Exam 5
mean arterial pressure (MAP)
(SBP + 2 DBP) ÷ 3
Presbycusis
*Sensorineural hearing loss that occurs in people as they age*, may be affected by genetic or acquired factors
What categories of drugs cause vasodilation?
- ACE inhibitors ("pril") - Calcium Channel Blockers (relaxes smooth muscle = vasodilators)- "pine" - Beta Blockers (↓renin = ↓angiotensin + ↓ angiotensin II = vasodilation)
Cardiac output
- Amount of blood pumped by each ventricle in one minute - CO= SV x HR - Stroke volume is the amount of blood ejected from one ventricle during contraction - Heat rate - Cardiac Index CO/ BSA - Ejection Fraction (EF)
Antihistamines
- Block histamine receptors, reducing the effects of histamine on body tissue First generation (most side effects)- - Diphenhydramine (Benadryl) - Promethazine (Phenergan) Second & Third generation- - Loratadine (Claritin) - Cetirizine (Zyrtec) - Fexofenadine (Allegra)
Two-career family
- Both partners work, may or may not have kids - good, affordable childcare is greatest stressor
Bradykinin
- Causes dilation of vessels - acts with prostaglandins to cause pain - increases vascular permeability - stimulates histamine release
Adolescent family
- Children born to teenagers - Parents often ill-prepared for parenthood - Children at higher risk for health, social problems
3 primary domains of learning theories
- Cognitive (thinking) - Affective (feeling) - Psychomotor (skill)
Family APGAR
- Concepts measured • Family adaptability • Partnership • Growth • Affection • Resolve
A client comes in with a broken tibia and is experiencing swelling at the site. The nurse knows that which chemical mediators are involved in this reaction (Select all that apply)
- Histamines - Complete Proteins - Bradykinins
Blood supply to the heart
- Left Coronary Artery supplies blood to left heart wall (when contracts) - Right Coronary Artery supplies blood to right heart wall
Histamine
- Mediates early acute inflammatory response: early vasodilation and increased permeability - chemically attracts eosinophils
Peripheral neuropathy symptoms
- Motor nerve damage: Muscle weakness, cramps, fasciculations (muscle twitching), muscle loss - Sensory nerve damage: Numbness, pain, burning or shooting pain, impaired touch, temperature, and pain sensation
Screening for hearing loss
- Newborns routinely screened - Pre-schoolers, school-age children screened periodically at school/healthcare provider - Early detection of problems is critical - Adults every 10 years until age 50, every 3 years after age 50
Risk Factors for Visual Impairment in older adults
- Open-angle glaucoma - Macular degeneration
Blood pressure is the result of
- Pumping action of the heart - peripheral vascular resistance - blood volume - blood viscosity
How can we reduce afterload?
- Reduce blood pressure through vasodilation or volume reduction - Repair a malfunctioning valve - Reduce the viscosity of blood
Risk Factors for Visual Impairments in children
- Retinopathy of prematurity - Low birth weight - Congenital cataracts - Fetal alcohol syndrome - Repeated bouts of otitis media
Risk Factors for Visual Impairment in adults
- Smoking - Ultraviolet Light Exposure (sunglasses) - Diabetes (uncontrolled) - Hypertension
Peripheral neuropathy treatment
- Surgery to relieve compression - Pharmacological therapy • Pain meds (NSAIDs, Lidocaine patches) • Anticonvulsants (gabapentin, elevil, SNRIs (synbaltra), Lerica, tendril, tonamax) - Therapy: PT/OT - Lifestyle Changes
Treatment of hearing loss
- Treat the underlying cause - Hearing Aids - Cochlear implants - Surgery
Vascular and Cellular Responses
- Vasoconstriction of the surrounding area - Vasodilation of the injured area - Hyperemia which causes heat and redness
During anaphylactic shock the mast cells and basophils release large amounts of histamine. What effects does histamine have on the body during anaphylactic shock? Select all that apply:*
- Vasodilation of vessels - Shifts intravascular fluid to interstitial space - constricts the airways - Stimulates contraction of GI smooth muscles - Itching
Calcium channel blockers
- agents that inhibit the entry of calcium ions into heart muscle cells, causing a - dilation of the coronary arteries and peripheral arterioles - decrease heart contractility - decrease automaticity at the SA node and conduction of the AV node (slowing of the heart rate)
Leukotrienes
- attracts neutrophils and macrophages
What body system/ receptors regulate the Heart and CV system?
- autonomic nervous system - chemo-receptors - Baro-receptors - RASS system
Mitral or aortic valve issue
- backflow into lungs - crackles, pulmonary edema - left side heart failure
Pulmonic or tricuspid valve issue
- backflow into the right ventricle which goes into right atrium back into vena cava - edema, enlarged liver, ascites - right side heart failure
LGBTQ families
- can have all previously outlined structures - differ in that two or more people share same-sex orientation - one parent might not have legal parental status
Why are beta blockers not the drug of choice for respiratory conditions, and use caution with diabetes and GI issues?
- cause bronchial constriction - cause glycogenolysis (lead to hyperglycemia) - increased GI mobility
Prostaglandins
- causes vasodilation - Acts with bradykinins to cause pain
What are vasopressors used for?
- constrict blood vessels - used to increase pre-load
What are the beneficial effects of beta blockers on the CV system?
- decrease contractility - decrease heart rate - decrease renin secretion (decreased sodium and water reabsorption)
left coronary artery
- divides into two branches: the circumflex artery and the left anterior descending artery - supplies blood to the left ventricle, left atrium, and interventricular septum
What can we give to change volume in the intravascular system?
- fluids to increase volume - diuretics to reduce volume (decrease pre-load by decreased fluid volume)
Complement proteins
- initiates chemotaxis of neutrophils and macrophages - Activates mast cells and basophils to release histamine and heparin - Onfuces series of inflammation responses that cause dilation, permeability, chemotaxis, phagocytosis, and histamine release
Baroreceptors
- located in Aortic notch, carotid sinus, vena cava, pulmonary artery • Sensitive to stretch and increased pressure • Increased arterial pressure slows HR - vasodilation • Decrease arterial pressure increases HR - vasoconstriction • Only temporary changes
Chemoreceptors
- located in aortic and carotid bodies • Respond to increased PaCO2 and to a lesser degree • Decreased PaO2 • Decreased pH • increase cardiac activity
What factors that affect circulation?
- pump - volume - electricity (SA node sending the message for the atrium to contract)
Afterload
- resistance left ventricle must overcome to circulate blood - Increased in Hypertension and Vasoconstriction
Adult learning theory
- self concept - experience - readiness to learn - orientation to learning - motivation to learn - reason to learn
Risk factors for perfusion disorders
- smoking - high cholesterol - obesity - sedentary lifestyle - hypertension -alcohol
What forces (PRESSURE) opposes ventricular ejection?
- systemic arterial pressure - value pressure - viscosity of blood
Sanguineous drainage
- thick, dark red exudate - hemoglobin of 8 - blood pressure of 95/50 - contains blood clots
purulent drainage
- thick, milky exudate - temperature - wound malodorous
Ask me 3
- used to better understand health conditions 1. What is my main problem? 2. What do I need to do? 3. Why is it important for me to do this?
Preload
- volume of blood in ventricle at end of diastole before next contraction - determines the amount of stretch placed on the ventricle - can be a bleed, volume, or vessel size issue
Lifespan considerations
- written handout should be written at a 5th to 6th grade level - patients should be educated on what reliable online resources
Factors that affect preload
-Volume in the intravascular system -Dilation of the venous system
Cognitive theory
1. Acquiring information 2. Processing information 3. using the information
Stages of inflammation
1. Stimuli 2. Vascular and Cellular Response 3. Exudate Production 4. Reparative Phase
Typical cardiac output
2-4 L
Normal CO
4-8 L/min
Average blood amount circulating
4.5-5.5L
A patient has a stroke volume of 80mL and a heart rate of 70bpm. What is the patients cardiac output?
5.6L
Normal SV
60-100 mL/beat
normal troponin level
< 0.5
Beta Natriuretic Peptide (BNP)
< 100 pg/mL - secreted by ventricular myocardium, acts as vasodilator - suppresses sympathetic tone and renin system - aids in the diagnosis in CHF
Fasting triglycerides
< 150 mg/dL
Normal serum cholesterol
< 200 mg/dL
BNP (brain natriuretic peptide)
<100 pg/mL means no heart failure
Convergence
A binocular cue for perceiving depth; the extent to which the eyes converge inward when looking at an object - prism glasses - moving pen light closer and farther away from face
CBC with differential
A lab test of WBCs, that has monocytes, lymphocytes, granulocytes, neutrophils, eosinophils, basophils - gives the percentage of types of WBCs
Nuclear family
A married couple and their unmarried children living together. - Additional support and role models in form of extended family members - Grandparents may raise children when parents cannot
Strabisms
A misalignment of the eyes. The visual system squashes vision in one eye to avoid double vision, so a person sees the world with only one eye at a time - cross-eyed
C-Reactive Protein
A nonspecific protein, produced in the liver, that becomes elevated during episodes of acute inflammation or infection. - <3 mg/L - may give false read in the presence of liver failure
Pulse
A wave of blood created by contraction of the left ventricle of and represent stroke volume
Client admitted with chest pain. Client is diaphoretic and short of breath. Client states, A nurse is admitting a client who reports chest pain. "Pain started when I began raking leaves in my yard." Pain "radiates to left arm and is a sharp pain." Cardiac enzymes indicate client is experiencing myocardial infarction. Provider notified and to prepare client for cardiac catheterization immediately.
A. Obtain Vital Signs C. Confirm the clients allergies E. Witness the clients signature on the informed consent form
Medications that cause vasodilation
ACE inhibitors
Blood vessel receptor and response
Alpha 1 - vasoconstriction
GI muscle receptor and response
Alpha 1, beta 2 - decreased GI mobility
autonomic nervous system
Alpha and Beta receptors that act as on/off switches that control the various sympathetic and parasympathetic effects in the body
12 lead ECG
An ECG that uses 12 leads attached to the patient's skin - looks at the electrical activity of the heart from different angles - identify specific areas of ischemia and infarction, as well as blocks and arrhythmias
Family
Basic unit of society and is a group of people related to each other by birth, marriage, or choice
SA and AV node receptor and response
Beta 1 - Increase HR
Cardiac muscle receptor and response
Beta 1 - Increased contractility
Kidney receptor and response
Beta 1 - Increased renin secretions
bronchial muscle receptor and response
Beta 2 - dilation
What is glycogenolysis?
Breakdown of glycogen to glucose for energy production
Chemical mediators of inflammation
Cellular injury -> Mast cell -> Release of chemical mediators -> 1. Vasodilation (redness, heat) 2. Vascular permeability (edema) 3. cellular infiltration (pus) 4. Thrombosis (clots) 5. Stimulation of nerve endings (pain)
Rhine test
Compares Air conduction (AC) with bone conduction (BC). Place fork on mastoid process, then quickly place next to ear canal comparing how long pt could hear the tuning fork in each location.
CUSHY CARL
Cushing-like symptoms bUffalo hump Sodium; Sweating Headache;hyperglycemia Increase: BP, HR, appetite Not healing quickly GI upset
DASH diet
Dietary Approaches to Stop Hypertension - potassium-rich vegetables and fruits and low-fat dairy products; includes whole grains, poultry, fish and nuts and limits sodium, red meat, and added sugars.
Med that affect hearing?
Diuretics
Binuclear
Divorced parents assume joint custody of children
Factors the inhibit learning
Emotions Cultural considerations Physiologic Status Psychomotor ability (muscle strength, coordination, energy, cognitive impairments) Time
What normal conditions would cause an increase in CO?
Exercise, increase in temp., stress
How can we reduce volume?
Fluid restriction and/or diuretics
Exudate
Fluid that has leaked out of the blood vessels, cytokines, histamines, dead tissue cells, inured tissue cells, and dead phagocytic cells are in the exudate.
Self-Awareness
Formation of reality-based perception of self
A nurse is planning to calculate a client's cardiac output. Which of the following data should the nurse obtain to calculate the cardiac output?
Heart rate - CO= SV x HR
Pulmonic valve
Heart valve between the right ventricle and pulmonary artery
increased contractility
Increases emptying of the heart
How do ACE inhibitors regulate the heart and CV system?
Inhibit ACE so angiotensin II is not formed, causes vasodilation
Hystagmus
Involuntary unilateral or bilateral rhythmic movements of the eye
What is a 12 lead EKG looking for?
Ischemia
What types of fluids are used for volume expansion?
Isotonic
Lub sound
Mitral and tricuspid valves closing (atrium squeezing)
Intergenerational family
More than two generations of a family living together
Factors the facilitate learning
Motivation Readiness Active Involvement Relevance Feedback Non-judgmental support Information that proceeds from simple to complex Repetition Timing Environment
Leukocyte extravasation
Neutrophils exit from blood vessels at sites of injury and inflammation in 4 steps: 1.) Margination 2.) Rolling 3.) Adhesion 4.) Transmigration
Inflammation
Nonspecific but complex response to reduce the effects of what the body sees as harmful.
Self-concept
Personal perception formed in response to interactions with people and the environment over a lifetime
Abnormal levels of what can cause dysrythmias?
Potassium, calcium, magnesium
Friedman Family Assessment Tool
Provides method for examining whole family in context of larger community
Dub sound
Pulmonic and aortic valve closing (ventricle squeeze)
Endophthalmos
Sunken eyeballs e.g. severe dehydration, "blow out" fracture
Corticosteroids
Suppress the immune response by inhibiting the synthesis of prostaglandins, suppressing the release of histamine, and inhibiting the function of phagocytes and lymphocytes. - "sone" ending
TEACH acronym
T - teach E - empower A - advocate C - community H - health
Weber test
Test done by placing the stem of a vibrating tuning fork on the midline of the head and having the patient indicates in which ear the tone can be heard. - should hear equally in both ears
Self esteem
The degree to which a person approves of and values themselves globally (overall) and specifically (certain aspects)
Serous fluid
Thin, clear exudate
serosanguineous drainage
Thin, pink exudate
Blended family
Two parents with biological children from previous relationships - parents may be married or coparenting
Causes of neuropathy
Type 2 Diabetes, Lime disease, AIDs, Spinal injury, vitamin B deficiency, Carpal tunnel syndrome, Alcoholic neuropathy, Helium Bare (on flu vaccine)
What can we use to decrease blood pressure?
Vasodilators and diuretics
Family ecomap
Visual representation of how a family is connected to other individuals and social systems; uses circles, lines, and arrows to show family relationships and the strength and directional flow of energy and resources to and from the family.
Cellular Infiltration
WBCs leave the intravascular space and enter the site of injury
Family systems theory
Within a family, each person is interconnected with, interdependent on other members as individuals and as a group
Monochromacy
a condition in which a person has only rods or has only rods and one type of cone; in either case, the person is totally color-blind, perceiving everything in shades of gray
Cardiac catheterization
a diagnostic procedure in which a catheter is passed into a vein or artery and then guided into the heart - consent needed - awake because may need to follow directions - if femoral entry need to lay down for 6 hours; if brachial artery need to keep arm flat for 6 hours
Single-parent family
a family in which only one parent is present to care for the children - highest poverty rates headed by women
Noise Induced Hearing Loss (NIHL)
a type of nerve deafness caused by repeated exposure to extremely loud noises such as a gunshot or to moderately loud noises that continue for long periods of time (earphones)
What is the one internal vessel we can sometimes palpate?
abdominal aorta
What does it mean if you can palpate the abdominal aorta?
abdominal aortic aneurism - need to be rushed into surgery because most rupture and die from blood loss
Graphesthesia
ability to "read" a number by having it traced on the skin
stereognosis
ability to recognize objects by feeling their form, size, and weight while the eyes are closed
Cushing syndrome
adrenal gland produces too much cortisol or when people take high levels of corticosteroids long term - cause growth suppression in children - dark facial hair and amenorrhea in women
the sympathetic nervous system can influence the contractility of the heart by
adrenaline
liver receptor and response
alpha 1 and beta 2 - glycogenolysis
Cardiac index
amount of blood pumped out of the heart per minute per sq meter of body mass - cardiac output divided by body mass - 2.5 to 4
paraesthesia
an abnormal sensation, typically tingling or pricking ("pins and needles"), caused chiefly by pressure on or damage to peripheral nerves.
Foster family
an adult or couple cares for children whose biological parents are unable to care for them
Reduced ventricular relaxation is from
an increase in HR - result in less coronary circulation
P wave
atrial contraction (depolarization) - SA node to AV node
Corneal reflex
blinking in response to irritation - failure may indicate a neurological disorder
Cardiac Glycosides (Digoxin)
block the movement of sodium and potassium ions resulting in increased intracellular calcium which causes: - increased contractility to treat systolic heart failure - decrease heart rate
Cardiac enzymes
blood test to determine the level of enzymes specific to heart muscles in the blood (every 6 hours for 24 hrs) - CKMB - CPK - Troponin (rise then gradually fall off, greater than 0.1 is elevated) - Myoglobin - C reactive protein
Leukocytosis
bone marrow produces more leukocytes into the bloodstream due to a drop in circulating leukocytes
Constructivist theory
build teaching on prior knowledge and learning experience
Exophthalmos
bulging eyes - graves' disease (thyroid problem)
Vasodilation
cause an increase in blood flow to the area
vascular permeability
characterizes capacity of a blood vessel wall to allow for the flow of small molecules or cells into and out of a vessel causing edema
Snellen chart
chart used for testing visual acuity; contains letters of varying sizes and is shown from a distance of 20 ft; avg person who can read at this distance is said to have 20/20 vision
Mixed hearing loss
combination of sensorineural and conductive hearing loss
CT angiography (CTA)
computed tomography scan used to visualize vessels in the heart and other organs
Person-role conflict
conflict that occurs when an individual in a particular role is expected to perform behaviors that clash with his or her personal values
Cells and muscle of the heart receive blood from the
coronary arteries
infarction or necrotic
death of tissue due to lack of oxygen with an inability to regenerate
Why is loss of taste and smell a problem?
decrease in appetite
hypoesthesia
decreased sensation
negative inotrope
decreases contractility of the heart
Negative inotrope
decreases the force of contraction - beta blocker, calcium channel blockers (pine ending and Diltiazem), and alcohol
PR interval
delay of AV node to allow filling of ventricles by valves closing
Role performance
demonstration of behaviors or actions associated with given role
Pulse pressure
difference between systolic and diastolic pressure, normally about 40mmHg
Amblyopia
dimness of vision or the partial loss of sight, especially in one eye, without detectable disease of the eye - lazy eye - eye patch first treatment
Vertigo
dizziness
Ptosis
drooping eyelid
Adrenergic agonists or blockers
drugs that inhibit the sympathetic nervous system
Anticholinergic drugs
drugs that interrupt or reduce the function of the parasympathetic system - increase heart rate - Atropine
Adrenergic Agonists
drugs that stimulate the sympathetic nervous system
Cerumen
ear wax
Self
entirety of an individual's being, including body, sensations, emotions, thought, conscious awareness of one's own being
Stress test
exercise tolerance test (ETT) determines the heart's response to physical exertion (stress) or medication - determines likelihood of blocked coronary artery
Inter-role conflict
family demands are incompatible with stresses of work-role
Family genogram
family tree format depicting relationships of family members over at least three generations
Hyperopia
farsightedness - can see far away but not close
Role strain
feeling not capable of fulfilling a role
Sympathetic nervous system
fight or flight - vasoconstriction - increased contractility - increased HR - increased renin recreations
Perfusion
flow of blood through arteries and capillaries, delivering nutrients and oxygen to cells
High-density lipoprotein (HDL)
greater than 40 mg/dL - good cholesterol
Role
grouping of behavioral expectations associated with specific societal or organizational position
Conductive hearing loss
hearing impairment caused by interference with sound or vibratory energy in the external canal, middle ear, or ossicle - impacts the outer and middle ear - sound is louder in one ear
sensorineural hearing loss
hearing loss caused by damage to the cochlea's receptor cells or to the auditory nerves; also called nerve deafness - impacts the inner ear
BNP levels of 100-300 pg/mL suggest
heart failure is present
Aortic valve
heart valve between the left ventricle and the aorta
5 cardinal signs of inflammation
heat, redness, swelling, pain, loss of function
tympanogram
how ear drum is working - see if fluid in ear or for tube placing - ear piece placed in ear and pressure and vibration used
What does ejection fraction represent?
how much blood is pushed out - 50-70%
MAP important for
hypotension because less than 60, their kidneys will not perfuse
Presbyopia
impaired nearsightedness from decreased elasticity as a result of aging
anesthesia
inability to feel
Positive inotropes
increase contractility - dopamine, dobutamine, digoxin, epinephrine, levophed, isuprel, calcium, milrone
Increased afterload=
increased cardiac workload
hyperesthesia
increased sensitivity to stimulation such as touch or pain
ischemia
insufficient blood flow of oxygenated blood to the tissues that may result in hypoxia.
Role ambiguity
lack of clarity about expectations, behaviors, or demands of role
Chronic inflammation
lasts months or years ■ inflammatory response unable to neutralize the harmful stimuli ■ persists after the invading pathogen is eradicated ■ Autoimmune disorders- immune system mistakes your own cells as pathogens
Social learning theory
learning occurs through observing or imitating - repeat demonstration
Behaviorist theory
learning occurs when an individual's response to a stimulus is either positively or negatively reinforced - important to provide positive reinforcement
High diastolic pressure means
less resting time
low-density lipoprotein (LDL)
less than 100 mg/dL - bad cholesterol
transmigrate
leukocytes leave the vessel toward the source of injury
H4 histamine receptor
located in WBCs particularly mast cells in our peripheral body parts
CBC (complete blood count)
looking at hemoglobin and platelet count
Ejection Fraction
measurement of the volume percentage of left ventricular contents ejected with each contraction - 50-70%
Erythrocyte Sedimentation Rate
measures time it takes for erythrocytes to settle to the bottom of a test tube (about an hour) - used to test for inflammation - how fast red blood cells separate - Males (0-15) and Women (0-20)
BNP levels above 300 pg/mL indicate
mild heart failure
BNP levels above 600 pg/mL indicate
moderate heart failure
Myopia
nearsightedness - can see close up but not far away
Teach Bank method
nurse teaching a particular topic then asking the patient to describe the main points from the teaching
Faster heart rate means less
oxygen
SA node
pacemaker of the heart
Personality disorder
pervasive pattern of behaviors, personal perceptions, inner experiences that are significantly incongruent with cultural expectations
H1 histamine receptor
primarily found on smooth muscle cells (GI tract), endothelium, and in the CNS
A-fib
quivering of the atrium that can cause clots
What is normal in raised intercranial pressure?
raised blood pressure
Reduced cardiac output results in
reduction of oxygenated blood reaching the body tissues (systemic effect) - can lead to shock, ischemia, cell injury, and cell death
Most common reason for changes in taste and smell?
respiratory congestion
Acute inflammation
response may occur within minutes of an injury (splinter or insect bite) or may take a few hours (bacterial infection) ■ Continues until trauma or infection is neutralized
Tinnitus
ringing in the ears - aspirin, obstruction
Lipid panel
series of blood tests (total cholesterol) used to assess risk factors of ischemic heart disease - need to be NPO before
BNP levels above 900 pg/mL indicate
severe heart failure
AV node
slows the signal of the sa node, giving adequate time for the atria to fill back up and depolarize again.
Cholinergic drugs
stimulate the parasympathetic nervous system - results in hypotension and bradycardia
Contractility
strength of a contraction - low contractility means less blood is coming out - can give Digoxin (positive inotrope) to increase muscle strength
Left anterior descending artery (widow maker)
supplies blood to the front and bottom of the left ventricle and the front of the septum - most likely to have sudden cardiac death
Circumflex artery
supplies the left atrium and the side and back of the left ventricle
right coronary artery
supplies the right atrium (SA node), right ventricle, the bottom portion of the left ventricle, and the back of the septum - abnormal electrical activity of the heart
Coronary veins
take oxygen-poor blood that has already been "used" by muscles of the heart and return it to the right atrium
Role development
teaching and modeling needed role behavior; includes socialization of individual preparing for a role
D-dimer test
tells whether a patient has a blood clot or not - ruled out if less than 250
Cardiac reserve
the ability of the heart to meet the demands of the body - RAAS system and sympathetic nervous system stimulate this - can be increased by increasing HR &/or SV
sensory perception
the ability to receive sensory input and, through various physiologic processes in the body, translate the stimulus or data into meaningful information
What is stroke volume?
the amount of blood ejected by the heart in any one contraction
Action potential
the change in electrical potential associated with the passage of an impulse along the membrane of a muscle cell or nerve cell. - result in exchange of sodium potassium and calcium causing depolarization, then repolarization
Diplopia
the perception of two images of a single object - double vision
Blood pressure
the pressure that is exerted by the blood against the walls of blood vessels
Accommodation
the process by which the eye's lens changes shape to focus near or far objects on the retina
Margination
the sticking of phagocytes to blood vessels in response to cytokines at the site of inflammation
Anoxia
total lack of oxygen in body tissues
Extended-kin network family
two nuclear families of primary or unmarried kin live in proximity to each other - Grandma lives on the same street as her two sons whom each have separate homes next to each other
Phagocytic cells
type of immune cell that can surround and kill microorganisms, ingest foreign material, and remove dead cells
transesophogeal echocardiogram (TEE)
ultrasound test that examines cardiac function and structure by using an ultrasound probe placed in the esophagus, which provides more direct views of the heart structures - no food or drink before - need ride home - numb the back of the throat (gargle lidocaine) - place bit mask in mouth during procedure - consent needs to be signed
Cohabitating family
unrelated individuals or families who live under one roof
Rosenbaum chart
used to assess near vision acuity
Mitral valve (bicuspid valve)
valve between the left atrium and the left ventricle
Tricuspid valve
valve between the right atrium and the right ventricle
T wave
ventricles relaxing
Coronary arteries fill during
ventricular relaxation
QRS complex
when the ventricles are contracting
Interprofessional conflict
wife thinks husband should cook every night when husband thinks wife should
Risk factors to hearing loss
• > 50% of cases of hearing loss at birth are linked to genetic abnormalities • > 25% due to environmental causes • Recurrent bouts of Otitis Media • Age - low birth weight - high Bilirubin level (yellow babies) - bacterial meningitis
Pharmacotherapy: Impaired Tissue (Local) Perfusion
• Anticoagulants • Thrombolytics • Lipid-lowering agents (statins) • Vasodilators • Antiplatelet agents and platelet inhibitors (aspirin)
Pharmacotherapy: Impaired Central Perfusion
• Antihypertensives • Antiarrhythmics (digoxin, calcium channel blockers, beta-blockers) • Inotropics (digoxin- positive; beta and calcium- negative) • Antianginal agents (given for chest pain) • Vasopressors (constrict blood vessels) • Vasodilators (digoxin, beta, ACE)
Tissue (Local) Perfusion interventions
• Bypass and/or graft surgery • Revascularization Procedures (Stent or angioplasty) • Endarterectomy
Central Perfusion
• Force of blood movement generated by cardiac output • Requires adequate cardiac function, blood pressure, and blood volume - impairment when cardiac output is inadequate
Poor central perfusion symptoms
• Heart rate and blood pressure measurements within normal limits • Oriented to time, place, person, and situation • Expected bilateral movement and sensation • Clear speech • Presence of carotid pulses • Absence of carotid bruit
Nursing Process: Diagnosis
• Impaired Tissue Integrity • Pain • Risk for falls • Infection • Poor tissue perfusion • Inadequate gas exchange • Need for education on healthy diet • Diarrhea
Symptoms of anaphylaxis
• Inflammation of the airways • Wheezing, labored breathing • Abnormal heart rhythm • Low blood pressure • Weakness, lightheadedness, dizziness • Anxiety, "feeling of impending doom" • Nausea, vomiting, diarrhea • Cyanosis due to decreased tissue perfusion (advanced manifestation) • Hives and itching
Central Perfusion interventions
• Pacemaker insertion • Electrical cardioversion • Ablation therapy • Intraaortic balloon pump • Cardiac valve surgery • Cardiac transplant
Inadequate cental perfusion in infants
• Poor feeding • Poor weight gain • Failure to thrive • Dusky color
Inadequate cental perfusion in toddlers and children
• Squatting and fatigue • Developmental delay (failure to hit milestones)
Tissue or Local Perfusion
• Volume of blood that flows to target tissue • Requires patent vessels, adequate hydrostatic pressure, and capillary permeability - impairment associated with loss of vessel permeability, or inadequate central perfusion - can lead to impaired blood flow, ischemia, and necrosis
Poor local perfusion symptoms
• Warm. • Pink. • Pulses palpable • Capillary refill < 2 seconds. • Ankle-brachial index, < 0.9. • No pain
Antihistamine side effects
● Anticholinergic and CNS depressant effects ● Tachycardia ● Confusion ● Tremors ● Dry mouth
Harmful Microorganisms
● Bacteria ● Viruses ● Fungi ● Helminths (parasitic worms) ● Protozoa
Corticosteroids interventions
● Do not stop abruptly ● Monitor weight ● Monitor blood glucose, especially in diabetics ● Contraindicated in patients with systemic infection (like sepsis) ● Take with food to prevent GI upset
Antihistamine interventions
● Encourage fluid intake ● Do not drink alcohol with antihistamines ● Caution with driving
Treatment for anaphylaxis
● Epinephrine- first line of treatment ○ Dilates bronchi ○ Constricts blood vessels
Fibrous Tissue (Scar Formation)
● Exudate from the inflammatory process plus fibrin provides the framework ● Granulation tissue then forms ● Scar tissue (cicatrex) remains after capillaries shrink ○ Scar tissue is more fragile and susceptible to reinjury ● Cells that have little regenerative capacity ○ Nervous ○ Muscular ○ Elastic tissues (cartilage, tendons, ligaments
For effective teaching, start an assessment of the learning needs of
● Identify the learners current understanding ● Identifies the learners learning objectives ● Identifies the learners desire to learn
Harmful chemical agents
● Internal ○ Hydrochloric acid ● External ○ Poisons ○ Gasses
Anaphylaxis
● Life threatening allergic reaction ● Result of a rapid release of inflammatory mediators to a stimulus ● Histamine plays a major role ● Most common triggers to anaphylaxis are peanuts, shellfish, milk, eggs, insect stings, latex, medications (NSAIDS, penicillin, anesthetic agents)
Regeneration
● Replacement of destroyed tissue cells by cells that are identical or similar in structure or function ● Architectural function of tissue is restored ● Cells that have great regenerative capacity ○ Skin ○ Digestive tract ○ Respiratory tract ○ Osseous ○ Lymphoid ○ Bone Marrow
What medications treat inflammation?
● Salicylates: aspirin ● Nonopioid Analgesics: acetaminophen (Tylenol) ● NSAIDS: ibuprofen (Advil, Motrin), naproxen (Alever) ● Corticosteroids ● Antihistamines
Antihistamine overdose
● Tachycardia ● Confusion ● Tremors ● Hallucinations ● Seizures ● Blurry vision ● Extreme Lethargy
Harmful physical agents
● Trauma ● Extreme temperatures ● Radiation
Corticosteroids side effects
● Weight gain ● Acne ● Hyperglycemia ● Nausea ● Impaired wound healing ● Mood changes ● Edema ● Masks signs of infection ● Suppresses immune system ● Hypertension ● Osteoporosis ● Cushing syndrome-long term use
