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Pharm Exam 2
Terms in this set (73)
Localized chest pain
- common sympton of pleural disorders
-presents as pain with max inspiration
-ask pt to localize pain with 1-2 fingers to guide exam
Trouble with heart diesease?
- often the first symptom is sudden death
Cardiac RED FLAGS (Associated s/s)
CHEST PAIN ACCOMPANIED by:
-Diaphoresis (excessive sweating)
-Pallor (pail in color)
-may or may not be cardiac in origin
-Presence of an irregular heart beat
-may be benign or serious
-signif if > 6 / minute
-IF it last for hourst it may be associated with other s/s
-Breathless/ SOA (subjective)
-Tachypnea (objective; 12-20/min normal)
-Depends on severity of disease
-P.N.D (paroxysmal noctural dyspnea) (ex: 2 pillow orthopnea)
-may accompany CHF
DOE = Dyspnea on Exertion
-Can be caused by decreased 02 to brain
-Vasovagal syncope can occur from noncardiac events
-consider c-spine involvement
-Can be linked to cardiac conditions
What should you do if fatigue is present?
-Monitor vital signs
-Consider pt meds (Ex: beta blockers)
-May need specific testing to link fatigue with cardiac factors
-usually related to pulmonary, but can be related to cardiac factors. (ex: CHF)
-smoker's morning cough different from normal. Decrease in coughing during sleep; mucus
What do you look for in a cough?
-Frothy, blood-tinged sputum
Cough is a normal defense mechanism (True/False)
What is the most common sign of lung disease?
What is a productive cough?
-cough w/ expelled sputum, ect.
What is a non-productive cough?
what is hemoptysis?
-clots or blood tinged sputum.
-usually frightens pt
Why are clots very serious?
-Indiactes malignancies, pulmonary emobolie (PE), or cardiac disease.
What are blood streaks common in?
-bronchitis, tumors or pneumonia.
**blood tinged "flecks"common in smokers
What is the normal sputum production?
-75-100 ml (30 oz)(by bronchi)
What should do you worry about with sputum?
-Christmas colors (green/red)
-Earth Tones (brown/orange)
What is cyanosis?
-blueish coloration of lips and nail beds
What is cyanosis due to?
-Can be cardiac or pulmonary
**heart takes 5% of oxygenated blood for itself; brain next most
-May be a red flag in CHF
-Can be cardiac or no cardiac
What is Claudication and what is it associated with?
- Leg pain
-Associated with PVD and CAD
**must differentiate between non-cardiac leg pain (pseudoclaudication)
Abnormal HR and SBP response to exercise
-steady HR/SBP with an increased workload
-Fall in HR/SBP despite increased workload (normal if on beta blockers)
-Resting DBP > 95
-Rise in DBP > 15 above RDBP
What causes angina?
-An imbalance between cardiac workload and 02 supply to the myocardial tissue.
**could be confused with heartburn, reflux, or GB
-Different in women and men
-severity not a good prognostic indicator
-Md must make differential diagnosis
-Usually last 5-10 min
Nitro and angina
-Have patient take up to 3 five minutes apart.
**if not relieved by NTG get help, Chew 2 ASA and call 911
What should NTG pills feel like if they are good?
-TIngle/burn when placed under tongue
-Can be reliably predicted with set level of myocardial demand.
-well established level of onset.
-can be controlled w/ reduction in intensity of activity or NTG
-presence of s/s of inadequate blood supply to myocardium in absence of demands that usually leads to an imbalance.
What are the unstable angina clinical clues?
-Angina at rest
-Onset of angina at significant lower level of activity than usual
-Deterioration of previously stable patter (more frequent)
What is a Myocardial Infarction?
-Development of ischemia and necrosis of myocardial tissue
-Clinical s/s much more common in AM (clotting more active)
-can be silent (20-25% of all)
-may be confused with other s/s
What is the most common cause of an MI?
-Partial occlusion and clot
What are the S/S of an MI?
-Angina (anything above waist)
Ex: chest,substernal, arm, jaw, toothache
-may wax or wane; NOT relieved by NTG
-Pt will often know
-Daiphoresis (excessive sweating)
MI Presentation: Men Vs. Women
-Often atypical presentation in women
-Can be much more vague, GI like distress
-May also refer to RIGHT UE (biceps)
What is defined as Hypertensive?
-Persistent DBP > 90 mm Hg
-Peristent SBP > 140 mm Hg
-Both measure on 2 seperate occasions at least 2 weeks apart.
What is the leading cause of cardiovascular morbidity and mortality?
Hypertension (2 kinds)
-Primary (essential): no definite etiology
-90% of pts!
-may be associated with stress, smoking, obesity
-Secondary: produced by specific cause
-Adrenal tumor leads to increased epinephrine renal artery stenosis
-Associated with increase in sympathetic activity
-sympathetic activity leads to excitatory effects on heart and peripheral vv's which increases BP.
-Vessels become less compliant (stiffer)
What are the symptoms of hypertension?
-Headaches (occiptal and AM)
What is CHF?
-Physiological state where heart is unable to pump enough blood to meet metabolic demands of body (02 consumption) at rest or exercise.
CHF (Congestive Heat Failure)
-Not really a disease; describes inadequate pump performance
-Lungs become congested (too much blood in pulmonary circulation) leads to SOB which leads to pulmonary congestion/edema
-often a result of heart damage during an MI.
-More than 5 million in US have CHF
What are common complications from CHF?
-pitting edema in extremities.
Due to: R side failer
Why cant CHF pts be supine?
-They cannot breath due to pulmonary congestion/edema
Why is massage for edematous extremities contraindicated in CHF pt?
- It pushes more fluid towards the heart and can actually worse the disease
What is the most common cause for hospitilization in people > 65?
What is a factor that predisposes one to CHF?
What are the pulmonary RED FLAGS?
-Influenza > 7-10 days
-Increased pulmonary s/s
-Wheezing/other changes in breathing pattern
-COPD: describes # of diferent airy disorders
-Airways narrow causing obstruction of airflow to/from lungs
-Traps air in brochioles and alveoli
-Acute: short therm; just feel sick
-Chronic: long term; may evolve during course of PT intervention.
What diseases make up COPD?
What are the main problems with Emphysema?
-Alveolar walls destroyed which decreases elastic recoil and causes a problem with expiration.
-pt cannot get air out due to airway collapse.
-Air becomes trapped (not mucus plugs, ex:bronchitis)
-Result: decreased 02 exchange
What are the signs and symptoms of Emphysema?
-DOE (dyspnea at rest)
-Pt thin with barrel chest (due to using access muscles to breath)
-"Blue Bloater" (trouble getting 02 out give blue tint)
-Tachypnea w/ prolonged expiration
-Teach pt to lean forward and use pursed lip breathing
-Pt must stop smoking
What are the inflammatory/infectious diseases?
What is asthma?
-Chronic inflammatory disorder of the airways.
-Reccurent and reversible SOA due to narrowing of bronchiols and bronchi.
**can be seasonal, idopathic or intrinsic.
What is status asthmaticus?
-A prolonged asthma attack.
-Life threatening and requires rapid, agressive treatment.
What are other types of asthma?
-Exercise induced asthma (EIA)
-may cause bronchoconstriction and wheezing within minutes of starting exercise.
-Asthma associated with COPD
-may coexist with COPD
-must be treated differently than if COPD exists alone
What are the EIA Theories?
-Inhalation of cold and dry air causes mucosal drying and osmolarity due to increased mast cell deregulation.(start pumping out histmaine)
-Rapid airway rewarming after exercise causes vascular congestion, permeability and edema that leads to an asthma attack.
-Inflammation is primary cause of asthma
-contributes to airy hyperresponsiveness, bronchoconstriction, airway edema, mucus plug formation and decrease FEV1.
What are the Asthma causes of inflammation?
-Enviromental (ex:cold air)
What is the asthma inflammatory process?
Offending agent (allergens) --> increase mast cell -->breaks open-->releases histamines and leukotrienes that increase inflmmation --> Bronchoconstriction, edema, and increased mucus
-Can be life threatening
-"The Bus" *****ask
What are some Asthma complications?
-can be life threatening
-be able to recongnize
-know pt's med hx
What is COPD?
-Refers to a # of lung disorders that affect movement of air in/out of lungs (especially small airways)
-2nd to heart disease as cause of disibility in adults >65 yrs
-3rd leading cause of deaths worldwide
-Almost always caused by enviromental irritants (smoking)
-Rare in non-smokers.
What is the most common form of COPD?
What are the main problems with emphysema?
-Alveolar walls destroyed -->decreased elastic recoil--> problem expiring air
-Pt cant get air out due to airway collapse
-Air becomes trapped
-Results in decreased 02 exchange ***
-Genetic lung disorder
-increase in mucous production in lungs
-Have person lean forward and pat them on chest to get mucous out.
What are PE's and DVTs?
-Deep Vein Thrombosis
What are three major risk factors with PE's and DVT's?
What are other risk factors with PE/DVT's?
-Surger (hip, knee, prostate)
- > 50 years old
-previous hx of clots, met CA
-Hx prior PE or DVT's
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