Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
228 Cards in this Set
- Front
- Back
Normal Sinus rhythm characteristics
|
- P, QRS, T wave present
- Regular heart rate - Rate 60-100 BPM - Normal PR, QRS, and QT intervals |
|
Sinus tachycardia characteristics
|
- P, QRS, T wave
- Regular heart rate - Rate >100 BPM |
|
Sinus tachycardia causes
|
- Pain
- Fever - Anxiety - Activity - Medications |
|
Sinus tachycardia treatments
|
- May be none
- Treat underlying cause |
|
Sinus Bradycardia characteristics
|
- P, QRS, T wave
- Regular heart rate - Rate <60 BPM |
|
Sinus Bradycardia causes
|
- Can be normal
- Drugs (B-blockers, dig, etc) - Enhanced vagal tone - Hypoxia |
|
Sinus bradycardia treatments
|
Symptomatic
- Atropine - Pacing Asymptomatic - Maybe none - Adjust medication |
|
Atrial fibrillation characteristics
|
- No P waves
- Irregular rhythm - Fibrillatory (F) waves |
|
Atrial fibrillation causes
|
- Sinus node is no longer in control of the heart
- Impulses are coming from everywhere in atria - CHF, hypertension, MI, fluid overload, valve dx - Emboli develop in quivering atria that can travel elsewhere |
|
Atrial fibrillation treatment
|
- Rate control (CCB, B-blockers, amiodarone, dig)
- Rhythm control (ibutilide, amiodarone, cardioversion) - RF abllation (go in, find the source of a fib and zap it out) - Anticoagulation (heparin, warfarin) |
|
Atrial flutter characteristics
|
- Regular flutter waves
- very fast but very regular |
|
Atrial flutter causes
|
- Sinus node is no longer in control of the heart
- Impulses are coming from everywhere in atria - CHF, hypertension, MI, fluid overload, valve dx - Emboli develop in quivering atria that can travel elsewhere |
|
Atrial flutter treatment
|
- Rate control (CCB, B-blockers, amiodarone, dig)
- Rhythm control (ibutilide, amiodarone, cardioversion) - RF abllation (go in, find the source of a fib and zap it out) - Anticoagulation (heparin, warfarin) |
|
PVCs characteristics
|
- Wide bizarre QRS
- Premature complex - Not associated with P waves |
|
PVCs causes
|
- Ischemia/injury
- Drugs or electrolyte imbalances - Invasive lines |
|
PVCs treatments
|
- Watch for frequency
- Assess for cause and treat it - Do not routinely give drugs to suppress |
|
Ventricular fibrillation characteristics
|
- Chaotic quivering of ventricles
- Grossly irregular electrical activity - Unable to recognize any waveforms - No pulse |
|
Ventricular fibrillation causes
|
- Drugs that increase QT
- Ischemia - Electrolyte abnormalities - Reduced EF |
|
Ventricular fibrillation treatments
|
- Call code
- CPR - Defibrillation - Epinephrine or vasopressin - Amiodarone - Lidocaine |
|
Ventricular tachycardia characteristics
|
- Wide QRS
- Rate > 100 BPM - A.V dissociation |
|
Ventricular tachycardia causes
|
- Electrolyte abnormalities (low potassium, low magnesium)
- Ischemia, acute MI - Reduced EF, CHF |
|
Ventricular tachycardia treatments
|
Pulse:
- EKG - Vital sings - Vagal maneuver - Drug therapy - Correct electrolytes No Pulse: - Call code - CPR - Defibrillation - EPI or vasopressin - Amiodarone - Lidocaine |
|
Torsades de pointes characteristics
|
- Twisting of VT around the baseline
- Rate > 250 BPM |
|
Torsades de pointes cause
|
- Drugs that increase QT
- Electrolyte abnormalities - Ischemia |
|
Tosades de pointes treatment
|
- Defibrillation
- Magnesium - Overdrive pacing |
|
P wave
|
Atrial depolarization
|
|
QRS wave
|
Ventricular depolarization
|
|
T wave
|
Ventricular repolarization
|
|
Normal PR range
|
.12 - . 2
|
|
Normal QRS range
|
.04 - .11
|
|
Normal QT range
|
.36 - .44
|
|
Angina pathophysiology
|
Results when there is an imbalance between the heart's oxygen demand and supply
|
|
Angina precipitating factors
|
- Age
- Cigarette smoking - Diabetes - Hypertension - Obesity |
|
Angina Manifestations
|
- Chest discomfort (pressure, heaviness, tightness, squeezing, burning or choking sensation)
- Pain in back, neck area, jaw, or shoulders (referred pain) |
|
Angina Therapy
|
- Nitroglycerin (vasodilator)
- Beta blockers and calcium channel blockers (decreases the heart's workload) |
|
Myocardial infarction pathophysiology
|
Most common triggering event is the disruption of atherosclerotic plaque in an epicardial coronary artery which leads to a clotting cascase
|
|
Myocardial infarction precipitating factors
|
- Age
- Gender - Diabetes - Hypertension - smoking - Obesity |
|
Myocardial infarction manifestations
|
- Chest pain (tightness, pressure, or squeezing)
- Radiating pain to left arm, lower jaw, neck, right arm, back, and epigastrium - Shortness of breath, weakness, sweating, nausea, vomiting, and palpitations |
|
Myocardial infarction complications
|
- May occur immediately following the heart attack
- Heart failure - Aneurysm or rupture of the myocardium - Arrhythmias |
|
Myocardial infarction therapy/management
|
- Oxygen
- Aspirin - Nitroglycerin may be administered |
|
Congestive heart failure pathophysiology
|
Causes by any condition which reduced the efficiency of the myocardium, or heart muscle, through damage or overloading
|
|
Congestive heart failure manifestations
|
Left-sided
- Tachypnea - Increased work of breathing - Rales or crackles - Cyanosis Right-sided - Peripheral pitting edema |
|
Congestive heart failure therapy/management
|
- Improving the symptoms and preventing the progression of the disease
- Re-establish adequate perfusion and oxygen delivery to end organs (ABC are adequate) |
|
HCTZ (hydrochlorothiazide) use
|
Management of mild to moderate hypertension.
|
|
HCTZ (hydrochlorothiazide) therapeutic effects
|
- Lowing of blood pressure in hypertensive patients and diuresis with mobilization of edema.
|
|
HCTZ (hydrochlorothiazide) assess before
|
- Assess patients, especially if taking digoxin, for anorexia, nausea, vomiting, muscle cramps, paresthesia, and confusion
|
|
HCTZ (hydrochlorothiazide) NOTIFY CLINICIANS IF:
|
- If signs of electrolyte imbalance occur
- Patients taking digoxin are at risk of digoxin toxicity because of the potassium-depleting effect of the diuretic. |
|
Metroprolol XL use
|
- Decreases blood pressure and heart rate
- Decreases frequency of attacks of angina pectoris - Decreases rate of cardiovascular mortality and hospitalization in patients with heart failure |
|
Metroprolol XL. To monitor
|
- Monitor intake and output ratios and daily weights
- Assess routinely for signs and symptoms of CHF (dyspnea, rales/crackles, weight gain, peripheral edema, jugular venous distention) |
|
Metroprolol XL. To assess before
|
- Take apical pulse before administering.
- If <50 BPM or if arrhythmia occurs, withhold medication and notify health care professional |
|
Enalapril uses
|
- Alone or with other agents in the management of hypertension
- Slows progression of left ventricular dysfunction into overt heart failure |
|
Enalapril therapeutic effects
|
- Lowers blood pressure in hypertensive patients.
- Improves symptoms in patients with CHF |
|
Enalapril Watch out for
|
- Warn patient not to discontinue ACE inhibitor therapy unless directed by health care professional
- Increase risk of hyperkalemia with concurrent use of potassium supplements, potassium-sparing diuretics, potassium-containing salt substitutes, or angiotensin II receptor antagonists |
|
Losartan indications
|
- Alone or with other agents in the management of hypertension
- Treatment of diabetic nephropathy in patients with type 2 diabetes and hypertension |
|
Losartan Therapeutic effects
|
- Lowers blood pressure
- Slows progression of diabetic nephropathy (ibesartan and losatran only) - Reduces cardiovascular death and hospitalization due to CHF in patients with CHF |
|
Losartan lab test considerations
|
- Monitor renal function and electrolyte levels periodically
- Serum potassium, BUM, and serum creatinine may be increased. |
|
U/A lab values
|
Males: (2-8)
Female: (2-7.5) |
|
U/A
|
Urinalysis can reveal disease that have gone unnoticed because they don't produce striking signs or symptoms
|
|
Calcium
|
8.5 - 10.5
|
|
Ionized Calcium
|
4-5
|
|
Chloride
|
95-107
|
|
Magnesium
|
1.5-2.5
|
|
Phosphate
|
2.5-4.5
|
|
Potassium
|
3.5 - 5
|
|
Sodium
|
136 - 145
|
|
BUN
|
10-20
|
|
Creatinine
|
.7- 1.5
|
|
Creatine phosphokinase
|
Male 25-90
Female 10-70 |
|
CPK means
|
CPK levels rise 4-8 hours after an acute MI< peaking at 16to 30 hours and returning to baseline within 4 days
|
|
Fasting glucose
|
65-110
|
|
Post prandial glucose
|
up to 140
|
|
Cholesterol
|
<200
|
|
HDL
|
> 40
|
|
LDL
|
1 - 129
|
|
triglycerides
|
45 - 155
|
|
Blood pressure measurement
|
Measurement of the force applied to the walls of your arteries as your heart pumps blood through your body
|
|
Chest x-ray
|
A noninvasive medical test that helps physicians diagnose and treat medical conditions.
|
|
ECG (electrocardiogram)
|
Used to monitor your heart. An EKG record electrical signs as they travel through your heart.
|
|
Nitroglycerin SL used for
|
- Acute and long-term prophylactic management of angina pectoris
- Increases coronary blood flow by dilating coronary arteries and improving collateral flow to ischemic regions. - Reduces myocadial oxygen consumption |
|
Nitroglycerin SL therapeutic effects
|
- Relieves or prevents anginal attacks
- Increases cardiac output - Reduces blood pressure |
|
Nitroglycerin SL TO DO
|
- First dose should be taken while in a sitting or reclining position, especially in geriatric patients
|
|
Nitroglycerin SL During Anginal attacks
|
- Advise patient to sit down and use medication at first sign of attack
- Relief usually occurs within 5 min - Dose may be repeated if pain isn't relieved in 5-10 min. - Call health care professional or go to nearest emergency room if anginal pain is not relieved by 3 tablets in 15 min. |
|
ASA use
|
- Prophylaxis of transient ischemic attacks and MI
- Decreases platelet aggregation |
|
ASA before hand
|
- Administer after meals or with food or an antacid to minimize gastric irritation
- Food slows but does not alter the total amount abosrbed |
|
ASA do not
|
- Do not crush of chew enteric-coated tablets
- Do not take antacids within 1-2 hr of enteric-coated tablets. - If MI is impending, have patient chew ASA to increase speed of absorption |
|
Atorvastin uses
|
- Lowers total and LDL cholesterol and triglycerides
- Slightly increases HDL - Slows the progression of coronary atherosclerosis with resultant decrease in CHD- related evented |
|
Atorvastin lab considerations
|
- Evaluate serum cholesterol and triglyceride levels before initiating, after 4-6 weeks of therapy, and periodically thereafter
|
|
Atorvastin monitor
|
- Monitor liver function tests, including AST, before, at 12 wk after initiation of therapy or after dose elevation, and then q 6 mo.
- If AST levels rise to 3 times nomral, HMG- C reductase inhibitor therapy should be reduced or discontinued |
|
Atorvastin STOP THERAPY if
|
- If patients develops muscle tenderness during therapy, monitor CK levels.
- If CK levels are >10 times the upper limit of normal or myopathy occurs, therapy should be discontinued |
|
T-pa (tissue plasminogen activator) uses
|
- Acute myocardial infarction (MI)
|
|
Nitroglycerin SL TO DO
|
- First dose should be taken while in a sitting or reclining position, especially in geriatric patients
|
|
Nitroglycerin SL During Anginal attacks
|
- Advise patient to sit down and use medication at first sign of attack
- Relief usually occurs within 5 min - Dose may be repeated if pain isn't relieved in 5-10 min. - Call health care professional or go to nearest emergency room if anginal pain is not relieved by 3 tablets in 15 min. |
|
ASA use
|
- Prophylaxis of transient ischemic attacks and MI
- Decreases platelet aggregation |
|
ASA before hand
|
- Administer after meals or with food or an antacid to minimize gastric irritation
- Food slows but does not alter the total amount abosrbed |
|
ASA do not
|
- Do not crush of chew enteric-coated tablets
- Do not take antacids within 1-2 hr of enteric-coated tablets. - If MI is impending, have patient chew ASA to increase speed of absorption |
|
Atorvastin uses
|
- Lowers total and LDL cholesterol and triglycerides
- Slightly increases HDL - Slows the progression of coronary atherosclerosis with resultant decrease in CHD- related evented |
|
Atorvastin lab considerations
|
- Evaluate serum cholesterol and triglyceride levels before initiating, after 4-6 weeks of therapy, and periodically thereafter
|
|
Atorvastin monitor
|
- Monitor liver function tests, including AST, before, at 12 wk after initiation of therapy or after dose elevation, and then q 6 mo.
- If AST levels rise to 3 times nomral, HMG- C reductase inhibitor therapy should be reduced or discontinued |
|
Atorvastin STOP THERAPY if
|
- If patients develops muscle tenderness during therapy, monitor CK levels.
- If CK levels are >10 times the upper limit of normal or myopathy occurs, therapy should be discontinued |
|
T-pa (tissue plasminogen activator) uses
|
- Acute myocardial infarction (MI)
|
|
T-pa (tissue plasminogen activator) therapeutic effects
|
- Lysis of thrombi in coronary arteries, with preservation of ventricular function
- Improvement of ventricular function - Increases risk of CHF or death - Lysis of pulmonary emboli or deep vein thrombosis - Lysis of trhombi causing ischemic stroke, drucing risk of neurologic problems |
|
T-pa (tissue plasminogen activator) Watch for
|
- Assess patient carefully for bleeding every 15 min during the 1st hr of therapy, every 15-30 min during the next 8 hr, and at least ever 4 hour for the duration of therapy.
- If uncontrolled bleeding occurs, stop medication and notify physician immediately |
|
Signs of internal bleeding
|
- Decreased neurologic status
- Abdominal pain with coffee- ground emesis - Black, tarry stools - Hematuria - Joint pain |
|
Troponin levels
|
Troponin I : less than 10 ug/L
Troponin T: 0 - 0.1 ug/L |
|
Troponin shows
|
- These proteins are released when the heart muscle has been damaged
- The more damage to the heart, the greater the amount of troponin in the blood |
|
Myoglobin values
|
0 - 85 ng/mL
|
|
Myoglobin shows
|
- When muscle is damaged, myoglobin is released into the bloodstream.
|
|
D- Dimer values
|
Around 500 ng/ml
|
|
D- dimer shows
|
- A fibrin degradation product, a small protein fragement present in the blood after a blood clot is degraded by fibrinolysis
|
|
WBC
|
4 - 11
|
|
PTT (partial thromboplastin) time
|
25 - 39 seconds
* If a person is taking blood thinners, clotting time takes up to 2 1/2 times longer |
|
PTT test
|
A blood test that looks at how long it takes for blood to clot
|
|
PT (prothrombin time)
|
11 - 13. 5 seconds
|
|
PT test
|
A blood test that measures the time it takes for the liquid portion (plasma) of your blood to clot.
|
|
Bleeding Time
|
1 - 3 minutes
|
|
Bleeding time test
|
Looks at how fast small vessels in the skin close to stop bleeding
|
|
Thallium scan
|
- Examining the heart to obtain information about the blood supply to the heart muscle
- Thallium is injected in the blood to be used as a tracer |
|
Cardiac catheterization
|
The insertion of a catheter into a chamber or vessel of the heart.
- X-ray opaque based contrast is injected to make the vessels show up |
|
PTCA (percutaneous translumial coronary angioplasty)
|
- injecting a radio-opaque contrast agent into the blood vessel
|
|
Furosemide uses
|
- For edema due to heart failure, hepatic impairment or renal disease
|
|
Furosemide Therapeutic effects
|
- Diuresis and subsequent mobilization of excess fluid
- Decreases Blood pressure |
|
Furosemide assess
|
- Assess fluid status
- Monior daily weight, intake and output ratios, amount & location of edema, lung sounds, skin turgor, and mucous membranes. * Potassium supplements or potassium-sparing diuretics can be used to prevent hypokalemia* |
|
Furosemide Notify physician if
|
- Thirst
- Dry mouth - Lethargy - Weakness - Hypotension - Oliguria |
|
Morphine uses
|
Pain associated with MI
|
|
Morphine therapeutic effects
|
- Decreases severity of pain
|
|
Morphine HIGH ALERT
|
- Assess level of consciousness, blood pressure, pulse, and RR before and periodically during administration
* If RR is <10/min, assess level of sedation* |
|
Digoxin uses
|
Treatment of CHF
|
|
Digoxin therapeutic effects
|
- Increases cardiac output
- Slows the heart rate |
|
Digoxin monitor
|
- Monitor apical pulse for 1 full min before administration.
- Witholhd dose and notify physician if < 60 BPM - Observe for signs and symptoms of toxicity |
|
Digoxin toxicity signs
|
- Abdominal pain
- Anorexia - Nausea - Vomiting - Visual distubrances - Brady - Other arrhythmias * Hypokalemia, hypomagnesemia, or hyper calcemia may make the patient more prone for toxicity* |
|
pH
|
7.35 - 7.45
|
|
pCO2
|
35 - 45
|
|
pO22
|
70-100
|
|
HCO3
|
19-25
|
|
O2 sat%
|
90-95
|
|
CVP (central venous pressure)
|
- Pressure of blood in the thoracic vena cava.
- Reflects the amount of blood returning to the heart and the ability of the heart to pump the blood into the aterial system. |
|
INR (international normalized ratio)
|
How long it takes blood to clot
Normal - 1 Anticoagulant : 2 - 3 Watch and monitor : 4 + |
|
Doppler studies
|
A non- invasive test that can be used to measure your blood flow and blood pressure by bouncing high-frequency sound waves off circulatingRBC
|
|
Warfarin uses
|
- Prophylaxis and treatment of: Venous thrombosis, Pulmonary embolism, Atrial fibrillation with embolization
|
|
Warfarin therapeutic effects
|
- Prevent thromboembolic events
|
|
Warfarin ASSESS
|
- Assess patient for signs of bleeding and hemmorrhage
- Monitor PT, INR, and other clotting factors during therapy ANTIDOTE : VITAMIN K |
|
Plavix clopidogrel uses
|
- Inhibits platelet aggregation by irreversibly inhibiting the binding of ATP to platelet receptors
|
|
Plavix clopidogrel therapeutic effects
|
- Decreased occurrence of atherosclerotic events in patients at risk
|
|
Plavix clopidogrel Lab test considerations
|
- Monitor bleeding time
- Prolonged bleeding time is expected - Advise patient t0 notify health care professional if fever, chills, sore throat, or unusual bleeding or bruising occurs |
|
Heparin therapeutic effects
|
- Prevents thrombus formation
- Prevents extension of existing thrombi |
|
Heparin Lab test considerations
|
- Monitor activated PTT and hematocrit prior to and periodically throughout therapy
|
|
Heparin toxicity and overdose
|
ANTIDOTE: Protamine sulfate
- Overdose can often be treated by withdrawing the drug |
|
Systemic circulation
|
Carries oxygenated blood away from the heart to the body, and returns oxygenated blood back to the heart
|
|
Cardiac circulation
|
The circulation of blood in blood vessels of the heart muscle
|
|
Systole
|
- Increased ventricular pressure
- AV valves close - Semilunar valves open - Blood injected into pulmonary artery and aorta - AV and PV close |
|
Diastole
|
- Ventricles relax
- AV valves open - Blood flows into atria/ventricles - Atria contracts |
|
Cardiac conduction system
|
SA Node, AV node, Bundle of his, Bundle branches, Purkinje fibers
|
|
Cardiac output
|
The volume of blood being pumped by the heart in the time interval of a minute
- HR x SV |
|
Stroke Volume
|
The amount of blood pumped by each ventricle with each heart beat ( avg 80 in adults at rest)
|
|
Preload
|
- Describes the degree of stretch of the cardiac muscle fibers at the end of diastole
|
|
Afterload
|
The pressure the ventricular myocardium must overcome to eject blood during systole
|
|
Ejection fraction
|
% of the end-diastolic volume ejected with each contraction (60-70%)
|
|
Peripheral vascular occlusive disease
|
- Blockages in the vasculature of the extremities
|
|
Peripheral vascular occlusive disease symptoms
|
Claudication (pain, weakness, numbness, cramping)
Sores, wounds or ulcers heal slowly Change in color or temperature Diminished hair or nail growth |
|
Peripheral vascular occlusive disease causes
|
- Smoking
- Diabetes - Dyslipidemia - Hypertension |
|
Peripheral vascular occlusive disease diagnosis
|
When BP readings in ankles are lower then in the arms
CT scan |
|
Peripheral vascular occlusive disease treatment
|
- Stop smoking
- Management of diabetes - Mangement of hypertension & cholesterol - Antiplatelet drugs - regular exercise |
|
Pulmonary emboli
|
A blockage of the main artery of the lung or one of its branches by a substance that has travelled from elsewhere in the body through the bloodstream
|
|
Pulmonary emboli symptoms
|
SOB
Rapid breathing Chest pain Cough/coughing up blood |
|
Pulmonary emboli treatment
|
Anticoagulation
Thrombolysis |
|
Deep vein thrombosis
|
A blood clot in a deep vein
|
|
Deep vein thrombosis symptoms
|
Pain & tenderness in the leg
Swelling Warmth Redness or discoloration Distention of surface veins |
|
Deep vein thrombosis Prevention
|
Surgery patients
- early ambulation - mechanical prophylaxis - low dose unfractioned heparin Hospital patients - anticoagulation - mechanical prophylaxis Travelers - frequent walking - calf exercises - aisle seating in airplanes |
|
Congestive heart failure
|
A cardiovascular condition in which the heart is unable to pump an adequate amount of blood to meet the metabolic needs of the body's tissues
|
|
Congestive heart failure compensatory mechanism
|
- Increase HR
- Increase SV - Arterial vasoconstriction - NA & H20 retention - Myocardial hypertrophy Overtime, compensatory mechanisms make it worse |
|
Pulmonary edema
|
- Fluid accumulation in the air spaces and parenchyma of the lungs
- Leads to impaired gas exchange and may cause respiratory failure |
|
Pulmonary edema symptoms
|
Difficulty breathing
Coughing up blood Pale Skin Excessive sweating |
|
Metabolic syndrome
|
A combination of medical disorders that increase the risk of developing cardiovascular disease and diabetes
|
|
Metabolic syndrome signs
|
Fasting hyperglycemia
High blood pressure Central obesity Decreased HDL cholesterol Elevated triglycerides |
|
Respiration
|
- O2 concentration in blood with in the capillaries of the lungs is lower than in the alveoli
- Concentration gradient leads to O2 diffusion from alveoli to blood - CO2 which has a high concentration in the blood than in the alveoli diffuses frmo the blood into the alveoli |
|
Ventilation
|
Movement of air in and out of the airwayds
|
|
PaO2
|
80-100
|
|
PaCO2
|
34-45
|
|
Pneumonia assessment
|
Dull percussion sounds
Consolidated breath sounds |
|
Pneumonia treatment
|
Medication
Hospital admission Plenty of rest Plenty of fluids |
|
Pneumonia symptoms
|
Fever
Cough SOB sweating shaking; chills headache fatigue |
|
Pneumonia interventions
|
Maintain patent airway
Monitor I & O Auscultate breath sounds every 4 hours at least Monitor patients ABG levels |
|
Pneumonia complications
|
Bacteria in bloodstream
Septic shock Fluid accumulation around lungs Lung abscess Acute respiratory distress syndrome |
|
Pneumothorax pathophysiology
|
- Partial or complete collapse of the lung due to positive pressure in the pleural space
- Occurs when air gets into pleural space - May occur from trauma or spontaneously |
|
Pneumothorax management
|
-Aspiraton
Putting a needle in the chest cavity to remove extra air - Chest tube Connected to a one-way valve system that allows air to escape but not re-enter the chest - Pleurodesis & surgery Obliterates the plerual space and attaches the lung to the chest wall |
|
Pneumothorax symptoms
|
Chest pain
Mild breathlessness Tension pneumothorax : increased HR, rapid breathing, respiratory distress |
|
Cor pulmonale physiology
|
-Enlargement of the right ventricle of the heart as a response to increased resistance or high blood pressure in the lung
- Pulmonary vasoconstriction, increased blood viscosity, pulmonary hypertension |
|
Cor pulmonale causes
|
COPD
Pulmonary hypertension Asthma Pulmonary embolism Loss of lung tissue |
|
Cor pulmonale symptoms
|
Shortness of breath
Wheezing Chronic wet cough Swelling of abdomen with fluid, ankles, and feet |
|
Cor pulmonalecomplications
|
- Blood backs up into the sytemic venous system
- Congestion in the liver leads to hypoxia and fatty changes of the peripheral hepatocytes |
|
Pleural effusion pathophysiology
|
Abnormal accumulation of fluid in the pleural space
Usually secondary to other diseases |
|
Pleural effusion causes
|
Transudative : Left ventricular failure & cirrhosis
Exudative: Bacterial pneumonia, cancer, viral infection, & pulmonary embolism |
|
Pleural effusion treatment
|
Intercostal drain
Pleural catheter Drainage catheter |
|
COPD pathophysiology
|
Disease state in which air flow is obstructed by emphysema, chronic bronchitis or both
|
|
COPD cause
|
Smoking
occupational exposures Air pollution Genetics Autoimmune disease |
|
COPD Management
|
Bronchodilators
B2 agonist Anticholinergics Corticosteroids |
|
COPD symptoms
|
Dyspnea
Rhonchi Airflow limitation SOB |
|
Emphysema pathophysiology
|
- Impaired gas exchange results form destruction of the walls of over distended alveoli
- Increases the work of breathing because the hyper inflated lungs cause the diaphragm to flatten |
|
Emphysema causes
|
Smoking
Air pollution Second-hang smoke Chemicals and toxins |
|
Emphysema management
|
Stop smoking
Avoid all exposure to smoke & lung irritans Pulmonary rehab Medications |
|
Emphysema symptoms
|
Shortness of breath
barrel chest Leaning forward to help breath |
|
Chronic bronchitis pathophysiology
|
Excessive accumulation of mucous and secretions block the airway
Gas exchange is hindered Mucous medium allows for frequent infections Leads to decreased PaO2, Hypoxemia, Increased PaCO2, repsiratory acidosis |
|
Chronic bronchitis symptoms
|
Cough
SOB wheezing Occasionally chest pains, fever, fatigue |
|
Albuterol use
|
Bronchodilator to control and prevent reversible airway obstruction caused by asthma or COPD
|
|
Albuterol side effects
|
nervousness
restlessness tremor |
|
Albuterol assess
|
Assess lung sounds pulse and blood pressure before administration and during peak of medication
Not amount, color, and character of sputum produced |
|
Atrovent use
|
maintenance therapy of reversible airway obstruction due to COPD including chronic bronchitis and emphysema
|
|
Atrovent side effects
|
Bronchospasm
Cough hypotension palpitations |
|
Fluticasone to use
|
-Instruct patient in the proper use of the metered-dose inhaler
- Most inhalers require priming before first use - Shake inhaler well - Exhale completely, and then close lips firmly around mouthpiece - While breathing in deeply and slowly, press down on canister - Hold breath for as long as possible to ensure deep instillation of medicine - Allow 1-2 min between inhalations |
|
Vancomycin
|
Antibiotic.
Used for resistant bacteria |
|
Vancomycin given
|
Given IV every 12 hours over 60-90 minutes
|
|
Vancomycin - Rapid IV infusion
|
- Rapid IV infusion leads to red neck syndrome with hypotension, flushing, erthematous rach on face and upper body
|
|
Vancomycin side effects
|
Ototoxicity
Nephrotoxicity |
|
Vancomycin monitor
|
- blood levels to prevent toxicity
- Assess hearing : affects CN VIII - Monitor I & O |
|
Hematacrit
|
Male 41-50%
Female 36-44% |
|
Pneumovax
|
Pneumonia vaccine
|
|
Isoniazid (INH) uses
|
Antituberculosis agent.
Given orally, daily |
|
Isoniazid (INH) Side effects
|
Peripheral neuropathy
parathesias hepatotoxicity |
|
Isoniazid (INH) risks
|
ETOH increase risks
Take on an empty stomach Vit B6 can decrease neuropathies |
|
Isoniazid (INH) watch
|
Liver enzymes need to be monitors
Look for signs of liver toxicity: dark urine, jaundice, clay colored stool |
|
Rifampin
|
Antituberculosis agent, antileprosy agent
Given orally QD |
|
Rifampin side effects
|
GI distress
Elevated liver function tests |
|
Rifampin how to take
|
Take on an empty stomach
Check liver enzymes periodically |
|
Rifampin watch
|
Drug will cause body fluids to be red-orange
Decreases effectiveness of oral contraceptives |
|
Ceftriaxone
|
Cepholosporin antibiotic
Used to treat lower respiratory tract infections |
|
Ceftriaxone side effects
|
Diarrhea
Nausea Vomiting Cholelithasis |
|
Ceftriaxone assess
|
-Assess for infection (vital signs, appearance of wound, sputum, urine, and stool, wbc)
- Obtain a history to determine previous use of and reactions to penicillins of cephalosporins - persons with a negative history of penicillin sensitivity may still have an allergic response |
|
Thoracentesis
|
An invasive procedure to remove fluid or air form the pleural space for diagnostic or therapeutic purposes
|