremia
persistent hyperkalemia
fluid volume excess with pulmonary edema or unresponsive to diuretics
uremic pericarditiis or encephalopathy
heart failure |
|
|
Term
|
Definition
hemodialysis (HD)
continuous renal replacement therapy (CRRT)
peritoneal - not for ARF, not rapid |
|
|
Term
|
Definition
- diffusion (clearance) is the movement of solutes such as urea, uric acid, potassium, and phosphate from the patients blood to the dialysate cleansing fluid, acorss the semipermeable membrane (artifical kidney) - from an area of greater concentration to an area of lesser concentration
-ULTRA filtration - the removal of water and fluid by using a pressure or osmotic gradient (increased pressure in the blood compartment or decreased pressure in the dialysate compartment of the dialysis machine) |
|
|
Term
| types of vascular accesses for hemodialysis |
|
Definition
internal arteriovenous fistula (AVF)
internal arteriovenous graft (AVG)
temporary percutaneous catheters |
|
|
Term
| internal arteriovenous fistula (AVF) |
|
Definition
usually created in the forarm with an anastomosis between a patient's OWN artery and vein (native)
created approximately 3 months prior to start of HD to allow for healing
high pressure arterial flow is routed through the vein to allow for rapid blood flow needed for HD
AVFs have best patency rates and fewer complications
not frequently seen now for a number of reasons (late referrals, less reimbursement, etc.)
use 2 large bore (14-16 guage) needles |
|
|
Term
| how long must you wait after an AVF is created before using it? |
|
Definition
| 3 months to allow for healing |
|
|
Term
| what type of vascular access has the best patency rates and fewest complications |
|
Definition
|
|
Term
| why are AVFs not frequently seen now? |
|
Definition
| late referrals, less reimbursement, etc. |
|
|
Term
| internal arteriovenous graft (AVG) |
|
Definition
made of synthetic material forming a "bridge" between a patient's artery and vein
can usually be used 2-4 weeks after insertion
accessed using 2 large bore needles
synthetic material is self-sealing when needle is removed - helps with quicker hemostasis
synthetic material does allow for increased risk of infection and clots |
|
|
Term
| how long must you usually wait before using a AVG |
|
Definition
| 2-4 weeks after insertion |
|
|
Term
|
Definition
| a "bridge" made of synthetic material connecting a patient's artery and vein |
|
|
Term
| what is a negative side effect of AVGs |
|
Definition
| synthetic material allows for increased risk of infection and clots |
|
|
Term
|
Definition
1 needle used to pull blood from patient, other used to return dialyzed blood
No BPs, IVs, or venipunctures on affected side - sign above bed
MUST ASSESS AND DOCUMENT THE PRESENCE OF A BRUIT AND A THRILL EVERY SHIFT as well as skin color, temperature, and condition
must call physician if not able to feel/hear bruit or thrill |
|
|
Term
| temporary percutaneous catheters |
|
Definition
used when immediate vascular access is needed
similar to a central line (usually double-lumen - one draws blood and other returns it)
Vas-cath is brand commonly used
usually inserted at bedside
Jugular vein is preferred over subclavian, but can also access femoral
no drugs administered or blood withdrawals performed by non dialysis staff; vas-cath has lots of heparin
may also insert a more long-term catheter which is inserted in the upper chest wall and tunneled to the internal or external jugular vein - Perma-cath brand is commonly used |
|
|
Term
| complications of dialysis |
|
Definition
hypotension
muscle cramps
loss of blood
hepatitis
sepsis
disequilibrium syndrome |
|
|
Term
|
Definition
|
|
Term
| nursing care for dialysis |
|
Definition
continuous monitoring
monitor labs - report abnormalities
hold medications that are dialyzed - ask dialysis nurse or pharmacist
hold anti-hypertensives until after |
|
|
Term
|
Definition
slower than hemodialysis*
method of removing solutes and fluids slowly and continuously in a patient that may be hemodynamically unstable |
|
|
Term
|
Definition
hypervolemia cardiac failure MODS - multiple organ dysfunction syndrome electrolyte and acid-base imbalance
**contraindicated in patients with HIGH hyperkalemia or pericarditis which require rapid resolution |
|
|
Term
| contraindications for CRRT |
|
Definition
| patients with HIGH hyperkalemia or pericarditis which require rapid resolution |
|
|
Term
|
Definition
continuous arteriovenous hemfiltration (CAVH)
or
Continuous venvenous hemofiltration (CVVH) |
|
|
Term
| continuous arteriovenous hemofiltration (CAVH) |
|
Definition
| one large bore needle inserted in an artery and one into a vein; the patients arterial pressure pumps the blood through the system and returns it to the patient; patient must have a healthy heart |
|
|
Term
| continuous venovenous hemofiltration (CVVH) |
|
Definition
| dual lumen venous catheter used; blood is pumped through the system using an external pump; anticoagulants used to prevent clotting in the filter |
|
|
Term
|
Definition
electrolyte and acid-base imbalances
fluid imbalances
hypotension
infection
bleeding from disruption of the catheter or system connections
filter clotting
air embolism |
|
|
Term
|
Definition
daily weights
I&Os
High calorie, low protein, low sodium, low potassium diet
hourly hemodynamic monitoring
hourly vitals
aseptic technique with changes of connections
oral care
safety measures - low bed, side rails, soft restraints if needed |
|
|
Term
|
Definition
| a clinical syndrome characterized by inadequate tissue perfusion that results in cellular, metabolic, and hemodynamic derangements |
|
|
Term
|
Definition
| a clinical syndrome characterized by inadequate tissue perfusion that results in cellular, metabolic, and hemodynamic deragnements; the body is not getting enough oxygen to the cells |
|
|
Term
|
Definition
| the process undertaken to restore adequate circulating blood volume and therefor tissue perfusion; what you do to make the patient better |
|
|
Term
|
Definition
hypovolemic
cardiogenic
distributive
- anaphylactic
- septic
- neurogenic |
|
|
Term
| what are the types of distributive shock? |
|
Definition
anaphylactic
septic
neurogenic |
|
|
Term
|
Definition
initiation
compensatory
progressive
refractory |
|
|
Term
| initiation stage of shock |
|
Definition
| no observable clinical signs; nurse's index of suspicion must be high; patient has something that could cause them to go into shock |
|
|
Term
| compensatory stage of shock |
|
Definition
| how long the body can maintain normal functioning level before changes are seen; different for each person |
|
|
Term
| s/s of compensatory stage of shock |
|
Definition
increased heart rate (except with neurogenic)
narrowed pulse pressure - systolic and diastolic coming closer together
rapid, deeep breathing -> respiratory alkalosis
thirst, dry mucous membranes
cool moist skin, not enough blood supply
oliguria, decreased urine output
diminished bowel sounds - ileus
restlessness progression to confusion - always assess reason for confusion before giving medication to sedate
hyperglycemia - liver converting glycogen to glucose - needs more energry, fight or flight response
increased uring specific gravity and decreased creatinine clearance (function of the kidney - the less creatinine you clear the worse the kidney function is) |
|
|
Term
| progressive stage of shock |
|
Definition
|
|
Term
| s/s of progressive stage of shock |
|
Definition
dysrhythmias - not getting enough oxygen to the heart
hypotension with narrowed pulse pressure
tachypnea (if not on ventilator)
cold, clammy skin
anuria - lack of urine output
absent bowel sounds
lethargy progressing to coma
hyperglycemia
increased BUN, Cr, and K+
Respiratory and metabolic acidosis - lactic acid will be elevated |
|
|
Term
| refractory stage of shock |
|
Definition
| IRREVERSIBLE; you can't make a difference, make patient comfortable, talk with family, patient will most likely die, entire body is failing |
|
|
Term
| s/s of refractory stage of shock |
|
Definition
life-threatening dysrhytmias - v-tach, PEA, vfib - heart is failing!
severe hypotension despite vasopressors
respiratory and metabolic acidosis
acute respiratory failure - lungs failing
ARDS - depending on what's wrong
DIC - depending on what's wrong
hepatic dysfunction/failure - jaundice
renal failure - kidney failure, BUN, and creatinine
cold, mottled skin - skin failing
hyperglycemic - pancreas failing
ileus, projectile diarrhea - intestines failing
increased entere feeding residual - stomach failing
myocardial ischemia/infarction/failure
cerebral ischemia/infarction |
|
|
Term
|
Definition
Glucose
BUN/Cr
Sodium, potassium, chloride
Lactate
CBC with differential – look at bone marrow, platelets, WBC, RBC
Bilirubin
ABGs
Cultures – review how to draw cultures, cultures x2 – 2 sides of the body 2 aerobic, 2 anerobic |
|
|
Term
|
Definition
Dobutamine/dobutrex – increases force and strength of heart contraction
Dopamine/intropin – renal perfusion – 5mic/kg
Norepinephrine/levophed leave them dead – increases vascular tone and HR so much that it causes increased myocardial oxygen demand – VERY toxic, used for least amount of time possible
Phenylephrine/neosynephrine – less toxic than Levophed, strong vasoconstrictor
Vasopressin – increases contractility of the heart , used in people with SLOW dysrhythmias
Nitroglycerine – venodilation, coronary artery dilation – can be used prophylactically in someone – dilate coronary arteries to increase cardiac function
Nitroprusside/nipride – arterial dilation, decreased afterload
Beta-blockers – to slow heart rate
Antibiotics – when necessary |
|
|
Term
| Dopamine must have above ___ mcg/kg for alpha effects, better alpha drugs for vasopressors |
|
Definition
|
|
Term
|
Definition
| age diminishes ability to tolerate shock |
|
|
Term
| cardiovascular affects of aging |
|
Definition
LV wall thickens
Compliance of heart and lungs decrease
Valves become calcified and fibrosed, don’t open and close as well, not as much blood in ventricle to be pumped out
SV and CO are decreased
Baroreceptors are less sensitive, drugs that affect vasoconstriction and vasodilation don’t work as well
Sympathetic nervous system less responsive
Arterial walls loose elasticity causing increased SVR
Many older patients on beta blockers which further decrease HR
Myocardial oxygen demand increased |
|
|
Term
| pulmonary affects of aging |
|
Definition
Decreased elasticity of lungs
Decreased alveolar perfusion
Decreased alveolar surface area
- Limited ability to increase oxygenation |
|
|
Term
|
Definition
decreased ability to concentrate urin
decreased GFR |
|
|
Term
|
Definition
decreased effectiveness, bone marrow doesn't work as well
- increased risk of infection
- increased risk of anaphylaxis |
|
|
Term
|
Definition
| the circulating volume is inadequate for the body's needs = the tank is not full |
|
|
Term
| causes of hypovolemic shock |
|
Definition
external fluid loss - blood loss, sweating, vomiting, diarrhea
internal fluid loss - third-spacing, pancreatitis, liver disease, internal bleeding |
|
|
Term
| clinical presentation of hypovolemic shock |
|
Definition
INCREASED
HR
RR
SVR
hematocrit - dehydrate - n/v, sweating, loss of fluid volume, third-spacing, plasma concentrated
DECREASED
BP
Urinary output
cool, pale skin
mentation
flat neck veins
CO
PCWP
CVP
SvO2
Hematocrit |
|
|
Term
| estimating systolic blood pressure |
|
Definition
radial = 80
femoral = 70
carotid = 60 |
|
|
Term
| how many classes are there of hypovolemic shock? |
|
Definition
|
|
Term
| classes of hypovolemic shock |
|
Definition
|
|
Term
|
Definition
Hypertonic – not used often, used later on to move fluid from extravascular space into vascular space – someone with lots of edema - 3% saline
Hypotonic – not used for resuscitation – leaks out quickly - D5W
Isotonic – GIVE ISOTONIC, same as our serum, stays in blood vessels the longest- two used normal saline and lactated ringers- most resuscitate with lactated ringers because glucose and electrolytes match normal fluid in our body |
|
|
Term
|
Definition
Blood – if they loose blood, we give them blood, has hemoglobin, carries oxygen
Albumin – expands volume – hypertonic – draws fluid in; can leak into lungs and cause ARDS, not used much during active resuscitation, may be used AFTER
Synthetic volume expanders – Hespan – stays in blood vessels, no hemoglobin, interferes with clotting, only given in small amounts 250-500 mL; expands blood volume enough to support blood pressure; >500 mL has too many complications |
|
|
Term
| average blood volume in men |
|
Definition
|
|
Term
| average blood volume in women |
|
Definition
|
|
Term
| conversion of centigrade to Fahrenheit |
|
Definition
|
|
Term
| core temperature related to mortality in shock |
|
Definition
34 C = 52%
33 C = 79%
32 C = 100%
The colder the patient, the higher the mortality. |
|
|
Term
| causes of cardiogenic shock |
|
Definition
MI
myocardial contusion - no signs or symptoms seen, chest wall pain, see nothing on echo, bruise of heart wall causes dysfunction
cardiomyopathy - doesn't matter what kind
myocarditis
severe heart failure - left OR right
dysrhythmias
valvular disease
ventricular septal rupture |
|
|
Term
| clinical presentation of cardiogenic shock |
|
Definition
INCREASED
HR - heart is trying to compensate
dysrhythmias - lack of oxygen
chest pain
RR - trying to oxygenate tissues
preload - heart not contracting well
CVP
PCWP
SVR - vasoconstriction to bring blood back to heart - cool, pale skin
DECREASED
BP
urinary output
mentation
Left ventricular failure - pulmonary edema
RV failures - CHF and or pulmonary edema
CO
SVO2 - body is using too much oxygen |
|
|
Term
| clinical presentation of cardiogenic shock |
|
Definition
INCREASED
HR - heart is trying to compensate
dysrhythmias - lack of oxygen
chest pain
RR - trying to oxygenate tissues
preload - heart not contracting well
CVP
PCWP
SVR - vasoconstriction to bring blood back to heart
cool pale skin
DECREASED
BP
urinary output
metatntion
LV failure - pulmonary edema
RV failure - CHF and/or pulmonary edema
CO
SvO2 - body is using too much oxygen |
|
|
Term
| management of cardiogenic shock |
|
Definition
- improve contractility with inotropic agents - Doubtuamine - people can go home with implantable dobutamine pumps, Vasopressin (if MI and heart not beating), intraortic balloon pump, bypass surgery - revascularization
-mechanical support
- revascularization
- reduce preload - venodilate with nitroglycerin, morphine, diuretics, decrease IV fluid rate, fluid restriction
- Reduce afterload with nirpide, can't go home on nirpide - use beta blockers, vasodilators, calcium channel blockers
- prevent/treat dysrhytmias |
|
|
Term
| causes of anaphylactic shock |
|
Definition
food
drugs
bites or stings
chemicals |
|
|
Term
|
Definition
| immediate total vasodilation; acts like hypovolemic |
|
|
Term
| treatment of anaphylactic shock |
|
Definition
|
|
Term
| clinical presentation of anaphylactic shock |
|
Definition
INCREASED
HR dysrhytmias
chest pain
RR
IgE
DECREASED
BP
chest pain
SVR - warm, flushed skin
urinary output
brain perfusion
GI perfusion
SOB, stridor, wheezing
CO
CVP, PCWP, SVR
SvO2 |
|
|
Term
| management of anaphylactic shock |
|
Definition
remove offending agent
maintain airway
epinephrine |
|
|
Term
| causes of neurogenic shock |
|
Definition
anesthesia
epidural
cervical spinal cord injury |
|
|
Term
| what is the most common cause of neurogenic shock? |
|
Definition
| cervical spinal cord injury |
|
|
Term
| above what level of the spinal column if injured is the patient more likely to have neurogenic shock? |
|
Definition
|
|
Term
| clinical presentation of neurogenic shock |
|
Definition
INCREASED
nothing
DECREASED
HR
BP
hypothermia
SVR - warm, dry, flushed skin
urinary output
neurological deficit
CO
CVP, PCWP
SvO2
sympathetic acitivy |
|
|
Term
| why do many medication not work when treating neurogenic shock? |
|
Definition
| the nerve pathways are not working; no nerve function to compensate |
|
|
Term
| managemnet of neurogenic shock |
|
Definition
eliminate or treat the cause
maintain MAP
DVT prophlaxis
Give FLUID or blood
*Eventually the sympathetic nervous system will react; support patient until then |
|
|
Term
|
Definition
Immunosuppression
-extremes of age
-malnutrition
-alcohol or drug abuse
-chronic illness
-malignancy
-immunosuppressive therapy
Significant bacteremia
-invasive procedures or devices
-dirty wounds
-untreated GI disease
-periotnitis
-food poisoning
-prolonged hospitalization
-translocation of bacteria |
|
|
Term
| clinical presentation of septic shock |
|
Definition
INCREASED
Early - HR, pulse pressure, temp, CO, SvO2
Late - HR, positive culture
DECREASED
early - normal or decreased BP, SVR, brain perfusion, U/O, CVP, PCWP
Later - BP, LOC, anureia, temp, SvO2, CVP, PCWP, and SVR varies |
|
|
Term
| management of septic shock |
|
Definition
good handwashing
identify source of infection
meticulous oral and airway care
meticulous catheter and wound care
avoid NPO status - overgrowth of intestinal bacteria, can transloacte, enteral feedings only
antibiotics as indicated
control hyperthermia - too much fever is bad
maintain MAP - orders will be written |
|
|
Term
| continuum of septic shock |
|
Definition
Infection
- Presence of fever
SIRS – systemic inflammatory response syndrome – hard at this point to determine pathogen, often have negative culture, remove source of infection if you can find it; physician may start broad-spectrum antibiotics ; no evidence of organ failure
- Tachycardia, tachypnea, hyperthermia
Sepsis – beginning organ dysfunction – hypoxia, decreased urine output, elevated bilirubin, decreased tolerance of tube feedings
- All of above and evidence of impaired perfusion and organ function
Septic Shock
- Hypotension, lactic acidosis, oliguria, acute change in LOC, low temp, low white count – body’s compensation failing
MODS – refractory
- Pulmonary, CV, hematologic, renal, liver, CNS, Metabolic |
|
|
Term
|
Definition
Progressive dysfunction of 2 or more organ systems
- Mortality is 45 – 55% with 2 systems involved
- Mortality is 80% with 3 systems involved
- Mortality is 100% with more than 3 systems involved
Sepsis is the most common cause
Management – prevention and support |
|
|
Term
| what is the most common cause of MODS |
|
Definition
|
|
Term
| what is the most common cause of DIC |
|
Definition
|
|
Term
| During DIC what is occurring in the body to cause a life-threatening condition? |
|
Definition
|
|
Term
| Your patient who is in the early stages of anaphylaxis is likely to complain of? |
|
Definition
|
|
Term
| If your patient were in cardiogenic shock, EKG findings would be consistent with? |
|
Definition
|
|
Term
| what is considered a normal fasting blood sugar? |
|
Definition
|
|
Term
| what is a normal hemoglobin level for men? |
|
Definition
|
|
Term
| what is the normal hematocrit for women? |
|
Definition
|
|
Term
| if a patient was in acute renal failure, what would you expect ABG results to show? |
|
Definition
|
|
Term
| in the patient with cirrhosis, elevated ammonia levels can lead to? |
|
Definition
|
|
Term
| the primary regulator of the body's internal environment |
|
Definition
|
|
Term
| acute renal failure is associated with |
|
Definition
| significant morbidity and mortality |
|
|
Term
|
Definition
| the basic functional unit of the kidney |
|
|
Term
| a cluster of minute blood vessels that filter blood |
|
Definition
|
|
Term
| what is filtered out of the blood across the glomerular membrane and into Bowman's capsule, to form what is known as FILTRATE? |
|
Definition
| water, electrolytes, and waste products |
|
|
Term
| what is too large to pass through the healthy glomerular membrane? |
|
Definition
| RBCs, albumin, and globulin |
|
|
Term
|
Definition
|
|
Term
| how much filtrate do the kidneys usually produce per day? |
|
Definition
|
|
Term
| what percentage of filtrate is reabsorbed into the peritubular capillaries |
|
Definition
|
|
Term
|
Definition
| the movement of substances from the filtrate back into the capillaries |
|
|
Term
|
Definition
| the movement of substances from the peritubular capillaries into the tubular network |
|
|
Term
| what hormones play a role in water reabsoprtion in the distal convoluted tubule and collecting duct? |
|
Definition
|
|
Term
| what is the average urine output |
|
Definition
|
|
Term
| When ______ is present, increased amounts of bicarbonate are excreted in the urine and cause the serum pH to return toward normal. |
|
Definition
|
|
Term
|
Definition
| a hormone that plays a role in blood pressure regulation |
|
|
Term
|
Definition
|
|
Term
| what is the most important renal physiological change that occurs with aging |
|
Definition
|
|
Term
| after age ___ there is a decline of approximately __-___ mL/min per decade |
|
Definition
|
|
Term
| why does GFR decrease with age? |
|
Definition
| reduction in renal mass, renal blood flow, and number of glomeruli |
|
|
Term
| what must be considered regarding medications in older patients? |
|
Definition
| aging decreases the kidneys ability to excrete drugs; including radiocontrast dyes used in diagnostic testing; decrease in dosing to avoid nephrotoxicity |
|
|
Term
| age-related changes in renin and aldosterone levels can lead to |
|
Definition
| fluid and electrolyte abnormalities; increased risk of hyperkalemia; decreased ability to conserve sodium, and tendency to develop volume depletion and dehydration |
|
|
Term
| the aging kidney is slower to correct __________ in acids, causing |
|
Definition
an increase;
prolonged metabolic acidosis and the subsequent shifting of potassium out of cells worsening hyperkalemia |
|
|
Term
| conditions that produce acute renal failure by interfering with renal perfusion are classified as |
|
Definition
|
|
Term
| the body attempts to normalize renal perfusion by |
|
Definition
| reabsorbing sodium and water |
|
|
Term
| if prerenal ARF is prlonged or severe, it can progress to intrarenal damage - |
|
Definition
|
|
Term
| acute renal failure resulting from obstruction of the flow of urine is classified as |
|
Definition
postrenal
or
obstructive renal failure |
|
|
Term
| what happens in postrenal ARF |
|
Definition
| increased intratubular pressure results in a decrease in the GFR and abnormal nephron functions |
|
|
Term
| conditions that produce acute renal failure by directly acting on functioning kidney tissue (either the glomerulus or the renal tubules) are classified as |
|
Definition
|
|
Term
| the most common intrarenal condition is |
|
Definition
|
|
Term
| predisposing factors for ARF |
|
Definition
| advanced age, diabetes mellitus, and dehydration |
|
|
Term
| what medications cause vasoconstriction of the renal vessels and can precipitate ATN? |
|
Definition
| NSAIDs, ACE inhibitors, ARBs, cyclosporine, and tacrolimus |
|
|
Term
| oxygen deprivation in the kidneys results in a rapid breakdown of |
|
Definition
|
|
Term
| why is ATP needed for kidney function? |
|
Definition
| the sodium-potassium ATPase of the cell membrane can not effectively transport electrolytes across the membrane without the presence of ATP |
|
|
Term
| contrast-induced nephropathy |
|
Definition
| as increase in the serum creatinine level within the first 24 hours after administration of radiocontrast; however, levels may rise for up to 5 days |
|
|
Term
| Patients with diabetes mellitus have a ___ xs greater risk for developing contrast-induced nephropathy vs nondiabetic patients |
|
Definition
|
|
Term
| what is another common cause of acute renal failure after a radiocontrast procedure? |
|
Definition
cholesterol embolism or atheromatous emboli;
the decline in renal function typically occurs over a period of 3-8 weeks rather than the rapid decline seen with contrast-induced nephropathy; patients also typically have evidence of embolization to other areas of the body, including the skin, CNS, and GI |
|
|
Term
| what are the tree phases of acute renal failure |
|
Definition
initiation phase - onset
maintenance phase - oliguria/anuria
recovery phase - diuresis |
|
|
Term
| the period that elapses from the occurrence of the precipitating event to the beginning of the change in urine output |
|
Definition
|
|
Term
| how longs does the initiation phase normally last? |
|
Definition
|
|
Term
| acute renal failure is ________ ______ during the initiation phase |
|
Definition
|
|
Term
| what is one way that may prevent contrast-induced renal failure? |
|
Definition
| expanding intravascular fluid volume with isotonic saline |
|
|
Term
|
Definition
| normal renal processes begin to deteriorate, but actual intrinsic renal damage is not yet established |
|
|
Term
|
Definition
| intrinsic renal damage is well established |
|
|
Term
| during what phase is urine volume usually at its lowest during ARF? |
|
Definition
|
|
Term
| how long does the maintenance phase of ARF normally last? |
|
Definition
|
|
Term
during what phase of ARF do complications from uremia arise?
What are some of these complications? |
|
Definition
maintenance phase;
hyperkalemia
infection |
|
|
Term
| the period during which the renal tissue recovers and repairs itself |
|
Definition
|
|
Term
| during which phase of renal failure does a gradual increase in urine output and an improvement in laboratory values occur? |
|
Definition
|
|
Term
| recovery from ARF may take as long as |
|
Definition
|
|
Term
| what medical conditions predispose the patient to acute renal failure |
|
Definition
diabetes mellitus
HTN
immunological diseases
hereditary disorders such as polycystic ovary disease |
|
|
Term
| common nephrotoxic medications |
|
Definition
aminoglycosides
amphotericin B
penicillins
acyclovir
vancomycin
rifampin
cephalosporin
cyclosporin
methotrexate
cisplatin
NSAIDs
ACE inhibitors
ARBs
Interferon
indinavir
ritonavir
adefovir |
|
|
Term
| risk factors for development of aminoglycoside nephrotoxicity |
|
Definition
voume depletion
prolonged use of drug (>10 days)
hypokalemia
sepsis
preexisting renal disase
high trough concentrations
concurrent use of other nephrotoxic drugs
older age |
|
|
Term
| symptoms of acute renal failure due to nephrotoxicity are usually seen |
|
Definition
|
|
Term
| patients with renal failure from prerenal causes may be ______ and ________ as a result of _____ _____ |
|
Definition
hypotensive and tachycardic
volume deficits |
|
|
Term
| ATN, particularly if associated with oliguria, often causes |
|
Definition
|
|
Term
|
Definition
| retention of nitrogenous substances normally excreted by the kidneys |
|
|
Term
|
Definition
| malaise, fatigue, disorientation, drowsiness |
|
|
Term
| A normal creatinine clearance is about |
|
Definition
|
|
Term
| ________ has the dual effect of creating a solute diuresis (increased flow of tubular cellular debris) and augmenting renal blood flow. |
|
Definition
|
|
Term
| In general, maintenance of cardiovascular function and _________ are the two key goals in the prevention of acute tubular necrosis (ATN). |
|
Definition
| adequate intravascular volume |
|
|
Term
| While undergoing his first ever hemodialysis treatment, the patient suddenly becomes confused, complains of a headache, begins to twitch, and proceeds to have a seizure. The nurse realizes that this most likely is due to: |
|
Definition
| cerebral edema;Dialysis disequilibrium syndrome often occurs after the first or second dialysis treatment or in patients who have had sudden large decreases in BUN and creatinine levels as a result of the hemodialysis. An osmotic concentration gradient established in the brain allows fluid to enter until the concentration levels equal those of the extracellular fluid. The extra fluid in the brain tissue creates a state of cerebral edema for the patient, which results in severe headaches, nausea and vomiting, twitching, mental confusion, and occasionally seizures. Hypotension, volume depletion, and low potassium levels can all be complications of dialysis, but would have different symptoms. |
|
|
Term
| Exposure to aminoglycoside antibiotics, such as gentamicin, might result in _____ ______ _______. |
|
Definition
|
|
Term
| Hypovolemia and cardiogenic shock are the contributors to ______ failure. |
|
Definition
|
|
Term
| Oliguria refers to a urine output of less than _____ mL in 24 hours. |
|
Definition
|
|
Term
| _______ ______ _____ ____ is particularly useful for patients in the critical care unit whose cardiovascular status is too unstable to tolerate rapid fluid removal. |
|
Definition
| Continuous renal replacement therapy |
|
|
Term
|
Definition
|
|
Term
| an oliguric patient with weight loss, tachycardia, hypotension, dry mucous membranes, flat neck veins, and poor skin turgor may be |
|
Definition
| volume depleted (prerenal cause) |
|
|
Term
| weight gain, edema, distended neck veins and hypertension in the presence of oliguria suggests an |
|
Definition
|
|
Term
| byproduct of muscle metabolism and is produced at a relatively constant rate, then cleared by the kidneys |
|
Definition
|
|
Term
| when kidney function decreases, creatinine levels |
|
Definition
|
|
Term
| the ____ _____ is not a reliable indicator of renal function because the rate of protein metabolism (urea is a byproduct of protein metabolism) is not constant. |
|
Definition
|
|
Term
| the same ______ ________ ______ can reflect very different GFRs in patients because of differences in muscle mass |
|
Definition
|
|
Term
| normal BUN/creatinine ratio |
|
Definition
|
|
Term
| a _____ BUN/creatinine ratio is present in ATN |
|
Definition
| normal; in ATN, there is actual injury to the renal tubules and a rapid decline in the GFR; hence, urea and creatinine levels both rise proportionately as a result of increased reabsorption and decreased clearance |
|
|
Term
| Steps in 24 hours urine collection |
|
Definition
1 - the patient empties his or her bladder, the exact time is recorded, and the specimen is discarded.
2 - all urin for the next 24 hours is save in a container and stored in a refrigerator.
3 - exactly 24 hours after the start of the procedure, the patient voids again, and the specimen is saved.
4 - the serum creatinine level is assessed at the end of 24 hours
5 - all the urine that was save is sent to the laboratory for testing (urine can also be obtained from an indwelling urinary catheter) |
|
|
Term
| analysis of _____ ______ and __________ ______ is extremely helpful in distinguishing among the various causes of ARF |
|
Definition
| urinary sediment and electrolyte levels |
|
|
Term
| in general, prerenal conditions cause ________ urine |
|
Definition
|
|
Term
| intrinsic azotemia causes _____ urine |
|
Definition
|
|
Term
| invasive diagnostic procedures for assessing the renal system include |
|
Definition
| intravenous pyelography, computed tomography, renal angiography, renal scanning, and renal biopsy |
|
|
Term
| keep ultrafiltration rate less than ______ because decreased cardiac reserve and autonomic dysfunction make ultrafiltration difficult |
|
Definition
|
|
Term
|
Definition
| 0.5 - 1 mL/kg of body weight each hour |
|
|
Term
|
Definition
|
|
Term
| a 1 kg gain in body weight is equal to |
|
Definition
|
|
Term
| _____ ________ ________ should be used with all intravenous lines (central and peripheral), including temporary access devices used for dialysis, is also of extreme importance, both at the time of insertion and during daily maintenance |
|
Definition
|
|
Term
| a peak is drawn __ - ___ hours after the drug is administered and reflects the highest level achieved after the drug has been rapidly distributed and before any substantial elimination has occurred |
|
Definition
|
|
Term
| when is a trough level drawn |
|
Definition
| just before the next dose is given; an indicator of how the body has cleared the drug |
|
|
Term
| where do must burn injuries occur? |
|
Definition
|
|
Term
| who is at greatest risk for burn injuries? why? |
|
Definition
| the extremes of age - young and old; infants have thinner skin; older adults have slower reflexes |
|
|
Term
| children who are burned usually have what type of injury |
|
Definition
|
|
Term
| what type of burn do elderly adults ususally experience |
|
Definition
|
|
Term
| factors influencing the severity of a burn |
|
Definition
extent
depth
age
body parts involved
past medical history
presence of inhalation injury
associated injuries |
|
|
Term
| how do you measure the depth of a burn? |
|
Definition
| 1st, 2nd, 3rd, or 4th degree |
|
|
Term
| why are younger children less able to compensate for burns? |
|
Definition
| their bodies are mostly water |
|
|
Term
| why are older adults less able to compensate for burns |
|
Definition
|
|
Term
|
Definition
face - 9%
anterior chest - 18%
posterior chest - 18%
right arm - 9%
left arm - 9 %
left leg - 18%
right leg - 18%
perineum - 1% |
|
|
Term
| what is the depth of burn injury dependent on? |
|
Definition
| the time exposed to heat source and the intensity of heat exposure |
|
|
Term
| layers of the skin associated with depth of burn |
|
Definition
epidermis - 1st degree
dermis - 2nd
adipose tissue - 3rd
fat, muscle, and bone - 4th |
|
|
Term
|
Definition
| injury to the skin's most superficial layer of skin - epidermis |
|
|
Term
| what are examples of a first degree burn? |
|
Definition
sunburn
microwave burn, heat
hot liquids |
|
|
Term
| how should you treat a first degree burn |
|
Definition
take anti-inflammatory
stay hydrated
aloe |
|
|
Term
| why should a first degree burn subside |
|
Definition
|
|
Term
|
Definition
| blistering of the skin and deeper damage |
|
|
Term
| why should you not pop little blisters due to second degree burns |
|
Definition
| the liquid can be a medium for healing |
|
|
Term
| why should you pop a large blister? |
|
Definition
| to prevent infection - CLEAN the area |
|
|
Term
| when does a 2nd degree burn heal |
|
Definition
| on its own within about 2 weeks; without surgery |
|
|
Term
| what depth of burns won't scar? |
|
Definition
|
|
Term
|
Definition
| damage to all layers of the skin |
|
|
Term
| pathophysiologic effects of burns |
|
Definition
Skin loss – temp control, infection prevention, fluid balance, potentially identity
Major systemic effects
Fluid and electrolyte disturbances
Cardiovascular
Pulmonary
Renal
CNS
GI
Metabolic
Immunologic
Can develop hypovolemic SHOCK |
|
|
Term
| what type of shock can occur due to burns |
|
Definition
|
|
Term
| what is the body's largest organ? |
|
Definition
|
|
Term
| functions of the integumentary system |
|
Definition
- protection
- regulation
- synthesis of vitamin D
- sensation
- identity |
|
|
Term
| What percentage of TBSA is considered a major burn? |
|
Definition
|
|
Term
| fluid and electrolyte disturbance associated with burns |
|
Definition
Cell walls are damaged – fluid can leak out
Increased capillary wall permeability
Fluid shifts
Intravascularly Hypovolemia
Interstitially hypervolemic – look edematous, giving fluid to sustain preload; Ringer’s is the fluid of choice for resuscitation – but it still leaks out; don’t normally develop pulmonary edema
Hemoconcentration – because they are hypovolemic – high blood levels – Hct Hgb
Electrolyte imbalances: hyponatremia (large fluid resusciation) , hyperkalemia (cell damage) – due to cell damage and massive amounts of fluid; watch mental status
Sodium below 120 – mental status changes |
|
|
Term
| hypovolemia associated with burns |
|
Definition
decreased preload
Eb stage - elevated CO, elevated afterload, elevated heartrate - trying to compensate
Flow - decreased CO, decreased pressure - body can no longer compensate
Older patients may not experience Eb phase |
|
|
Term
| what electrolyte imbalance occurs as a result of hypovolemia? |
|
Definition
metabolic acidosis due to decreased perfusion
hyperkalemia |
|
|
Term
| what is the fluid of choice for fluid resuscitation in burn patients? |
|
Definition
|
|
Term
| what is the consensus formula (Parkland formula) |
|
Definition
2-4ml LR x kg x % TBSA
Bolus over 5 min
Most resuscitation fluid goes 200-300 ml/hr
Give half in first 8 hours from time of burn
Remainder given in next 16 hours
Only a guide. Continually assess patient |
|
|
Term
| cardiovascular effects of burns |
|
Definition
Decreased cardiac output
Decreased oxygen delivery
Myocardial depression
COMPENSATORY MECHANISMS ACTIVATED
Burned tissue puts out myocardial depressant factor which further compromises myocardial output – monitor urine output – kidneys getting less perfusion increases chance of renal failure |
|
|
Term
| changes in blood components associated with burns |
|
Definition
High hematocrit
Decreased platelet count – reaction to burn; allergic to silver sulfodiazine (silvadeen) – causes decreased counts
Platelet malfunction because
Dilution of clotting factors with resuscitation fluid
Easier for patients to bleed
Monitor for blood in urine, puncture sites, mucous membranes, sclera
Burn tissue tends to become infected quicker than healthy tissue; prefer not to put IV catheter through, but can do if necessary |
|
|
Term
|
Definition
platelet count should return to normal in 48 hours if due to burn
won't return id due to Siverdeen cream - can't see normal reaction, rash due to burn |
|
|
Term
| pulmonary effects of burns |
|
Definition
carbon monoxide poisoning
Distinguish between:
- upper airway injury - above glottis
- lower airway injury - below glottis |
|
|
Term
| edema occurs up to ___ hours after the burn |
|
Definition
|
|
Term
| lower airway problems associated with burns |
|
Definition
| Lower airway is extremely dangerous – alveoli can’t open for air exchange if burned |
|
|
Term
| pulmonary effects of burns |
|
Definition
Interferes with adequate gas exchange
Carbon monoxide poisoning
- Pulse ox reads 100%
- Carbon monoxide readily binds to Hgb
Suspicion of injury – in enclosed space?
Is patient a smoker? They have a normal level of 15; most peoples are 0
Increased levels can change mental status
Don’t use vent less gas fireplaces |
|
|
Term
|
Definition
Kidney function affected by hypovolemia
Renal tubules can be damaged by hemoglobin and myoglobin in the circulation and in urine; makes urine look like coke
- Treat with fluids and diuretics (no diuretics in first 24 hours)
- May need to add bicarbonate – neutralize urine – hemoglobin and myoglobin have less potential to damage nephrons
Be careful if giving nephrotoxic drugs – ex. gentamycin; draw peak and trough as ordered; pay attention to BUN and creatinine
Late renal failure secondary to nephrotoxic drugs |
|
|
Term
| ruptured muscle cells release |
|
Definition
|
|
Term
|
Definition
Increased carbon or hemoglobin
Head trauma; associated trauma
Hypovolemic
NOT DIRECTLY burn related; unless electrical |
|
|
Term
|
Definition
| All patients greater than 20% burns get NG tube because of risk of ileus |
|
|
Term
| how do burns affect a patient's metabolism? |
|
Definition
| Hypermetabolism - 3xs higher than average; up to 4000 calories/day; tube feeding can be tailored |
|
|
Term
| emergency management of burns |
|
Definition
Stop the burning process
Airway – guard ET tube once placed
Breathing
Circulation – resuscitation fluid; don’t use diuretics, or vasoactive drugs; cut all jewelry and clothing off |
|
|
Term
| What should you assess when assessing the airway of a burn patient? |
|
Definition
Patent?
History of event – burned outside, inside, explosion, smoke, what burned – plastic, carpet, laminate
Signs & Symptoms – breathing, stridor, cough, singed nasal hair
Airway control if inhalation injury suspected
Protect c-spine! Could have fallen, been in accident |
|
|
Term
| emergency management of breathing |
|
Definition
Administer 100% oxygen
Assess respiratory status and ABGs
Assess chest wall compliance
Full thickness circumferential burn on chest causes high pressure alarm goes off on ventilator – escerotomry to release pressure; lactic acid can build up; restores and oxygenation! May bleed if good tissue is involved – pack; not an emergency; develops over time; usually performed while burn dressing team is present; fasciotomy goes into muscles; ASSESS peripheral pulse
On all body parts if circumferential |
|
|
Term
| emergency management of circulation |
|
Definition
Assess HR and B/P
Prevent shock
Avoid hypothermia
Assess for peripheral pulses |
|
|
Term
|
Definition
- provide aseptic environment - initially don't need anything sterile
- cool the wound - no ice; take clothing off; room temperature water-soaked sheets of gauze
- if transferring to burn center, apply dry sterile dressing |
|
|
Term
| Burn center referral guidelines |
|
Definition
- partial-thickness burns >20% (doesn't matter what degree) TBSA or full thickness injury
- burns of face, hands, feet, perineum, or major joins; areas have more risks for complications; may require skilled treatment
- pre-existing medical conditions with any size burn - diabetes, heart failure, chronic lung disease
- presence of inhalation injury or associated trauma
- extremes of age |
|
|
Term
| burn injury survival is influenced by: |
|
Definition
extent
depth
age
sex
presence of inhalation injury
preexisting medical conditions
associate trauma |
|
|
Term
|
Definition
| a physical injury caused by external forces or violence |
|
|
Term
| trauma is a major cause of death and disability for ages |
|
Definition
|
|
Term
| trauma is often associated with |
|
Definition
|
|
Term
| ____ and ________ contribute to a large percentage of trauma incidents |
|
Definition
|
|
Term
|
Definition
| provides an organized approach to trauma care using several components: 911, EMS, flight services, etc. |
|
|
Term
| how many levels of trauma care? |
|
Definition
|
|
Term
|
Definition
- maximum resources for trauma management
- must have immediate access to 24 hr in house general surgeons and multiple other specialties
- most are university-based teaching hospitals and leaders in trauma education and injury prevention |
|
|
Term
|
Definition
- can initiate definitive care for all injuries
- must have a minimum # of 24 hr in house general surgeons and some specialties |
|
|
Term
|
Definition
- provide prompt assessment, resuscitation, emergency surgery, and stabilization of trauma patient until a transfer can be arranged
- must have immediate access to 24 hour in house ER physicians as well as prompt (20-30 min) response of general surgeons and anesthesiologist |
|
|
Term
|
Definition
- able to initiate advanced trauma life support and prepare for immediate transport of the patient to a higher level facility
- must have basic ER and in-house 24 hr lab |
|
|
Term
| are required to have a certain number of surgeons and anesthesiologists on duty at all times, as well as an education program, preventive and outreach programs. The 24-hour coverage of surgery provides trauma patients with many surgical specialties as well, including neurosurgery, radiology, internal medicine, or critical care. In addition to be a teaching hospital, they also possess a research program, as well as being a leader in trauma education. |
|
Definition
|
|
Term
| A Level-2 trauma center usually works with a Level-1 center. Level-2 trauma centers are capable of providing comprehensive trauma care for trauma victims, and also possesses the clinical expertise of a Level-1 institution. Level-2 trauma centers possess all essential specialities, personnel, and equipment 24-hours a day. However, unlike a Level-1 trauma center, these institutions are not required to have a research program or a surgical residency program. As a result, these trauma centers are not teaching hospitals. |
|
Definition
|
|
Term
| A Level-3 trauma center possess the necessary resources for emergency resuscitation, surgery, and intensive care for most trauma victims. A Level-3 trauma center, however, does not have the full availability of medical specialists like the other two level distinctions. They often act as a back-up for Level-1 and Level-2 trauma centers and provide care of very severe injuries. They are often considered community-based or rural hospitals. |
|
Definition
|
|
Term
| In some states, there are Level-4 trauma centers acting as a replacement for Level-3 trauma centers. A Level-4 trauma center provides evaluation, stabilization, diagnostic capabilities, and transfer to high level trauma centers. The operation of any trauma center is extremely expensive, leading to under-served areas. Although trauma centers have a helipad for receiving patients from another hospital, it is important that trauma center coverage is extended to meet the medical needs of all Americans. |
|
Definition
|
|
Term
|
Definition
primary
secondary
tertiary |
|
|
Term
|
Definition
preventing the event/education
- driving safety classes
- campaigns against drinking and driving |
|
|
Term
|
Definition
minimize the impact of trauma
- seat belts
- helmets
- air bags
- car seats |
|
|
Term
|
Definition
maximize outcomes after trauma has occurred
- EMS
- trauma systems |
|
|
Term
|
Definition
emergency medical response (EMS) team
trauma surgeon (team leader)
emergency physician
anesthesiologist
trauma nurse team leader (coordinates and directs nursing care)
trauma team resuscitation nurse (hangs fluids, blood, and medications; assists physicians)
trauma scribe (records all interventions on the trauma flowsheet)
laboratory phlebotomist
radiological technologist
respiratory therapist
social worker/pastoral services
hospital security officer
physician specialists (neurosurgeon, orthopedic surgeon, urological surgeon) |
|
|
Term
|
Definition
similar to a code team
team members are pre-assigned and should fully understand individual role in trauma management
- trauma surgeons, ER physicians, specialties
- nurses
- ancillary services: radiology, lab, respiratory, social work |
|
|
Term
| pre-hospital care and managment |
|
Definition
rapid assessment and treatment of trauma victims is vital!
Treatment focuses on the following:
-establish airway
-provide ventilation
-pressure control of any hemorrhage
-immobilization
-stabilization of fracture
decision to transport via ground or air is made in field |
|
|
Term
|
Definition
essential for determining what level of care is appropriate
often made by pre-hospital personnel |
|
|
Term
| disaster and mass casualty management |
|
Definition
- level 1 centers take the lead in responding and preparing to treat the most severely injured
- hospital disaster plans are initiated |
|
|
Term
|
Definition
| how a traumatic event occurs, injuring agent, information about the type and amount of energy exchanged (kinetic, thermal, etc.) |
|
|
Term
| what are the different mechanisms of injury? |
|
Definition
blunt trauma
penetrating trauma
blast injuries |
|
|
Term
|
Definition
commonly associated with vehicular trauma
- acceleration deceleration injury - ex coup-countercoup injury
falls
sports injuries
severity depends on the amount of energy, body part involved, and the underlying structures
other forms include: shearing, crushing, compression injuries |
|
|
Term
| what does the severity of blunt trauma depend on? |
|
Definition
| the amount of energy exposure, body part involved, and the underlying structures |
|
|
Term
|
Definition
impalement of a foreign object
low-velocity injuries = stab wound
medium to high-velocity injuries = gunshot wound
severity of injury depends on body part involved and on the trajectory of the object
need to monitor for subsequent injuries:
- organ damage
- hemorrhage
- infection |
|
|
Term
| what does the severity of penetrating trauma depend on? |
|
Definition
| the body part involved and the trajectory of the object |
|
|
Term
| possible subsequent injuries after penetrating trauma |
|
Definition
organ damage
hemorrhage
infection |
|
|
Term
|
Definition
combination of blunt (energy) and penetrating (debris) injuries
shock waves can cause multiple injuries: lung contusion, tympanic membrane and organ rupture, intraoccular damage
other injuries may occur from being thrown or objects falling after a blast |
|
|
Term
| common injuries from a shock wave |
|
Definition
lung contusion
tympanic membrane and organ rupture
intraoccular hemorrhage |
|
|
Term
|
Definition
- patient is usually admitted directly to special trauma unit
quick assessment data is obtained
patient stabilized and team develops care plan based on needs
- trauma unit must always be in a state of readiness
- trauma surgeon must be present upon patient arrival, in the OR, and during critical care interventions |
|
|
Term
| initial assessment (trauma) |
|
Definition
| rapid evaluation of airway, ventilation, circulation are key! |
|
|
Term
|
Definition
1-2 min assessment of vital functions - ABCDE
life threatening conditions are identified and managed |
|
|
Term
|
Definition
performed after life-threatening injuries are identified and treated (FGHIs)
this consists of full body exam (head-toe, front-back)
more like a typical assessment
vitals are obtained during this phase
radiological and lab studies are performed
C-spine will remain immobilized until cleared by radiology |
|
|
Term
|
Definition
D - disability
E - expose patient
F - full set of vitals, fiver interventions, facilitate family presence
G - give comfort measures
H - history, head-to-toe assessment
I - inspect posterior surfaces |
|
|
Term
| what are the five interventions |
|
Definition
cardiac monitor
pulse oximetry
urinary catheter
NG tube
laboratory tests |
|
|
Term
|
Definition
Maintain airway patency
maintain effective breathing
maintain effective circulation |
|
|
Term
| what factors may affect the airway? |
|
Definition
facial fractures
bleeding
vomiting
smoke inhalation (after blast injury)
decreased sensorium (LOC) |
|
|
Term
| maintaining airway patency |
|
Definition
may need to insert nasopharyngeal or oropharyngeal (only if unconscious) airway if patient is spontaneously breathing
in patient is not spontaneously breathing - intubate
if you are unable to intubate, prepare for emergency cricothyrotomy
avoid nasal tubes in patients with maxillofacial trauma and basilar skull fractures |
|
|
Term
| maintaining effective breathing |
|
Definition
ongoing assessment is essential - o2 sat, respiratory status, suction secretions
goal is to improve ventilation and gas exchange
- supplemental O2 or mechanical ventilation
- thoracostomy - needle
- administration of fluid and blood products
- administration of sedation and analgesics |
|
|
Term
| causes of impaired gas exchange |
|
Definition
decrease in inspired air
retained secretions
lung collapse or compression
atelectasis
accumulation of blood in the thoracic cavity (hemathorax) |
|
|
Term
| what is the most common cause of hypotension in a trauma patient? |
|
Definition
hypovolemic shock
related to internal or external hemorrhage
requires ongoing assessment of VS, urinary output, mental status, and hemodynamics |
|
|
Term
| maintaining effective circulation |
|
Definition
assess for hypovolemic shock r/t internal or external hemorrahge - hypotension
goal is to stop the cause of hemorrhage and replace lost volume
- obtain venous access - 2 large bore (16-18 guage) needles
- need to consider as a trauma team the benefit of a central line
Administration of crystalloids and blood products
- LR is fluid of choice
- blood administration is based on patients response to initial fluid bolus and labs |
|
|
Term
| increasing serum arterial lactate levels indicate worsening underperfusion secondary to tissue anaerobic metabolism and metabolic acidosis |
|
Definition
| increases morbidity and mortality |
|
|
Term
| complications of massive fluid resuscitation |
|
Definition
acid-base abnormalities
fluid and electrolyte imbalances
hypothermia - cold fluid, fluid shifts
coagulopathies - massive fluid resuscitation and banked blood (high in citrate) can lead to decreased calcium levels which is necessary for coagulation cascade
organ dysfunction
volume overload |
|
|
Term
| exposure and environmental considerations |
|
Definition
standard practice in trauma management is to remove all clothing
trauma and exposure increases risk for hypothermia
- blood and fluid warmers
- keep trauma room warm
- warm blankets and bair hugger |
|
|
Term
| common thoracic injuries due to trauma |
|
Definition
cardiac tamponade
cardiac contusion
aortic disruption
tension pneumothorax
hemothorax
open pneumothorax
pulmonary contusion
rib fractures
flail chest |
|
|
Term
|
Definition
usually the result of penetrating or blunt trauma to the chest
bleeding into pericardial space
increased intrapericardial pressure limits venous return decreasing cardiac output
classic sign is beck's triad
treated with pericardiocentesis |
|
|
Term
| how is cardiac tamponade treated? |
|
Definition
|
|
Term
|
Definition
hypotension
muffled or distant heart sounds
elevated venous pressure -> JVD |
|
|
Term
| what is beck's triad a sign of? |
|
Definition
|
|
Term
|
Definition
most commonly related to blunt trauma to chest
bruising compromises cardiac function
assess carefully for dysrhytmias |
|
|
Term
|
Definition
life-threatening injury requiring emergency surgical intervention
symptoms include: weak femoral pulses, hoarseness, pain, widened mediastinum on chest xray |
|
|
Term
| symptoms of aortic disruption: |
|
Definition
weak femoral pulses
hoarseness
pain
widened mediastinum on chest xray |
|
|
Term
|
Definition
life-threatening emergency
increase intrapleural and intrathoracic pressure cause compression of heart and great vessels
- causes a shift towards unaffected side
- mediastinal shift and distended neck veins
leads to lung colapse
treated with thoracostomy
usually get chest tube after decompression |
|
|
Term
| how is tension pneumothorax treated? |
|
Definition
|
|
Term
| what can tension pneumothorax lead to? |
|
Definition
|
|
Term
|
Definition
blood in pleural space
chest tube is necessary |
|
|
Term
|
Definition
penetrating trauma results in wound that allows air to pass in and out of the pleural space
cover open wound with a 3-sided occlusive dressing - one-way valve, allows a small amount of air to escape, but none in
chest tube insertion is necessary |
|
|
Term
|
Definition
bruising of the lung tissue
associated with rib fractures and flail chest
often results in pneumonia and ARDS
may require long-term ventilator support |
|
|
Term
| what is pulmonary contusion associated with |
|
Definition
| rib fractures and flail chest |
|
|
Term
| what often occurs because of pulmonary contusion |
|
Definition
|
|
Term
|
Definition
seriousness varies
treatmnet depends on seriousness and may need:
- intubation
- pain management
pillow splinting
cough, deep breathe exercises
incentive spirometry
- pneumonia is the most common complication of rib fractures
may result in flail chest |
|
|
Term
| what is the most common complication of rib fractures? |
|
Definition
|
|
Term
|
Definition
2 or more adjacent ribs fracture in more than one location
flail segment "floats" freely
- paradoxical chest movement
- increase WOB
- tachypnea, hypoxemia
treated with intubation and pain management - may need to wire ribs together
assess for and prevent pneumonia |
|
|
Term
| how is flail chest treated? |
|
Definition
| intubation, pain management, possibly wiring ribs together |
|
|
Term
| what are the most common abdominal blunt injuries? |
|
Definition
liver and spleen
** bleeding from these organs is most common cause of death with these injuries |
|
|
Term
| ______ and ______ ________ injuries are most frequently related to penetrating trauma or gunshot wounds |
|
Definition
|
|
Term
|
Definition
many types of fractures are often present in a trauma
rarely take priority in trauma management UNLESS causing significant hemodynamic instability
unstable pelvic and femur fractures can result in lare amounts of blood loss
Assess the 5 ps
pain, pallor, and paresthesia supersede pulses and must be reported immediately |
|
|
Term
|
Definition
pain
pallor
pulses
paresthesia
paralysis |
|
|
Term
| unstable _______ and __________ fractures can result in large amounts of blood loss |
|
Definition
|
|
Term
| treatment for musculoskeletal injuries |
|
Definition
closed or open reduction
- may need traction
fluid and blood product administration
wound care
tetanus prophylaxis
anitbiotics - all trauma wounds are considered contaminated
assess for neurological and or vascular injuries |
|
|
Term
| complications of musculoskeletal injuries |
|
Definition
compartment syndrome
rhabdomyolosis
DVT
fat embolism |
|
|
Term
|
Definition
| breakdown of muscle tissues, does into blood and can cause clots |
|
|
Term
| Every trauma patient has the potential for ___________ obstruction. |
|
Definition
|
|
Term
| Fluid resuscitation is instituted when burns cover ____ to ______ of the body surface area. |
|
Definition
|
|
Term
|
Definition
| any of a group of naturally occurring, chemically related fatty acids that stimulate contractility of the uterine and other smooth muscle and have the ability to lower blood pressure, regulate acid secretion of the stomach, regulate body temperature and platelet aggregation, and control inflammation and vascular permeability; they also affect the action of certain hormones. |
|
|
Term
| Fresh frozen plasma (FFP) is administered to replace |
|
Definition
|
|
Term
| The ______ _______system is the first system to be affected by changes in cellular perfusion. |
|
Definition
|
|
Term
| Elderly patients who are taking selected medications such as ______ ______ have a decreased ability to increase heart rate in the initial phase of shock. |
|
Definition
|
|
Term
| Early goal directed therapy in sepsis includes administration of IV fluid to keep the right atrial pressure (RAP) or central venous pressure (CVP) ≥ ______ mm Hg. |
|
Definition
|
|
Term
| A measure of the overall state of shock, regardless of the cause of inadequate perfusion, is the serum ________ level. |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| founder of modern day nursing |
|
|
Term
|
Definition
| nurse during Civil War; founded Red Cross |
|
|
Term
| twentieth century nursing |
|
Definition
| movement toward a scientific, research-based practice |
|
|
Term
|
Definition
| many changes evolving to meet societal changes |
|
|
Term
|
Definition
| the study of philosophical ideals of right and wrong behavior; study of good conduct, character, and motives |
|
|
Term
|
Definition
| guidelines for safe and compassionate care; principles that are accepted by all members of a profession; a collected statement about the group's expectations and standards of behavior |
|
|
Term
|
Definition
|
|
Term
|
Definition
| taking a positive action to help others; encouraging the urge to do good |
|
|
Term
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| the agreemnet to keep promises |
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| American Nurses Association; a widely accepted CPE nurses attempt to follow |
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| the ability to answe for one's own actions |
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| being reliable and dependable; implies that the person knows right from wrong; a duty to perform actions well and thoughfully |
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| ensuring that information is accessible only to those authorized to have access |
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| (1996) legislation that defines the rights & privileges of clients for privacy protection without diminishing acces to health care |
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autonomy
caregiver
advocate
educator
communicator
manager
career development |
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| standards of professional performance |
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| standards of professional performance |
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| describes a competent level of behavior in the professional role |
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| standards of professional performance |
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| guidelines for nurses to be accountable for their actions, their patients, and their peers |
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| standards of professional performance |
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| assures clients they are receiving high-quality care and that nurses know exactly what is necessary to provide nursing care, and that measures are in place to determine if the standards are met |
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| describe a competent leve of nursing care; levels are demonstrated through the nursing process |
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| characteristics of professionalism |
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punctual
welcomes constructive criticism
recongnizes strengths and weekenesses
dress
communicates effectively
reports absences/tardies
maintains confidentiality
adheres to policies and procedures |
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| a more broad approach, looks at many possibilites |
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| active, organized, cognitive process used to carefully examine one's thinking and the thinking of others |
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| beliefs/conclusions about reality |
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| a process of purposefully thinking back or recalling an incident to discover its meaning |
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| associated with the ability to think meaningully |
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| direct understanding of particulars in a situation without conscious deliberation; sensing something |
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1. basic - trust experts know everything
2. complex - begins to analyze and examine alternatives
3. commitment - anticipates the need to make choices and accept responsibility |
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| 5 steps of the nursing process |
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Definition
1. assessment
2. nursing diagnosis
3. goals
4. intervention
5. evaluation |
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| deliberate and systematic collection of data to determine a client's current and past health status |
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| a clinical judgment about an individual, family, or community responses to actual and/or potential health problems or life processes |
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| what you want to accomplush to assist your patient; taken from the nursing diagnosis |
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| treatments or actions based on clinical judgment and knowledge that a nurse will perform to meet client's outcomes |
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| collaborative interventions |
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| therapies that require multiple health care professionals |
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| the purpose of assessment |
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Definition
| to establish a database concerning the client |
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