Term
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Definition
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Term
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Definition
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Term
|
Definition
| inflammation of a vein, is a common complication of peripheral IV therapy that’s associated with acidic or alkaline solutions or those that have a high osmolality |
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Term
| What are the S/S of phlebitis? |
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Definition
Redness or tenderness at the tip of the catheter
Puffy area over the vein
Elevated temp
Inspect site several times a day |
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Term
| What are the nursing actions for phlebitis? |
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Definition
At the first sign of redness or tenderness, stop the infusion
To ease your pt discomfort, apply warm compresses
Document your pt condition and interventions
If indicated, insert a new catheter at a different site, preferably on the opposite arm, using a larger vein or smaller device and restart the infusion |
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Term
| What does IV infiltration mean? |
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Definition
IV fluid leaks into surrounding tissue
Commonly caused by improper placement or dislodgement of the catheter
When the tip of the catheter is positioned near a flexion area, pt movement may cause the catheter to slip out or slip through the lumen of the vessel
The risk of infiltration increases in older patients because their veins are thin and fragile (also preterm infants)
S/S: swelling, discomfort, burning, tightness, cool skin, and blanching |
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Term
| What are the nursing actions for IV infiltration? |
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Definition
Stop the infusion and remove the device (unless the medication cause tissue burns or destruction consult the health care provider and pharmacy)
Elevate the limb to increase pt comfort and apply warm compresses
Check the pt’s pulse and cap refill time
Counteract the effects of the drug as ordered
Perform venipuncture in a different location and restart the infusion
Check the site frequently
Document your findings |
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Term
| What is one of the biggest reasons to give IV fluids? |
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Definition
Fluid volume deficit. such as:
Vomiting
Increased temperature
Blood loss
Drainage sites or tubes
Diarrhea
Diuretics |
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Term
| What things could cause a fluid volume excess? |
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Definition
Excess sodium intake
Medications
Renal or cardiac failure
Inaccurate IV infusion rate |
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Term
| What are some isotonic IV solutions? |
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Definition
LR: lactated ringer
NS: normal saline
*they promote homeostasis* |
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Term
| What are some hypertonic IV solutions? |
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Definition
D5W .45% NaCl
D5W NS
*they shrink the cell |
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Term
| What are some hypotonic IV solutions? |
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Definition
2.5% Dextrose
.45% NaCl
*makes the cell swell |
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Term
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Definition
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Term
| How is Strabismus detected? |
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Definition
1. Corneal light reflex-shine light in eye and light should shine equally in center of both eyes
2. Cover test-cover one eye and look to see if uncovered eye moves |
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Term
| What is conjunctivits? What are the causes for newborns, infants, and children |
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Definition
inflammation of the conjunctiva
cause in newborns-Chalmydia trachomatis or Neisseria gonorrhoeae (from parent)
cause in infants-Tear duct obstruction
cause in children- Viral, bacterial, allergic, or foreign bodies
*When cleaning eye-clean down and outwards. Use eye drops during day and ointment at night |
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Term
| What is Periorbital Cellulitis? |
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Definition
Infection of the eyelid
Symptoms: swollen, tender, red or purple eyelids
Treatment: antibiotics
Causative agents: staph auresis or haemophilus influenzae |
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Term
|
Definition
tumor (cancer) of the eye
Diagnosis-white glow to pupil, confirmed by ophthalmoscopic exam under anesthesia.
Treatment-chemotherapy, enucleation (removal of the eye), cryotherapy, or laser therapy
Genetic testing if disease in both eyes. |
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Term
| What are the contributing factors of otitis media? |
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Definition
frequent pacifier use (creating pressure and collapses the ear tubes, this causes an obstruction, which impairs drainage this causes fluid build in the middle ear aka an effusion)
exposure to second hand smoke (irritant
viral respiratory infections
bottle propping (formula pools in the back of the throat) |
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Term
| What are the treatments for otitis media? |
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Definition
| Symptom management, antibiotics deferred unless they are under 6 months (will give antibiotics if it goes longer than 3 days), placement of tube (pressure equalizing tubes, PET) if 6 infections in 4 to 6 months |
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Term
| Why are infants and young children predisposed to otitis media? |
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Definition
| Infants and younger children have shorter, wider, and straighter eustachian tubes. |
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Term
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Definition
| inflammation of the oral mucosa |
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Term
| What is the non infectious type of stomatitis? |
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Definition
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Term
| What is the infectious type of stomatitis? |
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Definition
| Herpetic gingivostomatitis |
|
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Term
| What is aphthous stomatitis |
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Definition
Painful ulceration commonly called a canker sore. Caused by trauma i.e. Biting cheek, toothbrush injury, or dental appliances.
Appearance- white ulcer surrounded by red border.
Treatment-pain control
Self resolves in 4 to 12 days. |
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Term
| What is Herpetic gingivostomatitis? |
|
Definition
Caused by the herpes simplex virus usually type 1.
Commonly called cold sores or fever blisters.
Treatment-pain relief, if severe acyclovir (IV).
Can be seen in cancer patients because they have immunosuppression |
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Term
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Definition
strep throat caused by group A B-hemolytic strep
Symptoms-sore throat, fever, and headache. Tonsils and pharynx usually covered with thick white exudate.
Diagnosis: throat culture.
Treatment: oral penicillin for 10 days. New toothbrush after 24 hours of antibiotics (test question!). Can also go to school after 24 hours of antibiotics.
If it is left untreated: rheumatic fever (inflammation of the joints and heart) or glomerulonephretitis (kidney disease |
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Term
| What is Tonsillectomy/Adenoidectomy post op nursing care? |
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Definition
Vital signs, pain control (IV), airway management, I&O, nutrition (liquids, no red popsicles), fluids, swallowing (if swallowing a lot they may be bleeding)
Positioning: don’t put on back flat to prevent aspiration
Coughing and nose blowing is not encouraged
Should be kept to bed activities
Can come back within for 10 days with a post op bleed |
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Term
|
Definition
Thrush
Causative agent: Candida albicans
Appearance: White coating to lips, tongue, buccal mucosa
Treatment: oral antifungal (nystatin), new nipples for bottle. If breast feeding mom must treat nipples.
NOTE check for diaper dermatitis. (thrush can also be in the peri area, satellite lesions) |
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Term
| What is infectious mononucleosis? |
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Definition
acute, self-limiting infectious disease in adolescents
Usual symptom severe sore throat and fatigue
Caused by Epstein-Barr virus
Diagnosis-Monospot test (blood draw on finger)
Treatment-Symptom treatment including pain control and rest. Avoid contact sports while symptomatic (spleen is enlarged and can rupture). Fatigue may persist for several months. |
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Term
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Definition
| Probability those with a certain gene will express it |
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Term
| What is the diagnostic criteria for diabetes? |
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Definition
| Symptoms plus a random plasma glucose > 200 mg/dL |
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Term
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Definition
Drug: Metformin
Actions: decreased hepatic glucose production, decreased intestinal glucose absorption, increased insulin action
Adv: no hypoglycemia, no weight gain
Disadv: GI side effects, lactic acidosis contraindications, reduced kidney function |
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Term
Diabetes Meds
GLP-1 receptor agonists (incretin mimetics) |
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Definition
Drug: exenatide, liraglutide
Actions: increased insulin secretion, decreased glucagon secretion, slows gastric emptying, increased satiety
Adv: Wt loss, potential for improved beta cell mass/function
Disadv: GI effects, acute pancreatitis, hypoglycemia, injectable |
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Term
Diabetes Meds
Insulin Secretagogues |
|
Definition
Sulfonylureas: glimepiride, gliclazide, glibenclamide/ glyburide, glipizide
Meglitinides: repaglinide, nateglinide
Actions: increased insulin secretion
Adv: well tolerated
Disadv: hypoglycemia, wt gain |
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Term
Diabetes Meds
Alpha-glucosidase Inhibitors |
|
Definition
Drugs: miglitol, acarbose
Action: Slow CHO digestion, thereby decrease after-meal blood glucose peaks
Adv: Lowers post prandial glucose, No hypoglycemia
Disadv: GI side effects |
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Term
Diabetes Meds
Thiazolidinediones (TZDs) |
|
Definition
Drugs: Pioglitazone, rosiglitazone
Action: Increase insulin sensitivity and glucose uptake increase
Adv: no hypoglycemia, increased HDL cholesterol, decreased triglycerides
Disadv: Wt. gain, edema, heart failure, bone fractures |
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Term
Diabetes Meds
DPP-4 inhibitors (incretin enhancers) |
|
Definition
Drugs: Sitagliptin, Vildagliptin, Saxagliptin, Linagliptin
Actions: increase active GLP-1 & GIP concentration, increase insulin secretion, decrease glucagon secretion
Adv: No hypoglycemia, wt. neutral
Disadv: Urticaria/angioedema, pancreatitis, long term safety unknown |
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Term
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Definition
lispro (Humalog)
aspart (Novolog)
glulisine (Apidra) |
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Term
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Definition
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Term
| intermediate acting insulin |
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Definition
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Term
|
Definition
glargine (Lantus)
detemir (Levemir) |
|
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Term
Insulin to carb ration
Correction Factor |
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Definition
1 unit insulin to 15 grams carbs
Units of insulin needed to correct a blood sugar level. (long acting insulin) 1 unit of rapid acting insulin/50 mg/dl > 150 mg/dl |
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Term
| What three factors go into insulin therapy? |
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Definition
| blood glucose testing, carb intake, and insulin regimen |
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Term
| Pediatric blood glucose goals: <6 yo (before meals and at bedtime?) |
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Definition
before meals 100-180
bedtime 110-200 |
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Term
| Pediatric blood glucose goals: 6-12 yo (before meals and at bedtime?) |
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Definition
before meals 90-180
bedtime 100-180 |
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Term
| Pediatric blood glucose goals: 13-19 yo (before meals and at bedtime?) |
|
Definition
before meals 90-130
bedtime 90-150 |
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Term
| What is diabetic ketoacidosis? |
|
Definition
Caused by an absolute or relative insulin deficiency and an increase in insulin counterregulatory hormones: catecholamines, cortisol, glucagon, and growth hormone.
Individuals with type 1 are more at risk.
Precipitated by lack of insulin, illness, infection, trauma, surgery, and stress |
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Term
|
Definition
Dehydration
Kussmaul respirations: rapid, deep, sighing
Metabolic acidosis (pH <7.2, bicarbonate < 15)
Nausea, vomiting, and abdominal pain mimicking an acute abdomen
Decreased level of consciousness
Acetone odor of breath (smells like rotten fruit, juicy fruit gum, or nail polish remover)
Weight loss |
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Term
| What is Hyperglycemic Hyperosmolar Nonketotic Syndrome (HHNK)(HHS)? |
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Definition
Characterized by a lack of ketosis, extremely high blood glucose levels, and increased fluid deficiency.
Type 2 and elderly more at risk.
Similar presenting symptoms as DKA. (treatment is the same) |
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Term
| What is HHS characterized by? |
|
Definition
Plasma glucose > 600 mg/dl
Absent to small ketonuria
Arterial pH > 7.30
Serum bicarbonate > 15 mmol/L
Effective serum osmolality > 320 mOsm/kg
Stupor or coma |
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Term
| What is one long term macrovascular complication of diabetes? |
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Definition
| heart and blood vessel issues including high cholesterol, hypertension, and atherosclerosis |
|
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Term
| What are three microvascular long term complications of diabetes? |
|
Definition
nephropathy
retinopathy
neuropathy |
|
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Term
|
Definition
Diabetic retinopathy estimated to be the most frequent cause of new cases of blindness among adults aged 20 – 74 years.
Retinopathy is related to: Duration of diabetes after puberty, Degree of blood glucose control, Hypertension, Tobacco use
Prevention is key! |
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Term
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Definition
Single leading cause of end stage renal disease, occurs in 20% – 40% of all people with diabetes.
Risk factors: After puberty, Long duration of diabetes, Poor diabetes control, Elevated blood pressure, Use of tobacco
Screening: serum creatinine level
Treatment: ACE inhibitors or ARB |
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Term
|
Definition
most common complication
poorly understood
Types: Distal symmetric polyneuropathy, Autonomic neuropathy
Symptoms: Pain, Loss of sensation and muscle weakness of hands, feet, leg, Burning sensations, Loss of sensitivity to warmth/cold, Numbness, Problematic bowel/bladder control, Impotence in men, Bone deformity in foot (“Charcot foot”), Gastroparesis
Treatment: stable blood glucose, pain management, dietary changes, |
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Term
| What are early behavioral signs of cognitive impairment? |
|
Definition
Decrease responsiveness to contact, voice, movement
Irritability
Poor/slow feeding
Poor eye contact during feeding
Gross motor delay |
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Term
| Definition of intellectual disability consist of three components: |
|
Definition
Intellectual function sub-average (IQ <75)
Diagnosis before age 18
Functional impairments |
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Term
| What are some causes of mental retardation? |
|
Definition
Intrauterine infection (rubella, syphilis) and intoxication (drugs, alcohol)
Trauma (prenatal, perinatal, postnatal)
Metabolic or endocrine disorders (hypothyroidism)
Inadequate nutrition
Postnatal brain disease (tuberos sclerosis (benign tumors in brain, skin, and kidneys)) |
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Term
| More causes of mental retardation? |
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Definition
Chromosomal anomalies (down syndrome, fragile X syndrome)
Prematurity, LBW, postmaturity
Environmental influences (parental history of low IQ)
Unknown prenatal influences (hydrocephalus)
Psychiatric disorders with onset in childhood (autism) |
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Term
| IQ classification of mental retardation |
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Definition
Educable/mild—IQ 50-75
Trainable/moderate—IQ 35-55
Severe—IQ 20-40
Profound—IQ <20-25 |
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Term
| What are some primary ways to prevent mental retardation? |
|
Definition
Encourage prenatal care
Rubella immunization
Genetic counseling
Use of folic acid supplements (prevents spinal cord and brain defects)
Educate about fetal alcohol syndrome
Educate about lead exposure |
|
|
Term
| What is the most genetic cause cause of mental retardation and most common chromosomal abnormality? |
|
Definition
|
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Term
| What are some congenital abnormalities associated with down syndrome? |
|
Definition
40%-45% have heart defects
Renal, Hirschsprung, T.E. fistula
Altered immune function
Skeletal defects |
|
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Term
| What is atlantoaxial instability? |
|
Definition
congenital abnormality of down syndrome.
It is the instability of 1st and 2nd cervical vertebrae, concern with sports activities, stress on head and neck= spinal cord compression |
|
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Term
| What is one helpful thing you can tell a breast feeding mother about her down syndrome baby? |
|
Definition
| Down syndrome babies have hypotonia of muscle and joint hyperextensibility = difficulty with positioning |
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Term
| Nursing care management for child with down syndrome |
|
Definition
Low muscle tone and underdeveloped nasal bone makes these infants more prone to URIs
Constant nasal congestion interferes with feedings, encourage parents to suction nares before each feeding
Tongue thrust also interferes with feedings. Parents need to know baby is not refusing feeding
Advise parents to use a small, but long straight-handled spoon to push food toward back and side of mouth.
Prone to constipation from decreased muscle tone affecting gastric motility. Encourage high fiber and increased fluids. For older children monitor for obesity
Promote good skin care. Often dry and rough which leads to cracking and infection. Limit soap and apply lubrication |
|
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Term
| What is the second most common genetic cause of cognitive impairment |
|
Definition
|
|
Term
| what are some classic behavioral features of fragile X |
|
Definition
Mild to severe cognitive impairment
Delayed speech and language
Hyperactivity
Autistic-like behaviors
Aggressive behaviors |
|
|
Term
| what is the therapeutic Management of Fragile X Syndrome? |
|
Definition
No cure for fragile X
Medical management may include the use of: Tegretol/Prozac— to control violent behavior
Stimulants for hyperactivity (similar to ADHD management)
Mimic behavior—“mainstream management”
Multidisciplinary therapy
Care given to these families is the same for any child with a CI
Hereditary disorder= encourage genetic counseling to inform parents and siblings of risk of transmission
Refer families to national fragile X foundation
Encourage testing of other siblings. |
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Term
|
Definition
Definition: brain dysfunction accompanied by broad range and severity of intellectual and behavioral deficits
Etiology unknown
Genetic basis – family with autism is at a higher risk to have another child with autism
Not caused by vaccination |
|
|
Term
| Diagnostic Criteria for Autistic Disorder |
|
Definition
Qualitative impairment in social interaction
Qualitative impairment in communication
Restricted repetitive and stereotype patterns of behavior, interests, and activities
Delays or abnormal functioning with onset before 3 yrs |
|
|
Term
| What are some clinical manifestations of autism? |
|
Definition
Trouble interacting
Avoiding eye contact
No pointing to objects
Unusual movements
Delays in developmental milestones
Playing with the same toy in a way that seems odd or repetitive
Not using or understanding language
No exploring of environment |
|
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Term
| Nursing care management of hospitalized autistic child |
|
Definition
Parent involved in care, encouraged to stay with child
Avoid over stimulation
Require individualized care
Care should be taken when performing procedures (some do not like to be touched) |
|
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Term
|
Definition
| weight >95th percentile for age, gender, and height |
|
|
Term
|
Definition
|
|
Term
| what is the mean age of onset of anorexia nervosa |
|
Definition
| 13.75 years, ranging from 10-25 years |
|
|
Term
| what are some clinical manifestations of anorexia nervosa |
|
Definition
Severe weight loss
Altered metabolic activity
-Amenorrhea
-Bradycardia, hypotension
-Hypothermia, cold intolerance
-Dry skin, brittle hair, and nails
-Appearance of lanugo |
|
|
Term
| diagnostic evaluation of ADHD |
|
Definition
Quality of motor activity
Developmentally inappropriate inattention, impulsivity, and hyperactivity
Wide variation of severity
Diagnostic criteria by American Psychiatric Association |
|
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Term
|
Definition
IQ
Hand-eye coordination
Visual and auditory perception
Comprehension
Memory |
|
|
Term
| Therapeutic management of ADHD |
|
Definition
Proper classroom placement, orderly with consistent rules, allow for frequent brakes
Family education and counseling
Behavioral and/or psychotherapy for child
Environmental manipulation, decrease distractions, need structure
Medication |
|
|
Term
|
Definition
Not all children benefit from pharmacologic therapy
Stimulants: Dexedrine, Adderall, Ritalin
Side effects: Insomnia, anorexia and weight loss, hypertension, long term use may suppress growth |
|
|
Term
| Where can central venous catheters be place? and what is their use? |
|
Definition
Placed into large vein: Subclavian, Internal jugular, Femoral
Placed for long term use for intravenous medication (antibiotics, chemotherapy), frequent blood draws and nutrition (Total Parenteral Nutrition) |
|
|
Term
| Why would you use a tunneled central venous catheter? |
|
Definition
| decreased infection and provide stability |
|
|
Term
| What are some complications of all CVC |
|
Definition
Infection
Air embolism
Thrombosis |
|
|
Term
| What are Increased Pulmonary Blood Flow Defects |
|
Definition
atrial septal defect
ventricular septal defect
patent ductus arteriosus |
|
|
Term
|
Definition
Description: abnormal opening between the atria, allowing blood from the higher-pressure left atrium to flow into the lower-pressure right atrium.
Clinical manifestations: patients may be asymptomatic, CHF, systolic diastolic murmur |
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|
Term
| ventricular septal defect |
|
Definition
Description: abnormal opening between the right and left ventricles. A left-to-right shunt is caused by the flow of blood from the higher-pressure left ventricle to the lower-pressure right ventricle
Clinical manifestations: CHF, loud holosystolic murmur. Patients are at risk for bacterial endocarditis and pulmonary vascular obstructive disease. |
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Term
|
Definition
Description: failure of the fetal ductus arteriosus (artery connecting the aorta and pulmonary artery) to close within the first weeks of life. Allows blood to flow from higher-pressure aorta to lower-pressure pulmonary artery causing a left-to-right shunt
Clinical manifestations: CHF or asymptomatic. Machinery-like murmur, widened pulse pressure, bounding pulses. Patients are at risk for bacterial endocarditis and pulmonary vascular obstructive disease in later life from chronic excessive pulmonary blood flow. |
|
|
Term
| What are obstructive defects of the heart? |
|
Definition
Structural abnormality on the left side of the heart causing decreased systemic blood flow
Presentation: decreased pulses, unequal limb blood pressures, to extremely ill presentations
Examples: coarctation of the aorta, aortic stenosis, pulmonic stenosis |
|
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Term
|
Definition
Description: localized narrowing near the insertion of the ductus arteriosus, which results in increased pressure proximal to the defect (head and upper extremities) and decreased pressure distal to the obstruction (body and lower extremities)
Clinical manifestations: higher BP in arms than legs, CHF, severe acidosis, hypotension, dizziness, headaches, fainting. Patients at risk for hypertension, ruptured aorta, aortic aneurysm, and stroke |
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Term
|
Definition
Description: narrowing or stricture of the aortic valve, causing resistance to blood flow in the left ventricle, decreased cardiac output, left ventricular hypertrophy, and pulmonary vascular congestion.
Clinical manifestations:
-Newborns: faint pulses, hypotension, tachycardia, and poor feeding
-Children: exercise intolerance, chest pain, and dizziness.
-At risk for bacterial endocarditis, coronary insufficiency and ventricular dysfunction |
|
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Term
|
Definition
Description: narrowing at the entrance to the pulmonary artery. Resistance to blood flow causes right ventricular hypertrophy and decreased pulmonary blood flow.
Clinical manifestations: asymptomatic or CHF. Newborns will be cyanotic. Loud systolic ejection murmur. Cardiomegaly. |
|
|
Term
| decreased pulmonary blood flow defects |
|
Definition
Structural abnormality causing too little pulmonary blood flow
Abnormality on the right side of the heart
Causes unsaturated blood to shunt to the left side of the heart, into the systemic circulation (via VSD, ASD)
Presentation usually hypoxemic and cyanotic
Examples: Tetralogy of Fallot,
Tricuspid stenosis/atresia, Pulmonary stenosis/atresia |
|
|
Term
|
Definition
Four components:
1. Pulmonary stenosis
2. Overriding aorta
3. Ventricular septal defect (VSD)
4. Right ventricular hypertrophy
Clinical manifestations:
-Cyanosis
-Systolic murmur
-Blue spells/ tet spells: times of hypoxia
-Risk for emboli, seizures, LOC, sudden death following an anoxic spell |
|
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Term
|
Definition
Examples: Transposition of great vessels, Total anomalous pulmonary venous connection, Hypoplastic left heart syndrome
Presentation: varies greatly depending on anatomy and amount of “mixing” |
|
|
Term
| Transposition of the great vessels (TGA) |
|
Definition
The great vessels (arteries), aorta and pulmonary artery, arise from the wrong ventricle
The great vessels are “transposed” (switched) from their normal position
Aorta comes off of RV
Pulmonary artery comes off of LV
Must have ASD, VSD, or PDA to allow “mixing” of blue and red blood
(Give baby prostalgandins to keep ductus arteriosis open) |
|
|
Term
| Hypoplastic Left Heart Syndrome |
|
Definition
Group of cardiac anomalies involving the left sided structures of the heart
One of the most complex of CHD
One of the most challenging to manage
Ductal dependent lesion (PGE1 infusion) |
|
|
Term
| Post-pericardiotomy Syndrome |
|
Definition
Symptoms: fever, malaise or irritability, nausea/vomiting pericardial friction rub
Occurs in first few days or weeks after surgery
Caused by an increasing pericardial effusion
Treatment includes: confirm dx with echo, anti-inflammatory drugs (steroid, NSAID), diuretics, may need drainage of fluid |
|
|
Term
| What are types of acquired heart disease? |
|
Definition
Congestive heart failure (CHF)
infectious heart disease
inflammatory heart disease |
|
|
Term
| congestive heart failure in children |
|
Definition
Pathophysiologic state in which the heart is unable to pump blood at a rate that meets the body’s metabolic needs
Volume overload is the most common cause in children
Causes: metabolic abnormalities, myocarditis (inflammation of the heart muscle), CHD, cardiomyopathies, etc. |
|
|
Term
| Signs and symptoms of CHF |
|
Definition
Impaired myocardial function
-tachycardia, sweating, fatigue, pale, cardiomegaly
Systemic venous congestion
-right-sided failure
-edema, weight gain, hepatomegaly, ascites
Pulmonary congestion
-left-sided failure
-Tachypnea, retraction, nasal flaring, poor feeding, exercise intolerance |
|
|
Term
|
Definition
Oxygen
Rest
Sodium/fluid restriction
Drug therapy: inotropes, afterload reduction
Correction on underlying CHD or precipitating cause |
|
|
Term
| predisposing factors for endocarditis |
|
Definition
Structural abnormalities: all CHD with the exception of secundum ASD
Bacteremia: any localized infection can seed organisms into the circulation, dental procedures, diseased teeth/gums, drug abuse |
|
|
Term
| clinical manifestations of endocarditis |
|
Definition
Hx of CHD, recent dental procedure
Insidious onset: fever, fatigue, weight loss
Murmur 100%
Fever 80-90%
Splenomegaly 70%
Laboratory findings: +BC, anemia, increased sed rate
Echo may indicate vegetations |
|
|
Term
| management of endocarditis |
|
Definition
3-5 blood cultures drawn in 24-48 hrs
Initial empiric therapy should be started before BC results available:
-Anti-staphylococcal penicillin (naficillin, oxacillin) and aminoglycocide (gentamicin)
-4-6 weeks of tx |
|
|
Term
|
Definition
Immunologic disease sequela of Group A streptococcal pharyngitis
Infrequently seen in U.S.; big problem in Third World
Inflammatory lesion found in many parts of the body (heart, brain, joints, and skin)
Dx with 2 major, or 1 major and 2 minor criteria… |
|
|
Term
|
Definition
Most common complication of rheumatic fever
Damage to valves as a result of rheumatic fever
Valvar lesions most frequently involve the mitral and less commonly the aortic valve |
|
|
Term
| Major clinical manifestations of rheumatic heart disease |
|
Definition
Polyarthritis (70%)
Carditis (50%) – tachycardia, murmur, cardiomegaly
Chorea (15%) – “St. Vitus Dance’=neuropsychiatric disorder
Erythema Marginatus (<10%) – rashes most on trunk
Subcutaneous nodules (2-10%) – hard, painless, freely mobile over bony prominences, scalp |
|
|
Term
| minor clinical manifestations of rheumatic heart disease |
|
Definition
Arthralgia
Fever
Elevated acute phase reactants (ESR, CRP)=objective evidence of an inflammatory process
Prolonged PR interval |
|
|
Term
| treatment of rheumatic fever |
|
Definition
Treatment of streptococcal pharyngitis
-Penicillin V is the drug of choice, PO
-Penicillin G, IM
-Erythromycin if PCN allergic
-ASA and bed rest, if mild-mod carditis
-Prednisone and bed rest if mod-severe carditis |
|
|
Term
| What is Kawasaki Disease? |
|
Definition
| Vasculitis of unknown etiology characterized by a multisystem involvement and inflammation of small to medium-sized coronary arteries with resulting aneurysm formation |
|
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Term
| What is the acute phase of Kawasaki disease? |
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Definition
Acute Phase (1-2 weeks)
Fever > 5 days
Erythema and edema of hands
Polymorphous rash
Conjunctivitis
“Strawberry tongue”
Cervical lymphadenopathy |
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Term
| What is the subacute phase of Kawasaki disease? |
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Definition
Subacute Phase (up to 30 days)
Resolution of fever
Peeling of fingers and toes
Increased platelet count
Onset of coronary aneurysms
Often diagnosed in this phase |
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Term
| Kawasaki Disease Treatment |
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Definition
| Aimed at reduction of inflammation within the coronary anatomy and prevention of thrombus by inhibition of platelet aggregation |
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Term
| Hypercholesterolemia in children |
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Definition
Children with LDL levels at least 130/mg/100 ml should be identified and evaluated
Primary (most likely familial) and Secondary (obesity, oral contraceptive, anabolic steroid, or Accutane use)
Treatment depends on type/cause
Only medication recommended – bile acid sequesterants:
-colestipol (Colestid) and cholestyramine (Questran)
-Increase excretion of bile acids in stool and increase LDL receptor activity |
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Term
| What is automaticity (rhythmicity) of the heart? |
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Definition
Ability of heart to initiate impulses regularly & spontaneously
Prominent in SA node (Dominant Pacemaker) |
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Term
| What is excitability of the heart? |
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Definition
| Ability of cardiac cells to respond to stimulus |
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Term
| What is conductivity of the heart? |
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Definition
| Ability of cardiac cells to respond & transmit impulses along cell membranes |
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Term
| What is contractility of the heart? |
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Definition
| Ability of cardiac cells to respond & contract (largest mass of myocardium) |
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Term
| What happens during diastole? |
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Definition
Isovolumetric ventricular relaxation & filling, atrial contraction
Aortic & Pulmonic valves close / AV valves open
Coronary arteries perfuse |
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Term
| What happens during systole |
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Definition
Isovolumetric ventricular contraction & ejection, atrial filling
Mitral & Tricuspid valves close / Aortic & Pulmonic open |
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Term
| What makes up cardiac output? |
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Definition
heart rate X stroke volume
Average: 4-8 L/min |
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Term
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Definition
Amount of blood that is ejected from the ventricle during each contraction
Made up of preload, afterload, and contractility |
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Term
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Definition
| volume of blood that can fill into the ventricles |
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Term
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Definition
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Term
| What causes the S1 (lub) sound? |
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Definition
systole
mitral and tricuspid closure
loudest at apex |
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Term
| What causes the S2 (dub) sound? |
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Definition
diastole
aortic and pulmonary valve closure
loudest at base of heart |
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Term
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Definition
“KENTUCKY”
occurs at beginning of diastole
Ventricular dysfunction/ Too much fluid entering the ventricle at beginning of diastole
MI, MVR, anemia, HTN, CHF
1st to appear in CHF |
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Term
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Definition
“TENNESSEE”
occurs at end of diastole when ventricle is full
atrial kick cannot empty into non-compliant ventricle |
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Term
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Definition
Increased rate of flow through normal heart (anemia, exercise)
Blood flow across obstruction (stenosis)
Septal defect: shunting
Backflow w/ incompetent valve (regurgitation)
Papillary rupture
Graded I - VI |
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Term
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Definition
Pericardial inflammation/ effusion/ pericarditis
Can occur 2-7 days after MI or CABG
Grating/ scratching sound during both systole & diastole
Heard best on inspiration
Sounds like a scratching nose, most likely to hear it after surgery |
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Term
| What is the order that you give someone meds for chest pain? |
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Definition
ONAM: oxygen
nitroglycerin
aspirin
morphine |
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Term
| Explain a myocardial infarction |
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Definition
Complete obstruction w/ immediate myocardial ischemia distal to blockage
Depressed myocardial contractility
If clot is not lysed, ischemia continues = myocardial tissue death (infarction)
May or may not effect all 3 layers of muscle
Area of infarction depends on artery occluded |
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Term
| diagnostic tests for coronary artery disease |
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Definition
Electrocardiography: Most useful when symptomatic/ Looking for ST segment and T wave changes
Blood:
-CPK: elevate in 4-8 hours, peaks in 12-18 hours, CKMB specific (isoenzyme of cretine kinase)
-Troponin I: high specificity, rises earlier than CK, normal <0.1 |
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Term
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Definition
Occurs when the myocardium cannot maintain a sufficient cardiac output to meet the metabolic needs of the body
Ejection Fraction <45% |
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Term
| Left Heart failure signs and symptoms |
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Definition
3 most common causes: HTN, CAD (coronary artery disease), AS (atrial stenosis)
Left Ventricular Cardiac Output is < blood received from Pulmonary circulation = congestion in LA, LV, and pulmonary circulation
S/S: anxiety, air hunger, PND (Paroxysmal nocturnal dyspnea), DOE (dyspnea on exertion), orthopnea, moist cough, frothy sputum, tachycardia, diaphoresis, cyanosis, pallor, insomnia, palpitations, weakness, fatigue, anorexia, changes in mentation |
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Term
| Left heart failure physical assessment |
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Definition
Decreased blood pressure
Crackles
Tachycardia, dysrhythmias
Wheezes
S3 & S4
Decreased Urine Output (kidneys are impacted, test BUN and creatinine to test kidney function) |
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Term
| right heart failure signs and symptoms |
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Definition
Fluid retention
Peripheral edema
Abdominal tenderness
Liver enlargement
N/V = anorexia |
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Term
| right heart failure physical assessment |
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Definition
Hepatosplenomegaly
Dependent, pitting edema
Jugular Vein Distension & hepatojugular reflux
Bounding pulses
Ascites (fluid build up)
**Left heart failure can easily lead to right heart failure and vice-versa** |
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Term
| heart failure diagnostic tests |
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Definition
CXR (chest x-ray): Enlarged silhouette
ECG: May have wide QRS (bundle branch block)
ECHO: Valve fxn & Wall motion (EF%) (low ejection fraction)
Cardiac Cath: Coronary Arteries & EF
LABS:
NA/ CL: ↓
BUN/CREAT: increased
RBC: ↓
PaO2/ PaCO2: ↓
BNP: >100 = CHF |
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Term
| heart failure patient education |
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Definition
Teach to monitor for s/s of fluid volume excess
Daily weight (report a 2-3 lb/ day gain)
Plan activity to avoid fatigue
Small meals/ Na free
Medications
Possible heart transplant work-up
Instill hope/ Advanced directives |
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Term
| What is primary hypertension? |
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Definition
essential HTN
Cause unknown
Suspected mechanisms of essential HTN:
-SNS Overstimulation
-Overactive Renin Angiotensin Aldosterone System (RAAS) (ACE inhibitors) |
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Term
| What is secondary hypertension? |
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Definition
caused by something else such as:
Acute stress
Meds: Oral contraceptives,amphetamines, gluco- and mineralcorticoids, NSAIDS, sympathomimetics.
Pheochromocytoma
Cushing’s Syndrome
Coarctation of the aorta
Pregnancy
Renal disease
Sleep apnea: 25% people with Htn. |
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Term
| clinical manifestations of HTN |
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Definition
Can be asymptomatic
Vascular changes (visible in retina macular degeneration)
Early AM headache
Organ systems damage: left ventricular hypertrophy (LVH), angina, MI, heart failure, CVA or TIA, nephropathy, PAD |
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Term
| goal of medical therapy of HTN |
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Definition
Preload Reduction (diuretics)
Afterload Reduction (vasodilation)
Improve Contractility (restoring blood flow to coronary arteries)
Increase CO |
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Term
| Compelling Indications for HTN Treatment |
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Definition
Angina
BPH
CHF
COPD/Asthma
Migraine HAs
Renal Insufficiency
Post MI
Pregnancy (NO ACE inhibitor, cause fetal demise)
Osteoporosis (No loop diuretics)
SVT |
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Term
| What is the first line drug for HTN |
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Definition
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Term
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Definition
Inhibits the reabsorbtion of NA and Chloride in distal renal tubule.
Decrease blood volume; direct effect on arteriole dilation Monitor BUN, Cr, Uric acid levels
Potassium supplements may be needed
May cause dry mouth, lethargy.
Low K, Low Mg (muscle aches, dose related). |
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Term
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Definition
furosemide (Lasix); bumetanide (Bumex)
Blocks reabsorption Na+ & water
Possible hypokalemia
Possible N/V, thirst, skin rash
Will not effect BUN/CR
Rapid volume depletion: Hypotension |
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Term
| Diuretics: Potassium-Sparing |
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Definition
spironolactone (Aldactone)
Competitive inhibitors of aldosterone
Weak Antihypertensives
May cause drowsiness, lethargy, H/A, hyperkalemia |
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Term
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Definition
Atenolol, metoprolol (beta 1 blockers)
Propranolol (beta 1 & beta 2 blocker)
Carvedilol (beta 1 & beta 2 blocker)
Block beta receptors & decrease HR, dilate arterioles/ veins
May cause bradycardia, hypotension, CHF, masks sx of hypoglycemia, bronchospasm |
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Term
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Definition
Captopril, Lisinopril, Enalapril
Inhibits conversion of angiotensin I to angiotensin II; decrease aldosterone (RAAS system)
Reduces total peripheral resistance
May cause hyperkalemia, give with caution in renal failure patients
Watch NSAID (Decrease effectivness)
Dry cough
Not used in pregnancy |
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Term
| ARBs (Angiotensin II receptor blockers) |
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Definition
Losartan, Valsartan
Block angiotensin II receptor sites; vasodilation and decreased aldosterone levels
May cause hyperkalemia, dizziness, muscle cramps
Will not cause dry cough
Not used in pregnancy |
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Term
| clinical manifestations of peripheral artery disease |
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Definition
Intermittant claudication (ischemic pain with exercise; relieved by rest)
Decreased mobility, leg “gives out”
Hair loss on effected extremities
Thick, brittle, slow growing nails
Shiny, thin, fragile skin; ulceration
Cool temperature
Diminished pulses
Pallor
Rubor (redness) when venous return is impeded |
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Term
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Definition
Ankle-brachial index (ABI)
Great toe doppler pressure
Arterial doppler exercise studies |
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Term
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Definition
ABI: ankle systolic pressure / highest systolic brachial pressure
Due to the high estimated prevalence of PAD in patients with diabetes, ABI should be performed in all diabetic patients >50yr
ABI should be considered in diabetic patients <50 yr who have other atherothrombotic risk factors |
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Term
| symptoms of acute arterial occlusion |
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Definition
Sudden and severe
Pain
Pallor
Pulselessness
Paresthesia (numbnes)
Cool to the touch |
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Term
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Definition
Assess neuro vascular status (looking for function of lower extremities. CMS checks: circulation, motion, and sensation)
Peripheral pulse check
Monitor labs (H&H, PT/ PTT/ INR, WBC)
Assess wound (monitor for infection)
Monitor kidney perfusion
Assess for chest pain (MI complication)
Impotency is complication (nerve damage to pudendal artery)
Respiratory care: ABCs
Pain management
GI status
Bowel status
Fluid balance
Ambulation |
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Term
| what is the etiology of deep vein thrombosis |
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Definition
Venous stasis; impaired venous flow
Damage to endothelial lining of vein due to venous distension
Hypercoagulability; increased blood viscosity (blood can not get to where it needs to) |
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