Nursing 171 Exam II

common cholesterol containing foods

these interfere with tissue healing

used to treat RA

limited effect on platelet function
fewer GI effects

-treatment:OA, RA, acute pain

Tx of mild to moderate OA, RA, and gouty arthritis
-severe GI toxicities

general term for any of several disorders charac. by inflamm., degeneration or metabolic derangement of connective tissue, esp. joints, muscles, tendons, bursar, fibrous tissue and ligaments

inhibits the enzyme xanthine oxidase, which prevents uric acid production

reduces the inflamm. response to the deposites of urate crystals in joint tissue

-used to treat gout

supplies the anterior portion of the heart and a portion of the RV

passes around to the left and back between the LA and LV to supply blood to those areas

supplies RA and RV and a portion of the posterior LV

amount pumped by each ventricle in 1 min
stroke vol X heart rate
5-6 L

amount of blood ejected from the ventricle per heart beat

amount of blood ejected from the ventricle at the end of the diastole

peripheral resistance or pressure the LV must overcome to eject during systole

increase HR
increase speed on impusle conduction through the AV node
increase force of atrial and ventricular contraction

decrease HR
slowed SA node rate
slowed contraction through AV node

causes decreases HR and peripheral vasodilation

stimulate the casomotor center to increase cardiac activity

peak pressure exerted against the arteries when the heart contracts

the residual pressure of the arterial system during ventricular relaxation

increased with atherosclerosis
decreased in cardiac failure of hypovolemia

perfusion pressure felt by organs of the body

blood studies for this system include serum lipids, c-reactive protein, homocysteine

when taking a stress tests hold beta-blockers for ___ hours

injection of contrast media allows visualization of the coronary arterier and the heart chambers
-used to diagnose severity of CAD

major cause of CAD

nonspecific marker of inflamm.
increased in patients with CAD

CAD
earliest lesions; potentially reversible
characterized by lipid-filled smooth muscle cells

CAD
beginning of progressive changes in the arterial wall
collagen forming a fibroud plaque that appears grayish or whitish
result=narowing of vessel lumen

continued inflamm. can result in plaque instability, ulceration and rupture
platelets accumulate and a thrombis forms
increased narrowing of total occlusion of lumen

drugs that restrict lipoprotein production;

drugs that increase lipoprotein removal

drugs that decrease cholesterol absorption

antiplatelet therapy

intermittent chest pain that occurs over a long period with the same pattern of onset, duration, and intensity of symptoms, rarely sharp or stabbing; does not change with position or breathing

reversible myocardial ischemia=
O2 demand>O2 supply

occurs in the absense of any subjective symptoms; confirmed with ECG changes; prevalent in persons with diabetesumn

occurs only at night but not necessarily during sleep

chest pain that only occurs while lying down; relieved by standing or sitting

unpredictable and unrelieved by rest
characterized by progressive severity

occurs usually in response in coronary spasm; may occur in the absence of CAD;

myocardial ischemia occurs as a result of two factors

most MIs involve the _____ ____

described as heaviness, constriction, tightness, burning, pressure or crushing

common locations: substernal, retrosternal or epigastric areas; pain may radiate

initially increased HR and BP and then decreased BP; crackles, jugular vein disten., vasoconstriction

requires cardiopulmonary bypass; uses arteries and veins for grafts

elevated BP with a specific cause

produces increased vasoconstriction, increased heartrate, increased Renin release

weight loss of ____ may decrease SBP by approx______-_____mm Hg

with hypertension a person should reduce sodium to ____

heart is unable to produce an adequate cardiac output to meet metabolic needs

increase in the muscle mass and caridc wall thickness in response to chroin dilation; heart muscle has ^O2 needs, poor contractillity, poor CA circulation

most common type of HF

ventricular dysfunction, back up of blood in atrium and pulmonary veins
1.pulmonary congestion
2.pulmonary edema

ventricular MI, backup of blood into the atrium and venous systemic circulation
1. jugular vein distention
2. hepatomegaly
3.Ascites(fluid in body cavity)
4. peripheral edema

S/S: fatigue, dyspnea, persistent, dry cough, unrelieved with position change or OTC cough suppressants, dependant edema, sudden game >3lbs

diagnostic studies to determine HF:

these drugs are used in the treatment of HF

used in heart failure and to control ventricular response to Afib, or flutter; drug levels must be monitored; love K increases its toxicity

^in force and velocity of myocardial contraction, w/o ^ in O2 consumption; results in reduced heart rate and improved cardiac efficiency; avoid high Fiber foods; visual disturbances

these bypass the liver and experience a lrg first-pass effect
potent dilator of coronary arteries

cause vasoconstriction due to relacation of smooth muscles, results in reduced O2 demand; alleviate coronary artery spasms
1. used for treatment of ischemic heart conditions(angina)

used in the Tx of angina, HTN, cardiac disrhythmias

especially used in the treatment of exertional angina

decreased HR, resulting in decreased myocardial O2 deman and ^ O2 delivery to the heart; decreased myocardial contractility, helping to conserve energy or decrease demand

block the harmful effecs of catecholamines, thus improving survival after MI
1. cause constipation
2. never be abuptly dicontinued

first line drugs for treatment of angina, HTN, and supraventricular tachycardia, coronary artery spasms (prinzmetals angina), short term A-fib and flutter

cause coronary artery vasodilation, peripheral arterial vasodilation, decreasing systemic vascular resistance, reduce the workload of the heart,
RESULT: decreased myocardial O2 demand

block the enzyme in the kidneys that converts angiotension 1 into angiotension II; recommended for anterior wall MIs or MIs that result in decreased lft vent function

can prevent of slow the progression of HF; results in dilation of peripheral blood vessels; ^ ejection fraction

results in the removal of sodium and water

inhibits sodium and chloride resorption; potent diuresis and subsequent loss of fluid
1. causes K depletion, ototoxicity

word in collecting ducts and distal convuluted tubules; block the resoption of sodium and water usually induced by aldosterone

prevents K from being pumped into the tubule, thus preventing its secretion; blocks the aldostone receptors and inhibit its action
1. hyperkalemia
2. weakness

act primarily in the dital convoluted tubule to inhibit tubular resorption of sodium, chloride, and potassium ions
RESULTS: water, sodium and cholirde excretion; dilate the arterioles by direct relaxation

monitored by activated partial thromboplastin times (aPTTs)

effects reversed by protamine sulfate

monitored by prothrombin time (PT) and INR (PT-INR)

this is given for warfarin toxicity

drugs that break down or lyse, preformed clots; reestablish blood flow to the heart muscle via coronary arteries, preventing tissue destruction

most potent LDL reducers
lower the rate of cholesterol production

inhibit the synthesis of cholesterol in the liver by blocking HMG-CoA reductase, which is used by the liver to produce cholesterol

this antilipidemics can cause myopathy, possibly leading to the serious condition rhabdomyolysis

inhibits synthesis and secrection of VLDL and LDL; thought to ^ activity of lipase which breaks down lipids

effective in lowering trigylceride, total serum cholesterol, and LDL levels; ^ HDL level

believed to work by activating lipase, which breaks down cholesterol;
1.suppress release of free fatty acid from the adipose tissue, inhibits sythesis of trigylcerides in the liver

decrease the triglyceride levels
^HDL by as much as 25%

prevent resorption or bile acids from the small intestine; used in the relief of pruritus associated with partial biliary obstruction

inhibits absorption of cholesterol and related sterols from the small intestine
-results in reduced total cholesterol, LDL, triglyceride level, also increases HDL levels

this antihypertensive is bad for CHF and renal failure

results in the depression of smooth and cardian muscle leads to depression of contraction, decreases contractiliy

these medications end in "pril"
-captopril
-Lisinopril
-Qinapril
-Enalapril

these meds end in "olol"
-Metoprolol
-Atenolol
-Propanolol
-Nadolol

these meds end in "azosin"
-Doxazosin(cardura)
-Prazosin
-Terazosin

these meds end in "ilol and alol"
-Carvedilol (Coreg)
-Labatalol

these meds end in "sartan"
-irbesartan(avapro)
-losartan(cozaar)
-valsartan(Diovan)

these meds end in "dipine, azem, amil"
-amlodipine(Norvasc)
-Diltiazem(Cardizem)
-Verapamil

these med end in "ide"
-Bumetanide(Bumex)
-Furosemide(Lasix)

these are present in muscle tissue and are released into the blood stream following myocardial damage, and aid in the diagnosis of MI

-this is a specific indicator of myocardial damage (0-6%)
-rises in the bloodsteam w/in 4-6 hours following myocardial damage, peaks in 18-24 hours
-returns to normal in 72-96 hours

-protein found in both cardiac and skeletal muscle(12-75 or 20-90)
-released from myocardium w/in 2-6 hr and peaks at 8-12 hr.

-^concentration in the heart, skeletal muscles, RBC's, liver, kidney, lung and brain
-high levels occur 12-24 hours after MI, peak occurs 2-5 days and remains elevated 6-12 days

myocardial injury marker that helps to distinguish true myocardial injury from non cardiac causes
-diagnositic window ends 24 hours after MI

-sensitive and specific indicator of an MI
-levels elevated for 5-7 days

-not usually present in body
-produced primarily by the liver buring the inflammation process due to tissue injury
-appears 6-10 hr after acute inflammation and tissue injury
-peaks 48-72 hr

this marker is increased in ruptured or eroded plaque
-normal <10ml/UL

-end product of fibrin breakdown and indicated an ongoing process of thrombus formaiton and dissolution at the site of active plaques in acute coronary syndromes
-Should be NEG

-the ventricular myocardium releases these peptides in response to ventric. dilitation and pressure overload
-associated with larger MI
-normal <80

-it predicts a future MI in healthy persons as well as mortality in the elderly

a serious side effect of of inamrinone

druges that influence the condustion of electrical inpulses

drugs that influence the rate of the heartbeat

drugs that influence the force of cardiac muscle contractions

a property of the pacemaker cells of the heart that allows self-activation

the period during the myocardium is unable to respond to electrical stimulation

a condition that leads to an increased potential for digoxin toxicity

a condition which may indicate the need for treament with digoxin-immune fab

a common cardia dysrhythmia involving atrial contractions

-causes complete emptying of ventricle during systole
-^force and velocity of myocardial contraction and total peripheral resistance
-reduces HR
-slows conduction thru AV node and bundle of HIS

binds with digoxin and digitoxin to neutralize action and rapidly reduces serum levels

rare, recurrent inflammatory vasoocclusive disorder of the small and medium sized arteries, veins and nerves of the U.E and L.E
-damages arterial wall
-eventually thrombosis and fibrosis cause tissue ischemia

S/S of this disease include claudication of the feet, hands and arms
-color and temp changes in affected limb
-paresthesia
-cold sensitivity

TX for this disease include:
-antiplatelet agents
-Ca Channel Blocker
-Alpha Blockers
-Anticoagulants

episodic vasospastic disorder of the small cutaneous arteries
-most fequently involving the fingers and toes
-color changes (white, blue then red)
-coldness, numbness, followed by throbbing, aching, then tingling and swelling

Tx for this disease includes:
-stress reduction technique
-Calcium Channel Blocker

localized platelet aggregation and fibrin entrap RBCs, WBCs, and more platelets
-50% of patients have no S/S

-palpable, firm, cardiac vein
-area around vein is tender, reddened and warm

Tx of thrombophelbitis include:

manifestations of this include:
-unilateral edema
-pain
-erythema
-warmth
-systemic temp >100.4

Tx for DVTs include:

-abnormally dilated, tortuous superficial veins
-ache and pain after prolonged standing
-pressure or cramping sensation
-swelling

-valves in the veins are damaged which results in retrograde veonous blood flow, pooling of blood in the legs and swelling

S/S of this disease are as follows:
-leathery skin
-brawny discoloration
-edema
-Puritis
-area warmth to touch

-located above the medial malleolus; can also occur near lateral malleolus
-wound margins irrg. shaped
-tissue is ruddy in color
-infection and cellulitis possible
-occasionally amputated

Tx of this disease is as follows:
-compression thru elastic wraps, Unna Boot
-moist dressing for wound healing
-diet with protein, vit. A and C, and Zinc

involves progessive narrowing and degeneration of arteries of neck, abdomen, and extremities
-atherosclerosis is the leading cause
-

S/S of peripheral arterial disease include:
-diminished or absent pedal, popliteal or femoral pulses
AND.....

Tx for PAD include:

drugs prescribed for Tx of intermittent claudication are:

the affinity of hemoglobin for oxygen

a receptor that responds to a change in the chemical composition of the fluid around it

respond to changes in the H+ ion concentration

respond to decreases in PaO2 and pH and to increases in PaCo2

what diagnostics studies are used with the respiratory system

what allergy stops people from having CT scans?

if a chest tube is placed high in the chest it is used to release _____, if it is placed low it is used to release _____

septum is bent from one side, altering air passage
-S/S; obstruct. breathing, nasal edema, dryness,

what should be withheld 2 weeks prior to septoplasty

what position should i person be placed in when they are experiencing epistaxis

the reaction of the nasal mucosa to an allergen such as pet saliva, dust mites, mold, pollen, etc

spread by airborne droplets, can survive on inanimate objects for 3 days
-common cold or coryza

what complications can result from acute viral rhinitis

cause significant morbidity and mortality
symptoms typically subside in 7 days

what is one major complication of the flu

when ostia from the sinuses are narrowed or blocked by inflamm. or swelling

what are the main Tx's for sinusitis

benign mucous masses that form slowly in response to repeated inflamm. of the sinus or nasal mucosa
-appear bluish and glossy

acute inflamm.; may include the tonsils, palate, and uvula
-can be caused by viral, bacterial, or fungal infection

what are the complications of Strept

this is often caused by inhaled corticosteroids

inflamm. of the lower respiratory tract, most ofter ciral but could also be bacterial; often follows a URI

the treatment for acute bronchitis includes ^ fluids, rest,.........

acute inflamm. of lung caused by microbial organism
-decreased cough and epiglottal reflexes may allow aspiration

what are the three ways organisms can reach the lungs causing pneumonia

onset outside hospital or during first 2 days of hopitalization; ^ midwinter

occuring 48 hours or longer after admission and not incubating at time of hospitialization

the second most common nosocomial infection

occurs from abnormal entry of secretions into lower airway; usually with hx of LOC; tube feeding is risk factor

pts at risk for this disease include;
severe protein-calorie malnutrition, immune deficiencies, chemotherapy/radiation,
transplant pts

this phase of pneumonia causes massive dilation of capillaries, causing lungs to appear red and granular

Pneumonia:
leukocyte and fibrin concolidate in affected part of the lung
-Decreased blood flow

unpon physical examination of this disease you will find; dullness on percussion, ^ fremitus, bronchial breath sounds, crackles

collapsed alveoli

pts with pneumonia should have fluid intake of atleast ___L per day and a caloric intake at least _____ per day

what are the risk factors for Buergers disease

a mugascan looks at what