Term
|
Definition
Immune mediated inflammatory disease that attacks the axons in the CNS destroying myelin
-results in slow, blocked or loss of transmission of nerve impulses
-more common in women
-temperate climates
-onset between 20-40, peaks at 30
-more common in African Americans |
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Term
|
Definition
| exacerbation with full recovery |
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Term
|
Definition
| progression from onset with no relapse |
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Term
|
Definition
| Begins as relapsing-remitting followed by steady worsening with or with out exacerbation |
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Term
|
Definition
| Progression from onset with exacerbation |
|
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Term
|
Definition
gradual onset, may not be diagnosed immediately
-location of demyelination determine deficit
-may have progressive deterioration or
exacerbation and relapses
-sensory lost
-blurred/double vision
-Fatigue
-stiffness w/ muscle cramps
-Cognitive impairment
-Pain
-heat intolerance
-Mood alteration |
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Term
|
Definition
clinical manifestations are severe and last more than 24 hrs.
-usually separated by at least 1 month |
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Term
|
Definition
| periods of time when manifestations are not obvious |
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Term
|
Definition
R/t MS
-short episodes of symptoms lasting from seconds to minutes often caused by increased temp or serum calcium levels
-S/S: paresthesias (abnormal sensations), dysarthria (decreased ability to articulate speech), Ataxia (inability to move), tonic head turning (involuntary spasm) |
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Term
|
Definition
increased body temp
physical or emotional trauma
fatigue
infection
climate change
immunization
delivery of baby |
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Term
|
Definition
H&P, must have 2 of the following:
-2 or more exacerbations seperated by 1 month lasting more than 24 hrs, with recovery
-HX of repeated exacerbation and remissions for 6+ months
-slowly increasing symptoms for at least 6 months
MRI: most definitive if a lesion is found |
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Term
|
Definition
Purpose: maintain optimal level of function, maintain remission, control exacerbation
Includes physical and occupational therapy
--maintain independence, muscle strength and mange spasms
meds. slow the progression of disease, decrease frequency of attacks and treat symptoms |
|
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Term
| Treating Exacerbation of MS |
|
Definition
Corticosteriods (methylprednisone)-decreases inflammation
Plasma Exchange |
|
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Term
| Disease Modifying Therapy for MS |
|
Definition
(not for secondary progressive)
Interferon beta: Avonex, betaseron, rebif-increase immune effects
Fingolimod: Gilenya
Glatiramer acetate: copaxine - stimulates myelin protein
Mitoxantrone: novantrone
Matalizumb: tysabri- indicated as monotherapy |
|
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Term
| Immunosuppressants for MS |
|
Definition
Azathioprine: Imutran
cyclophophamide: cytoxan
methotrexate (chemodrug) |
|
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Term
|
Definition
| Urecholine-for urinary retention |
|
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Term
|
Definition
| Ditropan-for bladder spasticity |
|
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Term
|
Definition
|
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Term
|
Definition
|
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Term
|
Definition
|
|
Term
|
Definition
-for spasticity/deformities
Intrathecal (baclofen) pump for spasms
Deep brain stimulation for uncontrollable tremors
Jejunostomy tube placement
rhizotomy |
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Term
|
Definition
Degenerative joint disease
affects younger men and older women
Risk factors: age, obesity, hx of repetitive joint stress, sedentary lifestyle, possible genetic factor |
|
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Term
|
Definition
Cartilage soaks up the synovial fluid, joints become dry and rough and painful because they don't have fluid movement
-cartilage is lost and bone is exposed |
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Term
|
Definition
more common than secondary
-affects weight bearing joints: knees, hips, lower back but also neck and fingers
-Obesity and family hx are main factors |
|
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Term
|
Definition
occurs as a result of unknown risk factors like:
trauma
Injury
Inflammation
neurological disorders
congenital deformities
hematologic disorders |
|
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Term
| Symptoms of Osteoarthritis |
|
Definition
pain-typically with movement, relieved with rest
joint stiffness and aching
joint deformities
numbness/tingling
joint enlargement
COOL on palpitation
Limited ROM
grating or crepitus movements
--symptoms are UNILATERAL |
|
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Term
|
Definition
bony enlargements of distal joints, may be painful, redness or swelling
Osteoarthritis |
|
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Term
|
Definition
bony enlargement of proximal joints
Osteoarthritis |
|
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Term
| Diagnosis of Osteoarthritis |
|
Definition
H&P
X-rays
Synovial fluid biopsy |
|
|
Term
| Nonpharmacological TX of Osteoarthritis |
|
Definition
ROM exercises with rest periods
Heat/Ice
Use of Assistive Devices
Weight Loss |
|
|
Term
| Pharmacological TX of Osteoarthritis |
|
Definition
1. Acetaminophen
2. NSAIDS
3. COX-2 Inhibitors: celebrex (possible cardio issues)
4. Trolamine salicylates (aspercreme, topical)
5. Capsaicin (capsin, topical)
6. Intra-articular injections: Hyaluronic acid and steriods for localized, short term use mostly for inflammation
7. Natural Products: glucasamine, chondroitin |
|
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Term
|
Definition
Autoimmune disease; progressive, systemic, inflammatory disease
-destruction of synovial fluid and cartilage
-periods of exacerbation and remission
-most common in wrists, hands, elbows, shoulders, knees and ankles --BILATERALLY
-most common in women |
|
|
Term
| Deformities specific to RA |
|
Definition
Boutonniere deformity:PIP is exteneded, DIP is flexed
Swan Neck: PIP is hyper extended, DIP is flexed
Ulnar deviation
Rheumatoid nodules |
|
|
Term
| Systemic manifestations of RA |
|
Definition
Increased risk for
CVD
Infection
Pulmonary disease
GI bleed
cancer:lung and lymphoma
osteoporosis |
|
|
Term
|
Definition
early morning stiffness
fatigue, weakness, anorexia, low grade fever
pain in joints at rest and with movement
swelling and WARMTH in joints
wrist involvement is UNIVERSAL |
|
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Term
|
Definition
Immune system attacks moisture producing glands
--eyes, mouth |
|
|
Term
|
Definition
In advanced RA
Enlarged Spleen and decreased WBCs |
|
|
Term
|
Definition
nerve damage related to swelling
-skin lesions |
|
|
Term
|
Definition
Bone scans: detect changes in bone
X-Ray: bone erosion, cartilage destruction, subluxation
Synovial Fluid aspiration: increased WBCs, and Rheumatoid factor present |
|
|
Term
|
Definition
NSAIDS, corticosteroids
Disease modifying antirheumatic drugs: (Rheumatrex)chemotherapeutic-interfere with cell growth
Methotrexate: stops disease progression -chemotherapeutic drug
Biological Response Modifiers: inhibit tumor necrosis factor and inflammation |
|
|
Term
| Nonpharmacological TX of RA |
|
Definition
Apheresis: filter plasma to remove antibodies
Surgical Intervention:remove synovial membrane
Alternative therapies |
|
|
Term
|
Definition
| a variety of disorders that influence blood flow to the brain resulting in neurological deficits from ischemia and necrosis |
|
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Term
|
Definition
HTN
CVD
DM
Hyperlipidemia (high cholesterol)
Smoking/Substance abuse
sickle cell disease
Hormone replacement therapy, estrogen, etc.
Obesity
--living in the stroke belt : Southeastern USA |
|
|
Term
| Transient Ischemic Attack |
|
Definition
Warning sign for stroke!(1/3 will have CVA later)
-r/t blockage from microemboli
-Often lasts 1-2 hrs, clears up in 24hrs
S/s depend on location of clot: weakness or numbness of extremity
speech and visual difficulties
confusion |
|
|
Term
|
Definition
result from decreased blood flow related to arterial occlusion
~80% of all strokes
2 subtypes: thrombotic and embolic |
|
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Term
|
Definition
bleeding into brain tissue, subarachnoid space or ventricles
~20% of all strokes
2 Subtypes: Intracerebral and subarachnoid |
|
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Term
|
Definition
ischemic
caused by formation of clot in a large artery that splits
-narrowing of vessel as clot size increases, progressing to occlusion of cerebral vessel
-result of atherosclerosis
ONSET: progressive as clot forms, often during rest/sleep--worsens in 1-2 days
--maximum deficit occurs ~3 days when stroke "completes"
Prognosis: depends on amount of deprived brain tissue and collateral circulation |
|
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Term
|
Definition
Ischemic--2nd most common
-originate in left chambers of the heart where plaque and thrombus break off and occlude smaller vessels
ONSET: very sudden, when awake may have a headache
Prognosis: r/t tissue deprived
-no time for collateral circulation
-increased risk for hemorrhage
--emboli may be absorbed |
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|
Term
|
Definition
Hemorrhagic stroke
-caused by bleeding from rupture of cerebral blood vessels
-more common in elderly
-most often fatal
--Most common cause HTN, also brain tumor, trauma, thrombolytic drugs and rupture aneurysm
Blood in an enclosed area leads to: increased ICP, ischemia, infarction |
|
|
Term
|
Definition
Hemorrhagic stroke
Onset: RAPID, with no warning often during activity
-more common in young people
-S/S: initial HA, N/V, unilateral weakness of extremities, loss of consciousness, seizures
Prognosis: pressure on brain tissue from increased ICP can cause coma and death |
|
|
Term
| Common symptoms of Stroke |
|
Definition
weakness of the face, arm or leg
numbness of one side of the face or body
Visual loss
Speech deficit
Sudden severe headache
Balance difficulties |
|
|
Term
| Sensoriperceptional Complications of Stroke |
|
Definition
Deficits in:
visual
hearing
smell
balance
taste
proprioception
perception of vibration, warmth, cold, pressure
Improper perception of self spatially--neglect affected side |
|
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Term
|
Definition
loss of 1/2 of visual field in one or both eyes
(homonymous hemianopia is same for both eyes) |
|
|
Term
|
Definition
| inability to recognize familiar subjects |
|
|
Term
|
Definition
| Inability to perform motor pattern with sufficient strength |
|
|
Term
| Cognitive/behavioral complications of Stroke |
|
Definition
Emotional: exaggerated, unpredictable emotions
laugh/cry inappropriately
loss of self control
decreased stress tolerance
Intellectual:
memory loss
decreased attention span
poor judgement |
|
|
Term
|
Definition
more cautious
more problems with memory/language/speech |
|
|
Term
|
Definition
more impulsive
move quickly |
|
|
Term
| Communication disorders R/t Stroke |
|
Definition
| Impaired motor function, speech, language, memory, reasoning, emotion |
|
|
Term
|
Definition
| paralysis of 1/2 the body |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| increased muscle tone, w/ some weakness |
|
|
Term
| Diagnostic study of Stroke |
|
Definition
H&P
NIH stroke scale
Serial CT scan
MRI |
|
|
Term
|
Definition
| Drug therapy: low dose aspirin, anticoagulants (coumadin), Platelet inhibitors (plavix) |
|
|
Term
| Surgical Intervention for Stroke |
|
Definition
Carotid endarterectomy: removes plaque on vessels occluded 70-99%
Carotid angioplasty: balloon opens stenosed arteries (risk for emboli)
Artery Bipass |
|
|
Term
|
Definition
Stroke Recognition
F: face, ask pt. to smile, does one side droop?
A: arms, raise both arms, does one drift downward?
S: speech, ask person to repeat a simple sentence, do they slur their words or have trouble repeating
T: time, if the pt. shows any of these symptoms time is very important |
|
|
Term
| Acute Care of Stroke pts. |
|
Definition
maintain airway: artificial airway, vent., pulse ox
monitor neuro status frequently
Interrupt ischemic cascade: decrease blood viscosity to promote blood flow to the area
-tPA: tissue plasminogen activator, dissolves clots within 3 hrs of formation
--MUST be done within 3 hrs of onset of symptoms
maintain fluid.electrolyte balance
Surgery
Rehabilitation: 12-24 hrs. physical, emotional, occupational therapy |
|
|
Term
| Symptoms of Dysphagia/Aspiration |
|
Definition
coughing during meals
hoarse voice after meals
gurgling sounds in throat
drooling
upper respiratory infection
pneumonia |
|
|
Term
| Symptoms of aspiration Pneumonia |
|
Definition
elevated Resp. Rate
fever, cough, chills
Pleuritic chest pain
Crackles
Delirium,increased confusion or falls |
|
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Term
|
Definition
single episode of uncontrolled electrical discharge of neurons in the brain the interrupts normal function
-more common in very young and very old, genetic link |
|
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Term
|
Definition
spontaneously recurring seizures that interrupt normal function and is a chronic underlying problem
2 or more seizures |
|
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Term
|
Definition
| imbalance of excitability of neurons with out proper inhibition--exceeds seizure threshold |
|
|
Term
|
Definition
repetitive electrical charge from epileptic focus causes permanent changes in neuron excitability
(seizures bring on more seizures)
neurons become more sensitive
--need consistent medication |
|
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Term
|
Definition
| Begin in a specific hemisphere |
|
|
Term
|
Definition
remains conscious, lasts less than one minute
-Affects depend on area of the brain affected: often recurrent muscle contractions of face, opposite hand or finger
-jacksonian march: muscle twitching that moves up the body
May have abnormal sensation or hallucination
-Deja vu, fear, anger
-tachycardia, flushed, hypotension/hypertension |
|
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Term
|
Definition
lasts greater than 1 minute, impaired consciousness
-may engage in repetitive, nonpurposeful activity
-may have an aura
-often experience post-ictal confusion and amnesia |
|
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Term
|
Definition
| repetitive, nonpurposeful behaviors |
|
|
Term
| Absence seizures (petit mal) |
|
Definition
most common in children
-brief loss of consciousness
-staring spell (5-10 seconds), unresponsive, cessation of normal motor function
-may have automatisms too
-can occur several hundred times a day if untreated |
|
|
Term
|
Definition
affects the entire brain at onset of the seizure
-ALWAYS have loss of consciousness (seconds to minutes)
Tonic/Clonic (Grand Mal): may experience cyanosis, incontinence, slaivation, bite cheeck/tongue
--Risk for Injury
lasts 60-90 seconds |
|
|
Term
| Tonic/Clonic Seizure Phases |
|
Definition
Tonic phase: sudden loss of consciousness, falls to ground, rigid/extended muscles and jerking, apneic, pupils fixed, lasts 15 seconds.
Clonic phase: stiff and relax, hyperventilation, foam at the mouth
Post-ictal phase: fatigued, relaxed, may sleep for several hours, head ache, no memory of seizure |
|
|
Term
|
Definition
sense of uneasiness
abnormal smell--possibly burning rubber
abnormal vision--blurry, halos, bright light
abnormal sound or sensation |
|
|
Term
|
Definition
Seizures occurring in rapid succession
-Short periods of calm
-seizures are intense and persistent
-muscle contractions interfere with respiration
-can cause permanent brain damage
Tonic/Clonic status epilepticus is most dangerous: can cause hyperthermia, hypoglycemia, hypoxemia, arrythmias, systemic acidosis
--CAN be FATAL, Call 911 |
|
|
Term
| Immediate Intervention for Status Epilepticus |
|
Definition
Establish/maintain airway
Ativan or Valium IVP
50% dextrose IV
Start Dilantin
-time seizure |
|
|
Term
| Complications of seizures |
|
Definition
physical injury: trauma, head injury, burns, drowning, MVA
psychosocial: embarrassment, discrimination, transportation |
|
|
Term
| Diagnostic Study of Seizures |
|
Definition
History and description of seizure
-EEG
CBC
Liver/kidney effects
Blood glucose-rule out metabolic issue
CT/MRI-rule out brain lesion
Lumbar puncture-rule out CNS infection |
|
|
Term
| Pharmacological TX of Seizures |
|
Definition
can be controlled NOT cured by medications
-Dilantin
-Ativan
-Lamictal
--watch for resp. depression with IVP
may do trial with drawl if seizure free for 3 years
work by stabilizing nerve cell membranes and decreasing the spread of epileptic discharge |
|
|
Term
|
Definition
-Resection of epieltogenic tissue (focal point) if drug therapy is ineffective-may reduce or halt seizures
Vagal nerve Stimulation: may reduce the number and intensity of seizures in some pts. |
|
|
Term
|
Definition
Don't usually require emergency care unless it is the first seizure or STATUS epilepticus
Priority: maintain airway, turn on side if able, stay with pt., record data pertaining to seizure (time), prevent client injury |
|
|
Term
|
Definition
any break in the continuity of the bone
closed: skin remains intact
open (compound): skin integrity is interrupted |
|
|
Term
| Classification of Fractures |
|
Definition
Oblique: at an angle to the bone
Spiral: curves around the bone
Avulsed: pulls bone and tissue away from point of attachement
compressed: bone is crushed
impacted: broken bone ends are forced into each other
depressed: broken bone is forced inward |
|
|
Term
|
Definition
Inflammatory phase
Reparative phase
Remodeling phase |
|
|
Term
| Inflammatory phase of Fracture Healing |
|
Definition
bleeding and inflammation that develop at the site of the fracture
-lymphocites and monocytes wall of the area of injury |
|
|
Term
| Reparative phase of Fracture Healing |
|
Definition
Calcium is deposited and a callus forms
Osteoblasts promote the formation of new bone |
|
|
Term
| Remodeling Phase of Fracture Healing |
|
Definition
| Excessive calcium is removed and new bone is laid down along the fracture line |
|
|
Term
| Risks associated with Falls/Fractures |
|
Definition
Lower extremity weakness
Hx of falls
Gait problems
Use of Assistive device
Visual Impairment
taking 4+ meds or and anticonvulsant/benzodiazapine
Dementia/Cognitive impairment
Osteoporosis
Fear of Falling |
|
|
Term
| Common Hip fracture sites? |
|
Definition
femoral neck fracture--intracapsular (most common)
Intertrochanteric Fracture--extracapsular |
|
|
Term
| Symptoms of Extracapsular Hip Fracture |
|
Definition
severe pain in the groin and hip-increases with movement, muscle spasm
Affected hip may be externally rotated and shortened |
|
|
Term
| Symptoms of Intracapsular Hip Fracture |
|
Definition
Moderate discomfort
may have movement
May or may not be able to bear weight
May not be shortened or rotated |
|
|
Term
| Hip Replacement Postop Precautions |
|
Definition
-most not allow internal rotation: use abduction pillow between legs
-Do not allow hip to flex >90 degrees
-Do not cross legs
-Do not put on own socks/shoes for up to 8 weeks |
|
|
Term
| Complications of Fractures |
|
Definition
Fat Embolism Syndrome: confusion, resp. distress, petichiae rash on the chest
Compartment Syndrome
Infection |
|
|
Term
|
Definition
large amounts of pressure in a limited space causes vessels to be constricted-affects BVs and neurons
r/t trauma, infiltration of IV, burns, tight casts
TX fasciotomy-open skin to relieve pressure |
|
|
Term
| 5 P's of Compartment Syndrome |
|
Definition
Pain (early)
Paresthesia (early)
Pallor (late)
Pulselessness (late)
Paralysis (irreversible damage) |
|
|
Term
|
Definition
metabolic disease:
osteoclasts break down bone faster than osteoblasts can deposit more
--porous bones |
|
|
Term
| Risk Factors R/t Osteoporosis |
|
Definition
W>M
Aging
small thin body type
sedentary lifestyle
excessive alcohol
smoking
low calcium
medications: aluminum containing antacids, anticonvulsants, PPIs, heparin, corticosteriods |
|
|
Term
| Conditions Associated with Osteoporosis |
|
Definition
Endocrine (DM)
Renal failure
Rheumatoid arthritis
Advanced alcoholism
Liver cirrhosis
Chronic eating disorder |
|
|
Term
|
Definition
"silent disease"
Loss of height
dorsal kyphosis and cervical lordosis (curving of the spine--hunch back/Dowager's hump)
fractures/pain associated with fractures |
|
|
Term
| Prevention of Osteoporosis |
|
Definition
begin as children!
weight bearing and resistance exercise
Avoid Alcohol, caffeine, tobacco
increase calcium and vitamin D in youth
Bone density scans |
|
|
Term
| Pharmacological TX of Osteoporosis |
|
Definition
Antiresorptive Therapies-inhibit bone resorption
-Estrogen replacement therapy
2. Biphosphonates-potent inhibitors of bone resorption and increase bone density in vertebrae and hip
-Fosamax
-Actonel
-Prolia
Selective Estrogen Replacement Modulators: Evista, Tamofen
Calcitonin: hormone used with calcium supplement
Anabolic therapy: stimulates bone growth |
|
|
Term
|
Definition
Application of pulling force to an injured or diseased part of the body
-reduce, realign and promote healing of fracture bone
-decreases muscle spasm and pain
-immobilization
-corrects/prevents deformity
-rests joint |
|
|
Term
|
Definition
tx: hip fracture or femoral fracture
pulley system doubles applied weight
--examine pts. position |
|
|
Term
|
Definition
Pulling force applied directly through pins inserted into the bone
-allows more weight to be applied
-risk for infection |
|
|
Term
| Glycemic Goals for Diabetics |
|
Definition
Before meals: 90-130
After meals: <180
A1C: <7% |
|
|
Term
| Diabetic Ketoacidosis (DKA) |
|
Definition
Type 1 DM--insulin deficiency leads to
acidosis and ketosis
hyperglycemia
dehydration
electrolyte imbalance |
|
|
Term
|
Definition
increased caloric intake
inadequate insulin dosage
physical/emotional stress
surgery, infection, illness
undiagnosed type 1 diabetes |
|
|
Term
|
Definition
BG >300
Dehydration:
polyuria initially
dry skin/mucous membranes
sunken eyes
tachycardia
Hypotension
Thirst
Hypovolemic shock
electrolyte imbalance
renal failure
coma, death
Ketosis: ketones in blood and urein
breath has sweet, fruity odor
Metabolic Acidosis: N/V, restlessness, confusion, lethargy
Kussmauls Respirations |
|
|
Term
|
Definition
Insulin
Fluids:
first .9%NS
second: 45%NS
third: Dextrose
Potassium Replacement: prevent cardiac dysrhythmias |
|
|
Term
| Hyperosmolar Hyperglycemic State (HHS) |
|
Definition
type 2 DM (non insulin dependent)
severe hyperglycemia
elevated plasma osmolarity
osmotic diuresis
severe fluid depletion/dehydration |
|
|
Term
|
Definition
hyperglycemia causes fluid to move from intracellular to extracellular spaces to dilute blood
cells become dehydrated leading to neurologic abnormalities and Altered LOC |
|
|
Term
|
Definition
Infection--most common
Acute illness- burns, stroke, MI, GI bleed, UTI, pancreatitis
Chronic Illness- renal or cardiac disease, hx of stroke
Therapeutic agents: diuretics, glucocorticoids
Therapeutic procedures: dialysis, surgery |
|
|
Term
|
Definition
extreme hyperglycemia >600
increased plasma osmolarity
dry, parched mouth, extreme thirst, altered LOC, warm dry skin with out sweating
Sever dehydration- leading to neuro issues like seizure, hyperthermiea, positive Babinski's somnolence, coma, hypotension and shock
No Acidosis or Ketones |
|
|
Term
|
Definition
Fluid and electrolyte replacement
0.9NS then 0.45NS then Dextrose
--need more fluids than DKA
-insulin is not administered until fluid replacement has begun--first bolus then continuous IV |
|
|
Term
| Sick Day management for DM pts. |
|
Definition
Continue Insulin/antidiabetic meds as prescribed
more frequent glucose testing, report >300
encourage fluids and food, report N/V/D |
|
|
Term
|
Definition
| excessive thyroid hormone (T3 and T4) not enough TSH |
|
|
Term
|
Definition
| Autoimmune disease- antibodies attach to TSH receptors on the thyroid gland which stimulate excess release of T3 and T4 |
|
|
Term
| Symptoms of Hyperthyroidism |
|
Definition
Heat intolerance
Excessive sweating, warm, most skin
Increased appetite with weight loss
thin sparse hair
fine hand tremors
hyperactivity: tachycardia
shortened attention span
diarrhea
Exophathalmos: bug eyes
Dermopathy (like an orange peel)
Goiter |
|
|
Term
| Diagnosis of Hyperthyroidism |
|
Definition
H&P
Thyroid antibodies (TA)
T3 uptake test
Thyroid suppression test
radioactive iodine test |
|
|
Term
|
Definition
Propylthioruil (PTU)
Methimazole (tapazole)
Radioactive Iodine
Thyroidectomy |
|
|
Term
|
Definition
| Tachycardia, increased systolic BP, N/V/D, abd. pain, restlessness, delirium, seizures, confusion, hyperthermia, psychosis, coma, fever |
|
|
Term
|
Definition
| Too little T3 and T4, too much TSH |
|
|
Term
|
Definition
-occurs often long standing untreated hypothyroidism
puffiness
periorbital edema
masklike look
-can lead to severe metabolic disorders, hypothermia, cardiovascular collapse, impaired cognition, coma |
|
|
Term
| Diagnosis of Hypothyroidism |
|
Definition
H&P
Serum blood levels of T3, T4 and TSH
Thyroid Radioactive uptake
Thyroid antibodies |
|
|
Term
|
Definition
lifelong medication
-synthroid |
|
|
Term
| Symptoms of Hypothyroidism |
|
Definition
| dry brittle hair, puffy face, goiter, slow HR, cold intolerance, dry skin, fatigue, heavy menstrual period, weight gain, constipation |
|
|
Term
|
Definition
Can be Acute or Chronic
-inflammation of the renal pelvis and parenchyma
-caused by infection of lower urinary tract that ascends to the kidneys
--can lead to sepsis |
|
|
Term
|
Definition
Scarring of tubules leads to recurrent infections that cause one or both kidneys to shrink and lose function
--can lead to end stage renal disease |
|
|
Term
| Symptoms of Pyelonephritis |
|
Definition
--rapid onset
Malaise
Fever-often >101
Chills
N/V
Flank pain/CVA tenderness
symptoms of UTI
bacteria, blood, WBC in urine |
|
|
Term
| Symptoms of Chronic Pyelonephritis |
|
Definition
| Urinary frequency, dysuria, nocturia, intermittent fever, back and flank barriers |
|
|
Term
| Diagnostic Tests for Pyelonephritis |
|
Definition
UA and C&S
Blood Cultures
Ultrasound Kidneys |
|
|
Term
| Treatment of Pyelonephritis |
|
Definition
Mild symptoms: oral antibiotics for 10-14 days
Severe symptoms (complicated by dehydration, fever, N/V): inpatient with IVPB antibiotics for several days and the orals for 2-3 weeks
-based on C&S |
|
|
Term
| Polycystic Kidney Disease (PKD) |
|
Definition
Genetic kidney disorder
-Adult and Child onset |
|
|
Term
|
Definition
Autosomal Recessive
-present at birth
-may be diagnosed prenatally or in infancy
-rare
-progresses rapidly, often requires transplant |
|
|
Term
|
Definition
Autosomal Dominant
-common
-symptoms arise by age 40-50
-occurs in both men and women |
|
|
Term
|
Definition
Fluid filled cysts form- affect kidney function and eventually other body parts
-cysts enlarge and so do kidneys (cause compression/damage to vessels and nephrons) |
|
|
Term
|
Definition
| Increased risk of Diverticular disease, subarachnoid hemorrhage, heart valve abnormality |
|
|
Term
|
Definition
Abd/flank pain
hematuria
proteinuria
polyurea/nocturia
Bilateral kidney enlargement (palpable)
HTN
UTI & Renal calculi
-progresses to ESRD |
|
|
Term
| Diagnosis/Prognosis of PKD |
|
Definition
Family Hx
Ultrasound
Intravenous pyelogram (IVP)
CT Scan
-50% will progress to ESRD by age 60 |
|
|
Term
|
Definition
Prevent damage from meds, uti, obstruction, HTN
Early: encourage fluids, later restriction
Renal diet: low sodium, low potassium, restricted protein
Can drain cysts
Dialysis/transplant |
|
|
Term
|
Definition
|
|
Term
| Symptoms of Urinary Calculi |
|
Definition
Pain (abdominal and flank)
Renal Colic-acute, severe flank pain that radiates
hematuria
Dysuria
N/V
Fever, chills (if UTI is present)
Mild shock |
|
|
Term
| Diagnosis of Urinary Calculi |
|
Definition
UA/C&S/pH
Stone Analysis
24hr.Urine
Serum Ca+
KUB
Ultrasound
CT scan
IVP
Cystoscopy
BUN/Creat. |
|
|
Term
|
Definition
Inflammation of the Liver
-most commonly caused by a virus
-can be acute or chronic |
|
|
Term
| Incubation period of Hepatitis |
|
Definition
| No signs, virus replicates |
|
|
Term
| Prodromal/Preicteric Phase of Hepatitis |
|
Definition
(1-21 days pre-jaundice)
-malaise, fatigue
-anorexia and weight loss
-GI symptoms: N/V, diarrhea or constipation
Muscle/body aches, flu-like symptoms
Mild RUQ pain |
|
|
Term
| Icteric Phase of Hepatitis |
|
Definition
Begins 5-10 days after onset of symptoms
-Jaundice
-Pruritis: itching
-light brown/clay colored stool
-brown urine |
|
|
Term
| Convalescent Phase of Hepatitis |
|
Definition
lasts several weeks post-jaundice (resolution)
-energy increases
-pain subsides, GI s/s minimal |
|
|
Term
| Hepatitis A Route/Source/Infectivity |
|
Definition
Fecal/Oral
poor hygiene/sanitation
Infectivity: up to 2 weeks before and 1 week after
No carrier-typically benign/self limiting |
|
|
Term
| Hepatitis B Route/Source/Infectivity |
|
Definition
Blood/body fluids
-needles, sex, tattoos, piercings, etc.
Infectivity: before/after ~4-6 months, carrier for life
--increased risk of developing liver CANCER! |
|
|
Term
| Hepatitis C Route/Source/Infectivity |
|
Definition
Blood/Body fluids
needles, blood transfusions
Infectivity: 1-2 weeks before/after, carrier for life
--Primary cause of chronic hepatitis, cirrhosis, liver cancer |
|
|
Term
| Hepatitis E Route/Source/Infectivity |
|
Definition
Recal/Oral
-contaminated drinking water
Infectivity: unknown, similar to to HAV |
|
|
Term
|
Definition
Rapid onset
-rare clinical syndrome resulting from severe impairment or necrosis of liver cells and liver failure
--Caused by HBV with HDV
rapidly progresses to liver failure- within 2-3 weeks |
|
|
Term
|
Definition
Immune response against the liver
-causes chronic inflammation, necrosis, fibrosis, scarring
-often with other autoimmune disorder
--can lead to cirrhosis, liver failure |
|
|
Term
| Vaccine Options for Hepatitis |
|
Definition
Hep A: 2 doses recommended
Hep A and B: TWINRX 3 injection series
Hep B: 3 Injection series-most effective |
|
|
Term
| Postexposure TX for Hepatitis |
|
Definition
Immunoglobin for HAV
HBIG for HBV
Interferon Alpha
Ribavirin |
|
|
Term
|
Definition
Diagnostic/Exploratory
Curative
Palliative
Cosmetic Improvement
Preventative |
|
|
Term
| When does preoperative care begin? |
|
Definition
| When patient realizes the need for surgery and determines they will indeed have the surgery |
|
|
Term
| Details of the Informed Consent |
|
Definition
Can only reiterate what the surgeon says.
Pt. should be alert and aware of what is being signed. |
|
|
Term
| Who makes up the surgical team? |
|
Definition
| Anesthesiologist, surgeon, circulating nurse, scrub nurse |
|
|
Term
|
Definition
| lack or normal pain sensation |
|
|
Term
|
Definition
| the absences of awareness of stimuli and events |
|
|
Term
|
Definition
| partial or complete loss of sensation with or with out loss of consciousness |
|
|
Term
|
Definition
Balanced Technique
-begin with IVP of barbituates-pleasant sleep
-inhalation of gas
-continue with adjuncts
(opiods narcotics, benzodiazapines, neuromuscular blocking agents) |
|
|
Term
|
Definition
Used in OR
-combination of medications to achieve depressed LOC
-patient retains airway reflex and responds to verbal or physical stimulation |
|
|
Term
|
Definition
Block's patient's sensory and motor function by interrupting nerve impulses
-pt. remains fully conscious |
|
|
Term
| Methods of Local Anesthesia |
|
Definition
Topical
Regional
Spinal & Epidural |
|
|
Term
| Side Effects of Spinal and Epidural |
|
Definition
| hypotension, bradycardia, nausea, vomiting, tingling in hands, numbness above site, respiratory depression |
|
|
Term
|
Definition
| increased CO2, muscle contractions, hyperthermia, hypoxia, arrhythmias, cardiovascular changes |
|
|
Term
| Immediate Assessments Post-Op |
|
Definition
| Airway, breathing, circulation, neurologic, LOC, ability to follow commands, Urine output, Surgical Site, BG of diabetic patients |
|
|
Term
|
Definition
lack of blood flow to the vital organs r/t low fluid volume
s/s: pallor, low BP, High HR |
|
|
Term
| Nursing Interventions for Hemorrhaging |
|
Definition
Apply pressure to area with gloved hand
Reinforce surgical dressing
-DO NOT remove the first surgical dressing |
|
|
Term
|
Definition
| DVT that traveled to the lungs |
|
|
Term
|
Definition
| Surgery, immobility, fracture, heart failure, chronic AFib, obesity, advanced age, oral contraceptive use, estrogen therapy. |
|
|
Term
| Clinical Manifestations of PE |
|
Definition
Subjective: anxiety, feeling of impending doom, pressure in chest, pain on inspiration, dyspnea, air hunger
Objective: pleurisy, tachycardia, hypotension, tachypnea, crackles and cough, diaphoresis, decreased O2 Sat. Petechiae, pleural effusion. |
|
|
Term
|
Definition
| Pulmonary Hypertension, pulmonary infarction (tissue death), Cor Pulmonary (hypertrophty of right ventricle) |
|
|
Term
|
Definition
Ventilation Perfusion Scan-checks circulation and gas distribution
D-dimer blood test
Coagulation and ABG's
Angiography
CXR, EKG |
|
|
Term
|
Definition
Morphine Sulfate-pain and anxiety
Vasopressors-shock (dopamine)
Digitalis & Diuretics - heart failure
Heparin/Coumadin
Fibrinolytic Therapy like tPA |
|
|
Term
| Surgical Treatment for PE |
|
Definition
Pulmonary Emboletomy- for large clots
Insertion of Filter -for prevention of further PE, CVA, etc. |
|
|
Term
|
Definition
Small cell carcinoma (25%, fast growth and spread)
Non-small cell carcinoma:
- Adenocarcinoma
- Squamous cell carcinoma
- Large Cell carcinoma |
|
|
Term
|
Definition
| Chronic Cough, hemoptysis, wheezing, SOB, dull chest pain, weight loss, anorexia, fatigue, weakness, paraneoplastic syndrome (hormones released the affect endocrine and autoimmune systems) |
|
|
Term
|
Definition
| CXR, sputum analysis, bronchoscopy with biopsy, CT, CBC, LFTs, electrolytes, PPD, PFTs, ABGs |
|
|
Term
|
Definition
Combo: particularly effective of small-cell
Surgery: non-small cell, 30% chance of cure
Radiation: may be used to treat vena cava syndrome
Bronchodilators
Analgesia and pain meds
CAM |
|
|
Term
| Primary Risk Factors R/t Breast Cancer |
|
Definition
Female, >50
prior breast cancer, atypical hyperplasia, carcinoma
1rst degree relatives with breast cancer
BRCA1 and BRCA2 mutation |
|
|
Term
| Secondary Risk Factors R/t Breast Cnacer |
|
Definition
Post menopausal obesity
early menarche or late menopause
1rst full term pregnancy >30 y.o.
Chest radiation <35 y.o.
Benign breast disease
hormone replacement
more than 2+ alcoholic beverages/day |
|
|
Term
| Noninvasive Breast Cancer |
|
Definition
Cancer in Situ= localized cancer
Ductal carcinoma= tends to be unilateral, may progress if untreated, most commmon
Lobular carcinoma in situ (LCIS)= premalignant lesion, often do not require treatment |
|
|
Term
|
Definition
Persistent lesion of nipple and areola with or without palpable mass.
s/s: itching, burning, nipple discharge with superficial erosion, ulceration
TX: simple or modified mastectomy |
|
|
Term
| Inflammatory Breast Cancer |
|
Definition
Most malignant, most rare
Aggressive and fast growing
Skin is rippled, warm and has thickened appearance
-inflammatory changes caused by cancer cells blocking lymph channels
-metastasis occur early and widely
-radiation, chemo, hormone therapy |
|
|
Term
| Diagnosis of Breast Cancer |
|
Definition
| Biopsy, Sentinel lymph node dissection (where it is likely to go next), axillary lymph node status, estrogen and progesterone receptor status, DNA content analysis, Her2 status, cell proliferation indices, CXR, CT of abd., Liver US, Bone scan |
|
|
Term
| Breast Conservation Therapy |
|
Definition
Lumpectomy
Partial Mastectomy |
|
|
Term
|
Definition
Total (simple) mastectomy
Modified radical mastectomy
Radical mastectomy |
|
|
Term
|
Definition
results from excision or radiation of lymph nodes, fluid causes obstructive pressure
S/S: swelling, heaviness, pain, impaired motor function, numbness/paresthesia of fingers |
|
|
Term
|
Definition
Frequent and sustained elevation of arms
Performing arm exercises
Avoid constricting clothes
Custom fitted pressure sleeve |
|
|
Term
| Breast Conservation Surgery |
|
Definition
Removal or entire tumor along with margin of normal tissue
-radiation delivered to entire breast following surgery
-Preserves breast including nipple
-considered standard treatment for early stages |
|
|
Term
| Modified Radical Mastectomy |
|
Definition
Removal of breast and most axillary lymph nodes
-preserves pectoralis major
-selected in tumor is too large to excise with good margins
-patient has option for reconstruction |
|
|
Term
| Postmastectomy pain syndrome |
|
Definition
chest and upper arm pain, phantom breast pain, tingling down the arm, numbness, shooting or pricking pain, unbearable itch.
TX: NSAIDS, antidepressants, topical lidocaine patches, EMLA, antiseizure meds. |
|
|
Term
|
Definition
Primary treatment to destroy or as companion to surgery
-shrink tumor
-palliative treatment to pain from local metastases recurrence. |
|
|
Term
|
Definition
-can decrease the size of the primary tumor
Suppresses tumor growth and prolongs survival
-often a combination of medications
-often for premenopausal women |
|
|
Term
|
Definition
Often for postmenopausalwomen
-blocks or destroys estrogen receptors
-EX: tamoxifen: reduces recurrence by 50% but carries the risk of uterine cancer
-Femara: reduces recurrence after surgery |
|
|
Term
| Biological therapy for Breast Cancer |
|
Definition
| for Her2+ tumors with mets -attempts to stimulate the body's natural defenses and attack cancer cells -trastuzmab :monoclonal antibody MAb to Her-2 antigen -maybe given in combination to increase survival time Side effects: cardiomyopathy, anaphylaxis, dyspnea, neutropenia exacerbation |
|
|
Term
|
Definition
3rd most common cancer diagnosed.
-most often from adenocarcinoma
tumors spread through the walls of the intestines or through the lymphatic or circulatory systems.
metastasis to lymph nodes is common. |
|
|
Term
| Clinical Manifestations of Colorectal cancer |
|
Definition
not specific and may not be noticeable until cancer has advanced. (5-15 years)
-early: change in bowel habits, rectal bleeding that leads to anemia.
-advanced: pain, anorexia, weight loss, palpable abdominal or rectal mass. |
|
|
Term
|
Definition
Diet: high it fruits and veggies, low in saturated fats, avoid red meats.
Exercise
Healthy Weight
Limit Alcohol
No smoking |
|
|
Term
| Diagnoses of Colorectal cancer |
|
Definition
| Family Hx., physical, sigmoidoscopy, colonoscopy, digital rectal exam, CXR, CT, MRI,US, CBC, CEA |
|
|
Term
| Stage 1 Colorectal Cancer |
|
Definition
tumor invaded submucosa or muscle
no metastasis |
|
|
Term
| Stage 2 Colorectal Cancer |
|
Definition
| Tumor through mucosa, perforates, not metastasis |
|
|
Term
| Stage 3 Colorectal Cancer |
|
Definition
| Any tumor invasion, 1-3 regional metastasis |
|
|
Term
| Stage 4 Colorectal Cancer |
|
Definition
| any tumor invasion, regional metastasis, distant metastasis |
|
|
Term
| Treatment of Colorectal Cancer |
|
Definition
Endoscopic polpectomy
Laser photocoagulation
Surgical therapy: hemicolectomy, resection, colostomy
Radiation, chemotherapy (5FU, Leucovorin, Camptosar) |
|
|
Term
|
Definition
| Permanent loss of blood flow to the myocardium resulting in cell death (irreversible damage) |
|
|
Term
|
Definition
| secondary channels used after a portion of the vessels are occluded |
|
|
Term
|
Definition
labeling is based on location
Location corresponds with the coronary artery.
-anterior wall MI= Left anterior descending coronary artery (LAD)
-Inferior wall MI: right coronary artery |
|
|
Term
|
Definition
| decrease in myocardial oxygen supply or increased oxygen demand, reversible, no permanent damage |
|
|
Term
| Clinical manifestations of MI |
|
Definition
angina: immobolizing, more intense, continuous, long lasting.
No change related to rest, nitrate or position change
heaviness, pressure, tightness, burning
Levine's sign: fist to chest
fatigue, SOB, indigestion, weakness, drenching perspiration, back pain |
|
|
Term
|
Definition
P= What precipates the pain? exertion? resting?
Q= quality of the discomfort, sharp, tightness, etc.
R= does pain radiate to te jaw, arm, back, etc.
S= severity (pain scale)
T= timing of onset of the current episodes and previous episodes |
|
|
Term
| Physical Assessment with MI |
|
Definition
Vitals: initially rapid HR and high BP but decreases causing hypotension and bradycardia, tachypnea, SOB, fever
BG: elevated
Skin:cool, pallor, clammy
Resp: crackles
Heart: distant hear sounds, develop. S3 or S4
GI: nausea, vomiting
Neuro: fatigue, dizziness, light-headed |
|
|
Term
|
Definition
Clinical hx of ischemia, ECG, Serum Cardiac Markers
(must have 2/3 for World health organization)
elevated cardiac enzymes |
|
|
Term
| Serum Cardiac Markers: Troponin T and I |
|
Definition
Troponin T (<.2 normal) and Troponin I (<3.1 normal)
-proteins released from the cardiac muscles due to necrosis , elevated 2-4 hrs. after MI, peak at 24 to 36 hrs.
-measured at time of admission and for 3 days following |
|
|
Term
| Serum Cardiac Markers: Ck and Ck-MB |
|
Definition
CK: Creatine Kinase-found in cardiac and skeletal muscles, elevated after MI for 4-6 hrs. peak 12-24, duratioin 48-72
CK-MB myocardial bands
-most sensative test for MI, present at 4-8 hrs, peak 18-24 hrs, duration 72 hrs. |
|
|
Term
| Serum Cardiac Markers: Myoglobin |
|
Definition
first to be elevated, non-specific tissue (found in cardiac and skeletal muscle)
elevated within 1-3 hrs, peaks at 12hrs, duration 24 hrs. |
|
|
Term
|
Definition
| nitroglycerin, beta-adrenergic blockers, anti-coagulant, antiplatelet, morphine, ACE inhibitor, Antidysrhthmia |
|
|
Term
|
Definition
| Arrythmia, CHF, Cardiogenic shock, papillary muscle disfunction, pericarditis, dressler syndrome |
|
|
Term
|
Definition
| Cardiac Catheterization, balloon angioplasty, stent implantation, atherctomy |
|
|
Term
|
Definition
focal deposits of cholesterol and lipids within the intimal wall of the artery
-lipids are entrapped in the endothelium and then calcify, platelets and adhere and clots form
-slow, progressive disease |
|
|
Term
|
Definition
coronary arteries are unable to dilate to meet increaed metabolic needs because they are already dilated beyond the obstructed area.
-ischemia occurs at >70-75%
reversible if <30 minutes |
|
|
Term
| Risk factors associated with CAD |
|
Definition
nonmodifiable: age, gender, genetics, race (more common in AA)
Modifiable: hypertension, DM, central obesity, smoking/second hand smoke, physical inactivity, elevated homocysteine levels, premature menopause, diet high in trans, saturated fat and triglycerides. |
|
|
Term
|
Definition
| CAD may lead to decreased O2 supply which leads to ischemia, which leads to anaerobic metabolism that produces lactic acid and causes chest pain. |
|
|
Term
|
Definition
pressure, pain, heavy sensation, suffocating, choking, does not change with position, or deep breath.
-also: indigestion, burning sensation, SOB, anxiety, cold sweat, weakness, paresthesis |
|
|
Term
|
Definition
| indigestion, nausea, vomiting, upper back pain, dyspnea, pallor, tachycardia, anxiety, fear |
|
|
Term
|
Definition
| does not occur with regular activity |
|
|
Term
|
Definition
| may occur with rapid or prolonged walking or stair climbing |
|
|
Term
|
Definition
| Significantly limits ordinary physical activity |
|
|
Term
|
Definition
| may have pain at rest along with during any physical activity |
|
|
Term
| Treatment of Stable Angina |
|
Definition
Nitrates, Calcium Channel Blockers, Beta Adrenergic Blockers
-goal is to decrease o2 demand and increase o2 supply |
|
|
Term
|
Definition
decrease heart work and O2 demand
-dilation
-decreased blood return to the heart
-decreases cardiac output
-decreases work load of the heart
-decreases o2 demand |
|
|
Term
|
Definition
blocks beta receptors on heart cells
-decreases HR and contractility
-decreased oxygen demand and blood pressure
*not for Asthma or COPD |
|
|
Term
|
Definition
block calcium ions to the heart
-decrease O2 consumption by relaxing arterial smooth muscle
-decreases BP and HR
-provides more O2 by dilating coronary arteries |
|
|
Term
|
Definition
may be a new onset or progression from stable to unstable.--EMERGENCY!
progressive and preinfarction in nature**
unpredictable, change in pattern of angina, increased frequency, easily provoked, lasts >10 minutes |
|
|
Term
|
Definition
| STAT ASA (chewable), Nitroglycerin (IV), beta blockers (IV) Heparin (IV), morphine (IVP) |
|
|
Term
|
Definition
occurs at rest, in response to spasm
-rare, not precipated by physical exertion
-triggered by smoking, demand for histamine, epinephrine, norepiniphrine, prostaglandins. |
|
|
Term
|
Definition
| Occurs while lying down, relieved by sitting up. |
|
|
Term
| Purpose of Blood Component Therapy |
|
Definition
Increase H&H:carry oxygen to cells, replace loss during active bleeding
Increase Intravascular volume
Replace deficiencies: Platelets, clotting factors |
|
|
Term
|
Definition
Used in hemorrhage or shock
-repalces volume and components (RBCs, plasma proteins, clotting factors, palsma)
-Large risk for incompatibility, overload, blood-born pathogens |
|
|
Term
|
Definition
Used for severe or symptomatic anemia-specifically boosts H&H
-usually if hemoglobin is <8.0
-1 unit should increase Hgb by 1g/dl in a 70kg adult
-no clotting factors
-Risk for Blood born pathogens |
|
|
Term
|
Definition
Used for thrombocytopenia and continued hemorrhage
-one unit (30-60 ml) raises it 30k-50k
NO compatibility testing needed, but do NEED Rh factor
--Risk of blood born pathogens |
|
|
Term
|
Definition
Restores clotting factor and plasma protein
-Need cross matching but not Rh- should be ABO compatible
-One unit = 200-250 mls
Thawed in water bath
--Risk for blood born pathogens |
|
|
Term
|
Definition
Hypovolemic shock and trauma, hypoalbuminemia (ascites, 3rd spacing)
-Moves water from extravascular to intravascular space
-5% to 25% solution
--risk of hypersensitivity and blood born pathogens |
|
|
Term
|
Definition
Replacement of clotting factors VIII and fibrinogen
-Rh compatibility not needed
-10-20mls/bag
Contains hemagglutinins
Risk of hemolysis |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| universal recipient--A, B, AB, O |
|
|
Term
|
Definition
|
|
Term
|
Definition
Presence of D antigen
--Should not be exposed to Rh+ blood
May cause severe hemolytic reaction |
|
|
Term
| Administration Procedure for Blood Products |
|
Definition
-Physicians order
-discuss religious/cultural beliefs about transfusion
-patient consent
-Type and Crossmatch
-Blood band on patient
-18 gauge or larger IV access
-Special Y-tubing and filter
--only with normal saline, blood can not be on the floor for more than 20 minutes
-Must have 2 RN's
-Invert bag
-Establish baseline vitals
-remain with pt for first 15 minutes
-Take vitals q15 minutes for first hr., maximum infusion time=4hrs. |
|
|
Term
|
Definition
Most common reaction to blood
-symptoms may often occur in the first 15 min. or delayed
s/s: chills, fever, headache, muscle pain
-WBC incompatibility
-often occurs with hx of multiple transfusions: need filter, washed cells, antipyretic |
|
|
Term
| Allergy/Hypersensitivity Reactions |
|
Definition
Sensitivity to blood donor's plasma proteins
-may be mild or anaphylactic
s/s: wheezing, reddened wheal on skin, itching, dyspnea, edema, shock, anaphylaxis
-occur during or after transfusion
TX: antihistamines for prevention, epinephrine and/or steroids for severe reaction |
|
|
Term
|
Definition
Caused by infusion of incompatible blood
-clotting RBCs may cause organ damage
-Free Hgb may block renal tubules causing renal failure
-Often after 100-200mls of incompatible blood
s/s: initial burning along IV site, flushing face, chills, fever, SOB, lower back pain, chest pain, tachycardia, hypotension, dark urine, jaundice
TX: prevention by careful checking of id to blood
-obtain specimens
-treat shock, maintain urine output (possible foley)
-need new type and crossmatch prior to next transfusion |
|
|
Term
|
Definition
Identify patients at risk
s/s: crackles, SOB, JVD
transfuse slowly
lasix may be fiven between units |
|
|
Term
| Massive Transfusion Reaction |
|
Definition
Caused by infusing large volumes of blood too quickly
--imbalance blood factors (clotting factor, albumin, platelets not in RBCs)
-hypothermia, hyperkalemia, citrate toxicity causing hypocalcemia
--monitor electrolytes and use blood warmers |
|
|
Term
| Delayed Transfusion Reactions |
|
Definition
Infections:
Hepatitis B and C
Human herpes virus type 6
HIV
HTLV-1
CMV
Malaria
West Nile Virus |
|
|
Term
| Slow or Stopped Transfusion |
|
Definition
Check bag height, check flow clamp
-make sure blood covers filters
-gently rock bag to agitate cells
-squeeze tubing or flash bulb
-untape dressing and check site
-dilute w 50-100cc normal saline |
|
|
Term
|
Definition
Autologous donor
-pt. may donate their own blood prior to surgery, may be frozen
-good for rare blood types, reaction and disease may be avoided
AUTOTRANSFUSION
-collection device used to collect, filter and return blood lost in surgery or trauma
-clots may occur and prevent re-transfusion
-may lack coagulation factors |
|
|
Term
|
Definition
An out pouching or dilation of the arterial wall, frequently involving the aorta
-most are found in the abd. aorta below the renal arteries
but may also occur in the thoracic or popliteal or femoral artery
-occurs more in men |
|
|
Term
| Risk factors for Aortic Aneurysm |
|
Definition
Risk increases with age, >65 y.o.
-smoking
-Atherosclerosis & arteriolsclerosis
-HTN
-Trauma
-Marfan syndrom: changes the structure of BVs |
|
|
Term
|
Definition
Affects all the layers of the vessel wall
-Fusiform: uniform in shape (symmetrical dilation, regular shape)
-Circumferential: all the way around the diameter |
|
|
Term
|
Definition
Trauma causes a disruption of all the layers of the arterial wall leading to a contained bleed
Saccular: out pouching of the vessel wall
Berry: congenital, often happens in the brain |
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Term
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Definition
Aneurysm that has a break causing blood to leak out
--LIFE threatening emergency |
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Term
| Symptoms of Aortic Aneurysm |
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Definition
Symptoms develop slowly and aneurysm may rupture without warning
Common ones: thoracic, abdominal, femoral, popliteal |
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Term
| Abdominal Aneurysm Symptoms |
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Definition
| pulsating mass, midabdominal or lumbar back pain, cool, cyanotic extremities, claudication |
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Term
| Thoracic Aneurysm Symptoms |
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Definition
| back, neck, chest pain, dyspnea, hoarseness, dysphagia, edema of the face and neck, JVD |
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Term
| Popliteal and Femoral Aneurysms Symptoms |
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Definition
| Intermittent claudication, pain at rest, numbness, pulsative mass in popliteal fossa |
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Term
| Symptoms of Dissecting Aneurysm |
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Definition
Extremely sudden, excruciating pain (tearing or ripping sensation
syncope (pass out)
dyspnea
BP increases then drops out |
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Term
| Complications of Aneurysm |
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Definition
Rupture: most common (mortality 50%), pt. may bleed to death, need emergency surgery, massive bleeding into abd cavity or retroperitoneal space
-weakness, paralysis
-ischemia/infarction of major organs
-aortic regurgitation |
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Term
| Diagnostic Tests for Aneurysm |
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Definition
Often in physical exam or Chest X-ray done for other conditions
-CT scan most accurate test to determine the size
ABD, femoral, extremity US
EKG
Angiography- assess involvement of other vessels
Transesophogeal echo (TEE) |
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Term
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Definition
Prevent rupture!
-assess size, location and surgical risk
-Keep BP under control: long term beta blockers, nipride, calcium channel blockers
Constant VS and UO monitoring |
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Term
| Surgical Repair of Aneurysm |
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Definition
Only if: >5cm, growing rapidly, pt. is symptomatic
Endovascular stent graft: metal sheath with fabric covering placed through femoral artery, shorter hospital stay, lower cost, fewer complications
Open Sugery: remove aneurysm, insert synthetic fabric graft, requires about 6 day hospital stay, 8 week rehab
--need long term anticoagulant therapy |
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Term
| Disseminated Intravascular Coagulation |
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Definition
DIC: a serious bleeding disorder including both clotting and bleeding
-always caused by an underlying condition
-Can be mild to life threatening
-Can affect one organ or can be widespread and eventually cause multiple organ failure |
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Term
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Definition
Tissue damage or toxins activates clotting cascade
-excessive thrombin cause accelerated clotting
-thrombi and emboli cause ischemia and necrosis
-decrease in clotting factor and platelets
-clots break down
-leads to uncontrollable bleeding |
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Term
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Definition
Trauma
Sepsis
OB complication
Cancer
Fat Embolism
Aortic Aneurysm
Acute glomerulonephritis |
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Term
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Definition
Bleeding: oozing or bleeding from incisions and punctures sites
-bruising, purpura, petichea
-GI bleeding
-hemoptysis
-tachycardia, hypotension
-hematuria, renal failure
-increased ICP
Clotting
-cyanosis or extremities
-dyspnea, tachypnea
-Mental status change |
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Term
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Definition
clotting tests are prolonged (PT, PTT)
raw materials used for clotting are decreased
Fibrin degradation products are elevated, D-dimer elevated
CBC and Platelets |
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Term
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Definition
Diagnose quickly, resolve underlying problem
-blood products (platelets, FFP)
-Anticoagulant therapy
-symptomatic treatment |
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Term
| Top Nursing Priorities for DIC patients |
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Definition
1. Ineffective tissue perfusion r/t decreased blood flow: assess extremities, cap refill, pulses
-do not elevate legs, minimize invasive procedures
2. Impaired gas exchange r/t clots: O2 sat. monitoring, bed rest in high fowlers
3. Pain r/t ischemia: handle gently, cool compresses
4. Fear r/t uncertain prognosis
-maintain calm environment, respond promptly to calls |
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