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Kennesaw Nursing Adult Health Exam 2
Terms in this set (122)
Diffuse inflammation and degeneration of myocardial fibers. Ventricular dilation, atrial enlargement - contractile dysfunction. Stasis of blood in LV. Impaired systolic function-problem with the pumping. Risk of sudden cardiac death (SCD) from lethal dysrhythmias. "Big Baggy balloon".
Asymmetric ventricular hypertrophy without ventricular dilation. Impaired diastolic function leads to impaired ventricular filling. Risk of SCD - most common cause in healthy young adults. It is a high inherited rate.
Least common, systolic function unchanged, impaired diastolic filling and stretch. Is a connective tissue disorder, makes heart stiff.
Valve leaflets blow back into heart chamber
Retrograde blood flow due to incompetent valves. Blood flows backward out of valve due to valve not closing properly.
Narrowing of valve, impedes blood flow. Valve does not open fully, blood is unable to get through.
Left-sided valve. Symptoms primarily related to decreased cardiac output. Symptoms: Fatigue, dyspnea with exertion, weakness, and syncope.
Mitral valve prolapse
Most common valvular disorder in US. Valve leaflets buckle back into left atrium. Usually benign, often genetic link.
Mitral valve stenosis
Common cause: Rheumatic heart disease. Adhesions cause thickening of valve fissure.
Mitral valve regurgitation
Common causes: MI, Rheumatic heart disease, mitral valve prolapse, infective endocarditis. LA and LV must work harder - hypertrophy.
Aortic valve stenosis
Fusion of commissures and calcification causes leaflets to stiffen. Obstructs blood flow out of left ventricle. Ventricular hypertrophy leads to pulmonary hypertension which leads to heart failure.
Aortic valve regurgitation
Incomplete closure of aortic valve leads to retrograde blood flow from aorta to LV. LV overloaded leads to LV hypertrophy which leads to pulmonary hypertension, which causes heart failure.
Left Heart Failure
Most common, LV failure - blood backs up into the left atrium and into the pulmonary veins. Left=Lung. S/S - blood backs up onto lungs. Dyspnea, crackles. Confusion, anxiety, poor perfusion, and decreased urine output.
Right Heart failure
Primary cause = left-sided heart failure. RV failure - backup of blood into the right atrium and venous circulation. Right = periphery. S/S - blood backs up into periphery, distended neck veins, edema in lower extremities, abdominal pain (especially upper right quadrant -liver), lose appetite. Not getting to lungs - cyanosis (not perfusing as well).
Systolic Heart failure
Most common type of HF, decreased ability to pump due to increased afterload, impaired contractile function, cardiomyopathy, or mechanical abnormalities. LV loses its ability to generate enough pressure to eject blood forward through the aorta. Hallmark = decrease in ventricular ejection fraction (EF). Low-output failure.
Diastolic Heart Failure
Inability of the ventricles to relax and fill during diastole. Leads to decreased stroke volume and CO. This then leads to venous engorgement in pulmonary and systemic vascular systems. Diagnosis: pulmonary congestion, pulmonary hypertension, ventricular hypertrophy, and a normal EF.
Progressive worsening of ventricular function. Chronic neurohormonal activity leads to remodeling of myocardium. Presentation dependent of factors such as age and extent of disease.
Severe LV impairment, rapid onset or progression from chronic HF. Most serious complication is pulmonary edema.
Clinical Manifestations of Chronic HF
Fatigue, dyspnea, orthopnea, paroxysmal nocturnal dyspnea. Persistent, dry cough, unrelieved with position change or OTC cough suppressants. Dependent edema and nocturia. Skin - dusky, cool, damp to touch. Restlessness, confusion, and decreased memory. Weight changes - anorexia, nausea, fluid retention.
Mitral regurgitation, Mitral prolapse, aortic stenosis, and pulmonic stenosis.
Mitral stenosis (low pitched), aortic regurgitation (high pitched), and tricuspid stenosis.
Early diastolic sound, low pitched, suggests poor systolic function and/or volume overload. Occurs when mitral valve opens and blood enters overfilled ventricle. Systolic dysfunction.
Late diastolic sound, low pitched, suggest poor diastolic function. Occurs from atrial kick squeezing blood into stiff ventricle. Diastolic dysfunction.
Clinical Manifestations of Acute HF
Manifests as pulmonary edema (lung alveoli become filled with fluid). S/S of pulmonary edema: anxious, pale (possible cyanotic), skin is clammy and cold, severe dyspnea, wheezing, coughing, frothy/blood-tinged sputum, crackles, wheezes and rhonchi. HR rapid, BP variable.
Treatment of Acute HF
Increase oxygenation: Oxygen, raise HOB, and manage anxiety. Reduce vol. overload: diuretics (furosemide). Improve ventricular function: vasodilators (IV nitroprusside, NTG), continuous monitoring. Increase the force of myocardial contraction: IV inotropes (Milrinone, dobutamine).
Lasts longer than biologic, higher risk of thromboembolism, require long-term anticoagulation, INR values of 2.5-3.5 considered therapeutic.
Less risk of thromboembolism, shorter life than mechanical valves, and patients with biologic valves and atrial fibrillation must be on long-term anticoagulation.
Infection of endocardial layer of heart. Classifies as acute or subacute. Bacterial, viral, fungal, but most commonly: Streptococcus viridans and Staph aureus. Endocardial layer continuous with heart valves. Valves commonly affected. Vegetations form on valves or endocardial surface. May become emboli.
Endocarditis risk factors
Age, IV drug use, prosthetic heart valves, prior endocarditis. Certain heart disorders: cardiomyopathies, congenital heart disease, acquired valves disease, and existing cardiac lesions. Invasive procedures: PA catheters and dialysis.
Often non-specific. Fever, malaise, weakness, anorexia, arthralgia, myalgia. Abdominal discomfort. Cutaneous signs: splinter hemorrhages, olser's nodes, Roth's spots (on retina) and Janeway lesions. Onset of new or changing heart murmur.
Antibiotics, prophylactic measures for high risk patients, antipyretics, pain relievers for arthralgia/myalgia. Bed rest usually not indicated. Patient education for high risk patients: infection prevention, avoiding fatigue, importance of oral hygiene, and treatment for IVDA.
Inflammation of pericardial sac. Often idiopathic. Non-infectious - uremia, AMI, trauma, radiation, post MI. Hypersensitivity -rheumatic fever, drug reactions, and rheumatologic disases (e.g. lupus, RA).
Pericarditis Clinical Manifestations
Chest pain - worse with inspiration. Often relieved by sitting forward, may be referred to trapezius. Pericardial friction rub, diffuse ST segment elevation. Ominous findings: muffled heart sounds, jugular vein distenson, pulsus paradoxus, tachycardia and tachypnea, and confusion, restlessness.
Treatment of pericarditis
Antibiotics - if it is an infection. NSAIDS, corticosteroids (used cautiously), and colchicine.
function of musculoskeletal system
Hematopoiesis - production of RBC, WBC, and platelets. Reservoir for vital minerals are stored within the bone. 98% calcium, magnesium, fluoride, and phosphorous.
A major hormone of calcium homeostasis and bone health. Detects low and high serum calcium. It is released from gland to mobilize calcium by demineralizing bone with increases serum calcium levels. A decreased release when serum calcium levels rise above normal limits, deposits calcium back into the bone.
Tingling sensation in upper/lower extremities, and mouth. Muscle cramping "hyperactivity" (spasm). "Foggy brain", depression or irritability. Abnormal heart rate.
Abdominal pain, thirst, nausea, fatigue, muscle aches (not spasm), bone pain, and kidney stones. Usually caused by overactive parathyroid gland or malignancies.
1000-1200 mg of calcium needed for bone health. (Cheese, yogurt, sardines, beans, lentils, almonds, and leafy greens). Vitamin D (sunlight and diet supplementation). Older adults 800-1000 UI. Weight-bearing (walking), and blood supply.
Protect vital organs, help with mobility, movement, and heat. Facilitates return of blood to the heart.
Length of muscle stays constant but force increases. "Pushing on a wall" or tensing the thigh.
Shortening of the muscle without increased tension. "Flexing". Walking is a combination of both this and isometric contraction.
Calcium contracts muscle, magnesium relaxes it.
Soft tissue injury therapy
Muscles, tendons, and ligament injury need rest with gentle integration back into exercise. Education: Adhere to a regimented program with appropriate meds. Rest, ice, compression, and elevation. Weight resistant. Isometric exercises for immobilized patients.
Chief complaint - focused: focused review of symptoms, duration of problem, if recurring, and pain. ADLs, skin integrity issues, lifestyle and diet, psychosocial, physician visits - compliance with restoring health. Past health history - joint function and surgeries.
Time of day. Increased or decreased with or without activity. Pain: type, neuropathic, musculoskeletal pain (tender, cramping, or knot-like), bone pain (dull, achy, or interferes with sleep), and alleviating treatments.
Muscle strength, posture, gait, bone/joint integrity, nodules, joint function, neurovascular, and neurological associations.
Resistance testing for irregular muscle tone. Affected by electrolyte disturbances, fasciculation, and neuromuscular diseases.
Smoothness, rhythm, and balance
Crepitus - listening for grating sounds between bones. Weakness/strength
RA, Gout, osteoarthritic deformities. Symmetric (RA) or asymmetric (osteoarthritis).
ROM. Contractures - atrophy of muscles proximal or distal to joint, ligament. Effusion - swelling with fluid (knee). Acitve systemic inflammation.
Abnormal changes to: circulation, reflexive movement, sensation, and skin (palpation (texture and color).
Electrical potential of muscle and nerves. Must not be on anticoagulants.
Joint aspiration to examine synovial fluid and pain relief.
Hair must be removed at site, analgesiscs needed for pain, ice applied post procedure and education on S/S of infection.
Metastatic disease or degenerative bone disease. IV radioisotope injection, empty bladder prior to scan to <interference. Scan performed 2-3 hours later. Nursing interventions: flushing or warmth will be experienced. Patient needs hydration to distribute and eliminate isotope.
Direct visualization of joint through fiber optic endoscope. Post examination by nurse: Applies compression wrap, ice applied for edema, elevation and extension of leg, neurovascular checks, and pt. education of activity/infection.
Progressive bone loss begins at 30 years. Osteoprosis, vertebral changes, osteoarthritis.
Fibrotic - becomes stiff. Atrophy, and less elasticity - injury.
Bone disease, gradual reduction in bone mass - deterioration of bone matrix and strength - bone turnover is altered with bone resorption > bone formation - spongy, fragile bone with vertebral collapse.
Osteoporosis Risk Factors
Diet and lifestyle (low calcium, eating unhealthy), GI disease (causes poor absorption), surgery (thyroid surgery, gastric bypass), being a women, weight and stature (smaller/thinner = lower BMI), and immobility. Fractures commonly in thoracic and lumbar spine (hip and wrist).
Osteoporosis Clinical Manifestations
Shortened height and kyphosis. ADL's restrictions: Back pain, bending, walking, and sitting. They would have associated pain. They would need parathyroid and thyroid tests done to rule out Graves or PTH dysfunction. Low calcium <8.5 mg/dl. Vitamin D <12. At risk for fractures.
Diet - add calcium, leafy greens, beans, etc. Sun exposure - 30 minutes a day. Exercise - walking. Pain relief - Tylenol, ibuprofen, and alternative treatments. Sleep on back or sideline. Body movements - avoid bending over or twisting.
Noninflammatory degenerative joint disease. Most common type of primary arthritis. Cartilage breakdown leading to bone spurs (osteophytes) within the joint space and narrowing causing decreased mobility. No systemic involvement and no autoimmunity. Use tylenol for pain relief.
Osteoarthritis Risk Factors
Aging >40 years old. Obesity, athletes, labor occupations (over using the joints), females (especially AA and Hispanics) and previous injury or trauma.
Osteoarthritis Clinical Signs
Increased pain - aggravated by movement, relieved by rest. Stiffness - morning lasting <30 minutes. Functional impairment weight bearing joints/fingers. Affected joint enlargement, Bouchard's and Heberden's. Inflammatory condition due to wearing down of joint on hands. Crepitus upon palpation.
Osteoarthritis Nursing Interventions
Reduce pain with tylenol. Physical therapy - gradual increase in exercise. Mechanical aides, alternative therapies. Education on home safety - warming solutions to ease pain, plan activities accordingly and use analgesics if needed.
Systemic disease. Autoimmune disease affecting synovial tissue of distal joint. Morning stiffness lasting > 1 hour. Symmetrical joint pain. Edema, warmth, erythema, loss of function, and deformities occur bilaterally - hands and feet (swan neck). Risk factors: smoking/pollution. Virus/bacteria (Guillian-Barre). Comorbid conditions - 40% cardiovascular death.
Rheumatoid arthritis nursing management
Nutrition therapy for weight loss with rheumatoid cachexia, anemia, and increased metabolism. Dietary plan within 5 food groups - proteins with emphasis on food high in iron, vitamins (Vitamin C), alternative foods for reducing inflammation (Ginger, green tea, turmeric, coffee). Steroid use may lead to weight gain. Understanding the disease process with resources and support. Home self-care: relieving pain, sleep disturbances, altered moods, fatigue and limited mobility, and home medication to compliance with biolic DMARDS. Safety in home (should have full carpeting, limited stairs).
Incomplete disruption of the continuity of the bone. Closed: no break in the skin. Open: break in the skin which extends to broken area of bone. Requires immediate immobilization -splint or casting. Symptoms: pain, loss of function, deformity, shortening, crepitus, and localized edema and redness.
Care for Fractures
Maintain alignment, assess for bleeding/edema, pain relief, ice and elevation, keep client warm, prepare for surgery if necessary, neurovascular checks for blood flow, and isometric and muscle exercises post operative.
Total Hip Replacement
Joint arthroplasty - surgical removal of unhealthy joint and replaced with metal or synthetic components. Treats severe joint pain, disability. Repair and management of joint fractures or joint necrosis. Osteoarthritis, rheumatoid arthritis, and femoral neck fractures. Nursing Interventions: prevent infection, antibiotic administration <60 minutes prior to surgery and after. Neurovascular checks - baseline assessment paramount. Post-op assessment during recover.
Prevention of Hip Prosthesis Dislocation
No adduction, full flexion at hip, no internal rotation of bilateral legs, and no flexion >90 degrees.
Considerations for Hip Replacement Patients
Alignment must be maintained for up to 4 months. Supine, HOB slight elevation, legs in neutral position. Abduction splint or wedge pillow needed for re-positioning. High seat chairs, raised bedside commode, reclining chairs. Early ambulation.
Monitor for Possible complications for hip replacement
Monitor wound drainage, normal 200-500mL in first 24 hours. 8 hours or by day #2 (48 hours): 30mL or less. Notify physician of foul smelling or excessive drainage promptly. Prevent VTE (venous thromboembolism), appropriate pharmacologic prophylaxis with compression boots. S/S of DVT: pain, tenderness, edema, temp. difference, and discoloration. S/S of PE: Acute dyspnea, tachycardia, confusion, chest pain, and cough.
Prevent fat embolism
Usually in femur fractures. Early immobilization of fractured bone, support with positioning, adequate hydration. S/S: life threatening. Subtle mental status changes (hypoxia), tachypnea/tachycardia/dyspnea/chest pain/crackles. Petechial rash.
S/S of Hip replacement complications
Popping sensation heard by client, acute pain, awkward looking position of joint/leg, decreased mobility and movement. This is a medical emergency, reposition joint in alignment, and call provider. Acute infection can occur up to 3 months post-op, and delayed infection can occur 4-24 months after.
Total Knee Arthroplasty
Nursing Interventions: Compression bandage and ice packs applied post-op. Encourage active flexion exercises every hour. Promote mobilization within first post-op day, acute rehabilitation 1-2 weeks. Knee immobilizer device at discharge.
Life threatening increased pressure within the compartment that is encased by bone or fascia. Deep throbbing pain out of proportion to injury despite pain medication administration. Intensifies with passive ROM, due to edema or hemorrhage from fracture site, and causes nerve and muscle anoxia and if > 4 hours muscle death.
Compartment syndrome nursing interventions
Call provider, maintain extremity at Level of heart, remove cast or compression wrapping, neurovascular checks, pulselessness is a late sign, monitor for DVT or DIC (disseminated intravascular coagulation).
Removal of a body part, most often a limb, used to relieve symptoms, improve function, and save the person's life. Caused by vascular disease, diabetes, fulminating gas gangrene, trauma, burns/frostbites/electrical explosions/ballistics, congenital, malignancies, and chronic osteomyelitis. Males and African Americans > risk for vascualr and traumatic events that females.
S/S of Respiratory Disease
Cough/sputum, hemoptysis and wheezing, chest pain, clubbing of finger nails, central cyanosis, use of accessory muscles to breath, and adventitious sounds.
Hi-pitched musical sound. On expiration for asthma, and on inspiration for bronchitis. Caused by broncho-constriction or airway narrowing.
Expectoration of blood from respiratory tract, usually frothy. Common causes: pulmonary infection, carcinoma of lung, abnormalities of heart/blood vessels. Pulmonary artery or vein abnormalities and PE or infarction.
Clubbing of the fingers
A sign of lung disease: chronic hypoxic conditions, chronic lung infections, and malignancies of the lungs.
Pulmonary Function Tests (PFTs)
Routinely used to diagnosis chronic respiratory disorders. Used to monitor treatment effectiveness, spirometry - forcefully exhale.
Arterial blood gases
Assesses the ability of the lungs to provide adequate oxygen and remove carbon dioxide and maintain pH.
Better to distinguish between normal and abnormal tissues compared to a CT scan. Contraindications: confusion, agitation, claustrophobia, and implantable metal. Nursing Interventions: All metal must be removed (nictotine patches), client will lie flat for 30-90 minutes. Client will hear loud thumping/humming noise, communicates via microphone, if claustrophobic, may need anti-anxiety medication, if confused may need to be sedation.
Nursing Interventions: informed consent, NPO 4-8 hours to prevent aspiration, dentures to be removed, patient is sedated, and topical anesthetic used to supress cough reflex. Complications: infection, aspiration, hypoxia, pneumothorax, bleeding, and perforation.
Aspiration of fluid and air from fluid space. Used for both diagnostic or therapeutic purposes. Can be used to instill medication into the pleural space. Complications: Collapsed lung.
Infection of the lungs, inflammation of the lung parenchyma (any part of lungs), inflammatory response, exudate is produced-interfering with diffusion of O2 or Co2. WBCs fill the air space, areas of the lungs are not properly ventilated. Hpypoxemia occurs.
Community acquired pneumonia
Occurs in the community or within the first 48 hours after hospitalized.
Health care acquired pneumonia (HCAP)
Non-hospitalized patient with extensive health care contact. Hospitalized within last 90 days, resident of long term care facility, home infusion therapy, wound care, or hemodialysis patient. Causative agent: often multi-drug resistant. Do not delay antibiotic treatment.
Hospital Acquired Pneumonia (HAP)
Develops 48 hours or more after hospital admission - does not appear to be incubating at time of admission. Virulent organisms such as MRSA or multi-drug resistant organisms. Occurs with underlying medical disorders, associated with high mortality.
A subtype of HAP. Patient has been intubated and received mechanical support for at least 48 hours.
Risk factors for pneumonia
Prior infection: flu or cold. Weak immune system: elderly, infants, autoimmune medications. Immobile: strokes or any other condition that causes decreased mental awareness or restrict ability to move. Lung problems: COPD, asthma, smokers. Post-op patients: not coughing or deep breathing.
Productive cough, pleuritic pain, neuro changes (esp. elderly), elevated labs: PCO2>45, increased WBC, unusual breath sounds, mild to high fever, oxygen saturation decreased, nausea and vomiting/loss appetite, increased heart rate, and aching all over with joint pain, activity intolerance with SOB.
Pneumonia Nursing Interventions
Monitor respiratory system, administration of ordered antibiotics (if bacterial), make sure to obtain cultures prior to starting antibiotics. Head of bed raised, removal of secretions (hydration, humidification, turning + positioning, and encourage deep breathing and coughing), rest avoidance of over exertion, and maintain nutrition. Educate of vaccines, stop smoking, avoid sick people. Monitor for complications (such as sepsis) and vital signs! Incentive spirometer to prevent atelectasis.
A systemic response to infection. It is manifested by two of the following: temp >38 C or 100.4 F, HR>90, RR>20, WBC>1200, or drop in O2 sat.
Circulatory imbalances occur and are profound. Hemodynamically unstable, perfusion that is not adequate to promote organ function, Hypotension and increased mortality.
Inhalation of foreign substances into the lungs. Leads to tachycardia, dsypnea, and hypotension. Risk factors: seizures, brain injury, decreased LOC, lying flat, stroke, swallowing disorders, and cardiac arrest. Prevention: Maintain HOB 30-45 degree angle. Use sedatives sparingly, before NG feed- confirm placement, monitor at risk patients.
Chronic bronchitis, emphysema, or both. Lungs abnormal inflammatory response to noxious particles or gas. Chronic inflammation occurs and body attempts to repair it, narrowing occurs in airways. Hypersecretion of mucus occurs. Preventable, treatable, but not full reversible.
Presence of cough and sputum production for at least three months in each of 2 consecutive years, lungs respond to smoke or other pollutants. Inflammation occurs, hyper secretion of mucous occurs, bronchial lumen decreases, and Pt. is more susceptible to respiratory to infection. Blue bloaters, causes shortness of breath, cyanosis and increase lung volume and edema.
Impaired O2 and CO2 exchange resulting from destruction of walls over distended alveoli, alveolar surface in direct contact with pulmonary capillaries continuously decreases leading to an increase in dead space. Decrease in O2 diffusion leads to hypoxemia. Co2 elimination is impaired leading to Co2 retention leads to respiratory acidosis. End stage progresses slowly over years. Pink puffers, shortness of breath, hyperventiliation, weight loss (from breathing), barrel chest.
COPD risk factors
Exposure to tobacco: 80-90%, second hand smoke, increasing age, occupational exposure, air pollution, certain genetic abnormalities, intensity of smoking related to the decline of pulmonary function.
Decreased breath sounds, expiratory wheezes, use of accessory muscles, barrel chest, clubbing of fingers, unable to finish a sentence without becoming short of breath.
Bronchodilators, corticosteroids, influenza and pneumonia vaccines. Stabilize the disease to reduce risk and symptoms, stop smoking.
Respiratoy insufficiency, respiratory failure, pneumonia, chronic atelectasis, pneumothorax, pulmonary arterial hypertension, abnormal enlargement of the right side of the heart as a result of disease of the lungs (cor pulmonale).
COPD nursing interventions
Breathing exercises (diaphragmatic breathing, pursed-lip breathing), effective coughing techniques, tripod positioning, pulmonary rehab (chest physiotherapy, vibration, postural drainage), nutritional therapy, vaccinations, coping measures, COPD action plan.
Chronic inflammatory disease of the airways. Largely reversible, the death rate from asthma continues to rise, experience symptom free periods alternating with exacerbations. Airway hyper-responsiveness, mucosal edema, mucous production, bronchoconstriction. Common symptoms: cough, dyspnea, wheezing, and chest tightness.
Cough with or without mucous production, mucus can be tightly wedged in the narrow airway that it can't be coughed up. Generalized wheezing (on expiration, then possibly on inspiration), generalized chest tightness, dyspnea, expiration requires effort and becomes prolonged. Diaphoresis, tachycardia, hypoxemia, and central cyanosis (late sign).
Acute Asthma Treatment
1. Quick acting beta2 - adrenergic agonist - via nebulizer. 2. Systemic IV corticosteroids may be necessary. 3. Oxygen supplementation may be required 4. Antibiotics
Asthma: Life Threatening Symptoms
Dyspneic at rest, speaks in words not sentences, patient usually sitting forward, audible wheezing, RR >30, HR >120, decreasing O2 sats. Accessory muscles in the neck are use, patient often agitated. Neck vein distention, may be drowsy or confused, deteriorating blood gases (respiratory acidosis).
Asthma Attack Nursing Management
Assessment of: Respiratory status, severity of symptoms, breath sounds, vital signs, pulse oximetry. Interventions: baseline vital signs, keep calm and comfort patient, auscultate lung sounds throughout. Administer bronchodilators as ordered by provider, administer O2, monitor skin color and WOB, peak flow, and patient may become dehydrated and need IV fluids. ABGs.
Asthma Nursing Teaching
How to identify and avoid triggers, how to use inhalers, how to use a nebulizer, how to perform peak flow monitoring, med. education on quick relief and long acting medication.s How to implement an asthma action plan, and when/how to seek assistance.
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