Term
|
Definition
| Peripheral artery disease |
|
|
Term
| Areas most affected by PAD |
|
Definition
| aortoiliac, femoral, popliteal, tibial, peroneal |
|
|
Term
| Most common area affected in non diabetic patients |
|
Definition
|
|
Term
| Definition of INTERMITTANT CLAUDICATION |
|
Definition
| Ischemic muscle ache/pain precipitated by a consistent level of exercise |
|
|
Term
| Relief of intermittant claudication |
|
Definition
| rest; usually 10 minutes or less |
|
|
Term
|
Definition
manifested by n/t in the toes or feet
RESULTS from nerve tissue ischemia |
|
|
Term
|
Definition
| Produces excruciating shooting/burning pain in the extremity |
|
|
Term
| What happens when there is diminished perfusion? |
|
Definition
| Perfusion to neurons=loss of pressure & deep pain sensations. Injury to extremity goes unnoticed. |
|
|
Term
| Skin appearance changes with inadequate blood flow |
|
Definition
| Skin becomes thin, shiny and taut. Loss of hair on lower legs, diminished or absent pedal, popliteal or femoral pulses. Pallor, blanching when elevated; hyperemia (redness when hung in dependant position. |
|
|
Term
|
Definition
| Happens forefoot/toes; aggravated by limb elevation; insufficiient blood flow to maintain basic metabolic requirements of the tissues and nerves of distal extremity. Occurs @ night-CO tends to drop and the limbs are at the level of the heart. Ptnt attempts to relieve by hanging over bed. |
|
|
Term
| Arterial Ulcers---where do they most commonly occur? and what do they look like: |
|
Definition
| Bony prominences on the toes, feet, and lower leg. Red, cool, shinny, decrease or absent pulses, rounded, dry |
|
|
Term
Common complications are arterial ulcers
End stage PAD |
|
Definition
| nonhealing and gangrene---amputation if blood flow not restored or if infection occurs. |
|
|
Term
| What do Diagnostic studies for PAD tell us? |
|
Definition
Doppler US-speed of blood flow
ABI-bipass graft patency
Duplex imaging-blood flow through the region of the artery
Angiography-determine the location and extent of the disease process; inflow and outflow vessels to plan for surgery. |
|
|
Term
| PAD increases risk of...... |
|
Definition
| MI, ischemic stroke, cardiovascular related death |
|
|
Term
| FIRST treatment goal for PAD |
|
Definition
| Smoking cessation (critical for slowing the progression) |
|
|
Term
| First line of oral anti-platelet therapy for PAD patients |
|
Definition
|
|
Term
| What type of patient can not tolerate aspirin therapy? |
|
Definition
|
|
Term
| What is the primary nonpharmacologic tx for claudication |
|
Definition
A formal extercise training program.
HOW? increase collateral blood flow to the legs and improves O2 extraction in the legs, skeletal muscle metabolism and vascular endothelial function. |
|
|
Term
| Instructions for a walking program |
|
Definition
| Warm up, walk to the point of discomfort, stop and rest, then resume walking again until discomfort occurs. |
|
|
Term
| PAD and nutritional therapy |
|
Definition
| BMI<25 and waist circum <40M; <35W; cholesterol <200mg/day. Soy proteins in place of animal proteins, sodium no more than 2g/day. |
|
|
Term
| What do you NOT DO to an affected limb.... |
|
Definition
| Soak it....do not do.....need to avoid skin maceration (breakdown). Keep limb DRY/CLEAN. DO NOT put HEAT or COLD on. |
|
|
Term
|
Definition
| Keep clean, dry, wrapped in dry dressing, sterile. If blood flow is not restored.....healing will not take place. |
|
|
Term
| Peripheral arterial bypass surgery |
|
Definition
| Uses native vein or synthetic graft material to bypass/carry blood around the lesion. |
|
|
Term
|
Definition
| Used for long bypasses ie. axillary-femoral or axillary-popliteal bypass. |
|
|
Term
| ENDARTERECTOMY-procedure? |
|
Definition
| Opening the artery and removing the plaque |
|
|
Term
| WHAT IS Patch-graft antioplasty |
|
Definition
| Opening the artery, removing the plaque and sewing a patch to the opening to widen the lumen. |
|
|
Term
| Drugs used to prevent bypass graft failure |
|
Definition
| Aspirin, ticlopiding, clopidogrel, dextran, heparin, anticoagulation agents |
|
|
Term
| Least desirable end-stage surgical option |
|
Definition
|
|
Term
|
Definition
| tobacco use, regular physical activity, diet modification-reducing cholesterol, saturated fat, refined sugar; proper care of the feet, avoidance of injury to the extremities. |
|
|
Term
| Post-surgical/radiological intervention |
|
Definition
| Assess extremity Q15m for the first hour, then hourly for skin color, temperature, cap reill, presence of peripheral pulses, sensation/movement. ABI should increase from the patient's baseline. |
|
|
Term
| NI: Loss of peripheral pulses/and or change in US doppler sound over a pulse |
|
Definition
|
|
Term
|
Definition
| should be compared with pre-operative/baseline findings and those in the opposite limb. May be opioid tolerant; may require aggressive pain management post-op. |
|
|
Term
|
Definition
| bleeding, hematoma, thrombosis, embolization and compartment syndrome |
|
|
Term
| Manifestations of Occlusion of the bipass graft |
|
Definition
| Severe increase of pain, loss of palpable pulse or pulses distal to the operative site, extremity pallor or cyanosis, decreasing ABIs, numbness, tingling, cold extremity |
|
|
Term
|
Definition
Knee-flexed-avoided except when exercising
Turned/positioned frequently with pillows to cushion the incision
First day post-op...patient out of bed several times
DO NOT sit for long periods of time (may cause edema,stress to incision line, discomfort, and may increase DVT)
Gradual physical activity post-op; regular physical activity has been shown to improve a number of cardiovascular risk factors including hypertension, high cholesterol, obesity and glucose levels |
|
|
Term
|
Definition
| Reclining position, leg is elevated above the heart level. Occassionally elastic bandages or elastic support stocking are used to control edema. Walking short distances is encouraged, use of a walker is OK. |
|
|
Term
| DEFINITION OF Acute Arterial Ischemia |
|
Definition
| Sudden interuption inthe arterial blood supply to tissue, an organ, or extremity. |
|
|
Term
| If Acute Arterial Ischemia is left untreated....... |
|
Definition
|
|
Term
| CAUSE of Acute Arterial Ischemia |
|
Definition
| Embolism, thrombosis of a preexisting atherosclerotic artery or trauma, venous outflow obstruction, low-flow. |
|
|
Term
| CL. MAN. acute arterial ischemia |
|
Definition
|
|
Term
| What are the 6 P'S of arterial ischemia |
|
Definition
| pain, pallor, pulselessness, parasthesia, paralysis and poikilothermia (adaptation of the ischemic limb to its environmental temp...most often cool) |
|
|
Term
| Very late sign of acute arterial ischemia |
|
Definition
| Paralysis---signals death of nerves supplying the extremity. |
|
|
Term
| TX OPTIONS for acute arterial ischemia |
|
Definition
| Anticoagulation, thrombolysis, embolectomy, surgical revascularization or amputation |
|
|
Term
| TREATMENT GOAL with catheter-directed thrombolysis using a thrombolytic agent |
|
Definition
| Percutaneous cath is inserted into the femoral artery, threaded to site of clot, and drug infused. Work by directly disolving the clot over a period of 24-48 hrs. |
|
|
Term
| THROMBOANGIITIS OBLITERANS |
|
Definition
| Buerger's disease-Strong relationship to smoking |
|
|
Term
DISORDER OF THE VEINS
VENOUS THROMBOSIS |
|
Definition
| Formation of a clot associated with inflammation of the vein |
|
|
Term
| Deep Vein Thrombosis (DVT) |
|
Definition
| Thrombus in a deep vein - iliac and femoral veins; can result in embolization of thrombi to the lungs |
|
|
Term
| 3 Causes of Venous thrombosis |
|
Definition
1-venous stasis
2-damage to the endothelium (inner lining of the vein)
3-hypercoagulability of the blood |
|
|
Term
|
Definition
Venous valves are dysfunctional or the muscles of the extremities are inactive.
People who are obese, chronic heart failure or atrial fibrillation, traveling on long trips w/o exercise, prolonged surgical procedure or immobile for long periods. |
|
|
Term
| CAUSES OF Endothelial Damage |
|
Definition
| trauma, external pressure; decreased fibrinolytic properties-predisposed to thrombus development, prolonged IV catheter in same site, contaminated IV equipment, fx that causes damage to blood vessels, DM, blood pooling, burns |
|
|
Term
| Hypercoagulability of Blood |
|
Definition
| Occurs primarily in polycythemia, severe anemia, cancers of the breast, brain, pancreas and gastrointestinal tract. |
|
|
Term
| Frequent site of thrombus |
|
Definition
Calve cusps of veins-
WHY??? Venous stasis occurs |
|
|
Term
|
Definition
| May/may not have unilateral edema, extremity pain, warm skin, erythema, temperature >100.4. Calf may be tender, +Homan's sign. |
|
|
Term
| Inferior Vena Cava involvement with DVT |
|
Definition
| the LE may be edematous and cyanotic |
|
|
Term
| Superior Vena Cave involvement in DVT |
|
Definition
| symptoms in the upper extremeties, neck, back and face. |
|
|
Term
|
Definition
| PE, chronic venous insufficienty and phlegmasia cerulea dolens. |
|
|
Term
| Definition of CVI (Chronic Venous Insufficiency) |
|
Definition
| valvular destruction, allowing retrograd flow of venous blood. Persistent edema, increased pigmentation, secondary varicosities, ulceration and cyanosis of the limb when placed in dependant position. S/S often take years to develope. |
|
|
Term
| What is the easiest and most cost effective prevention for DVT |
|
Definition
| Early mobilization. Patients on bed rest need to be instructed to change positions, dorsiflex their feet, rotate their ankles every 2-4 hours. Patients who can get out of bed need to do so---eating meals in a chair and ambulate 3x p/d |
|
|
Term
| ICD (intermittant compression devices) |
|
Definition
| Can be used with compression stockings for patients with moderate, high, or very high risk of DVTs or PE. |
|
|
Term
| DVT and nonpharmacologic therapy |
|
Definition
| Hospitalized patients-bed rest, elevation of the extremity to the level of the hear, warm compresses 2-4 days---until thrombus considered stable, and no edema |
|
|
Term
|
Definition
Anticoagulants for prevention/tx
goal is to prevent DVT or prevent propagation of the clot or development of new thrombi and embolism. |
|
|
Term
| 4 Types of anticoagulants |
|
Definition
| Vit K, indirect thrombin inhibitors, direct thrombin inhibitors and factor Xa inhibitors |
|
|
Term
|
Definition
| Done to prevent re-occuring PE |
|
|
Term
| TX GOALS for ptnts with Venous thrombosis |
|
Definition
| 1-relieve pain 2-decrease edema 3-no skin ulceration 4-no complications from anticoagulant therapy 5-no evidence of pulmonary emboli |
|
|
Term
| Nursing Interventions for DVT patients |
|
Definition
| Focus on prevention of emboli and decreasing inflammation; decrease risk of bleeding; observe for signs of bleeding |
|
|
Term
| Labs to watch for patients with DVT |
|
Definition
| ACT, aPTT, INR, hemoglobin, hematocrit, pla\telet levels, liver enzymes. |
|
|
Term
| MODIFIABLE RISK FACTORS for DVT |
|
Definition
| Smoking, OC, HRT, sedentary lifestyle and obesity |
|
|
Term
|
Definition
| Calcium and vit K-have important clotting components, proper hydration, avoid excessive Vit E and alcohol, if overweight-limit caloric intake + exercise program, |
|
|
Term
| Outcomes of patients with Venous thrombosis |
|
Definition
| Minimal pain....intact skin....no signs of hemorrhage or occult bleeding....no signs of respiratory distress |
|
|
Term
|
Definition
| dilated subQ veins found in the saphenous system. May be small, large, or bulging in size. |
|
|
Term
|
Definition
| Pain often associated with prolonged standing, relieved by walking or elevating the limb. |
|
|
Term
|
Definition
| Only if incompetency of the venous system occurs. Collaborative care=compression stockings, exercise (walking), elevated limb |
|
|
Term
| How do you prevent vericose veins |
|
Definition
| Avoid standing/sitting for long periods, maintain good body weight, precautions to injuries to the extremeties, wearing constrictive clothing, participate in daily walking program. |
|
|
Term
| What is Chronic Venous Insufficiency and Venous Leg Ulcers |
|
Definition
| Valves in veins damaged; retrograde venous blood flow, pooling of blood in the legs, swelling. Result of previous DVT---venous leg ulcers |
|
|
Term
|
Definition
| Not life-threatening; however, painful, debilitating and costly chronic conditions |
|
|
Term
| CAUSE of Venous Leg Ulcers |
|
Definition
| vein incompetence, DV obstruction, congenital venous malformation, AV fistula, calf-muscle failure. Result-hydostatic pressure in veins increase-serous fluid and RBCs leak from capillaries and venules into tissue-edema. Enzymes in tissue break down RBC-release of hemosiderin-causes brownish colored skin. Skin and tissue are replaced by fibrous tissue-thick hardened, contracted skin. |
|
|
Term
|
Definition
| skin of lower leg is leathery, brownish color, persistent edema, eczema, pruritus. Higher skin temp in ankle area. |
|
|
Term
| Venous Ulcer LOCATION & CHARACTERISTICS |
|
Definition
| above the medial malleolus. can occur near lateral malleolus. Irregularly shaped wounds, typically a ruddy color. Partial thickness (EPIDERMIS & DERMIS); has drainage, painful. |
|
|
Term
| NUTRITIONAL needs and CVI |
|
Definition
| Adequate protein (meat, beans, cheese, tofu), calories, vitamins A (green leafy veggies) & C (citrus fruits, tomatoes, cantaloupe), zinc (meat and seafood). |
|
|
Term
| Patient teaching for Venous Leg Ulcers |
|
Definition
| Avoid trauma to limbs, proper skin care, level of activity, limb positioning. Avoid standing/sitting for long periods of time, elevate legs above heart to decrease edema, once healed-walk daily, compression stockings worn daily and replaced 4-6 months |
|
|
Term
| ANEMIA/NOT A DISEASE, BUT A MANIFESTATION OF A PATHOLOGIC PROCESS |
|
Definition
| Deficiency in RBCs; quantity of HGB, volume of packed RBC (Hct) |
|
|
Term
|
Definition
| blood loss, impaired production of erythrocytes, increased destruction of erythrocytes. |
|
|
Term
| ANEMIA IDENTIFIED BY..... |
|
Definition
| thorough hx, physical exam, lab review of CBC, reticulocyte count, peripheral blood smear. |
|
|
Term
| LAB to determine severity of anemia |
|
Definition
|
|
Term
| Integumentary Changes-Anemia |
|
Definition
| pallor-reduced amts of Hb and reduced blood flow to skin. Jaundice-hemolysis of RBCs results in increased concentration of serum bilirubin. Pruritus-increased serum and skin bile salt concentrations. Eyes and mucous membranes evaluated for jaundice |
|
|
Term
| Blood products that can be infussed |
|
Definition
| Whole blood, packed RBCs, frozen RBCs |
|
|
Term
|
Definition
| assure normal ADL, adequate nutrition, no complications r/t anemia. Correcting the cause of the anemia |
|
|
Term
| S/S of Anemia in Older adults |
|
Definition
| pallor, confusion, ataxia, fatigue, worsening angina, HF |
|
|
Term
|
Definition
|
|
Term
ID Anemia-PRIMARILY affects what group?
(Iron Deficiency) |
|
Definition
| Very young, poor diets, women in reproductive years |
|
|
Term
|
Definition
| inadequate dietary intake, malabsorption, blood loss or hemolysis. |
|
|
Term
Common cause of Blood Loss-Anemia
GI & GU |
|
Definition
| GI blood loss-50-75ml (stools appear black-because of lack of iron in RBC. Common causes of GI bleeds are peptic ulcers, gastritis, esophagitis, diverticuli, hemorrhoids, and neoplasia. GU loss from menstrual cycle. |
|
|
Term
|
Definition
| Pallor, glossitis (inflammation of the tongue), cheilitis (inflammation of the lips), HA, paresthesias, burning sensation of the tongue |
|
|
Term
|
Definition
| Treat underlying condition first, replace the iron, |
|
|
Term
|
Definition
| Liver and muscle meats, eggs, dried fruits, legumes, dark green leafy veggies, whole-grain and enriched bread and cereals, potatoes |
|
|
Term
| 5 FACTORS of iron replacement/supplemental therapy |
|
Definition
| 1-Absorbed best from duodenum and proximal jejunum. enteric coated or sustained released capsules are counterproductive and expensive. 2-daily dosage 150-200mg of elemental iron 3-take about one hour b4 meals; taking with OJ or vitamin C enhances absorbtion 4-liquid may stain teeth 5-GI side effects-heart burn, constiption and diarrhea (patient can take stool softner). |
|
|
Term
| SICKLE CELL DISEASE (SCD) |
|
Definition
| Group of inherited, autosomal recessive disorders, presence of abnormal form of Hb in the erythrocyte. The abnormal Hb causes the erythrocyte to stiffen and elongate taking on sickle shape in response to low O2 levels. |
|
|
Term
| More on SCD; primarily AA disease |
|
Definition
| Genetic disease, identified during infancy, incurable, often fatal by middle age from renal/pulmonary failure. |
|
|
Term
|
Definition
| Event of SCD triggered by low O2 tension in the blood |
|
|
Term
| EVENTS that can TRIGGER a Sickling Episode |
|
Definition
| Hypoxia or deoxygenation or the RBCs secondary to viral/bacterial infection, high altitude, emotional or physical stress, surgery, blood loss. Infection (most common), dehydration, acidosis, increased plasma osmolality, decreased plasma volume, low body temp. |
|
|
Term
|
Definition
| VERY PAINFUL, acute exacerbation of RBC causing vasoocclusive crisis. Ischemia, infarction and necrosis eventually occur due to lack of oxygen. Shock is possible because of severe O2 depletion and reducing the fluid volume. |
|
|
Term
|
Definition
| Pallor of mucous membranes, fatigue, decreased exercise tolerance, jaundice, prone to gallstones. Remember---skin is darker, therefore, pallor will be a grayish color. 1/2 episodes are accompanied by objective clinical signs such as swelling, fever, tenderness, tachypnea, N/V. |
|
|
Term
| PRIMARY symptom of Sickle Cell |
|
Definition
| PAIN !!!!!!! Can range from trivial to excruciating. |
|
|
Term
| What other areas of the body can be AFFECTED by SC? |
|
Definition
| Back, chest, extremeties and abdomen. |
|
|
Term
| COMPLICATIONS of sickle cell |
|
Definition
| Gradual involvement of all body systems-spleen, lungs, kidneys and brain. |
|
|
Term
| MOST COMMON CAUSE OF MORBIDITY AND MORTALITY IN PATIENTS WITH SICKLE CELL |
|
Definition
| INFECTION-why? failure of the spleen to phagocytize foreign substances and it becomes infarcted and dysfunctional. Pneumonia is the most common infection. |
|
|
Term
|
Definition
<21 days 70-80% of RBCs are good
WBCs and platelets are not viable |
|
|
Term
|
Definition
| Dyspnea, cyanosis, decreased tissue perfusion |
|
|
Term
|
Definition
|
|
Term
|
Definition
| One unit contains 250-350mls; prepared from whole blood |
|
|
Term
|
Definition
| Severe anemia, acute blood loss-preferred. One pack can increase patient's Hb by 1g/dl or Hct by 30% |
|
|
Term
|
Definition
| The use allows for remaining components of blood-platelets, albumin, plasma to be used for other purposes. Less danger of fluid overload. |
|
|
Term
|
Definition
| Frozen for up to 3 years, must be used w/i 24hrs of thawing; infrequently used 2^ filters remove most WBCs |
|
|
Term
|
Definition
|
|
Term
|
Definition
| Removing whole blood from a person and transfusing that blood back into the same person. Anticoagulants may/may not be be added b4 reinfused |
|
|
Term
|
Definition
| ONLY supports patient until underlying problem is determined/resolved. Only be used if necessary |
|
|
Term
ADMINISTRATION of blood products
BLOOD TRANSFUSION |
|
Definition
18 or 19 gauge needle
Administer with NS - others induce RBC hemolysis
Use "filter" - "Y" type
Double check blood received from blood bank with another RN |
|
|
Term
| Why Large needle 18 or 19 gauge for blood transfusion? |
|
Definition
| Able to run unit into free flowing IV line--rapid transfusion |
|
|
Term
|
Definition
| Blood runs through one side and NS runs through the other. Has filters (filters out particulate). DO NOT GIVE anything else through this tube until cleared with NS. |
|
|
Term
|
Definition
Take baseline set of vital signs (pre-transfusion)
Take VS during transfusion
Take VS post transfusion |
|
|
Term
| NURSE & PATIENT during transfusion |
|
Definition
| Stay with patient for the first 15 minutes of the infusion to make sure there is not a reaction. |
|
|
Term
|
Definition
| 2ml/min or less. Transfusion lasts less than 4 hours |
|
|
Term
ACUTE Transfusion Reaction
WHAT DO YOU DO? |
|
Definition
1-STOP transfusion
2-Maintain patent IV line with NS
3-Notify BB & Physician
4-Get set of VS |
|
|
Term
| S/S Acute Hemolytic Reaction |
|
Definition
| Chills, fever, LBP, flushing, tachycardia, dyspnea, tachypnea, hypotension, jaundice, dark urine, bleeding, acute renal failure, shock, cardiac arrest, death |
|
|
Term
| How FAST is Hemolytic Reaction? |
|
Definition
| Usually w/i the first 15 minutes |
|
|
Term
| Etiology of Acute Hemolytic Reaction |
|
Definition
| ABO incompatibility. Antibodies in the recipients serum react with antigens of the donor's RBCs. |
|
|
Term
Etiology of Mild Allergic Reactions
Blood Transfusions |
|
Definition
| Sensitivity to foreign plasma proteins |
|
|
Term
| CL Man of Mild Allergic Transfusion Reactions |
|
Definition
| Flushing, itching, uticaria (hives) |
|
|
Term
| TX for mild allergic reaction to transfusions |
|
Definition
| OK to give antihistamine, corticosteroid |
|
|
Term
| Etiology of Febrile nonhemolytic transfusion reaction |
|
Definition
| Sensitization to donors WBCs, platelets or plasma proteins |
|
|
Term
|
Definition
| Patient had 5 or more transfusions develops circulating antibodies to WBCs. |
|
|
Term
| WHAT IS THE FIRST THING A NURSE DOES IF THERE IS AN ALLERGIC REACTION, FEBRILE REACTION, CIRCULATORY OVERLOAD, OR HEMOLYTIC REACTION. |
|
Definition
| STOP THE TRANSFUSION !!!!!!! |
|
|
Term
| CL MAN Febrile non hemolytic |
|
Definition
| Sudden chills, within 1 hour of onset of transfusion, HA, flushing and tachycardia |
|
|
Term
| ETIOLOGY of Circulatory overload |
|
Definition
| Fluid administered faster than the circulation can accommodate |
|
|
Term
| CL MAN of Circulatory overload |
|
Definition
| Cough, dyspnea, pulmonary congestion, HA, HTN, tachycardia, distended neck veins |
|
|
Term
Etiology of Transfusion related acute lung injury
USUALLY HAPPENS 2-6 HRS POST TRANSFUSION
COULD TAKE UP TO 48 HRS. |
|
Definition
| Reaction b/t transfused antileukocyte antibodies and recipient's leukocytes; causing pulmonary inflammation and capillary leak. NONCARDIOGENIC PULMONARY EDEMA. |
|
|
Term
| TX of transfusion related acute lung injury |
|
Definition
|
|
Term
| Massive blood transfusion reaction |
|
Definition
| Replacement of RBCs or blood exceeds the total blood volume in 24 hours. |
|
|
Term
| Massive blood transfusion rxt cont.... |
|
Definition
| No platelets, albumin or clotting factors |
|
|
Term
| Massive blood transfusion |
|
Definition
| Hypothermia, hypocalcemia, Hyperkalemia |
|
|
Term
| DELAYED transfusion Reactions |
|
Definition
Infection-hepatitis, CMV, HIV
Iron overload-deposits in heart, liver, pancreas, joints
delayed hemolytic reaction-5-10d post transfusion, fever, mild jaundice, decreased Hgb, no acute tx needed. |
|
|
Term
|
Definition
| Vaso-occlusive crisis, splenic sequestration (blood pooling in splene), aplastic crisis (cells not able to fight off infection), septicemia |
|
|
Term
|
Definition
| Transfusion/hypertransfusion to prevent stroke, keep hbg @ 20-30%, bone marrow transplant, uric acid build-up |
|
|
Term
| TX - MANAGEMENT of vaso-occlusive crisis in SCD |
|
Definition
| Fluids, O2, pain management |
|
|
Term
|
Definition
| Opioids-need large amounts; should be on PCA pump |
|
|
Term
|
Definition
|
|
Term
| TWO drugs NOT to give for SCD |
|
Definition
Demerol-VERY dangerous drug-can cause seizures/death
Aspirin (may increase acidosis) |
|
|
Term
| Potential Complications of SCD |
|
Definition
Hypoxia-transfusion
Pain r/t ischemia and vaso-occlusion
Ineffective mgmt of therapeutic regimen |
|
|
Term
| COMPLICATIONS of Thrombocytopenia |
|
Definition
Patients do not have ability to clot--potential bleed out. NO IM injections, NO aspirin, IV stick-LOTS of pressure
Monitor CBC, Hgb, coagulation tests, platelet count |
|
|
Term
| FACTORS that may lower platelet count |
|
Definition
| Abnormal hepatic fction, durg use-anticoagulants, alcohol, administration of non-platelet fluids |
|
|
Term
|
Definition
| Increases count by 10,000ul/per unit, stored at room temp for 1-5 days, transfuse <4hrs, multiple transfusions can cause reactions (chills/fever) |
|
|
Term
| Potential HEMORRHAGE complications |
|
Definition
| Monitor fluid status, surgical/trauma sites for bleeding, S/S of shock, CNS changes (increased restlessness, anxious) |
|
|
Term
| What is the FIRST sign of hemorrhage? |
|
Definition
| More restlessness, anxiety |
|
|
Term
|
Definition
| Factor replacement,desmopressin acetate (DDAVP), pressure, ice, gelfoam, fibrin foam, topical hemostatic agents |
|
|
Term
|
Definition
| Bleeding into soft tissue, muscle, joint capsule and hemarthrosis |
|
|
Term
| NURSING CARE - Hemorrhage |
|
Definition
| Immobilize joint while bleeding (keep as flt as possible), apply ice, when bleeding quits-resume gentle, progressive ROM |
|
|
Term
| 6 KEY CONCEPTS for burn patients |
|
Definition
| Fluids, infection, pain control, psychsocial support, caloric intake, respiratory function |
|
|
Term
| What are three phases of burn care? |
|
Definition
| Emergent, Acute Rehabilitation |
|
|
Term
| Characteristics of the emergent phase |
|
Definition
| From the time of burn until the point of diuresis |
|
|
Term
| Characteristics of the ACUTE phase |
|
Definition
| The period of diuresis and ends when all burns are covered by autograft |
|
|
Term
| Characteristics of the REHABILITATION phase |
|
Definition
| Starts when the patient is first burned---wound is covered with skin/healed and patient is capable of assuming self-care...more of ADLs. |
|
|
Term
|
Definition
| Stop the skin from burning, call 911, flush with COOL water |
|
|
Term
|
Definition
| Dry, clean sheet or blanket |
|
|
Term
| After a burn....what do you remove and why |
|
Definition
| Wedding ring...anything constricting....because of edema |
|
|
Term
| First line of care when at ED |
|
Definition
Airway-Ensure patency
Check for inhalation injury - visually..burned lips, singed nose hairs, coughing black spetum |
|
|
Term
|
Definition
| Monitor pulse, BP (may need to use doppler or cardiac monitor) |
|
|
Term
| Large Bore IV - BURNS - WHY? |
|
Definition
Need good IV lines...need good line for fluids
May need two lines if TBSA >40% |
|
|
Term
|
Definition
| Change in fluid shifting, kidneys profusing and to get accurate I&O |
|
|
Term
| Information to gather re: burn |
|
Definition
| HX of burn-mechanism, timing, exact injury, patient's temp and pre-burn weight, medical hx if possible, extent of burn, pain relief |
|
|
Term
|
Definition
|
|
Term
|
Definition
| plain kling gauze-NO OINTMENT |
|
|
Term
|
Definition
| Full thickness; partial thickness; emersion burn |
|
|
Term
| How to determine BSA of burns.... |
|
Definition
|
|
Term
|
Definition
| Extent, depth of burn, location, age, risk factors, |
|
|
Term
| Partial thickness burns....MAJOR BURNS |
|
Definition
>25% TBSA for adults
>20% for kids |
|
|
Term
| Full Thickness burns....MAJOR BURNS |
|
Definition
|
|
Term
| Deep burns involving....considered Major Burns |
|
Definition
hands, face, eyes, ears, feet or perineum
complicated by smoke inhalation
chemical/electrical burns
Poor risk patients |
|
|
Term
| BREATHING in burn patients |
|
Definition
| Ineffective airway clearance r/t sputum & mucosal edema, want lungs CTA |
|
|
Term
| NURSING INTV for respiratory of burn ptnts |
|
Definition
| Fiberoptic bronchoscopy, 02 with humidified air (never give dry air), chest physiotherapy, high fowlers position (position as best we can to promote open airway). |
|
|
Term
| Circulation and the burn patient |
|
Definition
| Hypovolemic shock b/c fluid shifting. Fluids shift from intravascula to interstitial space. Insensible loss is increased(by evaporation from large area burned-no skin). |
|
|
Term
|
Definition
K shifts to extracellular space
Na shifts to interstitial space
Increase or decrease depends on tx. |
|
|
Term
| Interventions CIRCULATION/Burns |
|
Definition
fluid replacement-starting with LR
Burn shock to some degree >20% TBSA |
|
|
Term
|
Definition
PARKLAND BAXTER
4 x kg x %TBSA |
|
|
Term
Administration of FLUIDS
***Use Lund Browder Chart*** |
|
Definition
| 1/2 of calculation has to be administered within first 8 hours of burn......1/4 over the next 8 hours.......24 hours is calculated from time of injury |
|
|
Term
|
Definition
| Be careful not to flood kids with fluids |
|
|
Term
| Difference of circulation fluids for kids |
|
Definition
| The majority of the fluid is NOT given in the first 8 hours; use different chart for TBSA |
|
|
Term
| Circulation, FLUID REPLACEMENT and Monitoring |
|
Definition
UO for adults-30-50mls/hr
1ml/kg for <30kg children
Weight gain 15-20% during initial resuscitation
LOC -alert, lucid, not restless or disoriented
VS-near normal BP-most important in kids
A pulse too high or low<60 or >100 should report |
|
|
Term
| PERIPHERAL ISCHEMIA-circumferential burns of L Leg |
|
Definition
| Assess pedal pulses, temperature, color, tissue pressure measurement--the higher the number - more potential for nerve/muscle damage. |
|
|
Term
|
Definition
| Not perfusing; high pressure in limb from fluid shifting in and out of cell. If pressure not releived-patient may loose limb. |
|
|
Term
| RENAL complication w/Burns |
|
Definition
| ATN-Acute tubular necrosis may result 2^ to hypovolemia; myoglobin and hemoglobin can occlude renal tubules |
|
|
Term
| TX for renal complications in burns |
|
Definition
|
|
Term
Paralytic ileus/ Gastric ulcer
(Bowel obstruction) |
|
Definition
Monitor BS
Treatment-NPO, pepcid IVPB to prevent curling ulcer (which is a generalized stress response) |
|
|
Term
Impaired skin integrity-BURNS
VERY STRICT ISOLATION--INFECTION |
|
Definition
Goals-clean area, minimize further destruction of viable skin, promote comfort.
Intervention-clean wound, topical antibiotic, cover wound |
|
|
Term
| Comfort - PO, Interventions |
|
Definition
PO-decrease pain
Interventions-give IV meds, morphine |
|
|
Term
| Pain control for burns--DOC |
|
Definition
Morphine-ptnt should be on PCA; continuous
When calculate morphine, calculate narcan |
|
|
Term
Interrupted family process
R/T....Interventions |
|
Definition
serious illness, feelings of guilt, significant disruptions in family routine
Interventions-psychosocial support, involve family in care, refer to social service |
|
|
Term
| Acute phase-Electrolyte imbalance |
|
Definition
| Hyponatremia, Hypernatremia, Hypokalemia, Hyperkalemia |
|
|
Term
|
Definition
| due to lengthy hydrotherapy-weakness, dizziness, muscle cramps, fatigue, HA, tachycardia confusion |
|
|
Term
|
Definition
Large amounts of hypertonic solution is needed;
CL MN-thirst, dried furry tongue, lethargy, confusion and convulsions |
|
|
Term
|
Definition
lengthy hydrotherapy and increased renal excretion associated with aldosterone release-stress response
Weakness, flaccid paralysis, polyuria, decreased BP |
|
|
Term
|
Definition
Due to renal failure and massive deep muscle injury
muscle irritability, paresthesia, nausea, EKG changes, diarrhea
NEED BASELINE !!!!!! |
|
|
Term
| RISK FOR INFECTION R/T and interventions |
|
Definition
R/T burn wound, inhalation injury
interventions-avoid prophylactic antibiotics, monitor for signs of infection (increased temp, increased resp, decreased BP, decreased UO, confusion, chills, malaise), culture wound,urine, sputum, oropharynx, IV site |
|
|
Term
|
Definition
Increased metabolic needs because of wound healing
PO=weight remains 10% of preburn weight (need BASELINE)
Interventions-High protein, high carb, PO intake or NG, NI preferred - decreases NPO time, 10% of weight loss is OK |
|
|
Term
| NUTRITION NEEDS AND CALCULATION |
|
Definition
| 25 CAL x Kg + 40kcal x %TBSA |
|
|
Term
| Impaired tissue Integrity Goals and Interventions |
|
Definition
R/t burn injury
Goals-prevent extension of burn wound, promote healing
Interventions-dress wound BID-partial thickness wounds heal in 7-14 days; skin grafts-split thickness grafts, cultured epithelial autograft |
|
|
Term
Risk for disuse syndrome from being on bed rest
Watch pressure sores--use diversional activity |
|
Definition
| respiratory complications, TCDB, chest PT, auscultate lungs, impaired physical mobility-intense PT program, position with care-no pressure on graft, splinting |
|
|
Term
|
Definition
R/T dressing changes
Interventions-pain control (PCA), distraction, imagery, combine meds (Versed & Buprenex) |
|
|
Term
| Ineffective Coping R/T and Interventions |
|
Definition
R/T fear, helplessness associated w/memories of burn injury (nightmares, increased pain)
Interventions - Therapy to work through memories of accident |
|
|
Term
|
Definition
| Start ADLs-Begins at beginning of burn and ends when patient is capable of achieving ADLs. |
|
|
Term
| Impaired physical mobility-R/T & Interventions |
|
Definition
R/T contractures 2^ to shortening of skin, scarring
Interventions-full ROM, intensive PT, Home plan for exercise (3x p/day) |
|
|
Term
| Body image disturbance r/t and Interventions |
|
Definition
R/T hypertrophic scarring
Interventions-pressure keeps scars flat, pressure garment, scare matures in 24m, reconstructive surgery |
|
|
Term
| Comfort alteration R/T and Interventions |
|
Definition
R/T itching-full thickness burns-destruction of sweat glands/oil glands
Interventions-apply nivea cream, protect from pressure, protect from direct sunlight |
|
|
Term
| Risk for ineffective management of therapeutic regimen R/T and interventions |
|
Definition
R/T lack of knowledge re: post burn care
Interventions-Education...avoid contact sports, avoid hyperthermia/hypothermia, wear pressure garment, do exercises and the patient demonstrate back |
|
|
Term
|
Definition
|
|
Term
| What do you ask to make your abdominal assessment more specific? |
|
Definition
| Location? description of pain? severity? when? relieved by? what makes worse? Hx of? BS present? shape of abdomen. |
|
|
Term
|
Definition
| Fatigue, dehydration, pain is crampy, hard to localize pain |
|
|
Term
| CL MAN of GI obstruction - Older adult |
|
Definition
dehydration, crampy, stringy stool, vague complaints
young person-board like, hard stomach |
|
|
Term
|
Definition
Constipation, difussed pain, low grade fever
(with flare-up) |
|
|
Term
| 2 types of Bowel Obstruction |
|
Definition
|
|
Term
| CL MAN of Mechanical Obstruction |
|
Definition
| SMALL BOWEL- Occlusion in intestinal lumen, caused by adhesions from surgery, strangulation hernias, tumors. LARGE BOWEL - Impaction, tumors, palops, diverticulitis |
|
|
Term
| CL Man of functional bowel obstruction |
|
Definition
| Paralytic ilius, thrombus, athlerosclerosis |
|
|
Term
|
Definition
| rapid onset, vomiting often-large amounts, crampy pain, comes and goes, still has bowel movement---up until nothing is below obstruction, abdomen bloated and large |
|
|
Term
|
Definition
| gradual onset, no vomit, crampy-not as severe (low grade pain), no BM, some abdominal distention |
|
|
Term
| 4 Classic orders for Bowel obstruction-typical tx |
|
Definition
| NPO, NG-low intermittant suction, pain mgmt, start IV fluids |
|
|
Term
|
Definition
| Bacteria builds up-fluids not flushing out and begins to flourish bacteria-stimulates additional fluids into bowel, increases distention, increases intraluminal bowel present, increases capillary permability, peritoneal cavity, low BP, decreased perfusion, neucrotic tissue |
|
|
Term
|
Definition
| pain control, LIS, fluids, NG tube (conservative treatment for 48-72 hours...if patient does not respond or deteriorates, conserv tx not working---BP drops |
|
|
Term
|
Definition
Double barrel-temporary
End stoma-permanent
Loop stoma-temporary |
|
|
Term
| NURSING CARE with ostomies |
|
Definition
Protection of the skin (wafer placement)
Emotional issues (body image, patient teaching) |
|
|
Term
| Characteristics of healthy stoma |
|
Definition
| Pink in color, skin around is not broken down |
|
|
Term
| Characteristics of BAD stoma |
|
Definition
| Brown/black in color (neucrosis, ischemia), pale (poor circulation) |
|
|
Term
| Steps to changing a stoma |
|
Definition
| change wafer, measure around stoma, skin prep, put wafer on--want a good seal. |
|
|
Term
|
Definition
Irritation of the skin around the stoma
Massive redness-skin being burned from leaking fluid |
|
|
Term
| What is Chronic Constipation? |
|
Definition
| Going less than normal. Chronic when the less amount is becoming a pattern. |
|
|
Term
|
Definition
| Fluids, fiber, increase activity, check meds, stool softner, when have the urge....go !!!!! |
|
|
Term
|
Definition
| Pain in lower abdomen; urinary retention |
|
|
Term
|
Definition
| prostate enlargement (internally), blocks flow urethra, causing complete/partial obstruction |
|
|
Term
|
Definition
| Age, family hx, western civilization, high fat diet, sedentary lifestyle |
|
|
Term
|
Definition
|
|
Term
|
Definition
| Secondary to enlarged prostate--S/S weak stream, hesitancy, dribble, difficulty starting urination |
|
|
Term
|
Definition
| Secondary to infection/inflammation, urgency, bladder pain, frequency, nocturia, incontinence |
|
|
Term
|
Definition
| Retention not relieved, stage 3 or 4 pressure ulcers, needing accurate I&O, urologic surgery |
|
|
Term
| Who removes urologist placed cath? |
|
Definition
| Urologist-----they put in, they take out !!!!!!! |
|
|
Term
Meds for BPH (2)
If combined, may help more |
|
Definition
| Alpha-blockers (increase contractility-relax smooth muscle of prostate), ACE inhibitors-shrinks things down. |
|
|
Term
| Assess symptoms of BPH with what tool? |
|
Definition
| Symptom Index-tells us what life is like with disease process. |
|
|
Term
|
Definition
| PSA, UA, K, Bun, Creatn, digital rectal exam, transrectal US (size of prostate), post-void residual (immediately after urination) |
|
|
Term
| K level is high....get orders for what? |
|
Definition
| Telemetry-increased K causes arythmias, Kayexalate (given oral or enema-pulls K through stool), dialysis-removes K, but more invassive |
|
|
Term
|
Definition
Transurethrial resection of the prostate.
GOLD STANDARD of treatment for BPH |
|
|
Term
| ARF (Acute Renal Failure) |
|
Definition
| Rapid onset, most of the time reversible, progressive azotemia, electrolye and fluid changes. Labs (K, Na, BUN, Crnt) look bad---patient may be asymptomatic |
|
|
Term
|
Definition
| happens outside kidney, problem is blood flow from heart, shock, CO low, peripheral resistance low--volume & pressure |
|
|
Term
|
Definition
| Damage to the kidneys themselves-impaires nephron function-causing ischemia. Can be caused by certain meds |
|
|
Term
|
Definition
| Outside Kidney, mechanical obstruction of urinary outflow, tumor, stone, BPH |
|
|
Term
|
Definition
Initiating phase-starts then symptoms
Oliguria phase-lasts a couple of weeks
Diahretic
Recovery |
|
|
Term
|
Definition
| If pre or post and we fix the problem, the renal failure will respond quickly. If problem is not found or fixed-starts to affect the kidneys. |
|
|
Term
|
Definition
| best long-term relief for BPH, Erectile dysfunction is unlikely |
|
|
Term
|
Definition
| trauma could lead to bleeding, retrograde ejaculation-into bladder |
|
|
Term
| What is CBI (Continuous Bladder Irrigation) |
|
Definition
| 3 way drain; 1 for balloon, 1 for drain, 1 for irrigation. The irrigation line is for flushing out blood or tissue. The flushing is hooked to irrigation fluids - usually large bags. When measuring UO-keep in mind the irrigation fluid. Color of drainage should be PINK...because mixture of fluid & blood. |
|
|
Term
|
Definition
| Bladder spasm, blood clot, bleeding, urinary incontinence once cath is removed |
|
|
Term
|
Definition
| Painful-treat with Belladonna supository |
|
|
Term
|
Definition
| manual flushing-use sterile technique |
|
|
Term
| Discharge teaching for BPH |
|
Definition
| Management of urinary incontinence, maintaining oral fluids, voiding q2-3 hours, S/S UTI, prevention of constipation, avoid lifting, no driving or intercourse, ejaculation issues. |
|
|
Term
|
Definition
| Heart is not pumping leading to decreased perfusion of the kidneys. S/S - decreased UO, edema (peripheral and pulmonary), bounding pulses, increased confusion |
|
|
Term
| GOALS OF TX for ARF r/t HF |
|
Definition
| Fix the heart failure-ARF will correct.....increase contractility so heart pumps more efficiently. Work on decreasing volume. |
|
|
Term
|
Definition
| Weight gain, Increased K, BUN, Crtn, increased confusion 2^ nitrogenaus waste products accumulating in CNS. Decreased UO, edema, HTN, bounding pulse, SOB |
|
|
Term
|
Definition
Phosphate binders - phoslo (take with meal)
Lasix
Volume-expanders
Dialysis (high K)
Anemic (Epogn)
Beta-blockers===HTN
ACE Inhibitors===HTN |
|
|
Term
|
Definition
| Low sodium, low protein, low K, low phosphorus, fluid restrictions |
|
|
Term
| Fluid balance for ARF ptnts |
|
Definition
| output of fluid from previous day + 600mls. |
|
|
Term
|
Definition
| Uses dextrose fluid, cath placed in the abdominal cavity, osmotic fluid (three phases), fluid in, let dwell, and drain. Orders will specify leaving dry or filled at end of exchange. Will also specify how many exchanges. ADVANTAGE-can do when sleeping |
|
|
Term
|
Definition
| Uses blood-pulled out, cleaned and put back into body. Go to a center to receive, often a disruption to lifestyle. |
|
|
Term
| Complications of dialysis |
|
Definition
| Cath is handled by dialysis nurse only, fluid in and out can lead to infection (paratinitis-remove cath, allow to heal and try again-use gentimiacin cream), add heprin to bag to break up fibrin. Fluid should be yellow-no fibrins |
|
|
Term
|
Definition
| Anastamosis b/t artery and vein--moves up the arm |
|
|
Term
Characteristics of a good fistula
Takes 3m to mature |
|
Definition
Should have bruits and thrills
That arm is off limits for BP, needle sticks, blood draws |
|
|
Term
|
Definition
| A HD cath with PIGTAIL is the only HD cath that can be used for IV fluids additionally |
|
|
Term
|
Definition
| Hypotension, blood loss during procedure, sepsis, hepititis, muscle cramps, disequalibrium changes |
|
|
Term
| Age Changes for urinary system |
|
Definition
| Muscle tone diminishes, urine not as concentrated, urine production stays same @ night, blood flow to kidneys is less, decreased bladder capacity, increased contractility |
|
|
Term
| Consequences of age related urinary changes |
|
Definition
| more frequent urination-disturbed sleep, fluid overload-body can not get rid of extra fluid, dehydration, increased risk of drug overdose, risk of UTI |
|
|
Term
| Assessment after cath removed????? |
|
Definition
| voids within 8hours-if not-can do bladder scan (999 is the most it will record), toiliting schedule Q2h, may clamp prior to removal to start training the muscles and body learns sensation of urge |
|
|
Term
| 2 Classes of incontinence |
|
Definition
|
|
Term
|
Definition
Suddenly occurs, need to find out why-delerium, stool impaction
DIAPERS acronym, |
|
|
Term
|
Definition
| ongoing, chronic in nature, urge, overflow, functional, stress incontinence |
|
|
Term
|
Definition
| ongoing, chronic in nature, urge, overflow, functional, stress incontinence |
|
|
Term
|
Definition
Suddenly occurs, need to find out why-delerium, stool impaction
DIAPERS acronym, |
|
|
Term
|
Definition
| Blood vessels widen, weakening occurs in the brain, aorta, thoracic and abdoman |
|
|
Term
|
Definition
|
|
Term
|
Definition
| Artery wall has at least one layer in tact |
|
|
Term
|
Definition
| Break in all layers (like a rupture) |
|
|
Term
|
Definition
| Diffused chest pain-otherwise no symptoms |
|
|
Term
| CL MAN Aortic arch Aneurysm |
|
Definition
| Angine (decreased blood flow), dizziness, horseness, dysphasia, edema of H/N, distended neck veins |
|
|
Term
| CL MAN of Abdominal aneurysm |
|
Definition
| Many times asymptomatic--leg pain, back pain, bowel changes, feel pulses in abdominal mass (heart bruits) |
|
|
Term
| CL MAN Anterior rupture of aneurysm |
|
Definition
| loose blood faster, shock quickly, UO decreased, cool, clammy, change in LOC, abdominal tenderness |
|
|
Term
| CL MAN Posterior aneurysm rupture |
|
Definition
| Have a lot of time to react, affects other organs, severe back pain, echamosis secondary to bleeding |
|
|
Term
| DIAGNOSTIC TESTS for size/location aneurysm |
|
Definition
| US(size), angeography(maps out entire system), MRI(location and severity), CATscan(size & presents of thrombi) |
|
|
