Glossary of Fall 2006 Final Review
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- What is heart failure?
- Inadequate cardiac output; inability of the heart to pump blood throughout the body
- What is the first and quickest compensatory mechanism when the heart begins to fail?
- Sympathetic nervous response
- What happens when the sympathetic nervous system responds to compensate for heart failure?
- Catecholemines are released (epinephrine & norepinephrine)
- What effect do the catecholemines epinephrine and norepinephrine have on the cardiac system?
- *Increase heart rate
*Increase blood pressure
- What is the formula for cardiac output?
- Heart rate x stroke volume = cardiac output
- What is one of the last compensatory mechanisms of the heart, which is indicative of an extremely oxygen-deprived heart?
- Describe hypertrophy of the heart:
- The heart walls become very thick and muscular, compressing the chambers of the heart
- Describe dilation of the heart:
- A compensitory mechanism in which the heart becomes very large in mass (not muscular)
- What do the kidneys release when they sense a "low-flow" state?
- Rennin is converted to angiotensin 1, which is then converted to what?
- Angiotensin 2
- What effect does angiotensin 2 have on the body?
- It is a potent vasoconstrictor
- What kind of medication counteracts the rennin-angiotensin-aldosterone system?
- ACE inhibitors
- How do ACE inhibitors work?
- They counteract the rennin-angiotensin system by preventing angiotensin 1 from converting to angiotensin 2
- ACE inhibitors work by inhibiting the conversion of angiotensin 1 to angiotensin 2; what specific effect does this have on the body?
- What is "preload?"
- Volume returning to the heart, or volume at end diastole
- What is "afterload?"
- The resistance the heart pumps against
- What is the most common reason for a preload problem?
- What is stroke volume?
- The amount of blood pumped out with each contraction
- What is cardiac output?
- The amount of blood ejected per minute
- What is ejection fraction?
- The percentage of blood pumped out of the ventricles with each beat
- What determines stroke volume?
- Stretch (amount of elasticity)
- The effects of right-sided heart failure are seen where?
- The effects of left-sided heart failure are usually seen where?
- The lungs/pulmonary system
- List some major signs/symptoms of right-sided heart failure?
- List some of the major signs/symptoms of left-sided heart failure:
- Why is morphine a good drug to treat pulmonary edema?
- It helps to keep the majority of the circulation in the peripheral blood vessels (away from the heart and lungs)
- In which drug class is digoxin?
- What effect does digoxin have on the heart?
- It increases contractility
- What is a toxic blood level for digoxin?
- Greater than 2
- List some signs/symptoms of digoxin toxicity:
- *bluured vision
*seeing halos around lights
- What pre-disposes an elderly person to digoxin toxicity?
- Low potassium
- What should the nurse do routinely if a patient is on digoxin
- *check potassium levels
*check dig levels
*check apical pulse
*educate patient not to take antacids
- What should the nurse watch for when a patient is taking an ACE inhibitor?
- *Orthostatic blood pressure
*Watch carefully for signs/symptoms of decreased blood pressure
- What do beta blockers do?
- Block the adrenaline affect on the heart
- What is the therapeutic effect of beta-blockers?
- Slow the heart rate
- Why do people usually NOT want to take a beta-blocker?
- It makes them feel tired/weak/dizzy
- What is nitroglycerin?
- a vasodilator
- What is important to know about Lasix?
- *Take with potassium
*Always check potassium level before administering
*Can be extremely ototoxic
- What should a nurse check to evaluate the effectiveness of lasix?
- lung sounds
- What is Nipride?
- A potent vasodilator
- What is Nipride often used for?
- Hypertensive crisis
- What is significantly important about Nipride?
- It is very quick-acting
- What is a major concern about Nipride?
- It can turn to cyanide in the body
- What lab value should be closely monitored to avoid nipride toxicity?
- thyocyanate level
- What should a nurse monitor closely in a patient who is on morphine?
- Respiratory status
- What is the antidote for morphine?
- What does a BNP level of over 100 indicate?
- heart failure
- What does Natracore mimic within the body
- What effect does Natracore have on the heart?
- *decreases preload
*mimics the endogenous process of BNP (vasodilation)
- What is the biggest side effect of Natracore?
- Among others, Natracore is incompatible with what major drug?
- Besides dysrhythmia, list some other side effects of Natracore:
- What is a cardiomyopathy?
- Heart disease that is caused by a change in either the structure or function of the heart
- Describe a heart that has a dilated cardiomyopathy
- Big and weak
- What is the treatment for dilated cardiomyopathy?
- heart transplant
- What is the major problem with a dilated cardiomyopathy?
- Systolic function problem
- Which cardiomyopathy is commonly found among athletes?
- Hypertrophied cardiomyopathy
- What is the major problem in a hypertrophied cardiomyopathy?
- Diastolic function problem
- What EKG changes will be seen in a patient who has had a heart transplant?
- *2 p-waves
- What should a nurse monitor for a heart transplant patient postoperatively?
- *Bleeding (cardiac tamponade)
- What are the signs/symptoms of cardiac tamponade?
- *Muffled heart sounds
*decreased blood pressure
*decreased cardiac output
- What is significant regarding innervation of a transplanted heart?
- it is a de-nervated heart (no response to vagal stimulation)
- Because the transplanted heart is de-nervated, what drug will not affect it?
- What is the hallmark sign of Mitral Valve Prolapse?
- mid-systolic click
- What is the hallmark sign of aortic stenosis?
- Fixed cardiac output
- What are the three cardinal signs/symptoms of a fixed cardiac output
- Which kind of replacement valves always require anti-coagulant therapy?
- Mechanical valves
- Which valve replacement MUST be mechanical?
- Aortic valve
- What is very important for a patient who has had a valve replacement?
- Always use antibiotic prophylaxis before procedures
- What is a normal blood pH?
- What is a normal PaCo2 level?
- What is a normal HcO3?
- Which system compensates very quickly for a metabolic problem?
- Respiratory system
- What is the hallmark sign of tension pneumothorax?
- *trachial deviation
- Which patients commonly have respiratory acidosis?
- What is the immediate treatment for a tension pneumothorax?
- Decompress the chest
- What are the signs/symptoms of a spontaneous pneumothorax?
- *chest pain
*shortness of breath
- With what suffix do the beta-blockers end?
- What should a nurse monitor closely in a patient who has just had a heart catheterization?
- What is the purpose of Heparin?
- Prevents further clotting
- What is the purpose of a thrombolytic?
- To dissolve existing clots
- What is the function of platelets?
- They promote blood clotting after injury
- What are reticulocytes?
- Immature red blood cells
- How much fluid intake is encouraged for patients who have sickle cell disease?
- 4-6 quarts per day
- How much fluid intake is encouraged for patients who are in sickle cell CRISIS?
- 6-8 quarts per day
- List some drugs that are used to manage pain in sickle cell patients:
- What lab levels should be monitored in a patient who is undergoing chronic transfusions?
- What should be avoided in patients with sickle cell disease?
- What is a critical intervention for a patient in sickle cell crisis?
- What kind of gene is affected in hemophilia A?
- Sex-linked recessive gene
- What clotting factor is deficient in hemophilia A?
- Factor VIII
- What is the preventive treatment for children with sickle cell disease?
- *Penicillin at age 3 mo.
*Pneumococcal vaccine @ 2, 4 & 6 mo.
*Flu shot @ 6 mo.
- What should be taught to parents of sickle cell patients?
- *Recognizing s/sx
*Give folic acid early
*Give protein supplements
*Get eyes tested early
- What is the difference between hemophilia and DIC?
- Hemophilia: involves only intrinsic clotting factors
DIC: involves both intrinsic and extrinsic clotting factors
- What is a good physical activity to suggest for a patient with hemophilia?
- When is hemophilia usually diagnosed?
- In early childhood (when the child begins to walk)
- What is the usual treatment for hemophilia?
- Replacement of coagulation factor that is missing
- What type of deformities are a complication of hemophilia?
- Joint deformities
- What are the signs/symptoms of hemophilia?
- *Prolonged bleeding anywhere in the body
- What laboratory finding will be abnormal in a patient with hemophilia?
- Will the PT lab value be normal or abnormal in a patient with hemophilia?
- What is DIC?
- Disseminated Intravascular Coagulation
- How will the PT / INR reflect in lab reports of a patient with DIC?
- How will the activated partial thromboplastin time (APTT) reflect in lab reports of a patient with DIC?
- How will the platelet count reflect in lab reports of a patient with DIC?
- How will the fibrinogen levels reflect in lab reports of a patient with DIC?
- How will the fibrinogen degradation product levels reflect in lab reports of a patient with DIC?
- How will the D-Dimer test reflect in lab reports of a patient with DIC?
- What is the cure for DIC?
- Treat the cause
- What are some nursing priorities in patients with DIC?
- *Maintain fluid balance
*Restore normal clotting factors
- What are some important things to remember when caring for a DIC patient?
- *No blood pressure cuffs
*Be careful with catheters, ET tubes, etc.
- What level of D-Dimer proteins indicate DIC?
- Greater than 250 per ml
- Explain erythropoesis:
- Kidneys respond to low O2 and release erythropoetin, which travels to the bone marrow to stimulate RBC production
- What is the normal range for platelets?
- What are the hard (positive) symptoms of schizophrenia?
Flight of ideas
Ideas of reference
- What are the soft (negative) symptoms of schizophrenia?
- Alogia (poverty of content)
Lack of volition
- Conventional (typical) anti-psychotic medications target which symptoms?
- Only the positive symptoms
- Give some examples of "conventional" anti-psychotic medications:
- Atypical anti-psychotic medications target which symptoms?
- Both the positive and negative symptoms
- List some of the atypical antipsychotics:
- Which anti-psychotics are available in a depot injection?
- Fluphenazine (Prolixin) and
- List the extrapyramidal side effects caused by antipsychotics:
- Are the extrapyramidal side effects reversible? How are they treated?
- Yes; Benadryl or Cogentin
- What are the characteristics of tardive dyskinesia?
- *Abnormal, involuntary movements (lip-smacking, tongue protrusion, chewing, blinking, grimacing, and choreiform movements of the limbs and feet).
- Is tardive dyskinesia reversible?
- No; only further progression can be stopped
- What is neuroleptic malignant syndrome?
- A frequently fatal side effect characterized by muscle rigidity, high fever, elevated creatine phosphokinase (CPK), elevated WBC's
- What should the nurse do if neuroleptic malignant syndrome occurs?
- Stop drug immediately
- Which anti-psychotic commonly causes agranulocytosis?
- Clozapine (Clozaril)
- What is agranulocytosis?
- Failure of bone marrow to produce enough WBC's
- What are the signs/symptoms of agranulocytosis?
- What should the nurse do if agranulocytosis occurs?
- Stop drug immediately
- What is required in order for the pharmacy to dispense Clozaril?
- WBC count (weekly)
- What are the signs/symptoms of dystonia?
- *Muscle spasms
- What are the signs/symptoms of psuedoparkinsonism?
- *Shuffling gait
- What characterizes akethisia?
- Inability to remain still
- Why does a person with OCD feel it necessary to complete his or her rituals?
- They help to decrease anxiety
- What is bipolar disorder?
- Mood cycles of mania and/or depression and normalcy
- What should the nurse be aware of if a bipolar patient begins rapid cycling between mania and depression?
- Increased risk of suicide
- List the atypical antidepressants:
- venlafaxine (Effexor)
- What are the common side effects for the atypical antidepressants?
- What are the manifestations of pseudoparkinsonism?
- *Shuffling gait
*Continuous muscle stiffness
*Ratchet-like joint movements
*Akinesia (slow/difficult movements)
- What are the hallmark symptoms of schizophrenia?
*Concrete or literal thinking
- What are the major symptoms of mania?
- *Grandiose mood
*Flight of ideas
- What are common side effects of lithium?
- *Mild nausea/diarrhea
*Fine hand tremor
*Metallic taste in mouth
- What are the signs of lithium toxicity?
- *Severe nausea/vomiting/diar.
*Severe mental confusion
- When is the onset of action for lithium?
- 2-3 weeks
- Which drugs are used for their mood-stabilizing effects in patients with bipolar disorder?
- Anticonvulsant drugs (Tegretol, Depakote, Lamictal, Topamax, Trileptal, Neurontin)
- Which benzodiazepine is used for its mood-stabilizing effect in patients with bipolar disorder?
- How should the nurse communicate with a bipolar patient?
- Use very short sentences
- What types of foods should be offered to the bipolar patient to ensure good nutrition?
- Finger foods (can be carried from place to place)
- What should the nurse do to promote sleep in a bipolar patient?
- Decrease environmental stimuli
- Where should the nurse channel a bipolar patient's energy?
- Into an activity that is socially acceptable
- What should be assessed in regards to safety with bipolar patients?
- Suicide risk
- What is a toxic level of lithium?
- 1.5 mEq or greater
- What symptoms of lithium toxicity are exhibited in patients with a lithium level of 1.5-2 mEq/L?
- What should the nurse do if the patient has a lithium level of 1.5 - 2 mEq/L?
- Withhold next dose; call physician. Serum lithium levels are ordered and doses of lithium are usually suspended for a few days or the dose is reduced.
- What symptoms of lithium toxicity are exhibited in patients with a lithium level of 2 - 3 mEq/L?
*Movement of limbs
*Large output of dilute urine
- What is the nurses action if a patients serum lithium level is 2 - 3 mEq/L?
- Withhold future doses, call physician, stat serum lithium level. Gastric lavage may be used to remove oral lithium; IV containing saline and electrolytes used to ensure fluid and electrolyte function and maintain renal function.
- What are the symptoms of lithium toxicity in a patient whose serum lithium level is 3.0 mEq/L and above?
- *Cardiac arrhythmia
*Peripheral vascular collapse
*Focal or generalized seizure
*Reduced LOC (stupor to coma)
*Myoclonic jerks of muscle groups
*Spasticity of muscles
- What is the nurses action if a patients serum lithium level is 3 mEq/L or above?
- All of preceding interventions plus lithium excretion is augmented with use of aminophylline, mannitol or urea. Hemodialysis may also be used to remove lithium from the body. Respiratory, circulatory, thyroid and immune systems are monitored and assisted as needed.
- The condition known as anti-social personality disorder in adults is diagnosed as _____________ in children
- Conduct disorder
- Discribe anti-social personality disorder:
- *Pervasive pattern of disregard for and violation of rights of others
*Poor work history
- Describe the general appearance/motor behavior of a client with anti-social personality disorder:
- *Appears "normal"
*May be charming/engaging
*Tries to manipulate
- Describe the mood/affect of a client with anti-social personality disorder:
- *Shallow emotions
*Chooses emotions to work to their advantage
*No genuine feelings of empathy
*Only remorseful if caught
- List some nursing diagnoses for clients with anti-social personality disorder:
- *Ineffective coping
*Ineffective role performance
*Risk for other-directed violence
- List some nursing interventions for clients with anti-social personality disorder:
- *Forming a therapeutic relationship (includes limit-setting & confrontations)
*Promoting responsible behavior
*Helping client solve problems and control emotions
*Enhancing role performance
- List some nursing care measures during status epilepticus:
- *Maintain ABC's
*O2 via nasal cannula
*Inform physician (intubation may be needed)
*Access vein/start IV NS
*Medications: ativan or diazepam followed by dilantin
*Never leave person alone
*Fosphenytoin (cerebyx) IM
- What are care measures during a seizure?
- *May just be observe & document
*O2 via nasal cannula, if indicated (cyanosis, etc.)
*Never leave person alone
*Lower to floor or bed
*Allow seizure to end without interference; note postictal events
- What is status epilepticus?
- *Continuous or recurrent generalized seizures, in rapid succession
- What is significant of status epilepticus?
- *Does not regain full consciousness between seizures
*Repeated seizures lasting over 30 minutes, or one seizure lasting over 10 minutes
*More intense then regular seizures
*A potential complication for all types of epilepsy
- What can cause death or brain damage in status epilepticus?
- What are the usual causes for status epilepticus?
- *Sudden withdrawal from anticonvulsants
- During status epilepticus, what is important to know regarding the administration of ativan or diazepam?
- No more than 50 mg/minute via IV push
- What is meningitis?
- inflammation of teh meninges of the brain & spinal cord
- What can cause meningitis?
- Which type of meningitis is usually not life-threatening?
- How is meningitis transmitted?
- List some predisposing conditions for meningitis:
- *Otitis media
*Fractured base of skull w/CSF leak
*Procedures like LP or surgery
*Anatomic abnormalities like spina bifida
*Foreign objects like ventricular shunts
*Can occur from a focal infection via blood
- What is the difference between viral and bacterial meningitis?
- *Viral is usually self-limiting; follows viral infection
*Bacterial is more serious; abrupt onset; leaves sequellae
- What is Kernig's sign?
- Pain in hamstring when hip & knee are flexed by examiner (positive meningitis test)
- What is Brudzinski's sign?
- examiner elevates head of patient; knees bend involuntarily (positive meningitis test)
- What is opisthotonus?
- severe spasm of back muscles (bends backward); positive meningitis test
- When does IICP occur?
- When the brain cannot accomodate the increase in volume of one of the components (failure to compensate)
- What areas of the brain are in danger with uncal herniation?
- What is the pupil response when uncal herniation is present?
- fixed and dilated
- True or False: the damage caused by uncal herniation is temporary if treated quickly
- false; the damage is irreversible
- What respiratory pattern is sometimes seen with increased ICP?
- What pupillary response is an EARLY sign of increased ICP?
- Unequal pupils
- What pupillary response is a LATE sign of increased ICP?
- fixed and dilated
- List the late signs and symptoms of increased ICP:
- *Fixed dilated pupils
*Loss of gag reflex
- What is Cushing's triad?
- *Severe HTN
*Wide pulse pressure
- List interventions for IICP:
- *Administer diuretics
*Administer sedation as ordered
*Avoid valsalva (inc. suctioning)
*Elevate head of bed to 45 degrees
*Maintain the patient's head in a midline position
*Maintain normal body temperature
*Decrease environmental stimuli
- What type of fluids are mostly used in patients with IICP?
- Regarding traumatic brain injuries, the extent of the injury depends on what?
- the amount of force
- What is the GCS in a mild head injury?
- What is the GCS in a moderate head injury?
- What is the GCS in a severe head injury?
- 80% of all skull fractures are what type of fracture?
- Linear skull fracture
- What is a common nursing assessment to determine whether fluid leaking from the ear or nose is CSF?
- the "Halo" test: fluid forms a yellow ring when blotted with a tissue
- What severe damage can result from a basilar skull fracture?
- Severe cranial nerve damage
- What are the signs/symptoms of a concussion?
*Possible loss of consciousness (usually brief)
- What is vasogenic edema?
- abnormal permeability of the cerebral vessel wall; plasma filters to ECS causing an increase in brain tissue volume
- What is cytotoxic edema?
- cellular edema; a result of hypoxic insult to the brain cells
- Of what is the brain depleted in cytotoxic edema?
- What can cause vasogenic edema, resulting in further IICP?
- cytotoxic edema
- What is low when cytotoxic edema is present?
- serum Na
- When does interstitial brain edema occur?
- in the presence of acute brain swelling
- Interstitial brain edema is associated with an increase in what?
- *Blood Pressure
- How is Cerebral Perfusion Pressure (CPP) calculated?
- Subtract CSF pressure from the mean arterial pressure
- What are hematomas?
- Space occupying lesions
- What is involved in an epidural hematoma?
- Middle meningeal artery
- Where does an epidural hematoma occur?
- around the temporal lobe
- With an epidural hematoma, how soon do signs & symptoms occur?
- Very rapidly
- What is the treatment for an artery that is injured by an epidural hematoma?
- suture the artery
- What is the treatment for a subdural hematoma?
- remove the hematoma
- What causes a subdural hematoma?
- ruptured veins
- When do signs/symptoms occur with a subdural hematoma?
- days to weeks
- Is there more or less bleeding with a subdural hematoma?
- True or false: clot formation is slower with subdural hematomas
- What is an intracerebral hemorrhage?
- Accumulation of blood within the brain tissue
- Which type of brain herniation causes compression of the medulla?
- What are the long-term effects of head injuries?
- *Motor deficits
*Difficulty with bowel/bladder function
- If your client has CSF drainage from the ear, what should the nurse assess?
- nuchal rigidity
- What does nuchal rigidity indicate in head injury patients?
- infection or blood in CSF
- What should the nurse rule out BEFORE assessing for nuchal rigidity
- spinal cord injury
- What should ALWAYS be assessed in head injury patients?
*Hypoxia or hypercapnea
- What are some nursing measures to decrease ICP?
- *Elevate HOB 15-30 degrees
*Avoid flexion of hips, waist & knees
*Logroll patient to transfer
*Avoid rotation/extreme flexion/extension of the head
*Space out nursing activities
*Avoid Valsalva type of activities: cough/vomit/strain
*Suction ONLY as necessary
*Provide O2 before & after suctioning
*O2 via mask or nasal cannula
*Possible ET tube to control pO2 & pCO2
*Prophylactic hyperventilation (only if on ventilator)
- What is significant about prophylactic hyperventilation?
- It has a mild vasoconstricting effect when done properly.
- When is prophylactic hyperventilation contraindicated?
- In the first 20 hours after injury
- When is prophylactic hyperventilation indicated?
- *Acute neurologic deterioration (for brief periods)
*Intracranial HTN that does not respond to standard treatment
- What is involved in a craniotomy?
- Removal of hematoma or parts of brain to reduce pressure
- What is normal ICP?
- 10-15 mmHg
- What should you remember when preparing your patient for cranial surgery?
- *NO enemas
- Into what position should a craniotomy patient be placed immediately after surgery?
- What is supratentorial positioning?
- *HOB 30-45 degrees
*large pillow under head & shoulders
- What is infratentorial positioning?
- *HOB flat with small pillow
*log roll with draw sheet
*NO neck flexion
- Regarding positioning, what is important to remember when a patient has had a craniectomy?
- Do not place on affected side
- What is significant about an ISCHEMIC stroke?
- caused by a thrombus or emboli (occluding the cerebral artery)
- What are the two types of ischemic stroke?
- What causes a thrombotic stroke?
- atherosclerosis of arteries
- What is an embolic stroke?
- Embolus or emboli break off from other parts of the body and enter cerebral circulation via the carotid artery
- What are the warning signs of ischemic stroke?
*Reversible ischemic neurological deficit (RIND
- What is a hemorrhagic stroke?
- Vessel breaks down; occurence of bleeding into brain tissue, subarachnoid space, or ventricles
- What are the causes of hemorrhagic stroke?
- Cocaine use causes what two side effects which increase the risk of stroke?
- What is dysarthria?
- nerve dysfunction
- What are the classic symptoms of CVA?
- *Contralateral weakness
*Transient loss of bowel/bladder control
*Diminished or loss of consciousness
- Which abnormal heart rhythm results in an increased risk for stroke?
- atrial fibrillation
- When is the risk for IICP highest in stroke patients?
- first 72 hours following injury
- When are anticoagulants contraindicated?
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