Term
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Definition
| A national organization that offers peer evaluation for accreditation every 3 years for all types of U.S. health care agencies that meet their standards. |
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Term
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Definition
| Save lives and decease the risk for harm by providing care to patients before a respiratory or cardiac arrest occurs. |
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Term
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Definition
| physician who specializes in critical care |
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Term
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Definition
| Family practitioner or internist employed by the hospital |
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Term
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Definition
| the medical-surgical nurse recognizes "the patient or designee as the source of control and full parter in providing compassionate and coordinated care based on respect for the patient's preferences, values, and needs" |
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Term
| self-determination/self-management |
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Definition
| patients are treated as autonomous individuals capable of making informed decisions about their care |
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Term
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Definition
| emphasizes the importance of preventing harm and ensuring the patient's well-being. |
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Term
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Definition
| refers to equality; that all patients should be treated equally and fairly. |
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Term
| three essential ethical principles: |
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Definition
1. self-determination
2. beneficience
3. social justice |
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Term
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Definition
| Entails planning, implementing, and evaluating patient care together using an interdisciplinary plan of care. |
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Term
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Definition
| process is to provide quality and cost-effective services and resources to achieve positive patient outcomes. in collaboration with the nurse, the CM coordinates inpatient and community-based care before discharge from a hospital or facility. |
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Term
| What is SBAR and what does SBAR stand for? |
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Definition
SBAR is a formal method of communication between two members of the healthcare team.
Situation: describe what is happening at the time to require this communication.
Background: explain any relevant background information that relates to the situation.
Assessment: provide an analysis of the problem or patient need based on assessment data.
Recommendations: state what is needed or what the desired outcome is. |
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Term
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Definition
| requires a broad knowledge base to meet the needs of adult patients in a variety of settings across the continuum. |
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Term
6 Core competencies for health care professionals: |
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Definition
1. patient-centered practice
2. teamwork and collaboration
3. evidence-based practice
4. quality improvement
5. informatics
6. safety |
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Term
| The steps of EBP Practice |
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Definition
1. Asking "burning" clinical questions
2. Finding the very best evidence to try to answer those questions
3. critically appraising and synthesizing the relevant evidence
4. making recommendations for practice improvement
5. implementing accepted recommendations
6. evaluating outcomes |
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Term
| What does PICO(T) stand for? |
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Definition
Population=the specific group of patients to whom the question applies
Intervention=pertains to the therapeutic effectiveness of a new treatment and may include 1)exposure to disease/harm 2)prognostic factor 3)risk behavior/factor
Comparison=may be either the standard or current treatment or may be another intervention with which the innovative practice is compared.
Outcome=the measurable and desired outcomes of your practice,innovation, diagnosis, or prevention intervention
(Time = added on when appropriate) |
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Term
| Reavy and Tavernier Model |
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Definition
| Reavy and Tavernier developed a model and process to implement EBP that uses concepts from previously developed models |
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Term
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Definition
The Advancing Research and Clinical Practice through Close Collaboration model of EBP- main components:
1.organizational assessment & readiness to implement EBP
2.Idenfication of strengths and barries to EBP implementation
3. Development and use of EBP mentors
4. Measurement of nurse, system, and patient outcomes |
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Term
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Definition
When making changes based on findings from the literature, use PDSA cycles to test the changes on a small scale.
Plan= first step in introducing a practice change
Do= the action-oriented phase of the process
Study= refers to the review and analysis of data collected during the "do" phase of the cycle
Analysis= analysis and evaluation of results from the small test to guide decisions about how to proceed.
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Term
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Definition
| addresses the relationship between a person's beliefs and behaviors |
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Term
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Definition
| the person's ideas, convictions, and attitudes about health and illness |
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Term
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Definition
Describes the multidimensional nature of people as they interact within their environment to pursue health.
This model focuses on 3 areas:
1. individual charachteristics and experiences
2. behavior-specific cognitions and affect
3. behavioral outcomes |
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Term
| moslow's hierachy of needs |
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Definition
Highest - lowest:
self actualization
self esteem
love and belonging needs
safety and security
physiological
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Term
| Internal variables that influence health beliefs and practices: (4) |
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Definition
1. developmental stage
2. intellectual background
3. emotional factors
4. spiritual factors
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Term
External variables that influence health beliefs and practices:
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Definition
1. Family practices
2. socioeconomic factors
3. cultural background |
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Term
| active strategies of health promotion |
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Definition
when individuals adopt specific programs
ex/ weight reduction and smoking cessation programs |
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Term
| passive strategies of health promotion |
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Definition
individuals gain from the activities of others without acting themselves
ex/ the city puts fluoride in the municipal drinking water or milk manufacturers fortify homogenized milk with vitamin D |
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Term
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Definition
| it precedes disease or dysfunction and applies to patients considered physically and emotionally healthy. |
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Term
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Definition
| focuses on people who are experiencing health problems or illnesses and who are at risk for developing complications or worsening conditions. |
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Term
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Definition
| occurs when a defect or disability is permanent, irreversible, and stabilized. |
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Term
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Definition
| based on judicial decisions or case law precedent |
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Term
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Definition
| rules codified by legislative bodies of government |
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Term
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Definition
| crime that while injurious, does not inflict serious harm |
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Term
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Definition
| a serious offense that results in significant harm to another person or to society in general |
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Term
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Definition
| civil wrongful acts or omissions against a person or person's property that are compensated by awarding monetary damage to the individual whose rights have been violated |
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Term
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Definition
| the failure to use that degree of care that a reasonable nurse would use under the same or similar circumstances. |
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Term
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Definition
preventable errors
ex/ may include falls, UTIs, pressure ulcers |
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Term
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Definition
| refers to the fundamental agreement to do no harm. |
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Term
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Definition
| defines actions as right or wrong based on "right-making charachteristics" like truth and jsutic |
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Term
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Definition
| a professional nurse's approach to identifying, diagnosing, and treating human responses to health and illness |
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Term
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Definition
| includes information about a patient's physical and developemental status, emotional health, social practices and resources, goals, values, lifestyle, and expectations about the health care system. |
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Term
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Definition
| prompts patients to describe a situation in MORE than one or two words. |
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Term
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Definition
| is the practice of giving positive comments such as "all right", "go on", or "uh-huh" to the speaker. |
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Term
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Definition
| a clinical judgement about individual, family, or community responses to actual and potential health problems or life processes. |
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Term
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Definition
| the identification of a disease condition based on an evaluation of physical signs, symptoms, history, and diagnostic tests and procedures. |
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Term
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Definition
| involves setting priorities, identifying patient-centered goals and expected outcomes, and prescribing nursing interventions |
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Term
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Definition
| the performance of nursing interventions necessary for achieving the goals and expected outcomes of nursing care. |
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Term
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Definition
crucial to deciding whether, after interventions have been delivered, a patient's condition or well-being improves |
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Term
| The process for an EB question or practice: |
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Definition
|
¡Step 1: Formulating a well-built question
§“Burning” question
§PICO format
¡Step 2: Identifying articles and other evidence-based resources that answer the question (lit review)
¡Step 3: Critically appraising the evidence to assess its validity
¡Step 4: Applying the evidence
¡Step 5: Re-evaluating the application of evidence and areas for improvement
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Term
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Definition
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•Limitation on freedom or autonomy for the individual’s “own good”.
•In healthcare, treating a person or persons without their consent, usually citing diminished capacity (either permanent or temporary)
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Term
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Definition
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•Ethical justification for actions that have both helpful and harmful aspects.
•Argues that even though consequences may be the same (example, death of a patient), the intent can make the action ethically acceptable (murder vs terminal sedation)
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Term
| C.O.D.E - The key to taking action in a dilemma: |
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Definition
|
•Courage: Determine if moral courage is needed to address the situation.
•Obligation to honor: Take a time out to reflect on ethical obligations.
•Danger management: Use cognitive approaches to handle your fear (deep breathing)
•Expression: Express your beliefs and take action through assertiveness.
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Term
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Definition
- Definite onset
- Cause usually known
- Short duration, self-limiting related to injury/illness
- Decreases as healing progresses
- Sympathetic response usually present
- Focus of treatment is on cause |
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Term
|
Definition
- Duration of at least one month longer than usual course or pain or healing of injury
- Cause may not be known
- Pathologic: serves no purpose, not a symptom, a condition in itself
- Little sympathetic response
- May have acute exacerbations |
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Term
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Definition
When gate (in spinal cord) is closed, pain is blocked
Stimuli other than pain pass through the same gate
Physiologic reason why nonpharmacologic pain interventions can work |
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Term
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Definition
| Pain receptors, sensory nerves that detect mechanical, thermal or chemical stimuli above an activation threshold |
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Term
| 4 processes of nociception |
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Definition
Transduction
Transmission
Perception
Modulation |
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Term
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Definition
Result of damage to nerves, spinal cord, or brain
Pain may have been originally related to an injury which affected nerves
Can persist for months or years |
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Term
| Types of neuropathic pain |
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Definition
Somatic: from the skin
Visceral: from the organs |
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Term
| Associated symptoms of neuropathic pain |
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Definition
Allodynia: pain from non-painful stimulus
Hyperalgesia: increased sensitivity to normally painful stimuli |
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Term
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Definition
| May help prevent post-herpetic neuralgia |
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Term
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Definition
Systemic type of neuropathic pain
- Diabetic neuropathy
- Alcohol-nutritional neuropathy
- HIV neuropathy |
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Term
|
Definition
Local type of neuropathic pain
- Nerve root compression
- Trigeminal neuralgia |
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Term
Consequences of Unrelieved Pain
Endocrine |
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Definition
- Sympathetic nervous system hyperstimulation
- Glucose intolerance, insulin resistance and hyperglycemia |
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Term
Consequences of Unrelieved Pain
Cardiac |
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Definition
- Increased HR, BP, cardiac workload, O2 demand, risk of myocardial infarction
- Hypercoagulability |
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Term
Consequences of Unrelieved Pain
Respiratory |
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Definition
- Decreased respiratory function
- Complications: pneumonia, atelectasis, PE |
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Term
Consequences of Unrelieved Pain
GI |
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Definition
- Delayed gastric emptying
- Decreased motility
- Ileus
- Nausea
- Anorexia and weight loss |
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Term
Consequences of Unrelieved Pain
Musculoskeletal |
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Definition
- Impaired muscle function
- Decreased mobility
- Decreased ability to ambulate
- Diminished short and long-term recovery and rehab |
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Term
Consequences of Unrelieved Pain
Cognitive |
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Definition
- Mental status changes
- Delirium
- Sleep and behavior disturbances
- Depression
- Anxiety
- Anhedonia |
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Term
Consequences of Unrelieved Pain
Personal |
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Definition
- Inability to perform ADLs
- Impaired relationships
- Impaired intimacy
- Social isolation
- Anger
- Loss of self-esteem
- Economic stress |
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Term
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Definition
- Pain is extremely common in the elderly
- Frequently multifactorial
- At increased risk of adverse drug events and drug interactions
- Frequently undertreated |
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Term
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Definition
Onset
Palliative measures
Quality
Radiation
Severity
Treatment |
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Term
| Reasons patient might not report pain |
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Definition
- Fear of diagnostic testing
- Fear of medications
- Fear meaning of pain
- Perceive physicians and nurses to be too busy
- Complaining may affect quality of care
- Believe nothing can or will be done |
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Term
| PCA (Patient-Controlled Analgesia) |
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Definition
| Opioid meds delivered via IV controlled by patient |
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Term
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Definition
- Maintains more constant level of pain relief
- Decrease patient anxiety by giving patient control
- Eliminates need for repeated injections |
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Term
| TENS: electrical counterstimulation |
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Definition
- Skin stimulation by mild electrical current passing through external electrodes
- Useful in managing postop pain, reducing pain from post op procedures |
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Term
|
Definition
Chronic relapsing condition characterized by
- Psychological dependence
- Compulsive drug-seeking
- Use of drugs despite harm
- Long-lasting chemical changes in the brain |
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Term
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Definition
| The need to increase a drug to achieve the same effect |
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Term
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Definition
| Development of a withdrawal syndrome when a drug is suddenly discontinued |
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Term
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Definition
Patient is seeking medication and seeming like they're addicted but really their pain is just not being managed
Symptoms go away when pain is managed properly |
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Term
| What are the 4 subgroups of aging? |
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Definition
Young old: 65-74
Middle old: 75-84
Old Old: 85-90
Elite Old: >100 |
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Term
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Definition
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Term
|
Definition
| Branch of medicine dealing with health and the care of old people |
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Term
|
Definition
| illness caused by by medical treatment |
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Term
| What are neurological changes related to aging? |
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Definition
*Impaired sensory intake (ex: poor vision, poor hearing)
*Slower reactions and responses
*Physical illness causes delirium
*Impaired thermoregulation
*Diminished balance and coordination |
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Term
| What are the Nursing Implications for neurological changes in aging? |
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Definition
*Identify baseline status
*Allow more time to process info
*Allow more time for physical activities, ADLs
*Assess confusion
*Does pt. have glasses, hearing aids, etc? |
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Term
| What are the cardiovascular changes related to aging? |
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Definition
*Arterial wall sclerosis (HTN)
* Sclerosis of heart valves (heart murmur)
* Ventricular and atrial hypertrophy (results in decreased coronary artery blood flow (supply) but increased cardiac workload (demand))
* Baroreceptors less sensitive
* More likely to have vague symptoms with CAD |
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Term
| What are the Nursing Implications for cardiovascular changes in aging? |
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Definition
*Have pt. change position in stages to avoid abrupt changes in BP
*Assess complaints centered in chest, and have high suspicion for vague systemic complaints
*Avoid extreme temperatures
*Encourage healthy lifestyle choices |
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Term
| What are the pulmonary changes related to aging? |
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Definition
*Stiffer chest wall and lungs
*Lower resp muscle strength, pulmonary reserve
*Less effective inhalation and exhalation
*Raised risk of infection and airway obstruction
*lowered awareness of hypoxia and hypercapnea |
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Term
| What are the Nursing Implications for pulmonary changes in aging? |
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Definition
*Monitor mental status
*Keep pt. hydrated
*Encourage activity, deep breathing & coughing
*Aggressive pulmonary toilet for at-risk pt
*Oxygen therapy, bronchodilators |
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Term
| What are the renal changes associated with aging? |
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Definition
*Kidney mass, glomerular filtration rate decrease by 10% each decade after 30 yrs
* Impaired ability to dilute/concentrate urine
* More susceptible to nephrotoxic drugs |
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Term
| What are the bladder changes associated with aging? |
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Definition
*Decreased bladder tone & capacity
*Increased post-void residual/difficulty emptying bladder
*Prostate enlargement
*Increased frequency |
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Term
| What labs should be monitored for renal/bladder implications for aging? |
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Definition
*Blood urea nitrogen (BUN), creatinine, Creatinine Clearance
*Monitor for renally cleared drugs
*Monitor I/O for fluid balance |
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Term
| What are oropharyngeal changes related to aging? |
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Definition
*May have poor dentition or ill-fitting dentures
*Decreased taste
*Increased difficulty chewing & increased risk of aspiration |
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Term
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Definition
| Drawing of foreign substance, such as gastric contents, into respiratory tract during inhalation |
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Term
| What are the stomach changes related to aging? |
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Definition
*Decreased gastic motility
*Atrophy of protective mucosa, increased risk of acid reflux, ulcers, hiatal hernia
*Increased risk of malnutrition |
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Term
| What are the liver changes related to aging? |
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Definition
*Reduced size and blood flow
*Reduced drug clearance
*Reduced capacity to regenerate cells |
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Term
| What are the intestinal changes related to aging? |
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Definition
| *Decreased motility, digestive enzymes secretion, defecation sensation |
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Term
| True or False: Constipation in the aging is to be expected. |
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Definition
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Term
| True or False: Incontinence in the aging is to be expected. |
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Definition
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Term
| What are the Nursing Implications for GI changes in the elderly? |
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Definition
*Monitor nutritional status and labs
*Monitor for fluid balance
*Education re: nutrition, bowel health, alcohol |
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Term
| What are the MSK changes related to aging? |
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Definition
*Decreased muscle mass, replaced by body fat
*Decreased bone density, increased joint degeneration
*Height reduction |
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Term
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Definition
| Extreme curvature of the upper back (AKA "dowager's hump") |
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Term
| What are nursing interventions for the changes in the MSK system related to aging? |
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Definition
*Teach safety tips to prevent falls, reinforce need to exercise
*Prevent pressure on bone prominences
*Teach proper body mechanics |
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Term
| What are the Integumentary changes related to aging? |
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Definition
*Thickness & elasticity of skin decreased r/t decreased elastin and collagen
*Less SQ fat
*Inability of skin to retain moisture
*More vulnerable to damage, slower to heal |
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Term
| What is Fried's Phenotype for Frailty? |
|
Definition
A screening tool in which 3 or more of the following equals frailty:
1. Shrinking
2. Exhausting
3. Strength
4. Slowness
5. Low Physical Activity |
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Term
| Geriatric Failure to Thrive |
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Definition
| Complex syndrome including under-nutrition, impaired physical functioning, depression, and cognitive impairment |
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Term
| Relocation Stress Syndrome |
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Definition
| Physical and emotional distress that occurs after the person moves from one setting to another |
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Term
|
Definition
|
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Term
|
Definition
| Farsightedness that worsens with aging |
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Term
| Geriatric Depression Scale--Short Form (GDS-SF) |
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Definition
| Valid and reliable screening tool available in multiple languages in which the patient selects "yes" or "no" to 15 questions. Score of 10 or greater is consistent with possible diagnosis of clinical depression |
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Term
|
Definition
| broad term used for a syndrome that involves a slowly progressive cognitive decline, sometimes referred to as chronic confusion |
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Term
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Definition
|
|
Term
| What are the 4 types of delirium? |
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Definition
1. Hyperactive
2. Hypoactive
3. Mixed
4. Unclassifiable |
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Term
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Definition
| The Beers Criteria for Potentially Inappropriate Medication Use in Older Adults is an assessment tool useful in screening for medication-related risks in older adults with chronic health problems |
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Term
|
Definition
Identifies 6 serious "marker conditions" that can lead to longer hospital stays, higher med costs, and deaths:
*Sleep disorders
*Problems with eating or feeding
*Incontinence
*Confusion
*Evidence of falls
*Skin breakdown |
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Term
| Lawton's Instrumental Activities of Daily Living (IADL) |
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Definition
| Scale developed to assess complex activities needed to function in community settings. Score ranges from 0 (dependent) to 8 (independent) for women, 0-5 for men. |
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Term
| What are the 3 types of abuse for the elderly? |
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Definition
1. Physical abuse
2. Financial abuse
3. Emotional Abuse |
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Term
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Definition
| Any device or drug that prevents the patient from moving freely - must be prescribed by healthcare provider |
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Term
|
Definition
Epidermis
Dermis
Subcutaneous (adipose or fat) |
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Term
|
Definition
| Protein produced by keratinocytes, making the epidermis waterproof |
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Term
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Definition
| The white, crescent shaped portion of the nail at the lower end of the nail plate |
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Term
|
Definition
| Produced by sebaceous glands. Mildly bacteriostatic substance that lubricates the skin and reduces water loss from surface. |
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Term
|
Definition
Protection
Homeostasis (water balance)
Temperature regulation
Sensory organ
Vitamin D synthesis
Psychosocial |
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Term
|
Definition
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Term
|
Definition
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Term
|
Definition
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Term
|
Definition
|
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Term
|
Definition
| Initial reaction to a problem that alters one of the structural components of the skin |
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Term
|
Definition
| Changes in the appearance of a primary lesion |
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Term
|
Definition
|
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Term
|
Definition
| Thickening of skin, can come from continual rubbing of area due to itching |
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Term
|
Definition
Asymmetry of shape
Border irregularity
Color variation within one lesion
Diameter greater than 6mm
Evolving or change in any feature |
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Term
|
Definition
| Macules, nodules, patches, cysts, papules, vesicles, bullae, plaques, pustules, wheals, erosions |
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Term
|
Definition
Primary Lesion
Flat lesions less than 1cm in diameter. Color different from surrounding skin. |
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Term
|
Definition
| Elevated marble like lesions more than 1cm wide and deep |
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Term
|
Definition
| Macules that are larger than 1cm in diameter. May or may not have some surface changes (slight scale or fine wrinkles) |
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Term
|
Definition
| Nodules filled with either liquid or semisolid material that can be expressed |
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Term
|
Definition
| Small, firm, elevated lesions less than 1cm in diameter |
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Term
|
Definition
| Blisters filled with clear fluid. Less than 1cm in diameter |
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Term
|
Definition
| Blisters filled with clear fluid. More than 1cm in diameter. |
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Term
|
Definition
| Elevated, plateau like patches more than 1 cm in diameter that do not extend into the lower skin layers. |
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Term
|
Definition
| Vesicles filled with cloudy or purulent fluid |
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Term
|
Definition
| Elevated, irregularly shaped, transient areas of dermal edema |
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Term
|
Definition
| Wider than fissures, but only involve the epidermis. Often associated with vesicles, bullae, or pustules |
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Term
|
Definition
| Scales, ulcers, crusts and oozing, lichenifications, fissures, atrophy |
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Term
|
Definition
| Visibly thickened stratum corneum. Appear dry and are usually whitish. Most often seen with plaques and pustules |
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Term
|
Definition
| Deep erosions that extend beneath the epidermis and involve the dermis and sometimes subcutaneous fat |
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Term
|
Definition
| Composed of dried serum or pus on the surface of skin, under liquid debris may accumulate. From broken vesicles, bullae, or pustules |
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Term
|
Definition
| Palpably thickened areas of epidermis with accentuated skin markings. Usually caused by chronic rubbing and scratching |
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Term
|
Definition
| Linear cracks in epidermis which often extend into dermis |
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Term
|
Definition
| Characterized by thinning of the skin surface with loss of skin markings. Skin is translucent and paper like |
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Term
|
Definition
| Small, reddish purple lesions that do not fade or blanch when pressure is applied |
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Term
|
Definition
|
|
Term
|
Definition
| Excessive growth of body hair or hair growth in abnormal body areas |
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Term
|
Definition
|
|
Term
|
Definition
| Inflammation of the skin around the nail |
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Term
|
Definition
| Inflammation of the skin around the nail that persists for months |
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Term
|
Definition
|
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Term
|
Definition
| Healing in which the wound can be easily closed and dead space eliminated without granulation, which thus shortens the phases of tissue repair. Results in thin scar |
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Term
|
Definition
| The formation of scar tissue for wound healing to occur |
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Term
|
Definition
| Healing of deep tissues or wounds with tissue loss in which a cavity-like defect requires gradual filling of the dead space with connective tissue. Prolongs the wound healing process |
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Term
|
Definition
| Delayed primary closure of a wound with a high risk for infection. Wound is intentionally left open for several days until inflammation has subsided and then is closed by first intention |
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Term
|
Definition
| Skin is intact. Area is red and does not blanch |
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Term
|
Definition
| Skin is not intact. There is a partial-thickness skin loss of the epidermis or dermis. |
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Term
|
Definition
| Skin loss is full thickness. Subcutaneous tissues may be damaged or necrotic. Does NOT extend to muscle or bone. |
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Term
|
Definition
| Skin loss is full thickness with exposed or palpable muscle, tendon, or bone. |
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Term
|
Definition
| Black, grey, or brown nonviable, denatured collagen |
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Term
|
Definition
| Separation of the skin layers at the wound margins from the underlying granulation tissue |
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Term
|
Definition
| Superficial infection involving the hair follicle |
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Term
|
Definition
|
|
Term
|
Definition
| Severe pain persisting after Shingles has resolved |
|
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Term
|
Definition
| Infestation by human lice (head or body) |
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Term
|
Definition
| Contagious skin disease caused by mite infestations |
|
|
Term
|
Definition
| Cysts, seborrheic keratoses, keloids, nevi |
|
|
Term
|
Definition
| Firm, flesh-colored nodules that contain liquid or semi solid material |
|
|
Term
|
Definition
| An overgrowth of a scar with excessive accumulations of collagen and ground substance |
|
|
Term
|
Definition
|
|
Term
|
Definition
| Squamous cell carcinoma, basal cell carcinoma, melanoma |
|
|
Term
|
Definition
| Cancer of the epidermis. Potentially metastatic. Chronic skin damage from repeated injury or irritation can predispose |
|
|
Term
|
Definition
| Arise from basal cell layer of epidermis. Metastasis is rare. UV exposure most common cause. |
|
|
Term
|
Definition
| Pigmented cancers arising from melanin-producing cells. Highly metastatic. |
|
|
Term
|
Definition
| Whiteheads and blackheads |
|
|
Term
|
Definition
| Often drug-induced immunologic skin reaction |
|
|
Term
|
Definition
| Abraded area where the skin is town or torn off. Can be due to scratching, funhal infection, incontinence, etc |
|
|
Term
|
Definition
| Caused by reactivated Varicella-zoster virus. S/S: burning/sharp/stabbing pain/aching/itching. Linear pattern of vesicles along a dermatome. |
|
|
Term
| Treatment of Herpes Zoster |
|
Definition
Antiviral agents
Systemic corticosteroids
Analgesics
Neuroleptics |
|
|
Term
| Systemic factors that influence skin |
|
Definition
General health and functioning
Incontinence
Nutrition
Blood sugar/diabetes
Infection
Medications
Stress
Smoking |
|
|
Term
| What to address to optimize wound healing |
|
Definition
Address etiology (most important)
Systemic factors (circulatoin, oxygenation, nutrition, diabetic management)
Local factors (infection, perfusion, edema, incontinence, pressure relief)
Topical therapy (last to be addressed) |
|
|
Term
|
Definition
Remove necrotic tissue
Maintain clean, moist wound surface
Identify and treat infection
Fill dead space
Absorb exudate
Insulate wound surface |
|
|
Term
|
Definition
Screening tool designed to determine pts risk of developing a pressure ulcer
6 subscales add together for a value from 6-23
Lower the score, higher risk of developing breakdown |
|
|
Term
| What to assess when you find a pressure ulcer |
|
Definition
Location on body
Size: length, width, depth, undermining, tunneling
Stage: I-IV
Wound bed type
Drainage: type, amt
Peri-wound skin: color, condition |
|
|
Term
| Tissue types in wound bed |
|
Definition
Epithelialization: pink and dry
Granulation: red and moist
Slough: yellow
Eschar: black |
|
|
Term
| Body's first line of defense to infection |
|
Definition
Barriers: stop pathogens before they enter environment
- Skin
- Mucus
- Saliva
- Gastric secretion
- Flushing action of tears/urine |
|
|
Term
| Body's second line of defense to infection |
|
Definition
Inflammatory response: kill pathogens after they enter body
- Vasodilation
- Increased capillary permeability
- WBCs |
|
|
Term
| Cell and vascular responses leading to S/S of inflammation |
|
Definition
- Vasodilation in affected area
- Increased capillary permeability
- Fluid goes from intravascular space to extracellular space
- WBCs (esp neutrophils) increase in #
- Inflammatory exudate (purulent drainage)
- Tissue repair |
|
|
Term
| Signs and symptoms of localized inflammation |
|
Definition
Redness
Swelling (edema)
Warmth
Pain |
|
|
Term
| Sighs and symptoms of systemic infection |
|
Definition
Fever (above 100.4)
Elevated heart rate (>90)
Elevated resp rate (>20)
WBC <4000, >12000 |
|
|
Term
| SIRS (Systemic Inflammatory Response Syndrome) |
|
Definition
When infectious microbes enter bloodstream and increase in number. Occurs as result of escaping local control
2 or more signs = SIRS |
|
|
Term
|
Definition
| Invasion and multiplication of microbs in body tissue that causes local cellular injury |
|
|
Term
| The 3 divisions of immune response |
|
Definition
Inflammation
Antibody mediated
Cell mediated
All 3 are necessary for complete immunity |
|
|
Term
| Inflammation vs. infection |
|
Definition
| Infection is usually accompanied by inflammation, but inflammation can occur without infection |
|
|
Term
|
Definition
| Shift to the left (or elevation) indicates infection |
|
|
Term
|
Definition
MRSA
VRE
MDR-TB/XDR-TB
Acinetobacter
C. diff |
|
|
Term
|
Definition
Infectious agent
Reservoir
Portal of exit
Mode of transmission
Portal of entry
Susceptible host |
|
|
Term
| Contagious (communicable) vs. infectious |
|
Definition
| Every contagious disease is infectious, but all infectious diseases are not contagious |
|
|
Term
| Colonization vs. infection |
|
Definition
| Colonization: presence and growth of microbes with a host but without causing symptomatic disease |
|
|
Term
|
Definition
CAUTI: catheter-acquired UTIs
CLABSI: central line associated blood stream infection
VAP: ventilator-associated pneumonia
SSI: surgical site infection |
|
|
Term
|
Definition
- Invasive diagnostic or therapeutic procedures
- Invasive medical devices
- Decreased immune response
- Exposure to pathogen (poor hand hygiene)
- Age: very old, very young |
|
|
Term
|
Definition
- For diseases spread by contact with blood/body fluids or via contaminated equipment or surfaces
- Gloves and gowns
- Dedicated equipment |
|
|
Term
|
Definition
| Must wash hands with soap and water (spores not killed by alcohol) |
|
|
Term
|
Definition
- Infection spread by close respiratory secretions
- Mask, gown and goggles for suctioning
- Private room if possible
- Pt wears mask
- Influenza, meningitis, pertussis, rhinovirus |
|
|
Term
|
Definition
- Infection can be spread over long distances bc particles remain suspended in air
- N95 mark or respirator, stand 3 feet away
- Negative pressure room
- TB, chickenpox, measles |
|
|
Term
|
Definition
- Pt is at high risk of getting disease from others
- Educate visitors
- No plants or cut flowers in room
- Keep room very clean
- No rectal temp or meds
- Dedicated equipment
- Pt wears mask outside of room |
|
|
Term
|
Definition
- Technique to keep pt free from exposure to infection-causing pathogens to minimize onset and spread of disease
- Hand hygiene, barrier technique, environmental cleaning |
|
|
Term
|
Definition
*Helps diagnose neuromuscular, lower motor neuron, peripheral nerve disorders
*Low electrical currents pass through flat electrodes placed along nerve
*If needles used, inspect needle sites for hematoma formation |
|
|
Term
|
Definition
| Complex vertical canal network in cortical compact bone containing microscopic blood vessels that supply nutrients and oxygen to bone and lacunae |
|
|
Term
|
Definition
| Cavities in bone that house osteocytes |
|
|
Term
|
Definition
| AKA Spongy bone that contain trabeculae (large spaces) filled with red and yellow marrow |
|
|
Term
|
Definition
| Production of blood cells-occurs in red bone marrow |
|
|
Term
| Fat Embolism Syndrome (FES) |
|
Definition
| a life-threatening complication in which yellow bone marrow (which contains fat cells) becomes dislodged and enters blood stream |
|
|
Term
| List the different minerals and hormones that affect bone growth and metabolism. |
|
Definition
1. Calcium
2. Phosphorus
3. Calcitonin
4. Vit D
5. Parathyroid Hormone
6. Growth Hormone
7. Glucocorticoids
8. Estrogens and androgens
9. Thyroxine
10. Insulin |
|
|
Term
|
Definition
1. Synarthrodial - immovable
2 Amphiarthrodial - slightly movable
3. Diarthrodial - freely movable |
|
|
Term
|
Definition
| The only type of joints lined with synovium, a membrane that secretes synovial fluid for lubrication and shock absorption |
|
|
Term
|
Definition
| Small sacs lined with synovial membrane, are located at joints and bony prominences to prevent friction between bone and structures adjacent to bone |
|
|
Term
|
Definition
|
|
Term
|
Definition
| A problem in muscle tissue - may be indicated by proximal weakness |
|
|
Term
|
Definition
| Problem with nerve tissue - may be indicated by distal weakness |
|
|
Term
|
Definition
| Abnormality in the stance phase of gait |
|
|
Term
|
Definition
| Abnormality in the swing phase of gait |
|
|
Term
|
Definition
| Tool that may be used to provide an exact measurement of flexion and extension or joint ROM |
|
|
Term
|
Definition
Grades muscle strength
5 - normal: ROM unimpaired against gravity with full resistance
4 - good: can complete ROM against gravity with some resistance
3 - Fair: can complete ROM against gravity
2 - Poor: can complete ROM with gravity eliminated
1 - Trace: no joint motion and slight evidence of muscle contractility
0 - Zero: no evidence of muscle contractility |
|
|
Term
| In a patient's serum calcium, hypercalcemia/hypocalcemia could indicate: |
|
Definition
Hyper:
*Paget's Disease
*Bone fractures in healing stages
Hypo:
*Osteoporosis
*Osteomalcia |
|
|
Term
| In a patient's serum phosphorous, hyperphosphatemia/hypophosphatemia could indicate: |
|
Definition
Hyper:
*Bone fractures in healing stage
*Acromegaly
Hypo:
*Osteomalcia |
|
|
Term
| Elevations in alkaline phosphatase (ALP) levels may indicate: |
|
Definition
*Paget's disease
*Osteomalcia |
|
|
Term
| Elevations in serum muscle enzyme creatine kinase (CK-MM) may indicate: |
|
Definition
*Muscle trauma
*Progressive muscular dystrophy
*Effects of electromyography |
|
|
Term
| Elevations in serum muscle enzyme lactic dehydrogenase (LDH) may indicate: |
|
Definition
*Skeletal muscle necrosis
*Progressive muscular dystrophy |
|
|
Term
| Elevations in serum muscle enzyme aspartate aminotransferase (AST) may indicate: |
|
Definition
*Skeletal muscle trauma
*Progressive muscular dystrophy |
|
|
Term
| Elevations in serum muscle enzyme Aldolase (ALD) may indicate: |
|
Definition
*Polymyositis and dermatomyositis
*Muscular dystrophy |
|
|
Term
|
Definition
| produces planes, or slices for focus and blurs images of other structures - helpful in detailing the MSK system |
|
|
Term
|
Definition
| Highlights the contrast between structures using edge enhancement - disadvantage include higher radiation dose to patient and inability to determine tissue density |
|
|
Term
| Computed Tomography (CT) scan |
|
Definition
| Good for detecting MSK problems, particularly those of vertebral columns and joints - always ask patient about Iodine allergy |
|
|
Term
|
Definition
*Fiberoptic tube inserted into joint for direct visualization
*Patient must be able to flex knee
*Evaluate neurovascular status of limb frequently |
|
|
Term
|
Definition
*Chronic metabolic disease in which bone loss causes decreased density and possible fracture
*Referred to as "silent disease" because first sign usually involves a fracture
*Spine, hip and wrist are most often at risk |
|
|
Term
|
Definition
| Loss of bone related to Vit D deficiency |
|
|
Term
| Paget's Disease (osteitis deformans) |
|
Definition
| Chronic metabolic disorder in which bone is excessively broken down and re-formed resulting in bone that is structurally disorganized and weak |
|
|
Term
|
Definition
| Infection in bone caused by bacteria, viruses, or fungi |
|
|
Term
| Dual X-Ray Absorptiometry (DXA) |
|
Definition
| Most commonly used screening and diagnostic tool for measuring bone mineral density - it is a painless scan that emits less radiation than a chest X-ray. It is the best tool currently available for a definite diagnosis of osteoporosis |
|
|
Term
| What are the primary problems in metabolic bone disease (Paget's disease)? |
|
Definition
*Strength
*Risk for fracture
*Injury prevention
*Nutritional status |
|
|
Term
|
Definition
| Slowly progressive thickening of palmar fascia, resulting in flexion contracture of the fourth and fifth fingers. Surgical release is only treatment. |
|
|
Term
|
Definition
| Round, benign cyst, often found on a wrist or foot joint or tendon. Painless on palpation, but they can cause joint discomfort. Can be drained, injected with cortisone, or surgically removed. |
|
|
Term
|
Definition
| Inflammation of plantar fascia which is painful. Most patients respond to conservative management, but endoscopic surgery is also a possible treatment. |
|
|
Term
|
Definition
| Occurs when vertebrae rotate and begin to compress. Can be treated with moist heat, pain meds, and exercise, but may require surgical intervention for curvature greater than 50 degrees. |
|
|
Term
| What are some priority concerns with MSK Disorders? |
|
Definition
*Contractures
*Pain
*Mobility impairment |
|
|
Term
|
Definition
| Break or disruption in continuity of a bone |
|
|
Term
| List the different types of fractures. |
|
Definition
1. Complete
2. Incomplete
3. Open
4. Closed
5. Pathologic
6. Fatigue or stress
7. Compression |
|
|
Term
|
Definition
| Myoglobulin release from skeletal muscle into the bloodstream |
|
|
Term
|
Definition
| occurs from an external crush injury that compresses one or more compartments in leg, arm, or pelvis - it is potentially life-threatening |
|
|
Term
|
Definition
| A fracture that has not healed within 6 months of injury - some fractures never achieve unions (nonunion); others heal incorrectly (malunion) |
|
|
Term
|
Definition
| Realignment of the bone ends for proper healing, is accomplished by a closed method or an open procedure |
|
|
Term
|
Definition
| Application of a pulling force to a part of the body to provide reduction, alignment, and rest. Also used as a last resort to decrease muscle spasm |
|
|
Term
| Open Reduction Internal Fixation (ORIF) |
|
Definition
| The open reduction allows the surgeon to directly view the fracture site. Internal fixation uses metal pins, screws, rods, plates, or prostheses to immobilize the fracture during healing. |
|
|
Term
|
Definition
| System in which pins or wires are inserted throught the skin and affected bone and then connected to a rigid external frame |
|
|
Term
|
Definition
| Electromotive drug administration, using a small electric charge to deliver a medicine or other chemical through the skin |
|
|
Term
| Acute Compartment Syndrome (ACS) |
|
Definition
| Increased intracompartmental pressure due to accumulation of necrotic debris and hemorrhage, especially hemorrhage related to fracture. Can lead to rhabdomyolysis and kidney failure. |
|
|
Term
| What are the 6 Ps we assess in order to monitor for early signs of Acute Compartment Syndrome (ACS)? |
|
Definition
1. Pain
2. Pressure
3. Paralysis
4. Paresthesia
5. Pallor
6. Pulselessness |
|
|
Term
| What are the 6 Ps we assess in order to monitor for early signs of Acute Compartment Syndrome (ACS)? |
|
Definition
1. Pain
2. Pressure
3. Paralysis
4. Paresthesia
5. Pallor
6. Pulselessness |
|
|
Term
| What are the possible complications of fractures? |
|
Definition
1. Shock
2. Fat Embolism Syndrome
3. Venous thromboembolism
4. Infection
5. Chronic complications - necrosis, AVN, delayed healing
6. Peripheral neurovascular dysfunction
7. Pain
8.Impaired physical mobility
9. Inadequate nutrition |
|
|
Term
| What are the possible complications of amputations? |
|
Definition
1. Hemorrhage
2. Infection
3. Phantom limb pain
4. Neuroma
5. Flexion contracture |
|
|
Term
|
Definition
| Minimally invasive surgical technique for treatment of vertebral compression fractures in which bone cement is injected through the skin directly in to the fracture site to provide stability and immediate pain relief |
|
|
Term
|
Definition
| Same as vertebroplasty except it includes additional step of inserting a small balloon into the fracture site and inflating it to contain the cement and to restore height to vertebra |
|
|
Term
|
Definition
| sensitive tumor consisting of damaged nerve cells |
|
|
Term
| Ankle-brachial index (ABI) |
|
Definition
| Calculated by dividing ankle systolic pressure by brachial systolic pressure. A normal ABI is 1 or higher |
|
|
Term
| Complex regional pain syndrome |
|
Definition
| a poorly understood dysfunction of the central and peripheral nervous systems that leads to severe, chronic pain. Most often results from fractures or other traumatic MSK injuries |
|
|
Term
|
Definition
| Common diagnostic technique for a torn meniscus in which examiner flexes and rotates the knee and then presses on medial aspect while slowly extending leg. Test is positive if clicking is palpated or heard |
|
|
Term
| Carpal Tunnel Syndrome (CTS) |
|
Definition
| Common condition in which the median nerve in wrist becomes compressed, causing pain and numbness. NSAIDs are commonly prescribed and a splint or hand brace may be used. Surgery is necessary in half of cases of CTS could return. |
|
|
Term
|
Definition
| Diagnostic wrist test for Carpal Tunnel Syndrome |
|
|
Term
|
Definition
|
|
Term
|
Definition
| Excessive stretching of a muscle or tendon when it is weak or unstable (aka muscle pulls) |
|
|
Term
|
Definition
| Excessive stretching of a ligament |
|
|
Term
| What is the difference between infectious and noninfectious respiratory diseases? |
|
Definition
| Infectious diseases are the ones that we can cure, noninfectious diseases are more chronic (in general) |
|
|
Term
| What are the structures of the lower respiratory system? |
|
Definition
1. Lungs
2. Pleura
3. Mediastinum (area between the lungs, contains heart, trachea, esophagus, and lymph nodes)
4. Bronchi and Bronchioles
5. Alveoli |
|
|
Term
| What part of the ABCD (Airway, Breathing, etc.) would ventilation problems be? |
|
Definition
|
|
Term
| What part of the ABCDs of nursing assessment would respiration problems be? |
|
Definition
|
|
Term
| What part of the ABCDs of a nursing assessment would gas exchange be considered? |
|
Definition
|
|
Term
|
Definition
| Movement of the air in and out of the lungs |
|
|
Term
|
Definition
|
|
Term
|
Definition
| Diffusion of oxygen & carbon dioxide across cell membranes |
|
|
Term
| The respiratory system depends on pulmonary perfusion. What is pulmonary perfusion? |
|
Definition
| Filling of the pulmonary capillaries with blood |
|
|
Term
| What would be the chief complaint, the risk factors, the signs and symptoms, and the characteristic symptoms of Obstructive Sleep Apnea? |
|
Definition
Chief Complaint: Insomina & Hypersomnolence
Risk Factors: Obesity, male gender, post-menopausal, advanced age
S&S: Frequent & loud snoring, snorting, & gasping, choking & apneic episodes
Characteristic: recurrent upper airway obstruction (lasting >10 sec, >5 x/hr) and reduced ventilation |
|
|
Term
| What are the complications and correlations of Obstructive Sleep Apnea (OSA)? |
|
Definition
Complications: Daytime sleepiness increases risk of accident/injury
Correlated with: HTN, HF, Stroke, Arrhythmia |
|
|
Term
| What are 2 medical managements of Obstructive Sleep Apnea? |
|
Definition
1. Continuous positive airway pressure (CPAP)
2. Bilevel positive airway pressure (BiPAP) |
|
|
Term
| Continuous Positive Airway Pressure (CPAP) |
|
Definition
| Delivers a set positive airway pressure continuously during each cycle of inhalation and exhalation |
|
|
Term
| What should you do for Nursing Management for OSA? |
|
Definition
-Teach about OSA S&S
-Teach proper use of CPAP/BiPAP
-Monitor resp status of pts with OSA-airway already compromised
-If pt uses CPAP at home, then they need while inpatient even if just "overnight"
-Watch for signs of undiagnosed OSA (high risk for respiratory depression/failure pot-op) |
|
|
Term
|
Definition
-Obstruction of a pulmonary artery by blood clot, air, fat, amniotic fluid, or septic thrombus
-symptoms are SOB, sharp pain in chest, coughing that produces blood |
|
|
Term
| 3 major risk factors for pulmonary emboli |
|
Definition
1. Hypercoagulable state
2. Vascular wall injury
3. Circulatory stasis |
|
|
Term
| What are the signs of a pulmonary embolism? |
|
Definition
-Tachycardia, tachypnea
-Crackles
-Pleural friction rub
-Diaphoresis
-Petechiae over chest and axillae
-Decreased O2 stats |
|
|
Term
| What are things a patient can do to prevent a pulmonary embolism? |
|
Definition
-Passive and active leg exercises to avoid venous stasis
-Early ambulatoin
-Anticoagulant therapy
-Sequential compression devices
-Avoid long, static positions. Push fluids when sitting
-Avoid Valsalva maneuver
-Smoking cessation |
|
|
Term
| What are treatment options for a pulmonary embolism? |
|
Definition
-Anticoagulation
-Thrombolytic therapy for hemodynamic instability
-Supportive measures to improve respiratory and CV status |
|
|
Term
|
Definition
| Common cause of spontaneous pneumothorax in young children and adults. Blebs are weakened out-pouchings in the upper lung, which can rupture |
|
|
Term
| What are the symptoms of pneumothorax? |
|
Definition
| Sharp pain with inhalation or cough, SOB, fatigue, tachycardia |
|
|
Term
| What are the treatments for pneumothorax? |
|
Definition
1. Tube thoracostomy: chest tube to suction
2. Oxygen therapy
3. Thoracotomy (surgical incision into the chest wall) |
|
|
Term
| What is Obstructive Pulmonary Disease and list some of examples of diseases that fit into this category. |
|
Definition
Characterized by increased resistance to airflow as a result of airway obstruction or narrowing
-Asthma
-Emphysema
-COPD
-Cystic Fibrosis |
|
|
Term
| What are the signs and symptoms of asthma? |
|
Definition
-Cough w/wo mucus production
-Dyspnea
-Wheezing (first on expiration, then during inspiration)
-Chest tightness
-Expiration require effort and becomes prolonged
-Status asthmaticus (Emergency!) |
|
|
Term
| What is some nursing management techniques for Asthma? |
|
Definition
-Determine severity of asthma attack
-Initiate emergency response if severe
-Pt. educuation re: taking meds regularly to prevent exacerbation, avoid allergens, peak flow monitoring |
|
|
Term
| What are some nursing managements for Emphysema? |
|
Definition
-Breathing exercises (diaphragmatic inhalation, pursed lip exhalation)practice
-Manage activities to avoid DOE
-Encourage adeq nutrition and hydration
-Pulmonary rehab |
|
|
Term
| What are nursing interventions for COPD? |
|
Definition
-Airway maintenance
-Monitoring/breathing techniques
-Positioning, coughing
-O2
-Hydration
-Suctioning
-Vibratory positive pressure
-Medication management/education
-Prevent wt loss through adequate nutrition
-Anxiety prevention and management
-Improve activity tolerance |
|
|
Term
| Which is worse, hypoxia or hypercapnia? |
|
Definition
|
|
Term
|
Definition
| CO2 level over 45mmHg, can drive serum pH down and result in respiratory acidosis |
|
|
Term
| Motivational Interviewing |
|
Definition
| Collaborative, person-centered form of guiding to elicit and strengthen motivation for change |
|
|
Term
| What are the symptoms of cystic fibrosis? |
|
Definition
-Very salty-tasting skin
-Persistent coughing, phlegm and mucus
-frequent lung infections
-Wheezing or SOB
-Poor growth/weight gain in spite of a good appetite
-Frequent greasy, bulky stools or difficulty in bowel
-Clubbing of fingers
-Osteoporosis
-May lead to: pancreatitis, liver disease, gallstones, diabetes, infertility |
|
|
Term
| What are some nursing managements for cystic fibrosis? |
|
Definition
-Weight management, prevent weight loss
-Education: medication management, infection prevention, pulmonary hygiene, nutrition/vitamin supplements, breathing techniques |
|
|
Term
| What are signs and symptoms of pneumonia? |
|
Definition
-Chills
-Fever
-Pleuritic chest pain aggravated by deep breathing and coughing
-Tachypnea
-SOB, dyspnea on exertion
-Use of accessory muscles
-Tachycardia |
|
|
Term
| What are the 2 major concerns re: severe pneumonia? |
|
Definition
1. Sepsis
2. Respiratory failure |
|
|
Term
| What are diagnostic tests for pneumonia? |
|
Definition
-Chest X-ray
-Physical exam
-Sputum exam (culture/gram stain)
-Blood culture to r/o sepsis |
|
|
Term
| What is the number 1 way to prevent infection while a patient is intubated? |
|
Definition
|
|
Term
| What are some treatments for fluid overload? |
|
Definition
-Oxygen
-Positioning
-Diuretics
-Vasodilators
-Meds to improve cardiac functioning |
|
|
Term
| What are some treatments for mucus? |
|
Definition
-Oxygen
-DB&C (incentive spirometer)
-Positioning and mobility
-Chest PT
-Hydration
-Antibiotics
-Corticosteroids (if inflammatory process) |
|
|
Term
| What are possible nursing diagnoses for pnemonia? |
|
Definition
1. Ineffective airway clearance
2. Impaired gas exchange
3. Activity intolerance
4. Risk for fluid volume deficit r/t fever and rapid RR, decreased po intake
5. Risk for aspiration |
|
|
Term
| Which populations are at high risk for the flu? |
|
Definition
-Older than 50
-Chronic illnesses or immune compromise
-Living in institutional setting
-Living with someone at risk
-Health care personnel providing direct care |
|
|
Term
| What are the airborne precautions for TB? |
|
Definition
-N95 mask or respirator
-Private room
-Negative pressure room if available |
|
|
Term
| What are signs and symptoms of active TB? |
|
Definition
-Persistent cough
-Weight loss
-Anorexia
-Night sweats
-Hemoptysis
-SOB
-Fever or chills |
|
|
Term
| What is the most important nursing intervention for a patient with TB? |
|
Definition
| Patient teaching about medication adherence (6 month regimens) |
|
|
Term
|
Definition
Accumulation of thick, purulent fluid in the pleural space related to a lung infection
Symptoms include:
-Pleuritic CP
-Dry cough
-Diaphoresis, fever, chills
-Malaise |
|
|
Term
| What is the treatment for empyema? |
|
Definition
| Antibiotics and a chest tube |
|
|
Term
|
Definition
Troponin (and tropomyosin) regulate contraction and relaxation of cardiac cells
Measure as a lab test to detect cardiac muscle death = MI |
|
|
Term
| Calcium and cardiac cell contractions |
|
Definition
| The more calcium, the faster the contraction and the longer the contraction is maintained |
|
|
Term
| Electrical conduction system of the heart |
|
Definition
- SA node (60-100bpm): primary pacemaker
- AV node
- Ventricles
- Sum of electrical activity of heart is measured by the EKG |
|
|
Term
| Electrical conduction: how do systole and diastole fit in |
|
Definition
Systole: follows depolarization of the ventricles
Diastole: follows repolarization |
|
|
Term
| Cardiac Output (CO): what is it and what affects it |
|
Definition
= stroke volume X heart rate
Factors affecting CO: exercise, age, fever, metabolism, pregnancy, disease |
|
|
Term
| Heart rate: how the ANS controls it |
|
Definition
Parasympathetic NS
- Inhibitory via vagus nerve
- Acetylcholine
- Decreases HR
Sympathetic NS
- Stimulatory
- Norepinephrine and epinephrine
- Increases HR and contractility |
|
|
Term
| What factors control stroke volume? |
|
Definition
Contractility
Preload
Afterload |
|
|
Term
| Contractility (Inotrophy) |
|
Definition
- Frank Starling Law: the more the heart can stretch, the greater the contraction's force
- Factors affecting contractility: sympathetic NS, Ca2+, medications, ischemia |
|
|
Term
|
Definition
The volume of blood in the ventricles at the end of diastole (filling)
- Determined soley by venous return
- Factors affecting preload: absolute blood volume, blood distribution in body, atrial kick, ventricular function (contractility), ventricular compliance (stiffness) |
|
|
Term
|
Definition
Resistance or pressure ventricle has to overcome to eject blood
- Factors affecting afterload: HTN, ventricular outflow obstruction (aortic valve stenosis), sympathetic NS stimulation
- Vasoconstriction increases afterload
- Vasodilation decreases afterload |
|
|
Term
| Non-modifiable risks for heart disease |
|
Definition
Age
Gender
Ethnic origin
Family history
Strep infections
Medical history |
|
|
Term
| Modifiable risk factors for heart disease |
|
Definition
Food choices
Activity
Obesity
Psychological variables
Cigarette use
Meds-estrogen |
|
|
Term
|
Definition
Heart has rich capillary system, big need for oxygen.
Supplied by blood from the aorta
Left coronary artery that branches into descending coronary artery is the one that usually gets blocked |
|
|
Term
| Why MIs are more dangerous at a younger age |
|
Definition
| Collateral circulation develops over time with chronic ischemia. If you have an MI earlier you don't have that collateral circulation |
|
|
Term
| Risk factors for atherosclerosis |
|
Definition
- Low HDL-C
- High LDL-C
- Increased triglycerides
- Genetic predisposition
- DM
- Obesity
- Sedentary lifestyle
- Smoking
- Stress
- African American or Hispanic ethnicity
- Older adult |
|
|
Term
|
Definition
- Small amounts of protein in urine
- Clear marker of widespread endothelial dysfunction in DV disease
- Detects cardiac compliance
- Good measure for HF, elevates before BNP rises |
|
|
Term
| How atherosclerosis happens |
|
Definition
- Injury brings platelets, they aggregate
- LDL accumulates, brings macrophages, try to eat LDL but can't, make them frothy
- Platelets seal them, results in smaller vessel
- Thrombus is what actually occludes the vessel = infarct |
|
|
Term
| Risk factors for hyperlipidemia |
|
Definition
- Cigarette smoking
- HTN
- Low HDL (<40)
- Family history of premature CHD (in male 1st degree relative <55, in female 1st degree relative <65)
- Age (men >45, women >55) |
|
|
Term
|
Definition
Desireable = <200
Borderline high = 200-239
High >240 |
|
|
Term
|
Definition
Optimal = <100
Near optimal/above optimal = 100-129
Borderline high = 130-159
High = 160-189
Very high = 190 |
|
|
Term
|
Definition
|
|
Term
| Causes of secondary dyslipidemia |
|
Definition
- Diabetes
- Hypothyroidism
- Obstructive liver disease
- Chronic renal failure
- Drugs that raise LDL and lower HDL (progestins, anabolic steroids, corticosteroids) |
|
|
Term
|
Definition
Plaque rupture leads to MI, depending on the degree of occlusion. The MI is usually a thrombus superimposed on a plaque
- Plaque with fibrous cap
- Cap ruptures
- Blood clot forms around rupture, blocking artery |
|
|
Term
| Stable vs. unstable plaques |
|
Definition
Stable:
- when it ruptures, thrombosis and constriction obstruct vessel causing inadequate perfusion and oxygenation to distal tissues
Unstable:
- Causes more severe damage, after rupture, causes rapid thrombus formation which can blood blood vessel and result in ischemia and infarction |
|
|
Term
| How damage happens from heart attacks |
|
Definition
- EKG changes after 30-60 sec, cells still viable for 20 min
Continuum of damage
- Blockage leads to ischemia (hypoxia)
- Cells need O2, do anaerobic metabolism, acid accumulates leading to acidosis
- Acid leads to cell death
- Leads to heart failure |
|
|
Term
|
Definition
- CAD: angina, MI, CABG
- PVD or CVA
- Dyslipidemia
- HTN
- Family history |
|
|
Term
| Cardiac enzymes for diagnosis of MI |
|
Definition
- Troponin
- CK-MB
- Myoglobin |
|
|
Term
| Physical assessment for MI |
|
Definition
- Monitor BP
- Palpate pulses in all major sites of body
- Assess for prolonged capillary refill
- Assess for bruit |
|
|
Term
|
Definition
- ST-elevation MI (STEMI): need immediate treatment
- T-wave inversion
- Non-ST-elevation MI (NSTEMI): indicates ischemia, cardiac enzymes can initially be normal
- Q wave: because necrotic cells don't conduct electricity, can be permanent |
|
|
Term
| Q wave MI vs. Non-Q wave MI |
|
Definition
Q waves are areas of infarct that can't be depolarized because they're dead
- Higher incident of acute mortality
- Increased muscle damage
- Development of CHF
Non-Q wave diagnosed by elevated troponin
- Higher long-term mortality due to less aggressive therapy |
|
|
Term
| Treatment of acute MI: anti-ischemia therapy |
|
Definition
- Nitroglycerin: converts to NO (endogenous vasodilator) - pain relief
- ACE inhibitors
- Beta blockers
- Calcium channel blockers |
|
|
Term
|
Definition
- Dilates coronary arteries
- Drive under tongue
- Pain relief in 1-2 minutes
- Give 3 doses in 5 min intervals
- Monitor pt for low HR and BP before and after administering |
|
|
Term
|
Definition
For left ventricle dysfunction or CHF, diabetics
- Promotes vasodilation
- Limits neurohormonal activation during ischemia
- Slow development of atherosclerosis
- Inhibit platelet activation
- Reverse negative vascular remodeling |
|
|
Term
|
Definition
- Decrease myocardial contractility and myocardial oxygen demand
- Decrease renin secretion and level of angiotension II
- Monitor for bradycardia, hypotension, decreased LOC, chest discomfort |
|
|
Term
|
Definition
| Use if beta blockers are contraindicated |
|
|
Term
| Treatment of acute MI: antiplatelet and anticoagulants |
|
Definition
- Antiplatelet: ASA, plavix, I ntegrilin
- Anticoagulants: Heparin, Lovenox, Fragmin |
|
|
Term
| Treatment of acute MI: revascularization |
|
Definition
Angioplasty/stent: used for 1-2 vessel disease or 3 vessel disease if normal LVF and no DM
- Monitor that clot has resolved
- Administer heparin
CABG: bypass occluded coronary artery with pts own blood vessel or synthetic graft
- For left main disease, 2-3 vessel disease and decreased EF
- Promote coughing and deep breathing
- Early ambulation |
|
|
Term
| Repair of damaged myocardium |
|
Definition
- 24 hours: enzymes break down necrotic cells
- 10-14 days: collagen matrix formed, initially weak, mushy, vulnerable to reinjury
- 6 weeks: necrotic areas replaced by scar tissue, unable to contract and relax like healthy tissue |
|
|
Term
| Nursing interventions to prevent future cardiac events |
|
Definition
Nutrition therapy
- Decrease LDL, increase HDL
- Total far to <30% total calories
- Increase fiber, decrease NA+
Activity
- Close monitoring
- Cardiac rehab
Stress reduction
Medication education |
|
|
Term
| 3 mechanisms that regulate blood pressure |
|
Definition
1. Autonomic nervous system: excites or inhibits sympathetic activity in response to impulses from chemoreceptors and baroreceptors
2. Kidneys: sense change in blood flow and activate the renin-angiotensin-aldosterone mechanism
3. Endocrine system: releases various hormones to stimulate the sympathetic nervous system at the tissue level |
|
|
Term
| Assessment of cardiac related pain |
|
Definition
Discomfort
Indigestion
Squeezing
Heaviness
Viselike |
|
|
Term
|
Definition
Chest pain or discomfort
Dyspnea
Fatigue
Palpitations
Weight gain
Syncope
Extremity pain |
|
|
Term
| The triad of symptoms women with CVD present with |
|
Definition
Indigestion or abdominal fullness
Chronic fatigue desite adequate rest
Inability to catch breath |
|
|
Term
|
Definition
Invasive diagnostic procedure performed when arterial obstruction is suspected
- Assess patient for allergy to contrast media
- Increase fluids because dye acts as diuretic |
|
|
Term
|
Definition
Most definite test in diagnosis of heart disease, insert catheter through femoral artery
- Prepare patient by explaining risks and side effects
- Monitor vitals
- Make sure patient lies supine for 2-6 hours
- Assess insertion site for bloody drainage
- Assess circulation distal to insertion site
- Assess for change in LOC |
|
|
Term
|
Definition
Cardiac dysrhythmias
Myocardial ischemia
Site and extent of MI
Cardiac hypertrophy
Electrolyte imbalances
Effectiveness of cardiac drugs |
|
|
Term
|
Definition
| Chronic stable angina and acute coronary syndromes affect arteries providing blood, O2, and nutrients to the myocardium |
|
|
Term
|
Definition
Chest discomfort that occurs with moderate to prolonged exertion in a frequency, duration, and intensity that remains the same over time
- Results in only slight limitation of activity
- Associated with fixed atherosclerotic plaque
- Relieved by nitroglycerin and rest, managed by drug therapy, rarely requires aggressive treatment |
|
|
Term
|
Definition
| Presentation with either unstable angina or an acute myocardial infarction, resulting in platelet aggregation, thrombus formation, and vasoconstriction |
|
|
Term
|
Definition
| Chest pain or discomfort that occurs at rest or with exertion, causes severe activity limitation, and the attacks and intensity of pain increase |
|
|
Term
| Populations with atypical angina |
|
Definition
- Women: may experience indigestion, pain btwn the shoulders, aching jaw, or choking sensation with exertion
- Diabetics: no pain bc of neuropathy
- Older adults: can't verbalize pain |
|
|
Term
| Symptoms of cardiac tamponade |
|
Definition
- Cessation of previously heavy mediastinal drainage
- JVD with clear lungs
- Pulsus paradoxus
- Cardiovascular collapse
- Friction rub |
|
|
Term
|
Definition
| Must be at least 60mmHg to maintain adequate perfusion to the tissues |
|
|
Term
|
Definition
| Indicates inflammation and is increased in people at risk for atherosclerosis and ACS, but it does not indicate an acute problem. |
|
|
Term
| Nursing priorities in dysphagia |
|
Definition
First priority; airway and breathing
Second priority: nutrition |
|
|
Term
| Causes of inability to protect airway (leading to aspiration pneumonia) |
|
Definition
- Local: poor chewing, oropharyngeal surgery, local cancer/treatment
- Systemic: stroke, Parkinson's, Alzheimer's/dementia, chronic illness |
|
|
Term
| Acute but temporary causes of dysphagia |
|
Definition
- Decrease in LOC
- Tube feedings or NG tubes
- Invasive airways
- Any procedure involving numbing the pharynx |
|
|
Term
| Why does increased age bring increased risk for aspiration pneumonia? |
|
Definition
- Slowed swallowing rate and digestion
- Poor dentition
- Chronic GI conditions
- More meds
- Might not show signs of aspiration until pneumonia develops so watch for respiratory trends |
|
|
Term
|
Definition
- Empiric (from symptoms, PMH, HPI, exam)
- FEES: flexible endoscopic evaluation of swallowing (by speech pathologist)
- Barium or video swallow (by radiology)
- Endoscopy |
|
|
Term
|
Definition
- Alternative texture diet
- Speech therapy
- Tube feeding to maintain nutrition
- Surgery or endoscopy to treat cause |
|
|
Term
| Interventions to prevent aspiration |
|
Definition
- Hold PO in pts with altered LOC
- Have complete suction set up at bedside
- Oral care before meals and at bedtime (to stimulate mouth)
- Position at 90 angle with PO intake
- Supervised slow feeding/handfeeding |
|
|
Term
|
Definition
Wasting syndrome
An objective sign |
|
|
Term
|
Definition
| Decline in muscle related to aging |
|
|
Term
|
Definition
- Transient impairment of GI motility after surgery
- Bowel distension, absence of BS, lack of flatus and stools
- Order of recovery: small intestine, stomach, colon |
|
|
Term
| What is the priority in a GI bleed? What are the symptoms? |
|
Definition
Shock
- increased HR (over 100)
- decreased BP (SBP under 90)
- decreased peripheral perfusion (cool extremities, thready pulse)
- Syncope
- Orthostatic BP
- Reduced LOC
- Vomiting bright red blood
- decreased Hct |
|
|
Term
| Upper GI (esophagus, stomach, duodenum) causes |
|
Definition
- Peptic ulcer disease (PUD)
- NSAIDs
- Anticoagulants
- Erosive esophagitis or gastritis
- Acute stress gastritis
- Gastric cancer
- Esophageal varices: can rupture
- Mucosal tears r/t forceful vomiting or injury |
|
|
Term
|
Definition
- Hematemesis
- Melena (black tarry stools)
- Syncope
- Dyspepsia
- Abdominal pain
- Weight loss |
|
|
Term
| Treatment of upper GI bleed |
|
Definition
- Stabilize hemodynamically
- NGT: relieve pressure in stomach, prevent vomiting, assess condition and response to treatment
- Treat cause
- Protect the airway |
|
|
Term
| Ways to diagnose GI bleeds |
|
Definition
- Labs: CBC, troponin (underlying cardiac issue?), coags, type and crossmatch (for blood transfucions)
- NGT lavage
- Endoscopy
- CXR, CT
- Tagged RBC bleeding scan, angiogram |
|
|
Term
|
Definition
- SE meds
- Diet lacking in fiber
- Lack of activity
- Laxative dependence
- Dehydration
- Rule out colon cancer |
|
|
Term
| Constipation complications |
|
Definition
- Hemorrhoids
- Fecal impaction/bowel obstruction (usually in descending colon)
- Increased risk of cancer |
|
|
Term
|
Definition
Dyspepsia
Regurgitation
Coughing, hoarseness or wheezing at night
Hypersalivation
Dysphagia
Odydophagia
Epigastric pain
Belching
Flatulence
Nausea
Pyrosis
Globus
Pharyngitis |
|
|
Term
|
Definition
- Eat 406 meals a day
- Decrease fatty foods, acid foods, coffee, and tea
- No evening snacks
- Eat slowly, chew lots
- Elevate HOB 6-12 inches
- Wt loss if overwt
- Avoid constrictive clothing
- Follow chewable antacids w/ 8oz h2o |
|
|
Term
|
Definition
- Rapid onset
- N/V
- Hematemesis
- Gastric hemorrhage
- Dyspepsia
- Anorexia |
|
|
Term
|
Definition
- Vague report of epigastric pain relieved w/ food
- Anorexia
- N/V
- Intolerance fatty/spicy foods
- Pernicious anemia |
|
|
Term
|
Definition
- Vasomotor symptoms occurring 30 min after eating bc of rapid emptying of food into SI
- Seen with gastric bypass
- Symptoms: vertigo, tachycardia, syncope, sweating, pallor, palpitations |
|
|
Term
| Treatment of dumping syndrome |
|
Definition
|
|
Term
| Small bowel obstruction causes |
|
Definition
- Site of most bowel obstructions
- Causes: adhesions, cancer |
|
|
Term
| Small bowel obstruction S/S |
|
Definition
Colicky severe abd pain, N/V
Absence of stools or flatus
Late sign: fecal vomiting |
|
|
Term
| Diagnosis and management of small bowel obstruction |
|
Definition
- Diagnosis: X-ray and CT show abnormal amt of air and fluid in intestine
- Management: decompression with NG tube and bowel rest.
If worsens and bowel at risk for ischemia then bowel resection |
|
|
Term
|
Definition
| Bands of scar tissue that bind 2 parts of tissues or organs together |
|
|
Term
|
Definition
Complete twisting of a loop of intestine around its mesenteric attachment
Causes strangulation |
|
|
Term
|
Definition
Slower onset of symptoms
- Constipation
- Abdominal distention
- Fecal vomiting
Diagnostics
- Abdominal X-rat
- CT reveal a distended colon |
|
|
Term
|
Definition
Protrusion fo part of organ through wall of cavity that contains it
In abdomen: loop of bowel slipping between weak areas in abdominal fascia/muscles |
|
|
Term
| Classification of hernias |
|
Definition
Reducible: you can push the bulge back in
Irreducible: the intestine is flat and you can't push it back in
Strangled: tightly trapped, blood supply cut off = medical emergency |
|
|
Term
|
Definition
| Gram+ bacteria produces toxins causing severe diarrhea and inflammator changes in colon when competing bacteria in gut has been wiped out |
|
|
Term
|
Definition
Significant diarrhea
Recent antibiotic exposure
Abdominal pain
Fever
Foul stool odor |
|
|
Term
|
Definition
Diagnosed by lab from stool specimen
Gone when stools are formed again |
|
|
Term
|
Definition
IV or oral Flagyl, if it doesn't work...
Oral vancomycin (not IV bc it has to work in gut)
- Spores can stay tucked in colon unaffected by meds, 24% reocurrence rate w/n 2 months |
|
|
Term
|
Definition
Inflammation of the appendix, can burst
- RLQ abdominal pain
- Rebound pain (on LLQ)
- Low grade fever
- N/V
- Leukocytosis |
|
|
Term
| Appendicitis complications |
|
Definition
- Performation (generally 24hr w/n onset of pain)
- Peritonitis
- Abscess formation |
|
|
Term
|
Definition
Immediate surgery, IV fluids and antibiotics
Nursing management:
- Relieve pain
- Promote wound healing
- Teaching re: wound care, nutrition, activity guidelines |
|
|
Term
|
Definition
| Presence of multiple diverticulum (sac-like herniation of lining of colon-95% in sigmoid colon) without inflammation or symptoms |
|
|
Term
|
Definition
| Inflammation of a diverticulum resulting from retained food and bacteria that can lead to obstruction, perforation, peritonitis and septicemia |
|
|
Term
|
Definition
- Pain in LLQ
- N/V
- Fever
- Chills
- Leukocytosis |
|
|
Term
| Diagnosis of diverticulitis |
|
Definition
- Diverticulosis diagnosed by colonoscopy
- Diverticulitis diagnosed by CT
= Lab: leukocytosis, elevated ESR (shows you have inflammation in body but doesn't say where) |
|
|
Term
| Diverticulitis medical treatment |
|
Definition
- Rest, analgesics, anti-spasmotics
- Clear liquid diet initially, then increase to high-fiber, low-fat diet as tolerated
- Antibiotics 7-10 days
- Acute cases: NPO, IV fluids, NGT to suction for bowel rest, antibiotics 7-10 days
- If complications (perforation, peritonitis, hemorrhage, obstruction) immediate surgery to remove diseased section of colon |
|
|
Term
| Nursing assessment for diverticulitis |
|
Definition
- Onset and duration of pain
- Dietary habits (fiber)
- History of conspitation/straining/abdominal distention
- Auscultate for bowel sounds
- Palpate for LLQ pain
- Inspect stool for pus/mucus/blood
- Vital signs |
|
|
Term
|
Definition
Inflammation of peritoneum usually from bacterial infection
- Abdominal pain increased w/ movement
- Abdominal rigidity
- Anorexia
- Low grade fever
- Tachycardia
- Leykocytosis
- Abdominal ultrasound may reveal abscesses and fluid collections |
|
|
Term
| Peritonitis complications |
|
Definition
Paralytic ileus
Bowel obstruction from adhesions
Sepsis
Septic shock
Respiratory distress |
|
|
Term
|
Definition
- Fluid and electrolyte replacement
- Analgesics
- Anti-emetics
- Antibiotics
- Oxygen therapy if respiratory distress
- Surgical management: resection (remove disease colon), repair (perforation), drainage (abscess) |
|
|
Term
|
Definition
Crohn's disease
Ulcerative colitis |
|
|
Term
|
Definition
A chornic autoimmune disease that most commonly occurs in ileum but can occur anywhere in GI tract
- Inflammation of GI tract wall extends through all layers
- Begins with edema and thickening of mucus
- Ulcers not continuous, makes cobblestone pattern
- As disease advances bowel wall becomes thick and fibrotic and intestinal lumen narrows |
|
|
Term
|
Definition
- Cramping abdominal pain
- Diarrhea unrelieved by defecation (caused by disrupted digestion and absorption), bloody stools
- Steatorrhea (fat in stools)
- Fever
- Weight loss |
|
|
Term
| Diagnosis of Crohn's disease |
|
Definition
- Stool positive for occult blood and steatorrhea
- Barium study showing classic string sign indicating constriction of intestine
- Labs: low H&H, high WBC, high ESR, low Albumin |
|
|
Term
| Complications of Crohn's disease |
|
Definition
- Intestinal obstruction or stricture formation
- Fluid and electrolyte imbalances
- Malnutrition
- Fistula and abscess formation |
|
|
Term
| What is ulcerative colitis |
|
Definition
- Recurrent ulcerative and inflammatory disease of the mucosal and submucosal layers of the colon and rectum
- Characterized by multiple continuous ulcerations, inflammations, and shedding of the colon's epithelium
- Bleeding from ulcers
- Begins at rectum and spreads up through entire colon |
|
|
Term
|
Definition
- Diarrhea (10-20/day)
- Stool contains mucus and pus
- LLQ abdominal pain
- Tenesmus (constantly feeling like you need to poop)
- Rectal bleeding |
|
|
Term
| Diagnosis of ulcerative colitis |
|
Definition
- Stool (positive for occult blood)
- Barium enema, colonoscopy, CT scan
- Labs: low H&H, high WBC, high ESR, low Albumin and protein |
|
|
Term
| Complications of ulcerative colitis |
|
Definition
- Toxic megacolon
- Perforation
- Bleeding |
|
|
Term
|
Definition
Medical management (80% effective)
- Nutrition (increase fluid, high protein, high calorie diet)
- Meds: anti-inflammatory (steroids), immunosuppressants, anti-diarrheals
Surgery if med treatment is ineffective
- UC: total colectomy w/ ileosomy or ileal conduit |
|
|
Term
| What is irritable bowel syndrome? |
|
Definition
Normal bowel structure
- Functional disorder of intestinal motility resulting in spastic contractions, distention, and mucous accumulation in the intestines
- Most common intestinal problem
- Diagnosis made after tests rule out other disorders |
|
|
Term
|
Definition
- constipation/diarrhea/both
- pain (precipitated by eating, relieved by defecation)
- Bloating
- Abdominal distention |
|
|
Term
|
Definition
- Relieve abdominal pain
- Control diarrhea/constipation
- Relieve stress |
|
|
Term
|
Definition
| The goal in managing fluid, electrolyte imbalances is to reestablish and maintain homeostasis |
|
|
Term
| Average amounts of fluid in the body: |
|
Definition
Average male of 70kg: 60% of body is fluid (40L)
Average female of 70kg: 55% of body is fluid (36.5L)
Geriatric: 10% less fluid
|
|
|
Term
|
Definition
60% of total body fluid
Primarily in skeletal muscle mass |
|
|
Term
|
Definition
40% of total body fluid
Interstitital - 80% of ECF 11L
Intravascular- 20% of ECF 3L Plasma
Transcellular -1 L (not counted in fluid calculations) |
|
|
Term
| What do the transcellular fluids include? |
|
Definition
digestive secretions; perspiration; and cerebrospinal, pleural, synovial, intraocular, gonadal, and pericardial fluids.
|
|
|
Term
|
Definition
Pressure exerted by the fluid on the walls of the blood vessel
Regulate fluid movement |
|
|
Term
Capillary hydrostatic pressure
|
|
Definition
Internal capillary blood pressure pushing out against walls
Decreases as blood moves from arteriole end to venule end
|
|
|
Term
Interstitialhydrostatic pressure
|
|
Definition
Remains constant but increases in relationship to capillary hydrostatic pressure as blood moves through capillary
|
|
|
Term
|
Definition
Force that pulls water towards the compartment with higher concentration of solutes
|
|
|
Term
| Capillary Osmotic Pressure: |
|
Definition
from plasma proteins, primarily albumin
Increases towards venule end of capillary as fluid leaves capillary and proteins become more concentrated in remaining fluid
Also called “oncotic pressure” or “colloid oncotic pressure”
|
|
|
Term
| Interstitial Osmotic Pressure: |
|
Definition
Much lower than capillary oncotic pressure
Remains constant but increases in force related to decreasing capillary hydrostatic pressure as blood moves through capillary
|
|
|
Term
So hydrostatic pressure ________ fluid from area of more pressure to area of lower pressure, while osmotic pressure ______fluid towards area of higher concentration of solutes (in this case the solutes are the proteins).
FILL IN THE BLANKS.
|
|
Definition
|
|
Term
Remember that hydrostatic pressure forces water _______ of a solution, whereas osmotic pressure draws water _____a solution.
FILL IN THE BLANKS.
|
|
Definition
|
|
Term
| Homeostatic response to Hypovolemia: |
|
Definition
↓ intravascular volume:
↓ net hydrostatic pressure
Hemoconcentration leads to ↑ net osmotic pressure
Results in:
↑ fluid entering the capillary from the interstitial fluid space
|
|
|
Term
| Homeostatic response to hypervolemia: |
|
Definition
↑ intravascular volume
•↑ volume leads to net ↑ hydrostatic pressure
•Dilution leads to ↓ net osmotic pressure
Results in:
•↑ fluid going to the interstitial fluid space from the capillary
|
|
|
Term
|
Definition
Sodium—main extracellular ion
Fluid follows Na+ via osmosis
Na+ retention=fluid retention
Normal Na+: 135-145 mEq/L
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Term
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Definition
Potassium—main intracellular ion
If extracellular K+ is low, it pulls from K+ from cells
If there is significant cellular damage (ex. Trauma, crush injury), intracellular K+ released into extracellular space & pt can develop hyperkalemia.
Normal K+: 3.8-5.0 mEq/L
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Term
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Definition
The sodium-potassium pump is the key to functions such as cardiac and renal activity, as well as all general transport processes into and out of the cell. The pump forms the basis for our ability to absorb a considerable number of nutrients, excrete waste products from the kidneys and regulate the water balance in the cells. If this little pump stopped pumping sodium ions out of the cells, the latter would rapidly swell up because of the infiltration of water and finally burst.
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Term
| Sensible vs Insensible Fluid: |
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Definition
Sensible (noticeable) fluid loss refers to fluid loss that is visible, just as urine, stool, blood loss in surgery, and perspiration.
Insensible fluid loss is not visible and not really measurable.
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Term
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Definition
*Regulate the volume and osmolarity of body fluids by controlling the excretion of water and electrolytes
*Filter 180L of plasma/day—99% reabsorbed and only 1000-1500mL of urine produced
*Respond autonomously and to hormones
*ADH
*Aldosterone
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Term
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Definition
Baroreceptors detect pressure and send impulses to respond
Autonomic nervous system responses: Sympathetic & parasympathetic
*HR
*Contractility
*Vascular responses
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Term
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Definition
Intake of flood and fluids
*8L of fluid/24 hours but most reabsorbed in small intestine so only 100-200ml/day lost in stool
*Vomiting & diarrhea can cause significant fluid & K+ loss
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Term
| Endocrine: Anti-diuretic hormone (ADH) |
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Definition
Released by pituitary when plasma osmolarity increases (sensed by osmoreceptors)
Stimulates the kidneys to increase water reabsorption & decrease urine output
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Term
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Definition
Renin released in response to decreased renal perfusion→ → angiotensin II → aldosterone
Angiotensin: vasoconstricts & increases arterial pressure (perfusion) and stimulates thirst
Aldosterone: increases reabsorption of water and sodium.
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Term
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Definition
Interstitial fluid loss
*Only fluid loss so always hypernatremic
*>5% dehydration detectable on exam
*Causes: vomiting, diarrhea, decreased fluid intake, profuse sweating, drugs (diuretics, BP meds)
*See Fig. 13-7 in Iggy
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Term
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Definition
Intravascular fluid loss
*Decreased perfusion
*>8% dehydration causes hypovolemia
*Causes: dehydration, bleeding, drugs (diuretics, BP meds), third spacing (significant edema or ascites)
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Term
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Definition
*MS changes: irritability; confusion; dizziness,
*Weakness; anorexia; extreme thirst
*Dry skin and mucous membranes; sunken eyeballs; poor skin turgor (check for skin turgor over sternum or forehead in elderly pt); tongue furrows
*Decreased urine output
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Term
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Definition
*Same as dehydration plus
*Orthostatic hypotension
*SBP drops 20 mmHg or DBP drops 10 mmHg of lying BP
*HR increase 15-30 bpm
*Monitor for symptoms: dizziness, pre-syncope
*Shock if > 25% loss of intravascular volume or if fluid loss is rapid.
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Term
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Definition
↑ BUN, normal creatinine
*↑ Hct
*Sodium and/or potassium may be elevated or reduced, depending on the cause
*↓ K+ with GI & renal fluid loss
*↑ Na with dehydration
*Urine specific gravity—measures ability of kidneys to excrete or conserve urine.
*Normal 1.010 to 1.025 (compare to distilled water 1.000)
*Osmolality—measures solute concentration in blood or urine.
*Urine osmolality 200-800 mOsm/kg
*Serum osmolality 280-300 mOsm/kg
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Term
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Definition
Fluid replacement
*Oral if not acute or severe
*IVF for rapid rehydration or if patient unable to take PO
*If UO remains low (<30 ml/hr)
*Fluid challenge (usually 250-500ml over 15-30 min), and monitor for increase in BP and UO within 1 hr
*If no response, may be acute tubular necrosis (acute kidney injury) r/t prolonged hypoperfusion and may need supportive dialysis
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Term
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Definition
Abnormal retention of fluid and sodium
*Always related to sodium but serum sodium concentration WNL
*Primarily of concern in patients who can’t manage fluid because of underlying cardiac, renal, or liver disease
*Causes:
*Heart failure
*Renal failure
*Liver failure (cirrhosis)
*Fluid overload
*Excess sodium consumption (food or fluid)
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Term
| Symptoms of Hypervolemia: |
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Definition
CV: tachycardia, increased BP, edema, JVD
*Resp if underlying HF: crackles, dyspnea, orthopnea, increased RR, decreased oxygen saturation
*Increased weight
*May have increased or decreased UO (depending on renal function)
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Term
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Definition
| Loop diuretics and thiazide diuretics will pull potassium and magnesium out with UO |
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Term
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Definition
| Potassium-sparing diuretics (Aldactone/spironolactone) |
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Term
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Definition
| A Normal blood sodium level is 135 - 145 milliEquivalents/liter |
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Term
| Normal blood potassium levels: |
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Definition
| The normal blood potassium level is 3.5 - 5.0 milliEquivalents/liter |
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Term
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Definition
| The normal serum range for chloride is 98 - 108 mmol/L. |
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Term
| Normal Basic chemistry panel levels: |
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Definition
- BUN: 7 to 20 mg/dL
- CO2 (carbon dioxide): 20 to 29 mmol/L
- Creatinine: 0.8 to 1.4 mg/dL
- Glucose: 64 to 128 mg/dL
- Serum chloride: 101 to 111 mmol/L
- Serum potassium: 3.7 to 5.2 mEq/L
- Serum sodium: 136 to 144 mEq/L
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Term
| Higher than normal BUN values can be due to: |
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Definition
Congestive heart failure
- Excessive protein levels in the gastrointestinal tract
- Gastrointestinal bleeding
- Hypovolemia
- Heart attack
- Kidney disease, including glomerulonephritis, pyelonephritis, and acute tubular necrosis
- Kidney failure
- Shock
- Urinary tract obstruction
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Term
| Abnormal BUN test values can be due to: |
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Definition
- Liver failure
- Low protein diet
- Malnutrition
- Over-hydration
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Term
High potassium levels can be due to:
Hyperkalemia |
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Definition
- Addison's disease (rare)
- Blood transfusion
- Certain medications
- Crushed tissue injury
- Hyperkalemic periodic paralysis
- Hypoaldosteronism (very rare)
- Kidney failure
- Metabolic or respiratory acidosis
- Red blood cell destruction
- Too much potassium in your diet
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Term
Low levels of potassium can be due to:
Hypokalemia |
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Definition
- Chronic diarrhea
- Cushing syndrome (rare)
- Diuretics such as hydrochlorothiazide, furosemide, and indapamide
- Hyperaldosteronism
- Hypokalemic periodic paralysis
- Not enough potassium in the diet
- Renal artery stenosis
- Renal tubular acidosis (rare)
- Vomiting
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Term
Higher than normal sodium levels:
hypernatremia |
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Definition
- Cushing syndrome
- Diabetes insipidus
- Hyperaldosteronism
- Increased fluid loss due to excessive sweating, diarrhea, use of diuretics, or burns
- Too much salt or sodium bicarbonate in your diet
- Use of certain medicines, including birth control pills, corticosteroids, laxatives, lithium, and NSAIDs such as ibuprofen or naproxen
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Term
Lower than normal Sodium levels can be due to:
hyponatremia |
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Definition
- Addison's disease
- Dehydration, vomiting, diarrhea
- An increase in total body water seen in those with heart failure, certain kidney diseases, or cirrhosis of the liver
- Ketonuria
- SIADH
- Too much of the hormone vasopressin
- Use of medications such as diuretics (water pills), morphine, and SSRI antidepressants
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Term
Normal H&H Levels:
Hemaglobin |
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Definition
Hemoglobin is the oxygen-carrying protein pigment in the blood, specifically in the red blood cells.
- Adult males: 14-18 gm/dl
- Adult women: 12-16 gm/dl
- Men after middle age: 12.4-14.9 gm/dl
- Women after middle age: 11.7-13.8 gm/dl
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Term
Normal H&H levels:
Hematocrit |
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Definition
The hematocrit is the proportion, by volume, of the blood that consists of red blood cells.
- Adult males: 42-54%
- Adult women: 38-46%
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Term
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Definition
3.5-10.5 billion cells/L
(3,500 to 10,500 cells/mcL) |
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Term
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Definition
For someone who doesnt have diabetes: 4.5 to 6 percent
Prediabetic: 5.7 and 6.4 percent
Diabetic: 6.5 percent or higher on two separate tests |
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Term
| Which population is most at risk for developing diabetes? |
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Definition
Men- Hispanic
Women- Hispanic |
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Term
| Which ethnic population is least at risk for developing diabetes? |
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Definition
Men- White Non-Hispanic
Women- White Non- Hispanic |
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Term
| Meaning of the words "Diabetes" and "Mellitus"? |
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Definition
"Diabetes" = "To go through"
"Mellitus" = "Sweet"
Sweet urine. |
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Term
Diagnosing Diabetes
(5 ways) |
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Definition
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A1C > 6.5%
fasting plasma glucose (FPG) 126mg/dL (7.0 mmol/l). Fasting is defined as no caloric intake for at least 8 h
2-h plasma glucose 200 mg/dL (11.1mmol/l) during an oral glucose tolerance test (OGTT). The test should be performed as described by the World Health Organization, using a glucose load containing the equivalent of 75 ganhydrous glucose dissolved in water;
patient with classic symptoms of hyperglycemia or hyperglycemic crisis,
random plasma glucose >200 mg/dL (11.1 mmol/l)
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Term
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Definition
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Cellular-mediated autoimmune destruction of the B-cells of the pancreas which leads to absolute insulin deficiency
- ¨ Islet cell autoantibodies
- ¨ Autoantibodies to insulin
- ¨ GAD autoantibodies
- Accounts for 5-10% of DM
- Generally diagnosed in childhood. More rapid B-cell destruction w/ younger age.
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Term
| Process of Type 1 Diabetes in the body: |
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Definition
1. The stomach changes food into glucose
2. Glucose enters the bloodstream
3. The pancreas makes little or no insulin
4. Little or no insulin enters the bloodstream
5. Glucose builds up in the bloodstream
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Term
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Definition
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Caused by insulin resistance with relative insulin deficiency to insulin secretory defect with insulin resistance
- Accounts for 90-95% of DM
- Generally goes undiagnosed for years
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Term
| Pre-disposing factors for Type 2 diabetes? |
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Definition
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Pre-disposing factors:
Obesity/overweight
Age
Lack of physical activity
Ethnic groups: AA, API, Hispanic Americans, AI
GDM- 50% rate of developing T2DM
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Term
| Symptoms of Hyperglycemia: |
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Definition
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3 Ps
Nocturia
Blurred vision
Fatigue
Recurrent infections
Wt loss
Slow healing cuts
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Term
| At risk for Pre-Diabetes if: |
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Definition
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FBS >100mg/dl
A1C- 5.7-6.4%
35% of U.S. adults aged 20 years or older had prediabetes = 79 million Americans (50% of those aged 65 years or older)
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Term
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Definition
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Healthy and balanced eating
Daily exercise
Stress reduction and management
Medication
Self Management – SBGM
Meeting diabetes guidelines for self management
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Term
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Definition
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DiaLOG (Diabetes tracking log)
VDC (Virginia Diabetes Council- is working to increase access to evidenced-based resources andpromote self-awareness and self-management of diabetes)
Diabetes A,B,C,D,E,F
A1C
BP
Cholesterol
Dilated Eye Exam
Education
Foot Care
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Term
| Goals of Medical Nutrition Therapy: |
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Definition
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Achieve and maintain BG levels in nl range and lipids to prevent vascular disease.
Normal BP (<130/80)
Prevent or slow rate of complications
Meet nutrition needs
Maintain the pleasure of eating (reduce the need to eat for meds)
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Term
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Definition
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Generally 1 unit fast acting insulin for each 15 grams CHO
This is dependent on the results of the SBGM.
With T1DM, can see varying ratios throughout the day, for example, 1:12 for breakfast, 1:15 for lunch, 1:20 for dinner |
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Term
| Insulin: Rapid Acting Information |
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Definition
Onset <15 mins
Peak 0.5- 3 hours
Duration 3-5 hours
Note: If mixing with NPH, rapid acting insulin should be drawn into the syringe first. Mixture should be given immediately to avoid effects on peak action.
EX/ Lispro, Aspart, Glulisine |
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Term
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Definition
Onset 0.5- 1 hour
Peak 2-4 hours
Duration 4-8 hours
Note: May be mixed with NPH in same syringe. Mixing order should be the clear regular drawn up first, then the cloudy NPH ("clear to cloudy")
EX/ Regular (Novolin R or Humulin R) |
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Term
| Insulin: Intermediate Acting |
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Definition
Onset 2-4 hours
Peak 4-10 hours
Duration 10-18 hours
Note: Available as pen or vial to be used with syringe. |
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Term
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Definition
Onset 4-6 hours
Peak Same action through out the day
Duration 24 hours
Note: DO NOT mix with other insulin.
Available in pen or in vial. |
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Term
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Definition
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Algorithm for rapid/fast acting
carb counting ratio plus
Correction factor (CF)
Generally 1 unit for each 30-50mg/dl above BG goal
For example: BG is 220, goal is 120, CF is 1/50
How much additional insulin would this person take to lower their BG down to goal? Answer: 2
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Term
| Nursing Considerations: Insulin |
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Definition
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Site of injection- what does it look like? Is there lipohypertrophy? How to examine this?
Rotation plan- “marching soldiers”
Insulin storage- cold insulin is more painful than room temp insulin.
Insulin life
Insulin transport- hot and cold temps
Needles: reuse – good, bad or ugly?
Users must understand insulin action times:
¨Onset, Peak, Duration
Label of vials/pens
Visual impairment
Dexterity
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Term
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Definition
Blood glucose: <70mg/dl
Signs/symptoms: Shake/extremely hungry, lightheaded/weak, cold/clammy skin, personality change, inability to waken
Causes: Too much diabetes meds, too much activity, not enough carb, alcohol, advancing age
Treatment: 15/15
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Term
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Definition
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Used to treat severe hypoglycemia
Route: IM, SQ, IV- almost always IM
Patient/family education is critical!!
Gluconeogenesis
Duration: 1-1.5 hr
Adverse effects: N, V, hyperglycemia
Must eat after administration
Glucose depletion
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Term
| Oral Agents, Insulin Secreters: |
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Definition
They help make the pancreas make more insulin. They work by stimulating the beta cells in the pancreas to release more insulin.
EX/ 1. Sulfonylureas - These drugs are generally taken 2x a day before meals
2. Meglitinides/ Nateglinide- They were similarly to Sulyonylureas except they act immediately in response to food, are very short acting and need to be taken before each meal. |
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Term
Oral agents, insulin secreters:
Common side effects |
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Definition
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Low blood sugar is the most common side effect and can be caused by taking too much of the drug, not eating enough carbs, or an unexpected increase in activity.
Other less common side effects include :
skin reactions
stomach upset
increased sensitivity to the sun
brown urine
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Term
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Definition
These drugs mainly slow the release of glucose from the liver and has a slight effect on helping the body use the insulin better. They should be taken with food for best results. Most frequently used diabetes drugs.
EX/ Metformin or Fortamet |
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Term
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Definition
Diarrhea, nausea/ vomiting, metallic taste
Side effects usually subside if dosage is increased very gradually.
Lactic acidosis is very rare though can be serious. |
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Term
| Who should not take Metformin? (3) |
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Definition
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Who should not take metformin:
people with certain kidney or liver diseases
people who drink alcohol more than 2-4 drinks a week should check with their doctor
people with serious infections or complicated heart problems
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Term
| TZDs (Thiazolidendiones) - Glitazones |
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Definition
They help insulin work better in muscle or fat, they lower insulin resistance, and have a small effect on slowing the release of sugar from the liver.
TZDs are taken once or twice daily.
EX/ Rosiglitazone, Pioglitazone |
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Term
| Side effects and considerations of TZDs: |
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Definition
SE:Headache, Muscle ache, swelling or fluid retention, liver damage
Considerations: Have been associated with liver abnormalities, may make contraceptive pills less effective |
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Term
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Definition
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The drug is controversial and is estimated to have caused 83,000 heart attacks in the United States alone.
Patients will be required to be informed of the risks associated with its use, and the drug will be required to be purchased by mail order through specified pharmacies.
Precautions: MI, Heart failure, CVA, bone fractures, macular changes, hepatatoxicity
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Term
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Definition
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There may be an increased chance of having bladder cancer when taking pioglitazone;
Do not take pioglitazone if receiving treatment for bladder cancer;
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Term
| Alpha-Glucose Inhibitors: |
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Definition
Starch blockers.
Slows or blocks the breakdown of starches and certain sugars in the intestines. Actions slow the rise in blood sugar levels following a meal. Should be taken with first bite of meal. EX/ Acarbose, Miglitol
SE: Intestinal gas, diarrhea, abdominal pain
Considerations: Those with any type of bowel disease or significant kidney disease shouldn't take this. |
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Term
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Definition
While taking a combination drug may be easier, you should remember if you combine two drugs into one- you are still at risk for the side effects of both medications.
EX/ Glucovance, Metaglip, Avandamet |
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Term
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Definition
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Small intestine hormones that responds to a meal. No hypoglycemia!
Ex/ GLP-1 (glucagon-like peptide), DPP-4 (dipeptidyl peptidase 4)
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Term
GLP-1 (glucagon-like peptide)
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Definition
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¨Extenatide (Byetta) and liraglutide
¨↑ insulin
¨↓ glucagon
¨Delay gastric emptying
¨↑ satiety
¨SQ administration
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Term
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DPP-4 (dipeptidyl peptidase 4)
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Definition
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¨Linagliptin (Tradjenta), Saxagliptin (Onglyza), sitagliptin (Januvia)
¨Work by preventing the breakdown of incretins, allowing higher hormone levels
¨Oral administration
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Term
| Exercise’s affect on Blood Sugar |
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Definition
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lower blood sugar levels
improve insulin sensitivity and
strengthen the heart
Precautions:
¨Type 1: dilated eye examine
Avoid if BG >250 or ketonuria
¨T2DM or adult w/ T1DM>5yr – cardiac w/u
¨Frequent monitoring for hypoglycemia –
Take precautions!
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Term
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Definition
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7% of all pregnancies
Increased incidence in overwt, AA, AA, HA, NA
75 g OGTT: FBS, 1, 2 h BG at 24-28 wks
DX w/
¨FBS > 92 mg/dl
¨1 h: > 180 mg/dl
¨2 hr:> 153 mg/dl
BG goal: ,90 pre-meals, ,140 I hr post meal, ,120 2 hr post meal
Treat with MNT, exercise, SBGM >4x/d,
¨if needed BG not at goal - insulin.
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Term
| Other types of DM (non-T1orT2) |
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Definition
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Genetic defects of the B-cell
Genetic defects in insulin action
Diseases of the exocrine pancreas
¨(pancreatitis, trauma, infection, ca)
Endocrinopathies (acromegaly, Cushing’s syndrome, glucaogonoma, pheochromocytomoa)
Drug or chemical-induced diabetes-insulin resistance prior to med
¨Glucocorticoids, nicotinic acid
Infections
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Term
| Diabetic Ketoacidosis - DKA |
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Definition
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S/S: severe dehydration, 3 Ps, fatigue, N,V, breath w/ fruity (alcohol) smell as the body attempts to remove ketoacids, as acidosis worsens, may lead to Kussmaul respirations w/ increase rate and rhythm, tachycardia and hypotension, may lead to stupor and death.
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Term
| Hyperosmolar Hyperglycemic State- HHS |
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Definition
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Mortality rate of 20-40%. Seen in elderly, obese, w/ co-morbid conditions. Gradual onset and may be viewed as a CVA due to neuro involvement (confusion / lethargy). Treat w/ fluid replacement while avoiding cerebral or pulmonary edema.
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Term
| Nursing Considerations for DKA and HHS |
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Definition
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Hydration!
K+ supplementation
Insulin administration- IV, IM, SQ
Monitor acidosis
I&O, VS, Wt, neuro status
Educate: cause, treatment, prevention
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Term
| What do stool studies evaluate? |
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Definition
- Function and integrity of the GI tract
- Detect the presence of infections, protozoa, parasites, and blood in the stool |
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Term
| What is the priority care after a patient has an upper endoscopy examination? |
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Definition
| Check for the return of the gag reflex before offering fluid or food, to avoid aspiration |
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Term
| What should you asses for in patients who have endoscopies? |
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Definition
-Bleeding
-Fever
-Severe pain |
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Term
| What should you check for in patients who have just had a colonoscopy? |
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Definition
| Passage of flatus before allowing fluids or food |
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Term
| Why does Gastroesophageal Reflux Disease (GERD) occur? |
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Definition
| As a result of reflux, or backward flow, of gastrointestinal contents in to the esophagus |
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Term
| What are symptoms of GERD? |
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Definition
-Dyspepsia
-Belching
-Flatulence
-Difficult or painful swallowing |
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Term
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Definition
| Protrusion of a portion of the stomach through the esophageal hiatus of the diaphragm into the chest |
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Term
| What are the symptoms of a hiatal hernia? |
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Definition
| Most patients are asymptomatic, but some have daily symptoms similar to those with GERD |
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Term
| What are some key points to remember when caring for patients with esophageal disorders? |
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Definition
-Remain with dysphagic pt. during meals to prevent/assist with choking episodes
-Teach oral exercises and correct positioning aimed at improving swallowing
-Elevate head of bed by 6 in. when sleeping to prevent nighttime reflux
-Instruct patient to sleep in right side-lying position to minimize the effects of nighttime episodes of reflux |
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Term
| What are the most common stomach disorders? |
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Definition
-Gastritis
-Peptic ulcer disease
-Gastric cancer |
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Term
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Definition
| Inflammation of the gastric mucosa |
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Term
| What can cause acute gastritis? |
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Definition
| Inflammation of the gastric mucosa or submucosa after exposure to local irritants or other cause |
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Term
| What is the most common bacterial cause of gastritis? |
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Definition
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Term
| What are the symptoms of acute gastritis? |
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Definition
| Mild to severe epigastric discomfort, anorexia, cramping, nausea and vomiting, abdominal tenderness and bloating, hematemesis, or melena |
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Term
| What are the symptoms of chronic gastritis? |
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Definition
| Few symptoms unless ulceration occurs |
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Term
| What is the gold standard diagnostic tool for gastritis? |
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Definition
| Esophagogastroduodenoscopy via an endoscope with biopsy |
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Term
| What is priority management for gastritis? |
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Definition
-Supportive care for relieving symptoms (acute gastritis healing is spontaneous, usually occurring within a few days)
-Removing cause of discomfort |
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Term
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Definition
| Mucosal lesion of the stomach or duoenum |
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Term
| What are 3 types of ulcers? |
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Definition
-Gastric ulcers
-Duodenal ulcers
-Stress ulcers |
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Term
| What causes peptic ulcer disease? |
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Definition
| Results when mucosal defenses become impaired and no longer protect the epithelium from the effects of acid and pepsin |
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Term
| What are the complications associated with peptic ulcer disease? |
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Definition
-Hemorrhage
-Perforation
-Pyloric obstruction
-Intractable disease |
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Term
| What are the signs of perforation of a peptic ulcer into the peritoneal cavity? |
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Definition
| The patient has a rigid, boardlike abdomen accompanied by rebound tenderness |
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Term
| What are the primary goals of drug therapy for peptic ulcers? |
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Definition
1. Provide pain relief
2. Eliminate H. pylori infection
3. Heal ulcerations
4. Prevent recurrence |
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Term
| What is important to know if a patient has an active GI bleed? |
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Definition
| This is a life-threatening emergency and requires supportive therapy to prevent hypovolemic shock and possible death |
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Term
| What are 3 general guidelines to keep in mind when caring for patients with stomach disorders? |
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Definition
1. Identify patients at risk for gastritis and peptic ulcer disease, especially older adults who take large amounts of NSAIDs and those with H. Pylori
2. Teach patients with abnormal symptoms, such as abdominal tenderness, abdominal pain that is relieved by food or pain that becomes worse 3 hours after eating, dyspepsia, melena, and/or distention to consult with physician immediately
3. For patients who have undergone a gastrectomy, collaborate with dietitian and instruct the patient regarding diet changes to avoid distention and dumping syndrome |
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Term
| What is Irritable Bowel Syndrome? |
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Definition
| A functional GI disorder characterized by chronic or recurrent diarrhea, constipation, and/or abdominal pain and bloating |
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Term
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Definition
| List the characteristic symptoms, including abdominas pain relieved by defecation or falling asleep or associated with changes in stool frequency or consistency, abdominal distension, the sensation of incomplete evacuation of stool, and presence of mucus with stool passage |
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Term
| Why would a patient with IBS have a hydrogen breath test? |
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Definition
| When small intestinal bacterial overgrowth or malabsorption of nutrients is present, excess hydrogen is produced |
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Term
| What are some interventions you need to implement for a patient with IBS? |
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Definition
-Health teaching
-Drug therapy
-Stress management |
|
|
Term
| What patient education should be included for patients with IBS? |
|
Definition
-Teach patients to avoid GI stimulants, such as caffeine, alcohol, and milk and milk products
-Teach patients to manage stress |
|
|
Term
|
Definition
| A weakness or defect in the abdominal muscle wall through which a segment of the bowel or other abdominal structure protrudes |
|
|
Term
| What is the risk for a strangulated hernia? |
|
Definition
| Can cause ischemia and bowel obstruction, requiring immediate intervention |
|
|
Term
| What is an intestinal obstruction? |
|
Definition
| Common and serious disorder caused by a variety of conditions and is associated with significant morbidity |
|
|
Term
| What should you assess in a patient with a nasogastric tube? |
|
Definition
Check every 4 hours for:
-Proper placement
-Patency
-Output |
|
|
Term
|
Definition
| An acute inflammation which occurs when the lumen of the appendix is obstructed, leading to infection as bacteria invade the wall of the appendix |
|
|
Term
| What are the causes of appendicitis? |
|
Definition
-Fecaliths
-Malignant tumors
-Worms
-Other infections |
|
|
Term
| What is the difference between the risks for slow onset and rapid onset appendicitis? |
|
Definition
-An abscess may develop in slow onset
-A rapid process may result in peritonitis |
|
|
Term
| What are the complications of peritonitis? |
|
Definition
They are all serious, some examples are:
-Gangrene
-Perforation |
|
|
Term
| What lab tests would you look for in appendicitis? |
|
Definition
| WBCs "shift to the left," and if the elevation is greater than 20,000 it may indicate a perforated appendix |
|
|
Term
| What should you do with a patient admitted for suspected or known appendicitis? |
|
Definition
| Keep them NPO to prepare for the possibility of emergency surgery and to avoid making inflammation worse. Surgery is required ASAP. |
|
|
Term
|
Definition
| A life-threatening, acute inflammation of the visceral/parietal peritoneum and endothelial lining of the abdominal cavity |
|
|
Term
| What are the cardinal signs of peritonitis? |
|
Definition
-Abdominal pain
-Tenderness |
|
|
Term
|
Definition
| An increase in frequency and water content of stools or vomiting related to infection and inflammation of the mucous membranes of the stomach and intestinal tract, usually self-limiting unless complications occur |
|
|
Term
| What should you be concerned about with a patient with gastroenteritis? |
|
Definition
| Weakness and cardiac dysrhythmias may be the result of loss of potassium from diarrhea |
|
|
Term
| What is inflammatory bowel disease? |
|
Definition
| Usually refers to disorders of the GI tract with no known etiology, such as ulcerative colitis and Crohn's disease, but may be idiopathic |
|
|
Term
| What is ulcerative colitis? |
|
Definition
| Creates a widespread inflammation of the rectum and rectosigmoid colon, associated with periodic remissions and exacerbations |
|
|
Term
| What are the symptoms of ulcerative colitis? |
|
Definition
-Patient's stool typically contains blood and mucus
-Patient's report tenesmus
-An unpleasant and urgent sensation to defecate
-Lower abdominal colicky pain |
|
|
Term
| What should you instruct the patient about activity after treatment for ulcerative colitis? |
|
Definition
| Activity is generally restricted because rest can reduce intestinal activity, provide comfort and promote healing |
|
|
Term
| What is the most definitive test for diagnosing ulcerative colitis? |
|
Definition
|
|
Term
| What should you assess for in a patient with an ileostomy? |
|
Definition
| Coping strategies and identify support systems |
|
|
Term
|
Definition
| An inflammatory disease of the small intestine, the colon, or both. It is a slowly progressive, unpredictable, and a recurrent disease with involvement of multiple regions of the intestine with normal sections in-between |
|
|
Term
| What are the signs and symptoms of Crohn's disease? |
|
Definition
-Severe diarrhea
-Malabsorption of vital nutrients
-Anemia is common
-Fistulas are common with acute periods |
|
|
Term
|
Definition
| An abnormal connection or passageway between two epithelium-lined organs or vessels that normally do not connect |
|
|
Term
| What are the complications of fistulas? |
|
Definition
-Systemic infections
-Skin problems
-Malnutrition
-Fluid and electrolyte imbalances |
|
|
Term
| What are the treatments of the patients with a fistula? |
|
Definition
-Includes nutrition and electrolyte therapy
-Skin care
-Prevention of infection |
|
|
Term
|
Definition
| Pouch-like herniations of the mucosa through the muscular wall of any portion of the gut, but most commonly in the colon |
|
|
Term
| What is the difference in the food a patient with diverticulosis should eat compared with a patient with diverticulitis? |
|
Definition
| Teach patients with diverticulosis to eat a high-fiber diet; diverticulitis requires a low-fiber diet, such as avoid nuts, foods with seeds, and GI stimulants |
|
|
Term
| What is the risk associated with diverticulitis? |
|
Definition
| Can result in rupture of the diverticulum with peritonitis, pelvic abscess, bowel obstruction, fistula, persistent fever or pain, uncontrolled bleeding |
|
|
Term
|
Definition
| An extensive irreversible scarring of the liver, usually caused by a chronic reaction to hepatic inflammation and necrosis |
|
|
Term
| What are the most common causes for cirrhosis? |
|
Definition
| Alcoholic liver disease and Hep C |
|
|
Term
| What are the risks associated with hepatic cell damage? |
|
Definition
| May lead to portal hypertension, ascites, bleeding esophageal varices, coagulation defects, jaundice, portal-systemic encephalopathy with hepatic coma, hepatorenal syndrome and spontaneous bacterial peritonitis |
|
|
Term
| What should the nurse make certain is done for a patient with cirrhosis and a GI bleed? |
|
Definition
| These patients should receive antibiotics on admission to the hospital |
|
|
Term
| How long does it take for hepatitis to be considered chronic? |
|
Definition
| When liver inflammation lasts longer than several months, usually defined as 6 months |
|
|
Term
| What puts people more at risk for gallstones? |
|
Definition
-If they are female
-Obesity
-Pregnancy
-Estrogen
-Birth control pills |
|
|
Term
| What pathologies could happen as a result of acute pancreatitis? |
|
Definition
| Severe, life-threatening complications sucha s jaundice from swelling of the head of the pancreas, calculi or pancreatic pseudocyst, transient hyperglycemia from release of glucagon, left lung pleural effusions, and total destruction of the pancreas leading to type 1 diabetes |
|
|
Term
| What would the nurse be concerned about in a patient with severe pain in the mid-epigastric area or left upper quadrant? |
|
Definition
|
|
Term
| What is the priority patient care for patients with acute pancreatitis? |
|
Definition
-Relieving symptoms
-Decreasing inflammation
-Anticipating or treating complications |
|
|
Term
| What is the focus of caring for a patient with chronic pancreatitis? |
|
Definition
-Manage pain
-Assist in maintaining a sufficient nutritional intake
-Prevent recurrence |
|
|
Term
| What is an alternative way to measure a patient's nutritional status if BMI is unavailable? |
|
Definition
| Measure patient's calf circumference |
|
|
Term
| What type of patients are likely to receive total enteral nutrition using a feeding tube? |
|
Definition
-Those can eat but cannot maintain adequate nutrition intake by oral intake of food alone
-Those who have permanent neuromuscular impairment and cannot swallow
-Critically ill patients |
|
|
Term
| What are some complications related to tube feeding? |
|
Definition
-Irritation
-Sinusitis
-Tissue erosion
-Pulmonary compromis |
|
|
Term
|
Definition
| A life-threatening metabolic complication that can occur when nutrition is restarted for a patient who is in a starvation state |
|
|
Term
| How often should a nurse check gastric residual volumes for a patient on tube feeding and why? |
|
Definition
| Every 4-6 hours or per agency policy, because overfeeding is a serious problem |
|
|
Term
| Who is a candidate for bariatric surgery? |
|
Definition
-Those who have repeated failure of nonsurgical intervention
-A BMI equal to or greater than 40
-Morbid Obesity |
|
|
Term
| What are indicators of malnutrition? |
|
Definition
-Weight loss of 5% in 30 days
-Weight loss of 10% in 6 months
-BMI <18 |
|
|
Term
|
Definition
| Vasomotor symptoms that occur as a result of rapid emptying of food into Small Intestine, occurs around 30 minutes after eating; often seen with Gastric Bypass |
|
|
Term
| Dumping syndrome symptoms and treatment |
|
Definition
Symptoms:
-Vertigo
-Tachycardia
-Syncope
-Sweating
-Pallor
-Palpitations
Treaments: Small meals, low CHO |
|
|
Term
| What are Small Intestine Bowel Obstruction S&S, Diagnostic findings, and medical management? |
|
Definition
S&S:
-Colicky severe abd pain, N&V
-Absence of stool or flatus
-Late sign: fecal vomiting
Dx:
-X-ray and CT show abnormal amount of air/fluid in intestine
MM:
-Decompression with NG tube and bowel rest
-If worsens and bowel at risk for ischemia, bowel resection |
|
|
Term
| What are the S&S and Diagnostics of Large Intestine Bowel Obstruction? |
|
Definition
S&S: (slower onset than SBO)
-Constipation
-Abd distension
-Eventually fecal vomiting
DX:
-Abd X-ray
-CT reveal a distended colon |
|
|
Term
| What is cystitis and what causes it? |
|
Definition
-Inflammation of the bladder
-Most commonly caused by bacteria moving up
-Catheters: high risk factor in developing nosocomial cystitis |
|
|
Term
| What are the S&S and diagnoses for cystitis? |
|
Definition
-Frequent urge to urinate
-Dysuria
-Urgency
-Urinalysis needed when testing for leukocyte esterase
-Organism type confirmed by urine culture
-Other diagnostic assessments |
|
|
Term
| What is pyelonephritis and what are the acute symptoms? |
|
Definition
-Bacterial infection in kidney and renal pelvis
Acute symptoms:
-Fever, chills, tachycardia, tachypnea
-Flank, back, or loin pain
-Abdominal discomfort
-Turning, nausea and vomiting, urgency, frequency, nocturia
-General malaise or fatigue |
|
|
Term
| What are the symptoms of chronic pyelonephritis? |
|
Definition
-Hypertension
-Inability to conserve sodium
-Decreased concentrating ability
-Development of hyperkalemia and acidosis |
|
|
Term
|
Definition
-Narrowed areas of urethra
-Most common symptom-obstruction of urine flow
-Surgical treatment by urethroplasty-best chance of long-term cure
-Dilation of urethra (temporary measure)
-Urethroplasty |
|
|
Term
| What is stress incontinence and what are it's causes and interventions? |
|
Definition
Stress incontinence is the most common type of incontinence among women.
Causes:
-Weakened pelvic muscles
-Weakening in the wall between the bladder and vagina
-Change in the position of the bladder
Interventions:
-Journaling, behavorial interventions, diet modification, pelvic flor exercises
-Diet therapy
-Drug therapy-estrogen
-Surgery
-Vaginal cone therapy |
|
|
Term
| What are the interventions for urge incontinence? |
|
Definition
-Drugs-anticholinergics, antihistamines, others
-Diet therapy-avoid caffeine and alcohol
-Behavioral interventions-exercises, bladder training, habit training, electrical stimulation |
|
|
Term
| What is overflow incontinence? |
|
Definition
| AKA known as reflex incontinence, a constantly full bladder triggers frequent urination or a constant dribbling or urine, or both |
|
|
Term
| What are the causes and interventions for overflow incontinence? |
|
Definition
Causes:
-Weakened bladder muscles related to autonamic nerve damage from diabetes and other diseases
-Blocked urethra due to kidney or urinary stones, tumors, an enlarged prostate in mean, female bladder surgery that is too tight, or a birth defect
Interventions
-Surgery to relieve obstruction
-Intermittent catheterization
-Bladder compression, intermittent self-catheterization
-Drug therapy
-Behavioral interventions |
|
|
Term
| What is functional incontinence and what are it's causes and interventions? |
|
Definition
Inability to get to toilet prior to urination
Causes: mobility, fragility, medications, diseases
Interventions:
-Treatment of reversible causes
-Urinary habit training
-Final strategy-containment of urine, protection of patient's skin
-Applied devices
-Urinary catheterization |
|
|
Term
|
Definition
| Presence of calculi (stones) in the urinary tract |
|
|
Term
|
Definition
-Uses sound, laser, or dry shock wave energy to break stones into small fragments
-Patient undergoes conscious sedation
-Topical anesthetic cream applied to skin site
-Continuous monitoring by ECG |
|
|
Term
| What is Polycystic Kidney Disease and what are it's symptoms? |
|
Definition
Inherited disorders; fluid-filled cysts develop in nephrons
Symptoms:
-Abdominal or flank pain
-Hypertension
-Nocturia
-Increased abdominal girth
-Constipation
-Bloody or cloudy urine
-Kidney stones |
|
|
Term
| What is nephrotic syndrome? |
|
Definition
-Condition of increased glomerular permeability; allows larger molecules to pass through the membrane into urine and be excreted
-Severe loss of protein into urine, edema formation, and decreased plasma albumin levels |
|
|
Term
| What is the treatment for nephrotic syndrome? |
|
Definition
-Immunosuppressive agents
-ACE inhibitors
-Heparin
-Diet changes
-Mild diuretics |
|
|
Term
|
Definition
-Thickening in nephron blood vessels; results in narrowing of vessel lumen
-Occurs with all types of hypertension, atherosclerosis, diabetes mellitus
-Collaborative management-control high blood pressure, perserve kidney function |
|
|
Term
|
Definition
-Processes affecting renal arteries; may severely narrow lumen, greatly reduce blood flow to kidneys
-Assessment
-Priority goals for care
-Interventions |
|
|
Term
| Benign Prostatic Hyperplasia |
|
Definition
| Glandular units in the prostate that undergo an increase in number of cells, resulting in enlargement of prostate gland |
|
|
Term
| What are the symptoms of Benign Prostatic Hyperplasia? |
|
Definition
-Hyperirritable bladder
-Urgency and frquency
-Hypertrophied bladder wall muscles
-Cellules and diverticula
-Hydroureter
-Hydronephrosis
-Overflow urinary incontinence |
|
|
Term
| What is a hydrocele and what are the treatments? |
|
Definition
-Cystic mass usually filled with straw-colored fluid forms around testis, results from impaired lymphatic drainage of scrotum, causing swelling of tissue surrounding the testes
Treatment:
-Drainage via needle and syringe
-Surgical removal |
|
|
Term
|
Definition
-Sperm-containing cyst develops on epididymis alongside the testicle
-Normally small and asymptomatic, require no intervention
-If large enough to cause discomfort, spermatocelectomy is performed |
|
|
Term
|
Definition
-Cluster of dilated veins occurring behind and above testis
-Can cause infertility
-Varicolcelectomy performed through an inguinal incision; spermatic veins are ligated in the cord |
|
|
Term
| What are the treatments for epiddymitis? |
|
Definition
-Bedrest
-Elevation
-Scrotal support when ambulating |
|
|
Term
| What is orchitis and how do you treat it? |
|
Definition
-Acute testicular inflammation resulting from trauma or infection
Treatment:
-Bedrest with scrotal elevation
-Application of ice
-Analgesics and antibiotics |
|
|
Term
| Care of patients with male reproductive problems |
|
Definition
1. Etiologies, risk factors, comorbities
2. Assessment (holistic approach)
3. Diagnostic tests
4. Nurse's role in management
5. Interdisciplinary team's role in management
6. Treatment and interventions
7. Teaching and health promotion
8. Teaching and health promotion for at-risk individuals |
|
|
Term
| What are acute symptoms that indicate urgent need for dialysis? |
|
Definition
-Encephalopathy
-Uncontrolled hyperkalemia
-Pericarditis
-Pulmonary edema
-Increasing acidosis
-Medications or toxins |
|
|
Term
| Care of the patient on dialysis |
|
Definition
Dialysis removes large volumes of intravascular fluid in 2-4 hours.
-Monitor closely for at least one hour for hemodynamic instability: HR, BP, orthostatic BP, dizziness, diaphoresis, nausea
Heparin given during procedure can cause bleeding
-Watch for overt/covert bleeding
Many medications are dialyzed out (many antibiotics)
-Adjust medication times if necessary to give after dialysis. Ask pharmacist or nephrologist if you have questions about pts meds.
-Discuss with MD if antihypertensives need to be held predialysis if patient regularly develops low BP |
|
|
Term
|
Definition
-Surgical anastomosis of artery and vein which allows for arterial flow through the vein which provides the rapid blood flow necessary for dialysis
-Vein becomes enlarged and tough
-Preferred access as it lasts longest and has least complications
-Must have good blood vessels for this
-Fistula must "mature" for 2-3 months before can be used |
|
|
Term
|
Definition
-Synthetic self-sealing graft that connects the artery and the vein
-Should be used primarily for patients with poor vessels
-Graft is accessed instead of vein
-Higher rate of clotting off and infection
-Needs to heal for only 2-3 weeks
-Easier for MD to put in |
|
|
Term
| Care of patient with AV Fistula or Graft |
|
Definition
-NO BP or venipuncture in affected arm. Place sign over bed and teach patient to remind caregivers
-Palpate for "thrill"
-Auscultate for "bruit"
-Monitor circulation distal to fistula or graft
-Monitor for aneurysm
-Pt. may have multiple old non-functioning grafts. Clarigy and assess current one |
|
|
Term
| Care of patient with peritoneal dialysis |
|
Definition
-Nurse may do PD or pt/family may do it. Need MD order for pt. to do it. RN still responsible for monitoring exchange and pt/family technique
-Peritonitis is a major concern:
--Wear mask and sterile gloves for procedure. Put mask on pt.
--Assess drained "effluent" for clarity. Cloudy effluent is sign of peritonitis
--Notify MD immediately for any abnormal findings. Send specimen of effluent for C&S, WBCs.
-Monitor catheter exit site for infection |
|
|
Term
| What are the functions of the renal system? |
|
Definition
-Fluid and electrolyte balance
-Blood filtration-remove waste products of the body's metabolic processes in the form of urine
-Acid-base balance
-Blood pressure regulation
-Erythropoietin production
-Vitamin D production |
|
|
Term
| What is the significance of Mean Arterial Pressure (MAP)? |
|
Definition
-Reflects the hemodynamic perfusion pressure of the vital organs
-Calculation: [(2xdiastolic) + systolic]/3
-Rule of thumb: MAP >65=adequate end organ perfusion |
|
|
Term
| RIFLE criteria for Renal Failure |
|
Definition
Risk: GFR >25%
Injury: GFR >50%
Failure: GFR >75%
Loss: Persistent AKI or complete loss of kidney function for more than 4 weeks
End-stage: Need for renal replacement therapy for more than 3 months |
|
|
Term
| What is Pre-renal Acute Kidney Injury and what are the causes? |
|
Definition
Most common type of AKI
-Hypoperfusion due to conditions that affect renal blood flow
-Nephrons remain structurally intact
Causes:
Hypovolemia
Hypotension
Sepsis
Hemorrhage
Renal atherosclerosis |
|
|
Term
| What is Intra-renal Acute Kidney Injury and what are the causes? |
|
Definition
Direct injury to the kidney with structural and functional damage to nephrons
Causes:
Ischemia (from emboli)
Inflammation
Infection
Toxins
Medications
IV contrast
Rhabdomyolysis |
|
|
Term
| What is Post-renal AKI and what are the causes? |
|
Definition
Least common cause of AKI
-Due to obstruction of urine outflow
-Reversible with removal of obstruction unless it has been present long enough to cause damage to kidney
Causes:
-Benign Prostatic hypertrophy (BPH)
-Tumors
-Kidney stone (renal calculi) - usually unilateral
-Neurogenic bladder |
|
|
Term
| What are the signs and symptoms of Acute Kidney Injury? |
|
Definition
-Oliguria: <0.5mg/kg/hr; <400ml/24hr
-Proteinuria
-Fluid retention
-Increased serum potassium
-Increased creatinine
-Decreased serum bicarb |
|
|
Term
|
Definition
-Progressive loss of decline in kidney function that correlated with loss of nephrons
-Symptoms occur when overall renal function is less than 20-25% of nephrons remain
-Until then, remaining nephrons hypertrophy to compensate by accepting larger blood volume |
|
|
Term
| What are the causes of Chronic Kidney Disease? |
|
Definition
-Diabetes
-Hypertension
-Unsuccessfully treated ARF
-Glomerulonephritis
-Autoimmune disorders
-Congenital defects |
|
|
Term
| What are the functions of the nervous system? |
|
Definition
-Direct all physiological, cognitive, and psychological activities
-Maintain homeostasis
-Gather sensory information, integrate it, and respond to it via motor activity |
|
|
Term
| What is the purpose of a lumbar puncture or a spinal tap? |
|
Definition
-To obtain pressure readings
-Obtain cerebrospinal fluid
-Check for spinal blockage attributable to a spinal cord lesion
-Inject contrast medium or air for diagnostic study
-Inject spinal anesthetics or other medications, and reduce mild increased intracranial pressure in certain conditions |
|
|
Term
| What should the nurse do during a lumbar puncture procedure? |
|
Definition
| Assist with patient (fetal position preferred) |
|
|
Term
| When is a lumbar puncture contraindicated? |
|
Definition
| In patients with symptoms suggestive of increased intracranial pressure |
|
|
Term
| What does normal cerebrospinal fluid look like? |
|
Definition
| Clear and colorless with few cells |
|
|
Term
| What should the nurse monitor for in a patient who just had an angiography? |
|
Definition
| -Bleeding (if bleeding is observed, call the radiologist immediately) |
|
|
Term
| What is multiple sclerosis? |
|
Definition
| A chronic autoimmune disease that affects the myelin sheath and conduction pathway of the CNS and is a leading cause of disability in young adults |
|
|
Term
| What are the signs and symptoms of MS? |
|
Definition
-Abnormal sensations
-Speech problems
-Tremors
-Bladder problems
-Difficulty walking |
|
|
Term
| What is the goal of care for a patient with MS? |
|
Definition
| Maintain maximum strength, function, and independence |
|
|
Term
| What are the functions of the CSF? |
|
Definition
-Protects the brain & spinal cord
-Circulates nutrients and removes waste products from brain (no lymphatics in brain)
-Helps maintain special environment that the brain requires |
|
|
Term
| How long can the brain go without blood supply before irreversible brain damage? |
|
Definition
|
|
Term
| What is the most effective way to protect the brain during focal and global ischemia? |
|
Definition
|
|
Term
| What is the difference between an upper motor neuron and a lower motor neuron? |
|
Definition
Upper motor neuron = from brain
Lower motor neuron = from spine |
|
|
Term
| What are the signs of upper neuron damage? |
|
Definition
Hyperactive reflexes
Rigidity
Tremor
Twisting irregular movements may be present |
|
|
Term
| What are the signs of lower neuron damage? |
|
Definition
Flaccid paralysis
No reflexes
Loss of muscle tone |
|
|
Term
| What does the mnemonic AEIOU TIPS to help recall common causes of altered LOC stand for? |
|
Definition
Alcohol
Epilepsy
Insulin
Overdose
Uremia
Trauma
Infection
Psychiatric
Stroke |
|
|
Term
| What are the 3 types of seizures? |
|
Definition
-Grand mal: entire brain depolarizes at once
-Focal: localized
-Status epilepticus: medical emergency |
|
|
Term
| During a seizure, what is priority? |
|
Definition
-Protect airway
-Safety precautions |
|
|
Term
| What should you remind patients who receive contrast media or isotopes to do? |
|
Definition
| Drink fluids to increase elimination of the material |
|
|
Term
|
Definition
| Person experiences 2 or more seizures |
|
|
Term
| What is the treatment for seizures and what should you teach patients who have seizures? |
|
Definition
-Drug therapy: major component of management. Generally introduce one AED at a time.
-Teach pts importance of taking drugs on time and as prescribed. Build up sensitivity, may lead to drug decline. MUST KEEP LAB APPTs!
-Healthy lifestyle: balanced diet, proper rest, stress reduction techniques, seizure diary, driving |
|
|
Term
| What are seizure precautions that should be employed? |
|
Definition
-Oxygen
-Suction equipment
-Airway: position patient on side during seizure
-IV access: may become dislodged during seizure
-Siderails up: padded?
-NO TONGUE BLADES |
|
|
Term
| What is status epilepticus and what is the management? |
|
Definition
-Prolonged seizures that last more than 5 min or repeated seizures over course of 30 min--medical emergency!
-Establish airway
-ABGs
-IV push lorazepam, diazepam
-Rectal diazepam
-Loading dose IV phenytoin |
|
|
Term
| What is meningitis and what are it's predisposing factors? |
|
Definition
Inflammation of the meninges that surround the brain and spinal cord
-PF: Otitis media, pneumonia, sinusitis, sickle cell anemia, brain or spinal surgery, immunosuppression |
|
|
Term
| What is Kernig's and Brudzinski's sign and what do they mean? |
|
Definition
Kernig's sign: with the pt in supine and thigh flexed to 90 degree angle, attempts to straighten or extend the leg are met with resistance
Brudzinski's sign: flexion of neck causes involuntary flexion of the knees and hips, or passive flexion of the leg on one side causes contralateral flexion of the opposite leg
-Positive sign means meningitis |
|
|
Term
| What are the lab tests used to diagnosis meningitis? |
|
Definition
-CSF analysis
-CT scan
-Blood cultures
-CBC
-Xrays to determine presence of infection |
|
|
Term
| What is the nursing care for a meningitis patient? |
|
Definition
-ABC
-VS and neuro check q2-4 hr
-Cranial nerve assessment
-Manage pain
-Record I&O
-Body weight to identify fluid retention
-Monitor labs
-ROM exercises q4hr
-Decrease environmental stimuli
-Monitor and prevent complications |
|
|
Term
| What is encephalitis and what are it's causes? |
|
Definition
Inflammation of the brain tissue
-Affects cerebrum, brain stem, cerebellum
-Usually caused by viruses, rarely bacteria, fungi or parasites
-Can be life threatening or lead to persistent neuro problems |
|
|
Term
| What are nursing interventions for encephalitis? |
|
Definition
| Same as meningitis--so look at that flashcard! ;P |
|
|
Term
| What is Parkinson's Disease and what are it's causes and treatment? |
|
Definition
Progressive neurodegenerative disease that affects 1 million people
-No cure
-No known cause/preventative measures
-Drug therapy
-Priority of care and management: medical and surgical |
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Term
| What are the stages of Parkinson's Disease? |
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Definition
Stage 1: Initial Stage
-Unilateral limb involvement, minimal weakness, hand and arm trembling
Stage 2: Mild Stage
-Bilateral limb involvement, masklike face, slow, shuffling gait
Stage 3: Moderate Disease
-Postural instability, increased gait disturbances
Stage 4: Severe Disability
-Akinesisa, rigidity
Stage 5: Complete ADL dependence |
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Term
| What are the nursing implications for Parkinson's Disease? |
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Definition
-Encourage self management
-Poor nutrition due to impaired swallowing, chewing (small, frequent meals, thickening agent, food records to record timing and amt of meals)
-Exercise and activity
-Impaired sleep
-Impaired cognition
-Financial considerations
-Safety
-Elimination issues - incontinence, constipation |
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Term
|
Definition
Loss of brain function that occurs with certain diseases. It affects memory, thinking, language, judgement, and behavior
-Most types are degenerative |
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Term
| What are nursing interventions for Alzheimer's Disease? |
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Definition
1. Maintain cognitive function for as long as possible
-Cognitive stimulation and memory training
-Prosopagnosia: use pictures and reminisce
-Reality orientation: works well in early stages
-Validation therapy: better in later stages
2. Consistent and structured environment
3. Promoting self-management: keep ADL items in same place
4. Encourage nutrition
5. Decrease anxiety
6. Promoting bowel and bladder continence
7. Promoting communication
8. Physical illness can worsen symptoms of AD, focus on illness prevention |
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Term
| What is myasthenia gravis and what is its cause? |
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Definition
Autoimmune disease, characterized by fluctuating weakness of the voluntary muscle groups caused by deficient acetylcholine receptors at neuromuscular junction
-Cause is unknown |
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Term
| What are nursing implications for Myasthenia Gravis? |
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Definition
Assessment
-Muscle strength, vision, respiratory status
N. Diagnosis and Interventions
-Activity intolerance
-Alteration in verbal communication
-Alteration in nutrition
-High risk of aspiration
-Disturbed sensory perception
-Risk for injury
-Ineffective respiratory function
-Disturbed body image
-Self care deficit
-Knowledge deficity |
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Term
| What is Guillain-Barre syndrome and what are its cause and treatment? |
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Definition
Acquired immune-mediated inflammatory disorders of the peripheral nervous system
-Cause is unknown
-No cure, but most patients (up to 85%) with GBS achieve a full and functional recovery within 6-12 months |
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Term
| What are the nursing implications for guillain-barre syndrome? |
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Definition
-Education about vaccination information
Assessment and interventions
-Weakness: acute onset
-Cranial nerve involvement
-Facial droop, Diplopias, dysarthria, dysphagia, opthalmoplegia, pupillary disturbances
-Sensory involvement
-Pain
-Autonomic
-Respiratory weakness |
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Term
| What are the stages of Huntington Disease? |
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Definition
Each last about 5 years
Stage 1: onset of neuro and psychological symptoms
Stage 2: increasing dependency on others for care
Stage 3: Loss of independent function |
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Term
| What are nursing implications for Huntington Disease? |
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Definition
Physical Assessment
-Choreiform movements
-Cognition
Drug therapy
Nursing implications: safety, nutrition, genetic screening
Health teaching: include psychosocial support resources, PT, OT, ST, nutritionist |
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Term
| What is the first indication that central neurological function has declined? |
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Definition
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Term
| What are the 4 stages of LOC? |
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Definition
-Alert: Awake and responsive
-Lethargic: drowsy or sleepy but easily aroused
-Stuporous: Arouse with painful stimuli
-Comatose: Unconscious and cannot be aroused |
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Term
| What is the Glasgow Coma Scale? |
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Definition
An objective and reproducible way to describe a patient's level of consciousness and arousal
-Takes 3-5 minutes
-Scores range from 3 to 15 with lower scores indicating more severe neurological deficiency
-Assesses eye opening, limb movement, and vocalization |
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Term
|
Definition
-Graphically records electrical activity of cerebral hemisphere
-Patient must be sleep-deprived before procedure
-Anticonvulsants may be withheld |
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Term
| How do you assess memory? |
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Definition
-Long-term (remote): birthdate, city of birth
-Recall (recent): Accuracy of medical hx, time of admission, mode of transportation to hospital
-Immediate (new): Give patient 2-3 unrelated nouns, ask to repeat immediately and in 5 minutes |
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Term
| How do you assess patient's attention? |
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Definition
-Number series
-Serial 7's ( count backwards from 100 subtracting 7, stop at 65)
-Higher Intellectual Functions: favorite hobbies, current events
-Abstract reasoning: meaning of proverbs (cultural sensitivity) |
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Term
|
Definition
| Normal blood supply to brain is disrupted by ischemia or bleeding |
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Term
| Causes of ischemic stroke |
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Definition
1. Atherosclerosis
2. Cardiogenic embolus
3. Most commonly due to atrial fibrillation
4. Associated with valvular disease |
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Term
| Where do most clots related to A. Fib originate? |
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Definition
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Term
| What are the symptoms of a left-sided stroke? |
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Definition
-Left gaze preference
-Right visual field deficit
-Right hemiparesis
-Right hemisensory loss, neglect & hemi-inattention |
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Term
| What are the symptoms of right sided stoke? |
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Definition
-Right gaze preference
-Left visual field deficit
-Left hemiparesis
-Left hemisensory loss, neglect & hemi-inattention |
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Term
| Phase 1: Hyperacute phase |
|
Definition
-First 3 to 24 hours
-Prehospital:
EMS activation and response
Time symptoms started or last seen "normal"
Rapid transport to stroke center preferred
-ED
Diagnosis of stroke
Cause
Determine plan of care |
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Term
| What are the maximal intervals recommended by NINDS for Potential tPA candidate? |
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Definition
1. Door-to-door first sees patient: 10 min
2. Door-to-CT completed: 25 min
3. Door-to-CT read: 45 min
4. Door-to-thrombolytic therapy starts: 60 min
5. Neurosurgical expertise available: 2 h
6. Admitted to monitored bed: 3 h |
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Term
| What is tissue plasminogen activator (tPA) and what are its contraindications? |
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Definition
Actively dissolves clot
-Contraindications:
Active bleed anywhere in body
Trauma
Bleeding risks and precautions |
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Term
| What statements must be true in order to consider tPA administration? |
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Definition
-Ischemic stroke onset within 3 hours of drug administration
-Measurable deficit on NIH Stroke Scale examination.
-Patient's CT does not show hemorrhage or non-stroke cause of deficit
-Patient's age is >18 years |
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Term
| Do NOT administer tPA if any of these statements are true: |
|
Definition
-Symptoms are minor or rapidly improving
-Patient has had another stroke or serious head trauma within past 3 months
-Patient had major surgery within the last 14 yrs
-Pt. has history of intracranial hemorrhage
-Pt. has symptoms suggestive of subarachnoird hemorrhage
-Pt. has had arterial puncture at non-compressible site within the last 7 days
-Pt. has sustained SBP >185 mmHg or DBP >110 mmHg, and aggressive tx is necessary to lower BP
-Pt. has had GI or Urinary tract hemorrhage within 21 days
-Pt serum glucose is <50 or >400
-Pt has received heparin within last 48 hrs
-Patients PT is >15 seconds or platelet count is <100,000 |
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Term
| What can be done if patient wit ischemic stroke symptoms does not qualify for tPA treatment? |
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Definition
| Can remove blockage mechanically up to 6 hours after onset |
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Term
| What is the ABCD scale (r/t stroke)? |
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Definition
| Used to predict the risk of stroke during the first seven days after a Transient Ischemic Attacks |
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Term
| What is a transient ischemic attack? |
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Definition
| Transient episode of neurological dysfunction caused by focal brain ischemia without acute infarction |
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Term
| Stage 2: Inpatient acute care (for stroke) |
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Definition
-24-72 hours
Nursing Management
-Preventing and monitoring for complications
-Assessing effectiveness of treatment, & improvement or worsening of condition
-Administering treatments
Start rehab ASAP
-Stable cardiac & respiratory status
-PT consult on admission
Prepare patient and family for discharge |
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Term
| What is the NIH Stroke Scale? |
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Definition
| Standardized stroke assessment done on initial assessment, changes of level of care & with change in status for the worse |
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Term
| What is Amyotrophic lateral sclerosis (ALS) aka Lou Gehrig's disease? |
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Definition
| An adult onset upper and lower motor neuron disease characterized by progressive weakness, muscle wasting and spasticity eventually leading to paralysis |
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Term
| What is nursing priority for patient's with ALS (aka Lou Gehrig's disease)? |
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Definition
| Monitor respiratory status carefully in patients with ALS since patient's experience respiratory failure in terminal stages of the disease |
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Term
| What is trigeminal neuralgia? |
|
Definition
| A disease that affects the trigeminal, or fifth, cranial nerve and entails a specific type of unilateral facial pain, which occurs in abrupt, intense spasms |
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Term
|
Definition
| An acute paralysis of cranial nerve VII |
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Term
| What is an occlusive stroke? |
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Definition
| Arterial blockage or narrowing cause ischemia in the brain tissue ultimately leading to infarction of neurons in the involved area of the brain |
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Term
| What is the difference between common onset times for ischemic strokes vs. hemorrhagic strokes? |
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Definition
| Ischemic strokes often occur during sleep, while hemorrhagic strokes tend to occur during activity |
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Term
|
Definition
| Inability to recognize oneself and other familiar faces |
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