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821 Cards in this Set
- Front
- Back
____ is also called fibrocystic disease of the pancreas, mucoviscidosis
|
cystic fibrosis
|
|
causes generalized dysfunction of the exocrine (sweat) glands that affects multiple organ systems
|
cystic fibrosis
|
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which nervous sys is affected in cystic fibrosis?
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autonomic
|
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what do kids w/cystic fibrosis retain?
|
NA+ and H2O
|
|
describe the secretions in cystic fibrosis?
|
thick and sticky rather than thin and slippery
|
|
how is cystic fibrosis passed down? who gets the most?
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an autosomal recessive trait(both parents must carry).
white |
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cystic fibrosis is one the most common inherited diseases and occurs equally in both sexes?
|
info
|
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life expectancy in cystic fibrosis?
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20-30yrs
|
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in cystic fibrosis the cumlative effect and may loose lung tissue, Cardic involvement, Cor Pulmonale.
|
info
|
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what is the presenting s/s of cystic fibrosis?
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Meconium ileus (bowel obstructed with meconium) at birth
|
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describe skin in cystic fibrosis?
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Salty taste on child's skin, bulky
|
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dscribe stool in cystic fibrosis?
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greasy foul-smelling stools that contains undigested food
(steatorrhea) |
|
what causes the airway obstruction(chronic airway infection) in cystic fibrosis?
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increased and constant production of mucus, little or no release of pancreatic enzymes (mucus plugging the pancreatic duct and its branches
|
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why are stools foul smelling and contain undigested food in cystic fibrosis?
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because pancreatic enzymes such as trypsinogen, lipase and amylase, do not reach the intestine to digest ingested nutrients
|
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what nutrients are malabsorbed in cystic fibrosis?
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fat, protein, and fat-soluble vitamins (A,D,E,K).
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|
Fat malabsorption results in cystic fibrosis results bulky, grey or light colored stools called?
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steatorrhea
|
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protein malabsorption in cystic fibrosis results in ___?
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failure to grow and gain weight
|
|
how is cystic fibrosis dx?
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sweat chloride 2-5x normal (abnormally regulated chloride channel activity), stool specimen analysis indicated the absence of trypsin.
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|
T/F Virtually all CF patients (95%) require pancreatic enzyme supplements due to an inadequacy of their own pancreatic secretions (High lipase preparations
|
T
|
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what vit and diet for cystic fibrosis?
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fat soluble, high protein
|
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what maybe done in cystic fibrosis with ariway obstruction?
|
chest physiotherapy
(Flutter device helps aid in breathing and force secrections up)"percussion/clapping" |
|
what meds maybe given in cystic fibrosis for airway obstruction and infection?
given how |
mucolytic, bronchodilator (theophylline), antibiotic
nebulizer |
|
how should po pancreatic enzymes be given in r/t meals
|
with meals
|
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what lung condition is common in CF?
|
pneumothorax
|
|
____involves postural drainage and mechanical devices or hands
|
chest physiology(percussion/clapping)
|
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congenital anomaly in which the esophagus and trachea don't separate normally
|
TRACHEO-ESOPAHGEAL FISTULA
|
|
the esophagus ends in a blind pouch, with the trachea communicating by a fistula with the lower esophagus and stomach
|
TRACHEO-ESOPAHGEAL FISTULA
|
|
feeding problems w/TRACHEO-ESOPAHGEAL FISTULA?
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difficulty feeding, such as choking or aspiration, cyanosis during feeding
|
|
respirator problems with TRACHEO-ESOPAHGEAL FISTULA?
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Respiratory distress to include tachypnea, cyanosis, sternal and substernal retractions
|
|
what prenatal problems are seen in tracheo esophageal fistula? why?
|
Maternal polyhydramnios (because fetus canÕt swallow amniotic fluid.)
|
|
how is tracheo esophageal fistula Dx?
|
abdominal x-ray shows the fistula and a gas-free abdomen
|
|
tx for tracheo esophageal fistula?
|
emergency surgical intervention to prevent pneumonia, dehydration, and fluid and electrolyte imbalances, maintenance of patent airway. Antibiotics as prophylaxis for aspiration pneumonia.
|
|
the proximal end of the esophagus ends in a blind pouch. Food can not enter the stomach via the esophagus
|
ESOPHAGEAL ATRESIA
|
|
s/s of ESOPHAGEAL ATRESIA?
|
excessive salivation and drooling due to inability to pass food through the esophagus. Regurgitation, possible aspiration
|
|
how is ESOPHAGEAL ATRESIA dx?
|
Newborns are fed first with a few sips of sterile water to detect these anomalies and to prevent the aspiration of formula or breast milk into the lungs
|
|
how is ESOPHAGEAL ATRESIA Tx?
|
surgical correction by anastomosing the esophageal ends. Repair is done in stages.
|
|
an obstruction of the bile ducts caused by their failure to develop normally in the fetus
|
BILIARY ATRESIA
|
|
s/s of BILIARY ATRESIA
|
Jaundice 2 weeks post-term
(maybe present at birth) |
|
BILIARY ATRESIA May be progressive or intermittent
Slow or absent weight gain |
info
|
|
describe urine in BILIARY ATRESIA
|
dark
|
|
what happens to the liver and spleen in BILIARY ATRESIA
|
Enlarged Spleen/Liver
|
|
describe stools in BILIARY ATRESIA
|
Pale or clay-colored. floating, foul-smelling stools
|
|
how might biliary atresia be dx?
|
Increased bilirubin in the blood and increased liver enzymes, abdominal ultrasound, HIDA scan, liver biopsy
|
|
the ________ to connect the liver to the small intestine, bypassing the malformed ducts, before the baby is 10 - 12 weeks old done in biliary atresia?liver transplant later prn
|
Kasai procedure
|
|
major nsg concern w/biliary atresia?
|
nutrition
|
|
With biliary atresia, not enough bile reaches the intestine to assist with the digestion of _____ in the diet
|
fats
|
|
____ & ___ deficiencies may occur due to liver damage in biliary atresia?
|
Protein,
vit |
|
Children with ____ disease require more calories than a normal child because of a faster metabolism.
|
liver
|
|
partial or complete defect of the lip that results in failure of the upper lip to fuse
|
CLEFT LIP
|
|
cleft lip Can range from a simple notch on the upper lip to complete cleft from the lip edge to the floor of the nostril, on either side of the midline, rarely along the midline itsel
|
info
|
|
major concern w/cleft lip?
|
Increased risk for aspiration because of the increased open space in the mouth
|
|
T/F cleft lip may be determined by prenatal ultra sound
|
T
|
|
____ performed between birth and age 3 months in cleft lip to unite the lip and gum edges in anticipation of teeth eruption
|
Cheiloplasty
|
|
how is cleft palate dx?
|
mouth examination after birth if cleft palate is present without cleft lip
|
|
cleft palate repair surgery (staphylorrhaphy) scheduled for about 18 months to allow for growth of the palate and to be done before the infant develops _____
|
speech patterns
|
|
what infections must in infant be free of in cleft palate sx?
|
ear and respiratory infection
|
|
RF of pyloric stenosis?
what races gee less? which sex? |
3/1000
black and asian 4/1 m/f |
|
T/F there is an Increase incident of pyloric stenosis in breast feed and young mothers
|
T
|
|
Hypertrophy and hyperplasia of the pyloric muscle leading to narowing, obstruction, inflammation and vomiting.
|
pyloric stenosis
|
|
when do s/s of pyloric stenosis show up?
|
after 2 wks
|
|
swhat happens @ 2-4 weeks in pyloric stenosis?
6wks? |
regurgation
complete obstruction |
|
#1 s/s o pyloric stenosis?
|
Projectile vomiting shortly after feeding
|
|
what other s/s of pyloric stenosis?
|
Vomitus non bilous and maybe blood tinged at times in pyloric stenosis, Failure to gain weight. Decreased stool. Dehydration. Abdomenal distention
|
|
what does palpation reveal in pyloric stenosis?
|
olive-shaped mass right of the umbilicus
|
|
Treatment for pyloric stenosis?
|
Pyloromyotomy
|
|
nsg int preop pyloric stenosis:Rehydration with ____ fluid. ____ to minmize vomiting: _____ feeding, Semi upright postion aka ____
|
IV
Feeding techniques Slow Portuguese sling |
|
nsg int p/o pyloric stenosis:____ posit after feeding to facilitate gastric emptying, Minimal handling after ___
|
High Fowlers
feedings |
|
what nsg care p/o pyloric stenosis?
|
Monitor VS, IV fluids, NG tubes
|
|
Parent education p/o pyloric stenosis?
|
diet from NPO to Clear liquids. Possible vomiting within 24 hour of surgery. Report all increase vomiting to MD.
|
|
_____ is a congenital birth defect that is the malformation of the bladder and urethra, in which the bladder is turned "inside out
|
Bladder Exstrophy
|
|
in bladder exstrophy the bladder does not form into its normal round shape but instead is ____ and exposed _____ the body
|
flattened
outside |
|
what part of the bladder fails to form correctly in bladder exstrophy?
|
The lower portion of the bladder, a funnel-shaped bladder neck, made up of muscles that open and close the bladder, fails to form correctly
|
|
describe the genitalia, anus and cat in bladder exstrophy?
|
The urethra and genitalia are not formed completely (epispadius) and the anus and vagina appear anteriorly displaced
|
|
widely separated pelvic bones seen in bladder exstrophy?
|
diastasis
|
|
coplications of bladder exstrophy?
|
leaky urine; small bladder with retrograde urine = kidney infection/destruction
|
|
how many stages to sx repair in bladder extrophy?
when may sx take place? |
3
as young as 48 hours old |
|
describe the 1st stage in bladder extrophy sx?
|
The first stage involves internalization of the bladder and closing the abdomen
|
|
2nd stage of sx in bladder extrophy?
|
done between age 1 and 2 and involves repairing the epispadias and other genital abnormalities
|
|
3rd stage of sx in bladder extrophy?
|
done at around age 3 and involves reconstruction of the urinary tract including the bladder, and other structures of the urinary tract.
|
|
congenital anomaly of the penis. The urethral opening may be anywhere along the ventral side of the penis
|
HYPOSPADIAS
|
|
major problem w/hypospadias?
|
This conditions provides a shorter distance to the bladder, providing easier access for bacteria
|
|
how is hypospadias dx?
|
observation confirms aberrant placement of the opening
|
|
what should be avoided in hypospadias? why?
|
avoid circumsion (the foreskin may be needed later during surgical repair), no treatment, mild disorder
|
|
hypospadias procedure in which the urethra is extended into a normal position) to restore normal urinary function
|
Meatotomy
|
|
At age ____months surgery to release the adherent chordee (fibrous band that causes the penis to curve downward) in hypospadias?
|
12-18
|
|
with analgesics for postoperative pain relief and antispasmodic agents such as _____for postoperative bladder spasms in hypospadias.
|
propantheline
|
|
____ is a genetic disorder characterized by the growth of numerous cysts in the kidneys filled w/fliud?
|
POLYCYSTIC KIDNEY DISEASE
|
|
PKD cysts can slowly replace much of the mass of the kidneys, reducing kidney function and leading to ____?
|
kidney failure
|
|
T/F PKD May be inherited or may be acquired with kidney failure
|
T
|
|
s/s of PKD?
|
pain in the back and the sides, H/A, hematuria
|
|
how is PKD dx?
|
ultrasound
|
|
tx for PKD?
|
pain meds, antibiotics, anti-hypertensives, eventual kidney transplant/dialysis
|
|
_____ is a collection of serous fluid that results from a defect or irritation in the tunica vaginalis of the scrotum; 1% of adult men and most hydroceles are congenital and are noted in children aged 1-2 years of age
|
hydrocele
|
|
Chronic or secondary hydroceles usually occur in men older than _____ years
|
40
|
|
how is hydrocele dx?
|
enlarged scrotum; adult-onset hydrocele may be secondary to orchitis or epididymitis
|
|
______ of the bladder may lead to hydrocele
|
exstrophy
|
|
how are hydrocele tx?
|
hydrocele is treated through inguinal incisions with high ligation of the patent processus vaginalis and excision of the distal sac.
|
|
T/F prognosis for congenital hydrocele is excellent
|
T
|
|
increase in the amount of CSF in the ventricles and subarachnoid spaces of the brain
|
HYDROCEPHALUS
|
|
hydrocephalus is caused by an imbalance in the rate of production and the rate of absorption of ____
|
CSF
|
|
____ hydrocephalus is non-communicating, blocked by tumors, hemorrhage or structural abnormalities that causes fluid to accumulate in the ventricle
|
Congenital
|
|
s/s of hydrocephalus: ____ sound when the skull is percussed, _____scalp veins, _____-pitched cry, rapid increase in head circumference and full, tense, ____ fontanels, ____ of the brain.
|
cracked pot
distended high bulging atrophy |
|
Acute symptoms of hydrocephalus may include ____.
|
change in the neurological state and seizure activity
|
|
what does xray of the skull show in hydrocephalus?
|
thinning of the skull with separation of the sutures and widening of fontanels
|
|
tx for hydrocephalus?
|
shunt insertion to allow CSF to drain from the lateral ventricle in the brain
|
|
what meds maybe Rx for hydrocephalus?
|
Anticonvulsants for seizures (pheobarbital, diazepam and phenytoin
|
|
priority NX in hydrocephalus?
|
Risk for injury
|
|
a metabolic disorder that is caused by an enzyme deficiency resulting in the accumulation of phenylalanine and its metabolites (as phenylpyruvic acid) in the blood and their excess excretion in the urine, that is inherited as an autosomal recessive trait
|
PKU
|
|
what does PKU lead to?
|
severe mental retardation, seizures, eczema, and abnormal body odor unless phenylalanine is restricted from the diet beginning at birth
|
|
2 other names of PKU?
|
phenylpyruvic amentia, phenylpyruvic oligophrenia
|
|
goal of Tx in PKU?
|
Treatment is to lower pku levels to prevent mental retardation
|
|
foods to avoid in PKU?
|
no protein/milk/nutrasweet
|
|
Foods allowed in measured amounts in PKU?
|
fruits, vergatables, cerals and grains
|
|
T/FDiet is considered life long in PKU
|
T
|
|
____ or tri-somy 21 chromosomal aberration characterized by mental retardation, dysmorphic facial features.
|
down's
|
|
Most w/down's also have congenital ____ defects, are predisposed to ____ infections, chronic _____ leukemia, and have a weak immune response to infection
|
heart
respiratory myelogenous |
|
____ (marbling and speckling of the iris is a common s/s of downs
|
Brushfield's spots
|
|
other s/s of down's:,sensory? ___ nose and ears, mild to moderate retardation, ____ tongue, short stature with hands, ___ crease of palms, small head with slow brain growth, upward slanting ___
|
my__opia, cataracts, nystagmus, strabismus
flat low-set protruding pudgy simian eyes |
|
what is Tx of down's based on?
|
treatment for coexisting conditions (congenital heart problems, visual defects, or hypothyroidism
|
|
_____ results from an abnormal development of the hip socket
|
DYSPLASIA OF THE HIP
|
|
when does hip dysplasia occur?
|
It occurs when the head of the femur is still cartilaginous and the acetabulum (socket) is shallow
|
|
causes of hip dysplasia?
|
breech delivery, fetal position in utero, genetic predisposition, and laxity of the ligaments
|
|
how hip dysplasia dx?
|
increased number of folds on the posterior thigh of the affected side when the child is supine with knees bent, appearance of a shortened limb on the affected side, restricted abduction of the hip
|
|
___ sign (a click is felt when the infant is placed supine with hips flexed 90 degrees, knees fully flexed, and the hip brought into midabduction seen in hip dysplasia?
|
Barlow's
|
|
____ click is present. (It can be felt by the fingers at the hip area as the femur head snaps out of and back into the acetabulum seen in hip dysplasia?
|
Ortolani's
|
|
____ test is positive in hip dysplasia?
|
Trendelenburg's
|
|
what happens when the child stands on the affected leg in hip dysplasia?
|
the opposite pelvis dips to maintain erect posture
|
|
tx for hip dysplasia?
|
hip-spica cast or corrective surgery for older children
|
|
what type traction and diapering for hip dysplasia?, harness
|
Bryant's traction and triple-cloth diapering
|
|
what type harness for hip dysplasia to keep the hips and knees flexed and the hips abducted? how long
|
Pavlik
at least 3 months. |
|
____ of the foot is turned inward and downward at birth and remains stuck in this position, resisting realignment.
|
CLUB FOOT -( Talepesis Equinovaus
|
|
____ is the most common disorder of the legs that children are born with. It can range from mild and flexible to severe and rigid.
|
club foot
|
|
The cause of club foot is not known, but the condition may be inherited in some cases
|
info
|
|
who gets club foot more?
|
male w/family hx
|
|
tx for club foot?
|
Gentle manipulation (stretching) and recasting occurs every week to improve the position of the foot
|
|
how many casts(tx) are usually necessary to tx club foot? how long does the final cast stay on?
|
5-10
3 wk |
|
after club foot realignment, the correction is maintained with a special type of brace, consisting of shoes attached to a bar called _____
|
Dennis Browne
|
|
The best results are obtained when the dennis brown brace is worn nearly fulltime for ___months, and then at night and during naps for up to ____ years.
|
3
3 |
|
surgery if the manipulation process is not successful, or if the deformity returns. Continued evaluation is recommended until the foot is fully grown.(club foot)
|
info
|
|
____ more common and less severe, characterized by incomplete closure of one or more vertebrae without protrusion of the spinal cord or meninges
|
Spina bifida occulta
|
|
where is the dimple seen in spina bifida occulta?(),
|
found on the skin over the spinal defect
|
|
what neuro defects maybe seen in spina bifida occulta?
|
no neurologic dysfunction except occasional foot weakness or bowel and bladder disturbances
|
|
_____ is soft fatty deposits that maybe seen in spina bifida occulta?, ulcerations,
|
Port wine nevi
|
|
where is the tuft of hair commonly seen in spina bifida occulta?
|
the skin over the spinal defect.
|
|
what are the 2 types of spina bifida cystica?
|
Meninogocele, Myelomeningocele
|
|
___which usually has no neurologic dysfunction and a saclike structure protruding over the spine
|
Meninogocele
|
|
_____(the worse) has an external sac -usually at lumbar- that contains meninges, CSF, and a portion of the spinal cord or nerve roots
|
Myelomeningocele
|
|
s/s of spina bifida cystica?
|
hydrocephalus, permanent neurologic dysfunction (paralysis, bowel and bladder incontinence), possible mental retardation, clubfoot, curvature of the spine and Arnold-Chiari syndrome
|
|
an obstruction may prevent information from passing freely from around the brain into the spinal canal seen in spina bifida cystica?
|
Arnold-Chiari syndrome
|
|
what is used to show neural tube defect in spina bifida cystica?
|
amniocentesis and ultra sound
|
|
___ alpha-fetoprotein (AFP) levels in the mother's blood may mean spina bifida cystica?
|
elevated
|
|
____ measurement can be used to confirm the diagnosis of spina bifida cystica?
|
Acetylcholinesterase
|
|
nsg care in r/t infant and defect in spina bifida cystica?
|
handling the infant with care and not applying pressure to the defect
|
|
care of the sac in spina bifida cystica: Intact, Moist and warm, ____ position to prevent tension trauma to sac
|
prone
|
|
Post Op care in spina bifida cystica includes?
|
Montior for ICP. Measure head circumference daily to watch for signs of hydrocephalus
|
|
menigitis maybe seen in spina bifida, what s/s to look for?
|
nuchal rigidity and fever
|
|
what is the goal of sx in spina bifida?
|
Surgery whose goal is not to repair faulty spinal cord, but to preserve existing function
|
|
number 1 concern w/spina bifida?
|
prevent menigitis?
|
|
what is done in spina bifida if hydrocephalus is present?
|
shunt
|
|
T/F Women who have spina bifida and parents who have one affected child have increase risk of having children with neural tube defects.
|
T
|
|
children w/spina bifida greater risk for ___ allergy than the general population
|
latex
|
|
____can be achieve by self-catheterization for kids 6-7y/o w/spina bifida?
|
Continence
|
|
_____ and ____if prescribed are used to help children retain urine rather than dribbling in spina bifida?
|
Tofranil, Ephed II
|
|
what to do in r/t bm and o/p w/spina bifida?
|
Assist with bowel training program, stool softeners, supp or enemas, may be used, encourage intake of high fiber, high fluid diet;
|
|
neuromuscular disorder resulting from damage to or defect in the part of the brain that controls motor function. Common in children born prematurely and can not be cured
|
cerebral palsy(CP)
|
|
what is Tx of CP aimed @?
|
interventions that encourage optimum development
|
|
what are the five types of cerebral palsy
|
Ataxia, Athetoid, Spastic, Rigidity type, Mixed
|
|
CP that is uncommon, disturbances in movement and balance w/involuntary, incoordinate motion with varying degrees of muscle tension
|
Ataxia
|
|
what face and mouth problems in Ataxia CP?
|
. Facial grimacing, poor swallowing and tongue movements cause drooling and poor speech articulation
|
|
intelligence for ataxia CP?
|
average
|
|
most common CP where hyperactive deep tendon reflexes, rapid involuntary muscle contraction and relaxation
|
Spastic
|
|
Describe the legs and toes in spastic CP?
|
Child's legs are crossed and the toes are pointed down, so the child stands on his toes
|
|
CP w/rigid postures and lace of active movement
|
rigidity type
|
|
severe disability involving more than one type of CP
|
mixed
|
|
causes of CP?
|
anoxia before, during or after birth, infection and trauma
|
|
s/s of CP(all types)?
|
abnormal muscle tone and coordination, dental anomalies, mental retardation, seizures, speech, vision or hearing disturbances
|
|
____ studies determine the site of brain impairment in CP
|
neuroimaging
|
|
___ and ___ to R/o other causes of CP?
|
Cytogenic and metabolic studies
|
|
what meds to control spasticity and seizures in CP?
|
Muscle relaxants, anticonvulsants
|
|
___ is a genetic disorder that occurs only in males, marked by muscular deterioration that progresses throughout childhood. It is due to a defect on the X chromosome. There is no known cure
|
MUSCULAR DYSTROPHY
|
|
s/s of MD?
|
begins with pelvic girdle weakness, indicated by waddling gait and falling, cardiac or pulmonary failure, eventual muscle weakness and wasting
|
|
____ sign which is the use of hands to push self up from the floor seen in MD?
|
Gowers'
|
|
_____ demonstrates short, weak bursts of electrical activity in affected muscles in MD?
|
electromyography
|
|
what does Muscle biopsy show in MD?
|
varied muscle fiber sizes and fat and connective tissue deposits
|
|
tx for MD?
|
physical therapy, surgery to correct contractures, use of devices to preserve mobility.
|
|
what type diet?
|
high-fiber, high-protein, and low, calorie d
|
|
lateral curvature of the spine, common among females. Identified at puberty and throughout adolescence
|
scolios
|
|
____ involves an absence in the autonomic ganglia of the smooth muscle in a section of the large intestine, with resulting loss of peristaltic function in this part and dilatation of the colon proximal to the aganglionic part -- called also _____?
|
Hirschsprung's Disease
congenital megacolon |
|
Tx for hirschsprungs
|
That non-functioning section of bowel is surgically removed to correct the problem
|
|
describe the sequence of problems in hirschsprungs
|
faliure of internal rectal sphincter to relax) > absents of peristaslsis > accumlation of intestinal contents > distention of bowel proximal to defect> megacolon
|
|
who gets hirschsprungs?
accounts for what % of neonate obstructions? |
males and downs
25 |
|
s/s of hirschsprungs in neonate?
|
Faliure to pass meconium with 24-48 hours after birth; overflow type diarrhea
|
|
neonate:
what does the vomit look like in hirschsprungs? does baby refuse to eat? what happens to belly? |
bile stained
yes distented |
|
s/s of hirschsprungs in infancy?
|
Constipation with explosive episodes of diarrhea,Abdomen distended
|
|
s/s of hirschprungs in childhood?
|
More Chronic Constipation, Ribbon like stools which are foul smelling, abdomen distended, Poor nourished child, Anemic
|
|
how is hirschsprungs dx?
|
X-Ray, Barium Enema
|
|
what does barium look like on xray?
|
white
|
|
Barium Enema {Barium is a dry, white, chalky, metallic powder that is mixed with water to make barium liquid. Barium is an x-ray absorber and appears white on x-ray film. When instilled via the rectum, barium coats the inside wall of the large intestine so that the inside wall lining, size, shape, contour, and the colon's atency are visible on x-ray
|
read over
|
|
what may result if barium is not eliminated from body?
|
constipation or impaction
|
|
___ to test neuro reflexes in hirschsprungs
|
Manometry
|
|
what does Rectal Biospy show in hirschsprungs?
|
Histologic evidence of aganglionic cell
|
|
what may be done for acute case of hirschsprungs?
|
Surgery with removal of aganglionic colon, temporary colostomy
|
|
pt teaching for chronic hirschsprungs?
|
stool softeners, Isotoinc enema, low residue diet to decrease bulk
|
|
Nursing interventions: Pre -Op in hirschsprungs?
|
Rehydration, informed consent, NPO and no rectal temps
|
|
Post Op care in hirschsprungs?
|
Monitor site, bowel sounds, rehydrate, NG Tube, Parent education regarding colostomy.
|
|
T/F Both parents must be carriers to have a child with tay sachs
|
T
|
|
Every on in 4 chance of having child with diease and a 2 in 4 chance of a child who is a carrier(tay sach)
|
info
|
|
Fatty substance called Ganglioside GM2 acculate in the nerve cells in the brain and the enzyme hexosamindiase A (Hex-A) is lacking to break GM2 down
|
tay sach's
|
|
Infants appear to be developing normally. As nerve cells acculate fatty material child starts to regress. loss of motor skills and mental function
|
tay sachs
|
|
what happens to pt in tay sachs? die by what age?
Tx? |
child becomes blind, deaf, mentally retarded, paralyzed and non responsive to environment. 5y/o. none
|
|
the child w/tay sachs looks like a child w/____?
|
downs
|
|
Appearance of Downs Syndrome child: Occiptal Flat, Eyes slanted upward Bridge of Nose: flat Mouth: Small Tongue: Larger and protruding Ears: Low set Limbs: short Stature: short and stocky. Muscle tone: Hypotonic Transverse palamar crease on hands and feet
|
info but know
|
|
___ Midline defect of the abdominal wall that results in herination of the bowel and intrabdominal contents into the umbilical cord
|
Omphalocele
|
|
are Maternal AFP levels are elevated in omphalocele?
|
no
|
|
____ will develop within the omphalocele sac
|
Ascties
|
|
_____ causes an interruption of blood flow to the fingers, toes, nose, and/or ears when a spasm occurs in the blood vessels of these areas
|
Raynaud's Disease
|
|
what causes raynauds to flare?
|
cold or stress
|
|
describe the color in raynauds?
|
turns white, then blue, then bright red over the course of the attack
|
|
what other s/s may be seen in raynauds?
|
tingling, swelling, or painful throbbing
|
|
T/F attacks in raynauds may last from minutes to hours and the areas may develop infection and ulceration.
|
T
|
|
who gets raynauds more
|
female
|
|
what is Tx of raynauds centered around?
|
minimizing or preventing exposure to cold and vasodilating medications.
|
|
____ is when Classic Factor 8 defect.
Hemophilla B or ____defect "A" most common |
Hemophilla A
Chirstmas Disease. Factor 9 defect |
|
Both have similiar symptoms, but "B" is simpler and milder
|
info
|
|
Mothers are the carriers and the infant ___ are affected w/hemophilia
|
sons(X gene)
|
|
concern w/hemophilias
|
Bleeding around vital structures, even bleeding into brain
|
|
where is bleeding most commonly seen in hemophila? results in?
|
Hemarthorsis, bleeding into joints causing large joints and leading to decreased cartilage(arthritis)
|
|
interventions for active bleed in joint in hemophila?
|
rest joint and immobilize
|
|
what to do in hemophilia after bleed as stopped in joints?
|
gradual movement to prevent contractors
|
|
T/F platelets are normal in hemophilia
|
T
|
|
Drugs: Factor 8 : Humafac or Koate Factory 9: Prolox or Konyne.
|
info but know and look up
|
|
3 C's associated w/hemophilia?
|
cough, cyanosis, choking
|
|
_____occurs when the maternal antibodies attach to the Rh site on the fetal red blood cells making them susceptible to destruction by phagocytes
|
erythroblastcystosis fetalis
|
|
what happens in infant in erythroblastcystosis fetalis
|
The fetal system reponds by increased red bood cell production then rapid and early destruction of erythocytes results in a marked increase in immature RBC that do not have the functional capapbilities of matrue cells and results in mulitorgan failure
|
|
what are the risks to the infant in Rh incompatibility?
|
bleeding tendencies due to assoiated thrombocytopenia and hypoxic damage to the capillaries
|
|
how does baby get hypoglycemia in Rh incompatibility?
|
Also hyperplasia of the adrenal cortex and pancreatic islet,
|
|
hernia of a bladder and especially the urinary bladder into the vagina : vesical hernia
|
cystocele
|
|
a decrease in the # of platelets in the circulating blood, major concern is bleeding
|
Thrombocytopenia
|
|
disorder of young adults, presence of Reed-Sternberg cells, involves lymph nodes, spleen and liver, progress depends on stage of disease.
|
Hodgkin’s Disease
|
|
w/Lasix (furosemide) and Lanoxin (digoxin)what needs to be watched for?
|
potassium-wasting diuretics, high risk for hypokalemia. Mo nitor for decreased serum potassium levels.
|
|
– fatigue, anorexia, nausea, vomiting, muscle weakness, leg cramps, decreased bowel motility, paresthesia and dysrhythmias.
|
Hypokalemia
|
|
tingling of the fingers and toes
|
low Ca+
|
|
diarrhea and intestinal colic
|
hypoK+
|
|
Alupent (metaproterenol sulfate) is a ____
|
adrenergic type of bronchodilator
|
|
Vanceril (beclomethasone) is a ___
|
glucocorticoid(steroid)
|
|
which to give 1st bronchodilator or steroid? why?
|
bronchodilator.
The bronchodilator widens the air passages and allows the glucocorticoid to work more effectively |
|
____– a bronchodilator for bronchitis, to relax relax smooth muscles of the bronchioles
|
Aminophylline (theophylline)
|
|
_____ causes orange-red discoloration of body fluids, should always be taken with food or antacids, doses sh ould not be doubled, take as directed by physician.
|
Rifadin (rifampin)
|
|
what R med if administered rapidly may cause tachycardia
|
theophyline
|
|
what med prolongs fibrin clot formation? affects which lab?
|
heparin
PTT (partial thromboplastin time |
|
anticoagulant that prolongs prothrombin time (PT) for overdose, antidote is ?
|
coumadin
vit K |
|
what med decreases platelet aggregation
|
Aspirin
|
|
necessary for formation of prothrombin and used as an antidote for Coumadin
|
vit K
|
|
– extremely low white blood cell count (WBC’s)
|
Neutropenia
|
|
dysrhymia that the result of an irritable myocardium and the hallmark is a wide, distorted QRS complex indicating abnormal conduction through the ventricles.
|
Premature ventricular contractions (PVCs
|
|
a progressively increasing P-R interval is indicative of a conduction defect through the AV node.
|
Second Degree AV block Mobitz Type 1
|
|
pain w/MI can not be relieved w/?
|
nitro
|
|
which cardiac enzyme is specific to the heart muscle and elevated levels indicates cellular necrosis or death
|
troponin 1
|
|
what is the goal of therapy w/nitro? does it affect dysrthymias?
|
goal of therapy is relief of pain. It dilates peripheral and coronary arteries, thereby increasing blood flow to the heart. Has no effect on dysrhythmias.
|
|
what is major problem w/chf?
|
primary problem is heart becomes an inefficient pump; blood and fluids back up into the lungs causing adventitious breath sounds
|
|
why do pt w/chf gain wt?
describe o/p in chf? |
fluid retention.
< urinary output by day, and > output at night |
|
what happens w/excess fluid in CHF when pt reclines?
|
reabsorbed and eliminated by the kidneys
|
|
As cardiac output falls in chf, blood flow to the kidneys ___ causing decreased glomerular flow. Kidneys interpret this as ____ and attempt to correct it by holding on to fluids
|
decreases
hypovolemia |
|
in chf the Kidneys > production and release of ____ causing sodium retention
|
aldosterone
|
|
what med to control the dysrhythmias of MI? thrombolytic agent administered intravenously to loosen the clot blocking the coronary artery. Best within the first ___hours following onset of MI?
|
Activase (thrombolytic enzyme alteplase)
6 |
|
blocks beta-adrenergic stimulation and causes a decreased heart rate, blood pressure and decreases the force of myocardial contraction.
|
Inderal (propranolol)
|
|
___ is an adrenergic and increases blood pressure and heart rate
|
Epinephrine
|
|
how do Drugs that < peripheral arterial resistance affect afterload?
|
decrease
|
|
– resistance to blood flow
|
Afterload
|
|
– amount of blood ejected by the heart with each beat
|
Stroke volume
|
|
– filling pr essure of the heart
|
Preload
|
|
cardiac sx to assess extent and severity of coronary artery blockage? what is done w/results?
|
Cardiac Catheterization.
Medical mgmt, angioplasty or coronary bypass surgery based on results. |
|
– indicates the lung has collapsed and will hear no air movement on auscultation.
|
Pneumothorax
|
|
Bronchoscopy – complications:
|
cyanosis, dyspnea, stridor, hemoptysis, hypotension, tachycardia, dysrhymias
|
|
hypoxemia, hypercapnia, dyspnea at rest and on exertion, O2 desaturation w/exercise and use of accessory muscles of respiration
|
COPD
|
|
what does cxr show in copd?
|
hyperinflated lungs due to trapped air
|
|
hallmark symptom is sudden onset of chest pain, dyspnea second most common symptom
|
pulmonary embolus
|
|
s/s of Pulmonary edema – symptoms include
|
crackles hea rd upon auscultation
|
|
characterized as an inflammation of the bronchioles, with air trapped in the small airways
|
asthma
|
|
hoarseness occurs early, because the tumor prevents the accurate approximation of the vocal cords during phonation, foul breath spitting up blood are late symptoms
|
laryngeal(voice) CA
|
|
Large extrinsic tumors produce difficulty and pain in swallowing. Nagging cough not related to this.
|
laryngeal(voice) CA
|
|
- post operative complication prevented by interventions such as deep breathing, coughing, turning, and using spirometer.
|
Atelectasis
|
|
- post operative complication due to depression of the gag reflexes during and immediately after general anesthesia.
|
Aspirtation Pneumonia
|
|
– heard over aortic area upon auscultation is sign of abnormal cardiovascular finding
|
Heart murmur
|
|
– heard over aortic area upon auscultation is sign of abnormal cardiovascular finding
|
Heart murmur
|
|
– pain produced by myocardial ischemia
|
Angina Pectoris
|
|
Abdominal aortic aneurysm – s/s include
|
pulsating abdominal mass, low back pain, lower abdominal pain.
|
|
Rheumatic endocarditis - caused by
|
Group A streptococcus organism
|
|
– potent inotropic agent that increases myocardial contractility, which leads to improved cardiac output and improved tissue perfusion
|
Intropin (dopamine hydrochloride)
|
|
At moderate doses, can maintain BP above 90 mmHg in pts with shock
|
Intropin (dopamine hydrochloride)
|
|
Also dilates the renal and mesenteric arteries, supporting renal perfusion
|
Intropin (dopamine hydrochloride)
|
|
High doses is a vasoconstrictor and may cause serious side effects, and not usually administered in high doses.
|
Intropin (dopamine hydrochloride)
|
|
the inability to absorb B12 due to a deficiency in intrinsic factor in the stomach
|
Pernicious anemia
|
|
___ attaches to B12 in the stomach and forms a complex that allows the vitamin to be absorbed in the small intestines.
|
Intrinsic factor
|
|
– bone scan to detect increased metastatic activity
|
Radioisotope
|
|
– is performed using the results of all diagnostic studies including tumor grading and tumor markers and determines the direction of the medical mgmt of a malignancy
|
Staging of a malignancy
|
|
- a malignant tumor developing in the uterus from trophoblast
|
Choriocarcinoma
|
|
Following the removal of a hydatidiform mole pt’s HCG levels should be monitored for ___yrs.
|
1 –2
|
|
Digitalis – pt experiencing sinus bradycardia relating to digitalis toxicity should be given ___
|
Atropine
|
|
what med blocks vagus nerve stimulation resulting in an increased heart rate
|
Atropine
|
|
- channel blocker will decrease heart rate
|
Calan (verapamil)
|
|
– an antidysrhythmic and used for tachyarrhythmias
|
Quinidine
|
|
a permanent urinary diversion wh ere a portion of the ileum is surgically resected and one end of the segment is closed.
|
Ileal conduit
|
|
The ___ are surgically attached to this segment in the ileum and the open end of the ileum is brought to the skin surface on the abdomen to form the stoma in ileal conduit?
|
ureters
|
|
– a tumor that arises from the sympathetic nervous system
|
Neuroblastoma
|
|
Most common form of extra-cranial solid tumor of childhood
|
Neuroblastoma
|
|
Neuroblastoma primarily affects what group?
|
peds
|
|
a malignant tumor of the kidney that primarily affects children and is made up of embryonic elements – also called nephroblastoma
|
wilm's tumor
|
|
s/s of wilm's tumor?
|
Hypertension and vomiting
|
|
- a sarcoma derived from bone or containing bone tissue, recurrent tumors may result in amputation -- called also
|
Osteosarcoma
osteogenic sarcoma |
|
- a tumor that invades the shaft of a long bone and that tends to recur and metastasizes frequently to the lungs
|
Ewing’s sarcoma
|
|
- a neoplastic disease that is characterized by progressive enlargement of lymph nodes, spleen, and liver and by progressive anemia
|
Hodgkin’s Disease
|
|
– involves an absence in the autonomic ganglia of the smooth muscle in a section of the colon.
|
Hirschsprung’ s Disease
|
|
what is done in sx to fix hirschsprung's?
|
non-functioning section of bowel is surgically removed
|
|
____ is caused by congenital absence of ganglion cells in the muscular wall of the distal part of the colon with resulting loss of peristaltic function in this part and dilatation of the colon proximal to the aganglionic part.
called also |
Megacolon
congenital megacolon |
|
- an abnormal increase in the amount of cerebrospinal fluid within the cranial cavity that is accompanied by expansion of the cerebral ventricles, enlargement of the skull and especially the forehead, and atro phy of the brain
|
Hydrocephalus
|
|
priority NX for hydrocephalus? why?
|
risk for injury
change in the neurological state and seizure activity. |
|
a metabolic disorder that is caused by an enzyme deficiency resulting in the accumulation of phenylalanine and its metabolites (as phenylpyruvic acid) in the blood and their excess excretion in the urine, that is inherited as an autosomal recessive trait, and that causes usually severe mental retardation, seizures, eczema, and abnormal body odor unless phenylalanine is restricted from the diet beginning at birth?
also called? |
PKU
phenylpyruvic amentia, phenylpyruvic oligophrenia |
|
– a sac-like structure outside the body and contains cerebrospinal fluid and the meninges
|
Myelomeningocele
|
|
– a sac containing cerebrospinal fluid and may contain the meninges, but does not contain neural tissue.
|
Meningocele
|
|
- hernia of a bladder and especially the urinary bladder : vesical hernia
|
Cystocele
|
|
a common disease especially in Caucasian populations that appears usually in early childhood, is inherited as a recessive monogenic trait, involves functional disorder of the exocrine glands, and is marked especially by faulty digestion due to a deficiency of pancreatic enzymes, by difficulty in breathing due to mucus accumulation in airways, and by excessive loss of salt in the sweat? aka?
|
CF
fibrocystic disease of the pancreas, mucoviscidosis |
|
T/FAntineoplastic agents have more of an effect on the tumor cells than n ormal cells because of their rapid growth
|
T
|
|
Those normal tissue cells that are the most effected by chemo are bone marrow (seen in low blood counts), hair follicles (seen by way of hair loss) and the GI mucosal epithelium (accounting for nausea, vomiting, loss of appetite, and diarrhea).
|
info but KNOW
|
|
It is a very narrow margin deciding the right dose to use for destroying the tumor cells in order to have the lease affect on normal healthy cells.
|
info
|
|
Endocrine antineoplastic chemotherapy such as ____ is what is considered additive or ablative therapy
|
Tamoxifen
|
|
T/F tamoxifen is not a cure but provides palliative therapy as effectively as does an oopherectomy( removal of ovaries
|
T
|
|
when is tamoxifen most effective?
|
It is most effective when used to prolong disease free survival in breast cancer therapies.
|
|
It is important to be alert to the signs and symptoms that may accompany the use of antineoplastics such as increased fluid retention leading to CHF, as well as, increased susceptability to infe ctions due to immunosuppression. Additional medications may need to be given to help resolve CHF. Good handwashing techniques before and after giving care will help to reduce possible introduction of infection.
|
info but know
|
|
It is recommended that care be given to prevent undue cytotoxic exposure, by wearing disposable ____ gloves when handling the medication.
|
nonpermeable
|
|
– a disorder of diffuse activation of the clotting cascade that results in depletion of clotting factors in the blood
|
Disseminated Intravascular Coagulation (DIC)
|
|
describe how DIC occurs?
|
occurs when the blood clotting mechanisms are activated throughout the body instead of being localized to an area of injury. Small blood clots form throughout the body, and eventually the blood clotting factors are used up and not available to form clots at sites of tissue injury. Clot dissolving mechanisms are also increased
|
|
DIC may be stimulated by many factors including?
|
infection in the blood by bacteria or fungus, severe tissue injury as in burns and head injury, cancer, reactions to blood transfusions, and obstetrical complications such as retained placenta after delivery.
|
|
Risk factors for DIC are?
|
recent sepsis, recent injury or trauma, recent surgery or anesthesia, complications of labor and delivery, leukemia or disseminated cancer, recent blood transfusion reaction, and severe liver disease.
|
|
Symptoms of DIC?
|
Bleeding, possibly from multiple sites in the body, Thrombosis formation evidenced by bluish coloration of the fingers, Sudden onset of bruising
|
|
what do labs show in DIC?
|
Elevated fibrin and/or fibrinogen degradation products, Decreased serum fibrinogen, Increased prothrombin time, Increased PTT, Platelet count, Thrombin time test
|
|
what is the goal of tx in DIC?
|
The objective of treatment is to determine the underlying cause of DIC and provide treatment for it.
|
|
what maybe done to relieve DIC?
|
Replacement therapy of the coagulation factors is achieved by transfusion of fresh frozen plasma
|
|
____may also be used if fibrinogen is significantly decreased in DIC?
|
Cryoprecipitates
|
|
___ a medication used to prevent thrombosis, is sometimes used in combination with replacement therapy in DIC?
|
Heparin
|
|
Vitamin ___ is deficient in Lung cancer
|
C
|
|
what med is used for asthmatic children, it is a mast cell stabilizer, it prevents allergic reactions
|
Intal (cromolyn sodium)
|
|
s/sx of iron deficiency
|
anemia are pallor, sensitivity to cold, weakness, and fatigue
|
|
Monitor _____ in Liver Cancer
|
alkaline phosphatase
|
|
S/sx of liver tumor include
|
dull ache, RUQ , epigastrium and back pain
|
|
If the portal vein is blocked in Liver cancer then ___ will be the complication, if the large bile duct becomes obstructed, the result will be _____.
|
ascites
obstructive jaundice |
|
S/sx of pernicious anemia include
|
tingling and paresthesia of hands and feet, weight loss, anorexia, and dyspepsia
|
|
Tx for pernious anemia is a diet high in ___ & ___, restricting ____ or extremely hot foods. Increased intake of vitamins
|
iron and protein
highly seasoned B12 and B 6, C and folic acid. |
|
S/sx of R sided heart failure include .
|
edema, swelling, dependent edema, distended neck vein, nocturia, weakness, hepatomegaly and weight gain
|
|
S/sx of R sided heart failure include .
|
edema, swelling, dependent edema, distended neck vein, nocturia, weakness, hepatomegaly and weight gain
|
|
S/sx of L sided heart failure (think pulmonary) include
|
SOB< dyspnea, moist cough, crackles and gallop rhythm (S3 and S40, crackles, coughing, tachycardia, and fatigue-ability.
|
|
childhood tumor of the kidney
|
Wilm’s Tumor
|
|
S/sx of wilm's tumor?
|
palpable firm, smooth mass in the abdomen, hypertension, vomiting.
|
|
why palpation contraindicated in wilm's tumor?
|
it could cause rupture and seeding
|
|
Post op concern in wilm's tumor
|
decreased urine output.
|
|
S/sx of ____ tumors includes hypermenorrhea, (dysmenorrhea or leukorrhea may occur) pain, backache, constipation, urinary frequency or urgency or intestinal obstruction.
|
uterine fibroid
|
|
Hx of pt undergoing heart catherization should include allergy to _____ because of use of dye during the procedure
|
shellfish
|
|
invasive procedure where they thread a hollow catheter through the femoral artery/vein
|
Angioplasty
|
|
during ____ a balloon tipped catheter is introduced and used during inflation to “crack” plaque in the vessel and reduce vessel stenosis to not more than 20%.
|
Angioplasty
|
|
chronic reactive airway disease
|
asthma
|
|
____ asthma is an antigen antibody reaction to pollen, dander, feathers, food, house dust and mites
|
Extrinsic
|
|
S/sx of asthma include
|
tachypnea, tachycardia, dyspnea, wheezing, hypoxemia, diaphoresis, used of accessory muscles
|
|
what to have child w/asthma do to increase vital capacity?
|
to blow pinwheels to incrase vital capacity
|
|
An undesirable s/e of premarin used to treat prostate cancer is?
|
gynocomastia (increased breast size.)
|
|
why is Constant irrigation is used post op of TURP?
|
to prevent obstruction of urine flow, and to prevent clot formation
|
|
S/sx of pulmonary embolism include
|
sudden onset of dyspnea, tachypnea, crackles, chest pain, cough, hemoptysis, tachycardia, anxiety.
|
|
what test to dx pulmonary embolism?
|
V/Q lung scan
|
|
____ disease is a form of peripheral vascular disease
|
Raynaud’s
|
|
who gets raynauds?
|
women between puberty and age 40
|
|
what usually precipitates the episodic vasospasm of raynauds?
|
stress or cold exposure
|
|
Raynaud's s/sx include?
|
tingling and numbness, blanching unrelieved by warming.
|
|
Digoxin is a ___?
|
cardiac glycoside
|
|
how does dig work?
|
It increases cardiac output and contractility (slows the rate
|
|
blood level for dig?
|
Therapeutic range is 0.8 to 2.0 ng/ml, toxicity> 2.4ng/ml
|
|
s/sx of dig toxicity?
|
S/e include nausea, vomiting, cardiac dysrhythmias, hypotension, yellow-green halos, blurred vision
|
|
T/F Md should be contacted for irregular heart beats and muscle weakness which could indicate hypokalemia w/dig?
|
T
|
|
what to monitor for if dig is taken with lasix?
|
watch out for cardiac dysrhythmias
|
|
Capoten is an ___?
|
ACE inhibitor
|
|
how does capoten work?
|
It decreases the work of the heart by promoting vasodilation and diuresis (while retaining potassium)
|
|
what labs to monitor w/capoten?
|
Monitor serum creatine and urine creatine clearance
|
|
S/E of capoten include?
|
S/e include hypotension, hypovolemia, and hyponatremia
|
|
T/F Taking capoten with food reduces absorption by up to 30%.
|
T
|
|
Dopamine is a ____. It will increase B/P and cardiac output through blood vessel _______
|
vasopressor
vasoconstriction |
|
what narc is used for severe pain because it depresses the pain impulse transmission at the spinal cord
|
Morphine
|
|
what med is used to inhibit cell division, common in tx of breast ca.
|
Tamoxifen
|
|
what to have woman do in r/t arm after mastectomy?
|
After mastectomy elevate the arm on the affected side to reduce tension on surgical incision, promote circulation and prevent venous congestion.
|
|
values in tumor lysis include
|
increased potassium, increased phosphate and uricemia with decreased calcium
|
|
Nursing priorities immediately following surgery include recovery from general anesthesia?
|
patent airway, prevention of aspiration, effective breathing pattern) and pain management.
|
|
accelerated clotting process caused depletion of circulating clotting factors and platelets which can provoke severe hemorrhage
|
DIC
|
|
lab test to dx DIC:
PT? PTT? Platelet count? Fibrinogen? |
PT greater than 15 seconds, PTT greater than 60-80 seconds, patelets less than 100,000/ul, fibrinogen level less than 150 mg/dl
|
|
what test is specific for DIC?
|
positive D-dimer test specific for DIC
|
|
T/F There is an decreased survival rate in chrondosarcoma following amputation
|
F
increase |
|
S/sx of chronic arterial occlusion include?
|
intermittent claudication, achy, cramping like pain, fatigue or weakness relieved with rest.
|
|
what increases pain in arterial occlusion?
|
Pain increases with elevation, limbs usually legs hand over the bed at noc to reduce pain
|
|
_____ is a common pneumonia. Incidence is greatest in patients with AIDS, and immunosuppression because of cancer tx
|
Pneumocystis carinii
|
|
T/F in PCP the mortality rate is 60-80%, complications include respiratory failure
|
T
|
|
Prevent skin breakdown by
|
repositioning every 2 hours
|
|
S/sx of Pyloric Stenosis includes
|
projectile vomiting, weight loss and constipation
|
|
who gets pyloric stenosis?
|
Defect is common in male infants between ages 1-6 months
|
|
2 foods tha reduce colostomy odor?
|
Spinach and parsley reduce colostomy odor
|
|
Thrombocytopenia is reduced ____. Normal is _____
____is serious, _____ may be life threatening. |
platelets
150,000-400, 000mm3. <20,000 < 10,000 |
|
____ is done to deliver a high dose to a localized area. how long left in place?
|
Implantable internal radiation.
48-72 hrs |
|
what to do for internal radiation pt?
|
should minimize their exposure TIME, stand at the side of the bed out of the direct line of radiation, keep their DISTANCE (radiation loses its intensity) and use of lead SHIELDS
|
|
how often should placement of internal radiation device be checked
|
every 4 hours
|
|
what should the RN always avoid in internal radiation device?
|
NEVER TOUCH THE RADIATION SOURCE WITH YOUR BARE HAND
|
|
S/sx of MI?
|
crushing substernal pain that may radiate to the jaw, back and arms
|
|
different btwn MI and angina
|
last longer and no relieved by nitro.
|
|
____ is the classic symptom of arteriosclerotic heart disease
|
Angina
|
|
what is the cause of angina?
|
inadequate oxygenation of the heart due to decreased blood flow to the cardiac vessels that feed the heart.
|
|
how does nitro work?
|
reduces the pain of angina by dilating the coronary arteries and improving blood flow to the heart muscle
|
|
should pt keep nitro at all times? what to do if pain lasts longer than 20min? how should nitro be stored? what should pt experience when taking nitro SL?
|
yes
call ems cool dark dry place slight burning/stinging sensation |
|
surgical removal of some or all of the larynx?
preop teaching for? |
laryngectomy
alternate methods of communication (writing, lipspeakin and word boards |
|
____ is a developmental anomaly of the placenta. A chorionic tumor
|
Hydatiform mole
|
|
SE of mole?
|
rapid uterine growth, extremely elevated HCG and US that fails to reveal a fetal skeleton.
|
|
T/F w/chest tubes bubbling in the water seal chamber should decrease as the need for the chest tube resolves
|
T
|
|
what does constant bubbling in chest tubes mean?
|
loose connection, and prompt correction (hemastat at the bedside) is necessary
|
|
what to do if chest tube becomes dislodged?
|
cover the opening immediately with petroleum gauze and apply pressure then call MD
|
|
what to assess for @ insertion site w/chest tubes?
|
subcutaneous emphysema and contact the doctor if it increases
|
|
NSG int r/t chest tubes?
|
Assure integrity of the system, measure the drainage, place below the level of the chest even during ambulation.
|
|
p/o pneumectomy care?
|
Position on operative side to promote full expansion of unaffected lung and to assist in drainage of secretions from operative site. Perform arm exercises to minimize complications and prevent degenerative changes in the joints. The patient should take frequent rest periods, avoid heavy lifting and prevent infection and stop smoking
|
|
S/sx of pneumothorax include?
TX? |
diminished or absent breath sounds, dyspnea, tachypnea, subcutaneous emphysema, cough, sharp pain that increased with exertion. Bronchus deviated from midline. Tx-chest tube.
|
|
Vesicular I>E, both lungs soft and low, Bronchovesicular equal I/E anterior between scapulae, Bronchial E>I loud and relatively high pitch, Tracheal I/E equal very loud.
|
KNOW
|
|
____ is the inflammation of both layers of the pleurae. Causes include
|
Pleuritis.
pneumonia, TB, collagen disease, primary and metastatic cancers and thoracotomy. |
|
____ shock is compromised tissue perfusion and reduced cardiac output because the heart fails to adequately pump
|
Cardiogenic
|
|
causes of cardiogenic shock?
|
MI, heart failure, myocarditis, cardiomyopathy and advanced heart block
|
|
what might Tx of cardiogenic shock consist of?
|
Tx can include digoxin, dopamine, diuretics, vasodilators and vasopressors, increased oxygen to maximize cardiac, pulmonary, renal fx and Use of IABP (intra-aortic balloon pum) may be used
|
|
In IABP coronary artery perfusion is increased with the aortic valve closes and the balloon inflates during diastole. The balloon is inserted through the femoral artery into the descending aorta
|
info but know
|
|
____ crisis is a vaso-occlusive episode and it is very painful
|
Sickle cell
|
|
Interventions during sickle cell crisis include?
|
warm compresses to painful areas, (cold aggravates the condition), maintaining bed rest to reduce workload on the heart, and increased fluid intake to prevent dehydration which can precipitate a crisis
|
|
pt teaching to avoid sickle cell crisis?
|
avoid strenuous exercise , high altitude, unpressurized aircraft, cold and vasoconstrictive drugs.
|
|
_____ is a diffuse endothelioma or endothelial myeloma forming a fusiform swelling on a long bone
|
Ewing ’s sarcoma
|
|
The largest risk factor in cervical cancer is ____? It can be detected by a ____. Unlike uterine cancer that requires a ____ and the use of ____ test.
|
multiple partners
pap smear biopsy Schiller’s |
|
bradycardia in a newborn (<100), up to 3 months (<80), 3months to 2 years (<70), 2-10 years (<55), adult (<60
|
info but know
|
|
uterine fibroids, hydatiform moles, fibrocystic disease of the breast, pyloric stenosis and prostatic hyperplasia are all ____?
|
Benign tumors
|
|
After the treatment of Basal Cell epithelioma patients should be instructed to___?
|
avoid sun exposure, use of protective clothing (such as hats, gloves), used of sunscreens (zinc oxide is best) and have all lesions checked promptly.
|
|
Squamous cell carcinoma usually affects ___ males over the age of 60
|
caucasian
|
|
causes of Squamous cell carcinoma?
|
. Causes include sun exposure, x-ray therapy, arsenic ingestion (gardener), carcinogen exposure (tar and oil) and chronic skin irritation and inflammation.
|
|
which squamous cell lesions have poor prognosis?
|
lip and ear
|
|
___ is an immunosuppressant anti-neoplastic. Give ___ 24-48 hours after tx to prevent reversal of bone marrow and GI toxicity.
|
Folex (methotrexate)
Ca+ |
|
Nursing care for stomatitis:
|
Careful mouth care with soft bristled brushes, restriction of foods that may cause trauma or be difficult to chew. Continuous lubr ication of lips. Avoid extreme food temp and spicy foods. Consume foods that are soft and easy to chew.
|
|
what to avoid in pku diet?
|
protein/milk/ nutrasweet
|
|
Lab values for chemo pt: CEA> ___ ng, elevated ____, and Beta ___, ACTH, UA would reveal ___ protein, melanin, Decreased platelet count.
|
10
AFP HCG Bence Jones |
|
CA patient nutrition:
|
small, frequent, high nutrient foods, eat prior to chemo/rad tx. Food consistency should be tolerated and swallowed well, encourage supplemental feeding and reduce lactose in the diet.
|
|
Cancer protection(diet):
|
Increased intake of fresh vegetables, especially cabbage, increase intake of Vitamin A/C, decrease fat, salt, cured, smoked, nitrate foods, decrease alcohol and tobacco use.
|
|
life span of rbc?
|
7-10d
|
|
Tetralogy of Fallot aka cyanotic heart disease is associated with ___ and use of ____?
|
FAS
thalidomide |
|
goal of tx in CF?
|
improve O2
|
|
s/s of CF?
|
S/sx salty taste on child’s skin (sweat chloride 2-5 x normal), bulky, greasy foul-smelling stools that contain undigested food. Mal-absorption due to enzyme deficiency.
|
|
Hirschsprung’ s disease (barium enema bad) considered hereditary
|
info
|
|
in ___ the Bowel segment contracts but feces cannot be pushed forward because the bowel is unable to completely relax, leading to intractable constipation and sometimes overflow diarrhea?
|
hirschsprungs
|
|
T/F in hirschsprungs the Corrective surgery to pull-through normal ganglionic tissue to the anus or management with colonic lavage is necessary to keep the bowel empty.
|
T
|
|
know that losing excess weight is a way to treat ___?
know that smoking is a major cause of ____ |
hypertension
HTN |
|
what is the difference between how a acute and chronic arterial occlusion feels?
|
because there is time for development of collateral circulation in chronic.
|
|
know that a pulsatile mass in the abdomen is a sign of an ____?
|
abdominal aortic aneurysm
|
|
know that having a person with orthopnea ____ helps them breathe better
|
hang their legs over the edge of the bed
|
|
know that ascites is a sign of ___ side heart failure.
describe the tongue in iron deficient anemia? |
right
red, smooth and sore |
|
T/F IM B-12 shots are used to treat deficiency
|
T
|
|
know that you should check ____ in sickle cell anemia patients.
|
“H&H” hemoglobin and hematocrit
|
|
describe the skin in impaired circulation?
|
shiny, cool skin is a sign of impaired circulation
|
|
sudden onset of chest pain and difficulty breathing is a sign of ___?
|
a pulmonary embolism
|
|
that if a patient is on lasix (furosemide) and digoxin that they should be
watched for ____ |
hypokalemia
|
|
that a person taking catopen should ____
|
change positions slowly
|
|
___ is best way to diagnose a pulmonary embolism
|
arteriography
|
|
ph is down and paco2 is up=
that sometimes suctioning is used to remove secretions |
respiratory acidosis
info |
|
____ breathing is taught to COPD patients to help them prolong the expiratory cycle and have more positive airway pressure.
|
pursed lip
|
|
definitive sign of COPD is decrease in ___?
|
FEV (forced expiratory volume
|
|
signs of an air leak in a chest tube
|
-constant bubbling
|
|
pink-frothy sputum is a sign of ___
|
pulmonary edema
|
|
pulmonary hypertension is a cause of ____ side heart failure
|
right
|
|
____ sarcoma is more common in immune suppressed persons
|
Kaposi’s
|
|
why are steriods given in asthma?
|
to reduce inflammation
|
|
what to watch for in pt getting steriods?
|
s/s of infection
|
|
___ tumors may cause abnormal vaginal bleeding
|
fibroid
|
|
know definition of HPS (hypertrophic pyloric stenosis)
|
look up
|
|
failure to thrive is a sign of _____.
|
HPS
|
|
40th birthday present for men?
|
bph
|
|
most common sign of bladder CA?
|
painless hematuria
|
|
what might hip pain 1 mo after sx in prostate CA mean?
|
spread to the bone.
|
|
which hormone is assoc w/breast CA?
|
estrogen
|
|
SIADH causes what E imbalance?
|
low Na
|
|
for a child with Wilm’s tumor labs should be checked for __
|
anemia
|
|
you should never palpate the abdomen of a child with ____ tumor
|
Wilm’s
|
|
teenage boy with chronic leg pain may have ____ sarcoma
|
Ewing’s
|
|
T/F treating chrondosarcomas with amputation increases survival
|
T
|
|
exposure to ____ is risk factor for cervical cancer
|
hpv
|
|
which 2 cells are greatly affected by radiation because they grow fast?
|
GI and hair
|
|
what does chemo due to bone marrow
|
suppresses it
|
|
if a chemo drugs extravasated to ____ the infusion and place ___ on the site
|
stop
ice |
|
sickle cell crisis can be treated with ___ moist compresses
|
hot
|
|
after a prostate surgery the major intervention is to check for ___ and ___
|
bleeding and shock
|
|
describe a healthy stoma
how often to do bse? |
beefy red
monthly after period |
|
s/s of patent ductus arteriosis?
|
constant murmur
|
|
what posit for symptomatic TET babies?
|
knee-chest position-like squatting
|
|
chest physiotherapy is an important part of ___ treatment
|
CF
|
|
nursing dx of hirschspring’s disease is?
|
risk for injury related to lack of intestinal motility”
|
|
Down’s syndrome children are often mentally challenged
60. know about clubfoot-nursing interventions know about DDH (developmental dysplasia of hip) |
info
look up |
|
a _____ should be kept moist
|
meningeoclele
|
|
children with a meningeocele usually have ____ problems
Know what CP (cerebral palsy) and MD |
neuro
look up |
|
that patients with leukemia should be checked for ___?
|
thrombocytopenia
|
|
pt teaching to decrease oxygen demand.
|
pace activities or do them in the morning
|
|
T/F nitro can be taken before hard work
|
T
|
|
a patient with neutropenia should not eat ___
|
raw veggies
|
|
why is O2 given @ low rate in COPD?
|
to keep from suppressing their drive to breathe.
|
|
a patient with coronary artery disease should avoid exercising outside
when it is _____ |
very hot or very cold
|
|
T/F that orchiectomy does not cause impotence
|
T
|
|
what should pt do if wakes up and HR is below 60
|
call md
|
|
muscle weakness is a sign of which E imbalance?
|
hypokalemia
|
|
concern p/o wilm's tumor?
undesirable sign of hormone therapy for inoperable prostate cancer is ____ |
o/p
gynomastia |
|
what is the purpose of constant irrigation of catheter after TURP?
|
to prevent occlusion of urine flow
|
|
cold fingers =____
|
raynauds
|
|
immediate intervention after treatment for basal cell carcinoma treatment?
|
all lesions should be checked promptly
|
|
what type care is important in CA Tx?
CEA (Carcinoembryonic antigen) is a lab used to dx _____. |
po
cancer |
|
To avoid an error of parallax when taking a client's blood pressure, the nurse should
|
An improper reading of the level of mercury will be obtained if the reader is
not perpendicular to the column. An error of parallax results when an object is displaced by an observer's altered position |
|
The nurse explains to a client that the mechanism mediating long term blood
pressure regulation is the |
If there is a decrease in urinary output with increased conservation of body
fluid, the blood pressure will be increased and vice versa |
|
When taking a client's apical pulse the nurse should place the stethoscope
|
The heart's apex is between the 5th and 6th ribs at the midclavicular line. It is
closest to the chest wall here, so auscultation is easier |
|
The nurse institutes safety precautions for a client receiving oxygen because
oxygen |
An open flame or spark from static electricity can initiate an explosion and
fire in the presence of higher than normal oxygen |
|
When instituting oxygen therapy, the nurse recognizes that the method of
oxygen administration least likely to increase apprehension in the client is |
oxygen via nasal cannula is the most comfortable and least intrusive,
because the cannula extends minimally into the nose |
|
The nurse identifies a commonality between the strain on a client's heart with prolonged anemia or polycythemia to be
|
With anemia there is a greater return of blood to the heart from the
peripheral vessels; the greater volume of blood returning to the heart stretches it and results in greater cardiac output. With polycythemia the heart must work harder to propel the more viscous blood through the circulatory system |
|
A client with pyrexia will most likely demonstrate
|
The pulse increases to meet increased tissue demands for oxygen in the
febrile state |
|
The nurse asses that a client's pulse pressure is decreasing. This would be
evaluated by calculating the |
- pulse pressure is obtained by subtracting the diastolic from the systolic
readings after the blood pressure has been recorded |
|
Following open heart surgery a client develops a temperature of 102°F. The
nurse notifies the physician because elevated temperature |
temperatures of 102°F or greater lead to an increased metabolism and
cardiac workload |
|
The nurse should teach clients with peripheral vascular disease to stop
smoking because nicotine |
Constriction of the peripheral blood vessels and the resulting increase in
blood pressure impair circulation and limit the amount of oxygen being delivered to body cells, particularly in the extremities |
|
With chronic occlusive arterial disease the precipitating cause for ulceration and gangrenous lesions often is
|
injured tissue cannot heal properly because of cellular deprivation of
oxygen and nutrients; ulceration and gangrene may result; diminished sensation decreases awareness of injury |
|
When obtaining data from a client with thromboangitis obliterans (Buerger's
disease), the nurse would expect the client to demonstrate or report |
Buerger's disease is characterized by vascular inflammation, usually in the
lower extremities, leading to thrombus formation. As a result of impaired circulation, there is a burning pain and intermittent claudicaation |
|
A simple test for varicose veins is the
|
the trendelenburg test evaluates the backflow of blood through defective
valves. If, after raising the legs to empty the veins, the client stands and the veins fill from above the site of the suspected varicosity, the diagnosis is supported |
|
Following a vein ligation and stripping, the client should be positioned
|
the legs should be elevated to promote venous return by gravity
|
|
Prolonged bed rest after surgery appears to promote hemostasis, particularly
in the deep veins of the calves. The most likely pathologic result of such hemostasis may be thrombus formation and |
the pulmonary capillary beds are the 1st small vessels (capillary beds) that
the embolus encounters once it is released from the calf veins |
|
the 1st positive deflection after the P wave on the ECG
|
R wave
|
|
atrial depolarization and the time for an impulse to travel through the AV node and the bundle of His
|
PR interval
|
|
atrioventricular (AV) node normally depolarizes at a rate of
|
(40-60)
60-100 |
|
The ability of cardiac cells to spontaneously depolarize without being
stimulated by a nerve describes the property of |
automaticity
|
|
The dominant pacemaker of the heart is the
|
sinoatrial (SA) node
|
|
in LEAD ____ the left leg is positive and the right arm is negative
|
II
|
|
The waveform that reflects ventricular repolarizarion is the
|
T wave
|
|
The PR interval is measured
|
beginning of the P wave to the beginning of the QRS complex
|
|
The PR interval normally measures
|
0.12-0.20 second
|
|
The ability of cardiac cells to transfer an impulse from cell to cell is
called |
conductivity
|
|
The duration of a normal QRS complex is
|
0.08-0.12 second
|
|
The vertical axis on ECG paper measures ___. Each small square equals
|
voltage, 1 mm (0.1 mV)
|
|
The horizontal axis on ECG paper measures ___. Each small square
|
time, 0.04 second
|
|
Purkinje fibers normally depolarize at a rate of
|
20-40/minute
|
|
The ability of cardiac cells to respond to an electrical stimulus is called
|
contractility
|
|
The sinoatrial (SA) node normally depolarizes at a rate of
|
60-100
|
|
The process that occurs when the cell membrane actively pumps sodium
out of the cell and potassium into the cell, thus returning the cell to its resting state, is called |
repolarization
|
|
The process that occurs when an electrical stimulus causes sodium rush
into a resting cell, changing the cell's electrical potential from negative to positive is called |
depolarization
|
|
The 1st negative deflection after the R wave is the
|
S wave
|
|
Which of the following statements are correct concerning the determination of heart rate from a rhythm strip?
|
To calculate the heart rate using the six-second count method,
count the number of complete complexes between two vertical |
|
a straight, flat line recorded on the ECG when the electrical activity of
the heart is nor being detected |
isoelectric line
|
|
What information can be obtained from a single monitoring lead
|
the effectiveness of myocardial contraction
|
|
The dysrhythmia commonly related to the respiratory cycle- gradually
increased with inspiration and decreasing rate with expiration is |
sinus dysrhythmia
|
|
List 5 steps used in ECG rhythm analysis
|
rate, regularity, P wave (presence, absence, relation to QRS,deflection),
PR interval, QRS interval |
|
An electrical impulse moving directly toward a positive electrode will
create a(n) _________ deflection on ECG paper. |
upward
|
|
Which of the following may produce artifact on the ECG
|
Muscle tremors
loose electrodes respirations |
|
The electrocardiogram is used to
|
evaluate electrical activity of the heart
|
|
The 3 primary function of the AV node includes which of the following
|
1 delays conduction to allow the atria to empty their contents into the ventricles
2. act as a “stop gate” 3. act as an escape pacemaker if a higher pacemaker site fails |
|
In normal sinus rhythm, the P wave should have the following 3
characteristics |
be present before every QRS complex, uniform size and shape, upward
deflection |
|
When a client is receiving anticoagulants, the nursing care should include
observations for: |
epistaxis
|
|
client is receiving Dicumarol, a coumarin derivative. The test that would
be most specific for calculating the daily dosage of this anticoagulant would be the |
prothrombin time
|
|
client with coronary artery disease has a sudden episode of cyanosis
and a change in respirations. The nurse starts oxygen administration immediately. In this situation |
the nurse's observations were sufficient to begin administration of the
oxygen |
|
.When preparing a client for discharge following surgery for a coronary
artery bypass graft, the nurse should teach that there will be |
The client is up more at home so edema usually increases
|
|
The nurse suspects a client is in cardiogenic shock. The nurse understands
that this type of shock is |
shock may have different etiologies, but always involves a drop in BP
and failure of the peripheral circulation because of sympathetic nervous system involvement |
|
The nurse assists the physician in treating a client in shock. One modality
of treatment that employs the physical law explaining the increased venous return accompanying mild vasoconstriction underlies the use of |
adrenalin is used to treat shock because the induced arterial
constriction reduces blood pooling and increases venous return and cardiac output |
|
The nurse finds an injured person, sitting in a chair obviously in shock.
The nurse should |
this position is useful in treating shock because it promotes gracity
induced venous return. Warmth and fluids are also supportive to the person |
|
The adaptations of a client with Adams-Stokes syndrome would most
likely include |
Adams-Stokes syndrome is a result of complete AV block. The
ventricles take over the pacemaker function in the heart, but at a much slower rate than that of the SA node. As a result there is a decreased cerebral circulation, causing syncope |
|
The nurse is aware that the term bradycardia means
|
<60 bpm
|
|
The nurse should prioritize care and provide treatment first for a client with?
|
ventricular fibrillation will cause irreversible brain damage then death
within minutes because the heart is not pumping blood |
|
List in order, the structures of the heart as blood would pass beginning at the right atrium
|
tricuspid valve
pulmonary artery pulmonary vein mitral valve left ventricle |
|
Which of the following would cause the heart rate to decrease
|
Vagal stimulation
|
|
All of the following are properties of the cardiac muscle cells except
|
secretion
|
|
Place the following in order as a normal cardiac electrical impulse would travel through them
|
SA node
Intra-atrial pathways AV junction Bundle of His Purkinje fibers |
|
Which of the following is considered the dominant pacemaker of the heart
|
SA node
|
|
When the Purkinje fibers function as an escape pacemaker, you would expect the
|
20-40 beats/minute
|
|
The functions of the AV node include which of the following
|
Delays the conduction to allow the atria to empty their contents into the
ventricles 2. Acts as a “stop gate” 3. Acts as an escape pacemaker |
|
The electrocardiogram shows
|
electrical activity of the heart
3. rate and rhythm of the heart |
|
The P wave of the normal EKG represents
|
atrial depolarization
|
|
The normal PR interval is
|
0.12-.20 sec
|
|
A “sawtooth” waveform is a distinct characteristic of which of the following
rhythms? |
atrial flutter
|
|
The P wave in a normal sinus rhythm should have which of the following characteristics?
|
upright
2. regular in rate 3. similar in shape to each other preceding the QRS complex |
|
Dysrhythmias can be caused by which of the following
|
ischemia
2. hypoxia 3. acidosis 4. electrolyte imbalance 5. myocardial infarction |
|
The nurse understands that in the absence of pathology, a client's respiratory center is stimulated by
|
the respiratory in the medulla responds primarily to increased carbon
dioxide concentration in the blood |
|
The efficacy of the abdominal-thoracic thrust (Heimlich maneuver) to
expel foreign object in the larynx demonstrates the gas volume related to the individual's |
the residual volume is the amount of air remaining in the lungs after
maximum exhalation |
|
A client states that the physician said the tidal volume is slightly
diminished and asks the nurse what this means. The nurse explains that tidal volume is the amount of air |
tidal volume is defined as the amount of air exhaled normally after a
normal inspiration |
|
Air rushes into the alveoli as a result of the
|
thoracic pressure is reduced because thoracic volume is increased as
the diaphragm descends |
|
A client is scheduled for a pulmonary function test. The nurse explains
that during the test the respiratory therapist will ask the client to breathe normally to measure the |
5) 1- tidal volume is the amount of air inhaled and exhaled while breathing
normally |
|
Oxygen dissociation from the hemoglobin and therefore oxygen delivery to the tissues are accelerated by
|
6) 3- the lower the PO2 and the higher the PCO2 , the more rapidly oxygen
dissociates from the oxyhemoglobin molecule |
|
With an oxygen debt, muscle shows
|
7) 1- with an oxygen debt, a muscle would show primarily low levels of oxygen
and low levels of ATP caused by the low levels of aerobic respiration and high levels of lactic acid formation |
|
A nurse initially will use an Ambu-Bag in the intensive care unit when
|
8) 1- An Ambu-Bag is a piece of equipment that can be compressed at regular
intervals by hand for temporary ventilation of the client in respiratory arrest |
|
To facilitate maximum air exchange, a client should be placed in
|
the orthopneic position is a sitting position that permits maximum lung
expansion for gaseous exchange, because the abdominal organs do not provide pressure against the diaphragm and gravity facilitates the descent of the diaphragm |
|
A client begins to expectorate blood. The nurse describes this episode as
|
10)3- hemoptysis is expectoration of blood-stained sputum derived from the
lungs, bronchi, or trachea |
|
The position in which a client with dyspnea should be placed is
|
11)3- orthopneic position refers to sitting up and leaning slightly forward,
which drops the diaphragm, allowing the lungs more room for expansion |
|
Radium is stored in lead containers because
|
Radium atoms are unstable and spontaneously disintegrate. This
disintegration produces potentially harmful radiation; lead is a barrier to these radiations |
|
A systemic drug that may be prescribed to produce diuresis and inhibit
formation of aqueous humor is |
Acetzilamide (Diamox) is a carbonic anhydrase inhibitor that decreases inflow of aqueous humor and controls intraocular pressure
|
|
A client is receiving an antihypertensive drug intravenously for control of
severe hypertension. The client's blood pressure is unstable and is at 160/94 before the infusion. Fifteen minutes after the infusion is started the blood pressure rises to 180/100. The response to the drug would be described as |
paradoxical response to a drug is directly opposite to the desired
therapeutic effect |
|
A client is to be discharged on a diuretic and digitalis. The nurse reviewing the
client's diet would be especially careful to look for adequate sources of potassium because |
toxic levels of digitalis overstimulate the vagus nerve, leading to depressed
conduction through the AV node (AV block of any degree) as well as SA node depression (sinus bradycardia). In addition, ectopic pacemakers are accelerated, leading to premature beats. Such pathologic effects are enhanced by low serum potassium levels from diuretics, vomiting, and nasogastric drainage as well as by chronic arterial hypoxemia and impaired renal function. |
|
A client complains of fatigue and dyspnea and appears jaundiced. The nurse
questions the client about medications taken routinely. In light of the symptoms, the nurse should be most concerned about |
methyldopa is associated with acquired hemolytic anemia and should be
discontinued to prevent progression and complications |
|
A client is receiving amniophylline intravenously to relieve sever asthma. The
nurse should observe for |
Amniophylline, a theophylline derivative, promotes diuresis and relaxes
smooth muscles, resulting in hypotension |
|
Before giving a client digoxin, the nurse should obtain the
|
Because digoxin slows the heart, the apical pulse should be counted for 1
minute before administration. If apical rate is below 60 (bradycardia), digoxin should be withheld because its administration could further depress the heart rate. If the heart rate is above 120, digoxin should be withheld because the client may be in digitalis toxicity. |
|
The nurse should teach a client to suspect that nitroglycerin SL tablets have
lost their potency when |
Nitroglycerin tablets are affected by light, heat, and moisture. A loss of
potency can occur after 3 months, reducing the drug's effectiveness in relieving pain. A new supply should be obtained routinely. |
|
Evaluation of the effectiveness of nitroglycerine SL is based on
|
Cardiac nitrates relax the smooth muscles of the coronary arteries so that
they can dilate and deliver more blood to relieve ischemic pain. |
|
The drug the nurse should expect the physician to order if symptoms of
Dicumarol overdose are observed would be |
Dicumarol depresses prothrombin activity and inhibits the formation of
several of the clotting factors by the liver. Its antagonist is vitamin K, which is involved in prothrombin formation. |
|
The loop diuretics alter active transport systems in the kidney tubules,
resulting in increased excretion of sodium, and secondarily, water. The principle explaining secondary water loss(diuresis) is |
The presence of excess sodium (a solute) in the nephric tubules effectively
decreases the water concentration of the glomerular filtrate and urine; water passively diffuses (osmosis) from the kidney tubule cells into the urine to equalize the water concentration. |
|
A client receiving hydrochlorothyazide (hydroDIURIL) asks what this drug
actually does. The nurse explains that the planned therapeutic effect of the drug is to |
Hydrochlorothiazide (hydroDIURIL) inhibits sodium reabsorption in the
nephron, causing an increased excretion of sodium and chloride |
|
When teaching a client receiving prazosin (Minipress) for hypertension why
orthostatic hypotension occurs, the nurse knows that this antihypertensive causes vasodilation by |
Prazosin blocks the response to norepinepherine bound to alphaadrenergic
receptors relaxing smooth muscle in peripheral vessels, increasing circulation and decreasing blood pressure |
|
In a patient with leukemia, the blood level is affected is ____.
|
wbc
|
|
A mother cannot afford to buy meat for her family. You suggest she buy ____
|
corn and beans.
|
|
A mastectomy patient would show the beginnings of acceptance when she ____
|
touches the wound
|
|
Compensation for respiratory acidosis would show increased ____
|
hc03
|
|
A patient receiving a blood transfusion develops a fever. The nursing action is to _____
|
stop the transfusion and infuse with normal saline.
|
|
The most important nursing measure intervention hen caring for a patient who is receiving intravenous nitroprusside sodium for sever hypertension would be to compare ____
|
serial blood pressure readings.
|
|
. Expect that a patient with a new colostomy is ready to start self care would be ____
|
looking at and touching her colostomy
|
|
For a child with WBC of 12K, RBC 4 million, Hgb 8, and a resp of 24, you would _____?
|
limit activity
|
|
A patient on diuretics needs further teaching instruction if she states____?
|
" I void every fours."
|
|
For a patient with a radical neck dissection, the immediate concern is ____
|
respiratory distress
|
|
The symptoms usually associated with respiratory acidosis are _____?
|
irritability, headache, and confusion.
|
|
Following laryngectomy, to decrease anxiety and fear you would teach the patient and family ____?
|
esophageal speech
|
|
Your patient whoi had had a pneumonectomy refuses to move or do exercises. You should give ____?
|
pain medication 30 minutes before activity.
|
|
A habit that would increase a patient's risk of colon cancer would be a _____ diet
|
high fat
|
|
At risk to have varicose veins would be a patient who was an _____?
|
OR nurse for 15 years
|
|
A patient taking digoxin and lasix should call the physician when he experiences ____?
|
muscle weakness
|
|
A patient with fibrocystic breast disease should not include ____ and ____.
|
caffeine and salt
|
|
A weight gain of four pounds in 24 hours would most likely be caused by ___
|
chf
|
|
A clinical laboratory finding for a patient with rheumatic fever is increased ____
|
esr
|
|
In a baby having difficulty in breating, the nurse wil see ____
|
substernal retractions
|
|
Nicotine in cigarettes causes decreased ciliary ____
|
cleaning action
|
|
The most common complication of pancytopenia in patients on chemotherapy would be ____&____?
|
infection and bleeding tendencies.
|
|
A patient is receiving cytoxan chemotherapy for ovarian cancer. The lab value that would indicate the need for you to contact the physician is platelet count of _____.
|
50k/mm3
|
|
To evaluate a patient for chest pain, the nurse should ask, ____?
|
Are you having chect pain?"
|
|
Clinical signs of respiratory distress in the newborn are _____
|
nasal flaring, expiratory grunting, and see-saw retraction.
|
|
nursing diagnosis for a female patient with a diagnosis of uterine cancer would be
|
Body image disturbance
|
|
A 78 year old patient with lung cancer is admitted following 48 hours of nausea and vomiting. He has shallow breathing and an irregular pulse. You expect imbalance?
|
respiratory alkalosis
|
|
The drug classification that would be most effective for increasing cardiac output would be a ____
|
calcium antagonist.
|
|
The most likely cause of a decreased PO2 level in a patient with bilateral pneumonia is that the ____
|
alveoli are blocked by secretions preventing adequate exchange of gases.
|
|
To obtain an urine specimen from an infant, you should use a ____
|
specimen bag.
|
|
The discharge health teaching for a patient with a tracheal stoma secondary to pneumonia is to ___
|
humidify the air at home.
|
|
Upom auscultation of the lungs you would expect to hear vesicular breath sounds at the base of the ____ and bronchovesicular sounds between the _____& _____
|
lungs
scapulae and lateral to the sternum. |
|
Upper abd. distention is most closely associated with what congenital disease.
|
puloric stenosis
|
|
A patient is admitted to the ER with dyspnea, stridor, and wheezing. These symptoms indicate ___?
|
asthma.
|
|
Sickle cell crisis is vaso-____.
|
occlusive
|
|
For a child in a mist tent, you should ____
|
change her clothes
|
|
A patient with emphysema develops right-sided heart failure. This is most likely caused by increased ____
|
vascular resistance.
|
|
An adverse reaction to Digoxin is ___
|
nausea and vomiting.
|
|
Tamoxifen acts as an estrogen ____ and is used in adjunct treatment for breast cancer.
|
antagonist
|
|
Sickle cell crisis is vaso-____.
|
occlusive
|
|
For a child in a mist tent, you should ____
|
change her clothes
|
|
A patient with emphysema develops right-sided heart failure. This is most likely caused by increased ____
|
vascular resistance.
|
|
An adverse reaction to Digoxin is ___
|
nausea and vomiting.
|
|
Tamoxifen acts as an estrogen ____ and is used in adjunct treatment for breast cancer.
|
antagonist
|
|
For a patient with cancer of the mouth, have her gargle with ____ and use _____ swish for pain.
|
normal saline
lidocaine |
|
The bleeding associated with leukemia is usually caused by decreased _____
|
platelets.
|
|
Elevated lab values post MI are CPK, CK-MB, LDH 1 greater than _____.
|
LDH 2
|
|
T/F For a patient with PVD, do not elevate on a pillow and do not use ice compresses
|
T
|
|
T/F Grade 111 cancer means the cells are likely to mets
|
T
|
|
The symptoms of pneumocystic carinii are ____&____
|
dyspnea and non productive cough
|
|
A patient diagnosed with stomach cancer should avoid ____ & ____ in his diet
|
gravy and sauce
|
|
Iron is injected into a pt. by refracting the skin over the muscle of the upper quadrant of the buttock
|
z track
|
|
An increased alkaline phosphatase may signal ____ cancer of the prostate
|
metastic
|
|
A clinical sign of PVD is no ___
|
pedal pulse
|
|
Findings of concern in an infant with hypoxia and in oxygen therapy would be _____.
|
arterial PaO2
|
|
Nitrogen balance is used to estimate the balance between intake and utilization of ____ in the body.
|
protein
|
|
A sign of resp distress in newborns is expiratory ___.
|
grunting
|
|
For a pt. with emphysema, somking decreases ____
|
ciliary action
|
|
Following a pneumonectomy, instruct the pt. to do arm exercises to prevent ____
|
frozen shoulder
|
|
Ascites develops because of a blocked ____ vein.
|
portal
|
|
A nurse is assisting a physician in the ER to suture a laceration on the upper eye. The doc does not explain the procedure to the pt. The nurse should ask to speak with the doc before assisting.
|
info
|
|
A clinical manifestation of a MI is numbness in the ___
|
jaw
|
|
Before obtaining a sputum culture, give am care or at least have the pt. ____
|
rinse the mouth.
|
|
The aspect of ABG's that would be of most concern is ____.
|
ph
|
|
ARDS usually develops in the ___ patient.
|
premature
|
|
Rotating tourniquets are used for the client experiencing pul edema or severe chf. The longest time to put tourniquets on each extremity is ___ minutes.
|
45
|
|
Clinical signs of a TIA attack involve ____ and ___ function.
|
sensory and motor
|
|
Clinical manifestations of ____-sided heart failure are edema, distended neck veins, nocturia, weakness, and hepatomegaly.
|
right
|
|
what should pt experience when taking nitor SL
|
Ntg should cause a slight burning/stinging sensation under the tongue when it is potent.
|
|
A pt. with an on demand pacer set at 60 should notify his doc if ____
|
pulse is less than 60
|
|
Timolol is contraindicated for use in ___
|
copd
|
|
Following a prostatectomy the purpose of irrigation of the bladder is to decrease pressure of the ___.
|
bladder
|
|
After a cardiac catheter procedure, the nurse should observe for bleeding at the ____.
|
puncture site
|
|
Calcium channel blockers are given to reduce spasms of ____
|
coronary arteries
|
|
The post radical-mastectomy patient should be positioned how ?
|
with the affected arm on pillows with the hand elevated.
|
|
Bacterial pneumonia has clinical manifestations of productive cough with ____ sputum.
|
purulent
|
|
For a pt. on diuretics, the foods to be allowed would include ___
|
citrus fruits
|
|
The physiology of angina is that myocardial oxygen demands exceeds ____
|
myocardial oxygen
|
|
Included in a diet for pernicious anemia would be ____
|
orange juice, raisins, and a turkey sandwich
|
|
The purpose of TURP irrigation every half hour is to check for patency of the ___ and to prevent
|
urethra
clot formation |
|
Chondromasarcoma is a malignant tumor of the ___ cartilage. The common sites are___ and ____ with mets to ____
|
hyaline
ribs and pelvis lungs. |
|
You know your patient understands about mild restriction of sodium intake when he states" I buy bottled water because we have a water softner."
|
info
|
|
A clinical sign of cervical cancer is post menopausal ____
|
bleeding
|
|
4 Side effects of doxorubicin are
|
alopecia, hepatic dysfunction, red urine, and cardiomyopathy
|
|
During a colostomy irrigation the patient complains of incomplete evacuation. The nursing action shoould be to ____.
|
irrigate with NS
|
|
For a patient on a vent who becomes restless, the nurse should ____
|
suction the pt
|
|
Advise a pt. with MI not to walk in what type weather?
|
extreme cold, hot, or windy climates.
|
|
____ indicates laryngeal obstruction
|
Stidor
|
|
A pt, whose cancer has mets is experiencing low back pain. This is due to decompression of the ___
|
spinal cord
|
|
The most common position for a pt. following a radical mastectomy is ___
|
semi - fowlers position with the hand on the affected side kept elevated above the elbow.
|
|
Common clinical manifestations of pancytopenia in a pt. undergoing chemotherapy are ____ and ____
|
hemorrhage and infection
|
|
NTG should be kept in a ___
|
dark glass container, tightly closed
|
|
A pt. with breast cancer one-week post mastectomy has an elevated serum calcium level. The reason for this is the cancer has ___
|
mets.
|
|
You discharge instructions for a pt. with basal cell carcinoma would include ____
|
wearing sunscreen when out in the sun to protect from ultraviolet rays.
|
|
Whem giving an iron injection, retract the skin.
|
z track
|
|
For a child diagnosed with iron deficiency anemia and who drinks milk only, you would see a hgb of ___
|
8mg/dl or lower.
|
|
At risk for cervical cancer would be the pt. with ____
|
STD's
|
|
A clinical lab finding for a pt. with rheumatoid arthritis is increased ___
|
ESR
|
|
A pt recovering from an MI asks the nurse when he can hve sex. The nurses reply is ____
|
when you can climb a flight of stairs without experiencing resp distress.
|
|
Discharge instructions for a pt. going home after a lkaryngectomy should include ___
|
that the air should be humidified
|
|
The statement most appropriate to make to a 5 year old child who is about to undergo a cardiac cath is ____
|
when the special medication is put into the tube, it will feel warm.
|
|
A patient woth uterine cancer would have the clinical sign of ___
|
post menopausal bleeding
|
|
A pt. with hypertensive crisis is on Nipride IV therapy. To check if the IV is effective the nurse should take ____
|
serial BP readings.
|
|
A clinical sign of PVD would be mild pain ___
|
following exercise
|
|
Laryngotracheobronchitis tx includes ____
|
postural drainage before meals
|
|
Painless hematuria is an early sign of cancer of the ____.
|
bladder
|
|
The primary nursing goal for a pt. with HTN is to describe _____
|
the medication and treatment regimens
|
|
In a pt. diagnosed with mild thrombophlebitis,the nurse would expect mild ____
|
cramping upon exertion
|
|
Side effects of bronchodialators is
|
tachycardia and headache
|
|
A pt. with emphysema shows that he has understood the nurses health teaching by using ____
|
pursed lip breathing during activity.
|
|
Late symptoms of renal cancer are ____?
|
hematuria, flank pain and palpable mass in the flank.
|
|
A radiation blister appears on a pt. 2 weeks after tx. You know that ____
|
this is normal but you also notify the physician
|
|
Administration of spironolactone is most likely to cause what E imbalance
|
hyperkalemia
|
|
___ is the difference between apical and radial pulses.
|
Pulse deficit
|
|
what is the difference between acute and chronic arterial disease
|
chronic arterial disease there has been enough time to build up collateral circulation.
|
|
For a 2 year old child with Wilms tumor, you should ___
|
avoid palpation of the mass
|
|
Following a mastectomy, instruct the pt. to do arm exercises to prevent a ___
|
frozen shoulder
|
|
A pt. on coumadin does not need to eat ____
|
green leafy veggies.
|
|
You position a pt. with thrombophlebitis in the ____ position
|
Trendlenburg
|
|
If a pt's PO2 is 60mm Hg, the test needed to confirm this result is ___
|
HGB
|
|
The difference between angina and MI is duration of the ___.
|
pain
|
|
what lab to monitor for coumadin
|
pt/inr
|
|
___ occurs when clotting of small vessels throughout the body causes depletion of platelets and other clottiing factors leading to generalized bleeding from multiple sites.
|
DIC
|
|
In a pt. with a hypertensive crisis you would expect to find what sensory problem?
|
blurred vision
|
|
The best assessment history for a pt. diagnosed with melanoma would find that the pt. has always worked ___.
|
outdoors
|
|
The health teaching for a pt. using steroids is that the medication may ____
|
mask signs of infection.
|
|
The best way to help an infant with pyloric stenosis to retain his feedings would be to ____
|
place him on his left side with the head elevated after feedinsg.
|
|
what % of htn is primary(unk cause? accelerarted =____.
s/s? dx? |
95.
htn crisis usually asymptomatic 140/90 |
|
meds to tx htn:
beta blockers end w/___? how do they work? |
OLOL
Decrease Heart Rate Decrease BP Decreases PVR decreases 02 consumption of the heart |
|
SE if beta blockers?
|
Bronchospasms, Bradycardia, Fatigue, heart failure, Sexual dysfunction
|
|
Use beta blockers cautiously in which pts?
|
Respiratory Diseases [COPD-Asthma], CHF, & heart blocks
|
|
pt teaching w/beta blockers?
|
Caution with diabetics & PVD.
Take with meals Don't stop suddenly Don't take with nasal decongestants/OTC cold meds |
|
the alpha blockers are also used to Tx?
how do they work? |
bph
Decrease PVR by dilating arterioles and veinioles |
|
what are the alpha blockers?
|
cardura
minipres Terazosin aldomet hytrin |
|
how does clonidine work?
|
stimulates alpha-adrenoreceptors in the brain stem. This action results in reduced sympathetic outflow from the central nervous system and in decreases in peripheral resistance, renal vascular resistance, heart rate, and blood pressure.
|
|
SE clonidine?
|
Syncope, othro hypotension, weak, palpitations, sexual dysfunction
|
|
pt teaching for clonidine?
|
Change positions slowly; Can have first dose syncope, maintain recumbent for 90 minutes. Wear medical identification tag. Full therapeutic effects may require several weeks of therapy. Avoid high sodium foods.
|
|
s/s of PVD include ___ edema, burning, itching, prominent ____ veins, ulcers and skin changes. ____ is used to look at veins via radiographic dye.
|
moderate
superficial Venogram |
|
goal of tx in pvd?
Complications include |
aimed at vasodilation, pain relief, and maintaining skin integrity.
gangrene, and pressure sores. |
|
what should be avoided in PVD?
|
Do NOT use a heating pad to keep extremities warm.
|
|
what meds for pvd?
|
antiplatelet (aspirin), vasodilators (Trental), anticoagulants (Coumadin), Lipid reducers (Questran, Mevacor).
|
|
NSG and pt teaching for PVD?
|
Encourage walking and other leg exercise, watch for signs of decreased peripheral circulation. Avoid temperature extremes, prolonged standing, constrictive clothing or crossing the legs at the knee when seated. Provide instruction about foot care and exercise programs. Develop a plan for smoking cessation. Increased incidence of peripheral vascular disease in older adults.
|
|
hardening of the arteries
plaques; homocystine is linked with CAD and plaque levels |
Arteriosclerosis
Atherosclerosis |
|
vascular disease linked to cigarette smoking and Jewish ancestry between the ages of 20-40
|
Buegers disease
|
|
most common s/s of Buerger's Disease
|
Intermittent claudication (limping that occurs from leg cramps) is the most common symptom
|
|
tx of buergers is aimed at
describe to how to do buerger-allen exercises for relief? |
tx s/s
Begin with the patient lying flat in bed with legs elevated above the level of the heart for 2 minutes or until blanching takes place. Then exercise the feet 3 minutes until the legs are pink. Next, instruct the patient to lie flat for 5 minutes. These exercises may be repeated 3 times/day. |
|
episodic vasospasms precipitated by stress and exposure to cold. Common in women between puberty and age 40.
what body part is mostly affected? |
raynauds
hands |
|
when is blancing in raynauds relieved?
|
when heat is applied
|
|
--High levels of cholesterol in the blood increase the risk of plaque formation. Use statins and standard healthy living.
|
"Dyslipidemia"
|
|
Total Cholesterol___
LDL ___ HDL ___ what should ldl to hdl ratio be? VLDL (triglycerides) ____ of Total Cholesterol? Triglycerides Men __ Women ____ Lipids should be drawn after ___ Hour fast. |
140-200
<130 35-85 3.5:1 25-50% of total chol. 40-160 35-135 12 |
|
AHA recommends less than __% fat in diet and less than ___mg of cholesterol; less of each after MI. ____ has been shown to modestly reduce total cholesterol and LDL cholesterol levels. Alcohol has a beneficial effect on ____.
|
30
300 Soluble fiber HDL |
|
how do statins work?
|
inhibit the enzyme required for hepatic synthesis of cholesterol
|
|
tx of CAD includes decreasing ___ and ___lipid levels (clofibrate, cholestyramine (Questran)), modify diet to limit ___ __ and ___and quit smoking. Limit alcohol intake to __ ounces.
Complications include? |
lipid and htn
meat, dairy and high-fat foods, 2 angina, MI, CHF, and arrhythmias. |
|
ANGINA- usually lasts ___ minutes. Associated with ____. STABLE angina is predictable and controlled with nitroglycerin and rest. ___ is not predictable and may occur even at rest.
|
3-5
physical exertion, emotional excitement and exposure to cold UNSTABLE |
|
what does ekg show in angina?
|
Dx- EKG: ST depression, T wave inversion during acute pain
|
|
NSG for nitro paste
|
do not rub it in and rotate sites
|
|
meds to tx angina?
|
beta blockers, Ca blockers, nitrates
|
|
calcium channel blockers:
|
(Verapamil, Cardizem, Procardia
|
|
pt teaching for angina?
|
keeping nitro available at all times, use at the first sign of pain and stop and rest until pain subsides. Seek medical attention if pain lasts more than 20 minutes. Instruct the patient about risk factors for MI
|
|
precipitators to angina?
|
exposure to cold, emotional upset or excitement, exertion, smoking, heavy meals, and rushing about as well as decongestants, diet pills, caffeine and nicotine
|
|
best ways to prevent angina?
|
Prevention is the best treatment and includes reducing risk factors, reducing calories, fats, salt and getting regular exercise.
|
|
Complications opf angina include?
|
arrhythmias, CHF, and MI.
|
|
what are the Three types of ABDOMINAL AORTIC ANEURYSMs?
which is most common and deadly? |
Ascending (most common and deadly), Descending or Transverse
|
|
s/s of AAA?
|
Sx- Bradycardia, pericardial friction rub, pulse intensity disparity
|
|
how is AAA dx?
is it life threatening? |
xray
yes |
|
TX for AAA?
|
decreasing hypertension, myocardial contractility, pain control and relief of respiratory distress while preparing for surgical intervention
|
|
Sx for AAA where removal of a portion of weakened arterial wall with an end-to-end anastomosis to a prosthetic graft.
|
Abdominal aneurysm resection
|
|
lack of oxygen supply that leads to thrombosis and tissue necrosis and localized edema
|
gangrene
|
|
S/sx-severe localized pain, discoloration and swelling that usually occurs within 72 hours of surgery or trauma are s/s of ____?
|
gangrene
|
|
characterized by gradual, insidious compression/obstruction of the superior vena cava (SVC
|
SVC syndrome
|
|
what is SVC most commonly assoc w/?
|
malignancy (90%) pressing on the weak SVC, and thrombi
|
|
s/s of SVC syndrome?
|
Dyspnea is the most common symptom, followed by trunk or extremity swelling
|
|
what is Tx SVC syndrome geared towards?
|
tx underlying cause
(Therefore, treatment might include radiation treatment, antibiotics, chemotherapy clot-busting (thrombolytic) drugs, blood thinners (anticoagulation), and balloon angioplasty and even surgery) |
|
Left-sided heart failure=
|
lung problems
|
|
other abnormalities seen w/L side chf?
|
crackles, and gallop rhythm: S3 and S4
|
|
Right-sided heart failure =
|
systemic(edema in the body)
|
|
in CHF Elevated left ventricular preload may be identified by positive hepatojugular tests --This sign consists in a distension of the superficial veins of the neck, occurring when firm pressure is exerted over the liver in the direction of the spinal column
|
info but know
|
|
most common causes of L chf?
|
coronary arteries, hypertension, cardiomyopathy and rheymatic heart disease
|
|
how is chf dx?
Mean arterial blood pressure is rough indicator of left ___ afterload. |
cxr
ventricular |
|
_____ is regular failure. Diastolic is failure to fill adequately, due to failure to relax the ventricles or stenosis.
|
Systolic
|
|
Rx for CHF includes, low-sodium diet, fluid restriction, IABP (Intra-Aortic Balloon Pump), O2 therapy, ACE inhibitors (captopril, lisinopril), angiotensin receptor blocker (ARB -- Cozaar, Diovan) morphine sulfate, digoxin, Inotropic agents (dopamine, dobutamine, amrinone milrinone--all may vasodilate and pt must be monitored for this.), Diuretics (lasix), Nitrates, and vasodilators. Beta Blockers, calcium channel blockers
|
info but know
|
|
NSG in CHF:keep the patient in ___position to increase chest expansion and improve ventilation. Administer __ to enhance arterial oxygenation. Monitor patient for fluid gain to assess worsening; "restrict fluids after ___ days of weight gain." Plan periods of relaxation for patients with cardiac failure. Restrict fluid intake after two consecutive days of weight gain
|
semi-fowler's
O2 2 |
|
in chf as cardiac output falls, blood flow to the kidneys falls causing ___ glomerular flow. Kidneys interpret this as ____ and attempt to correct it by holding on to fluids. Kidneys > production and release of ___ causing sodium retention
|
decreased
hypovolemia aldosterone |
|
Hx of pt undergoing heart catherization should include allergy to ___ because of use of dye during the procedure.
|
shellfish
|
|
Class___ drugs are less likely to promote longevity of life.
they include? |
I
sodium channel blockers. |
|
Class II drugs are ___ blockers
|
beta -
|
|
Class III drugs are ___ channel blockers
|
potassium
|
|
Class IV ___ channel blockers
|
calcium
|
|
pacemaker codes:
First letter identifies ____ being paced. Second letter describes the chambers being ___ Third letter describes ____ |
chambers
sensed type of response by pacemaker to what is sensed |
|
meds:
___ is an antidysrhythmic and used for tachyarrhythmias ___ for the management of ventricular arrhythmias unresponsive to less toxic agents. ___ for life-threatening ventricular dysrhythmias --for A-fib, A-flutter |
Quinidine
amiodarone procainamide Betapace |
|
_____ Relating to or influencing the conductivity of nerve fibers or cardiac muscle fibers; P to T time
|
Dromotropic
|
|
___ effects are ones that change the heart rate; P to P time
|
Chronotropic
|
|
antiarrhythmic agent, cardiotonic and inotropic agent for CHF
|
digoxin
|
|
how does dig work?
|
Increase the force of myocardial contraction, prolongs refractory period of the AV node, decrease conduction through the SA and AV nodes
|
|
desired results of dig?
|
increase cardiac output and slow the hear rate; improves blood flow to the kidneys, which promotes diuresis
|
|
dig level
what drug potentiates dig SE? |
0.5-2.0
lasix |
|
Loading and maintenance doses should be reduced in clients with ___ failure and closely monitored. Digoxin immune fab ___ is the antidote.
|
renal
(Digibind) |
|
s/s of dig toxicity?
|
fatigue, headache, weakness, blurred vision, yellow vision, arrhythmias, bradycardia, ECG changes, anorexia, nausea, vomiting, diarrhea, gynecomastia, thrombocytopenia
|
|
when to hold dig?
what foods to have pt eat? |
<50 or >120
hi K+ |
|
Always consider what drug in any patient on digoxin who presents with symptomatic bradycardia..
|
atropine
|
|
T/F Women: studies have shown that postmenopausal women on hormone replacement therapy (HRT) with estrogen alone or estrogen and progestin had increased rates of thrombolytic events such as myocardial infarction (MI) and stroke, as well as breast cancer. Because of these risks to women, the AHA no longer recommends HRT to prevent or manage CAD, and its use to prevent and treat osteoporosis is under scrutiny
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T
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Concurrent ___segment elevation on the ECG is far less likely during MI
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ST
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During an acute MI, discomfort is more likely to occur in her neck, back, arm, shoulder, jaw, or throat, possibly accompanied by symptoms such as nausea and vomiting, indigestion, upper abdominal pain, dyspnea, fatigue, diaphoresis, dizziness, or fainting
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info but know
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T/F A woman who is elderly or who has diabetes may not experience any pain during an MI.
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T
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EKG in MI: enlarged __ wave, elevated __ segment, __ wave inversion
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Q
ST T |
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what happens to cardiac enzymes in MI
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increase
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cardiac isoenzyme specific to cardiac, and therefore, diagnostic).
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CK-MB fraction
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__ - is specific to the heart muscle and elevated levels indicates cellular necrosis or death
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Troponin 1
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Medical management of MI includes beta-adrenergic blockers (propranolol-Inderal, Lopressor) * contraindicated if patient also has ___?
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CHF, hypotension or bronchospasm
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Thrombolytic therapy in MI includes the use of __?
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Streptase, Activase, and Eminase
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when are clot busters contraindicated?
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These are contraindicated if the patient has had recent surgery, or experienced a fall or head wound concurrent with the MI
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___ is used in angiography to locate blockage, and stent is used to open/keep open arteriies.
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Thallium 1000
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Plan of care post MI should include discussions on ___?
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the resumption of patientÕs sexual activities (based on endurance- ability to climb 2 flights of stairs without pain, sob).
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VALVULAR HEART DISEASE- Three main types: ___ or narrowing, ___ closure of the valve, and ___ of the valve.
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stenosis
incomplete prolapse |
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Aortic insufficiency : Causes include
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enocarditis, hypertension, rheumatic fever, and syphilis
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in aortic insuffiency echocardiography shows L ventricular ___. ___ shows L ventricular enlargement and pulmonary vein congestion.
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enlargement
x-ray |
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in ___ insufficiency:the atrium enlarges , the ventricle dilates
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Mitral
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causes of mitral insufficency?
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Causes include L ventricular failure, mitral valve prolapse, and rheumatic fever
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