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