Exam (elaborations)
NUR 397-600 Adult I - Medsurg Exam 2 Study Guide.
- Course
- Institution
NUR 397-600 Adult I - Medsurg Exam 2 Study Guide/NUR 397-600 Adult I - Medsurg Exam 2 Study Guide.
[Show more]
Seller
Follow
bestnurse
Reviews received
Content preview
Inflammatory Heart Disease Endocardial Disease – infective organism invades endothelial lining of heart involving one or
more valves
Rheumatic endocarditis → infection of endocardium(inner layer of heart) secondary to strep
bacteria. Causes lesions in heart.
o s/s → fever, chest pain, tachy, SOB, systemic symptoms:rash on trunk, joint pain, muscle
spasms. PE: murmur, friction rub
Infective endocarditis → infection of endocardium secondary to strep or staph bacteria. Damage
to endothelial surface- attachment of infective organism to valves.
o s/s → flu-like symptoms. PE: murmur, petechiae, +blood clot
Myocarditis → inflammation of myocardium. Myocyte destruction and necrosis. Secondary to
viral, fungal, bacterial infection.
Pericarditis → outermost layer (heart encased in thin, fibrous layer)
o Need to r/o pleural effusion, tamponade- pericardiocentesis if that is the case
o Inflammation of pericardium → Both visceral(inner) & parietal(outer) layers -Viral
infection – Echovirus & coxsackievirus - s/p URI - Bacterial infection – Staph, Strep -2/2
MI – infarction pericarditis
o inc cardiac enzymes → blunt chest trauma s/s: chest pain/pressure “sharp or stabbing”
SOB
o PE: pericardial friction rub auscultated – scratchy sound. Pain relieved when sitting &
leaning forward Pericardial effusion: rub? Decreased heart sounds tamponade (Becks
Triad) *caution with a/c therapy
o Risk factors – common causes
Heart valve replacement, Intravenous drug abuse, Immunosuppression: HIV,
Cancer pt Rheumatic Fever, other infections. Malnutrition Overcrowded areas–
urban life Lower socioeconomic status
o Diagnostics/ Treatment → Dx: Lab Tests Blood cultures CBC w Diff, inc WBC– infection?
Cardiac enzymes – inc with pericarditis, ESR(erythrocyte sedimentation rate) how quickly
blood settles at the bottom of the test tube. Fast means inflammation. CRP (c-reactive
protein) (both are inflammatory markers) inc Throat. Cx: strep+? Can lead to RF Dx
Procedures EKG– heart block? ST changes Echo – inflamed heart layers Vegetation on
valve (bacterium), administer O2, administer abx, pain meds and antipyretics, encourage
rest-dec myocardial O2 demand and prevent further myocardial damage
o Tx for strep infections, prophylactic abx - HIGH RISK PTS, vaccine-up to date? Flu and
pneumonia vaccines, monitor for bleeding and cardiac tamponade
o Prophylactic antibiotic therapy: high risk patients.
o Complications from IE Infection of endocardium 2/2 strep or staph bacteria. Damage to
endothelial surface - attachment of infective organism to valves. Intravenous drug abuse.
Patients with cardiac malformation, S/S fever and flu like symptoms. PE murmur
petechiae + blood CX.
Aneurysms:
Risk factors→ advanced age, hx of HTN, smoking, atherosclerosis TEST QUESTION, connective
tissue disorders, diabetes, trauma
Common causes → congenital, mechanical, traumatic (pseudoaneurysms), inflammatory
(noninfectious), infectious (mycotic), pregnancy-related degenerative, anastomotic (post
arteriotomy)
Complications→
o aortic dissection- may be caused by sudden tear in aortic intima, opening way for blood
to enter aortic wall.
Pain- tearing, ripping, stabbing, excruciating; moves from point of origin- may be
located in the anterior chest, back, neck, throat, jaw
Circulation to any major artery can be impaired- neuro, renal, iliac, femoral
BP elevated unless tamponade or rupture
, o Complications of major arteries affected:
Dissection of carotid artery → neurologic symptoms
RN interventions → control the underlying dx/risk factors, prevent tissue damage, improve blood supply
o Position- avoid crossing legs, elevate legs to reduce swelling
o Warmth
o Exercise- builds collaterals
o Avoid vasoconstrictors → exposure to cold, avoid stress, caffeine, smoking
o Promote vasodilation → warm environment, insulated socks
o Meds → antiplatelet- reduce blood viscosity (ASA, clopidogrel (plavix)), statins
PVD → want legs elevated
o Damage or blockage in the blood vessels distant from the heart
(Arterial)
o Control the underlying disease/ risk factors
o Prevent tissue damage
o Improve blood supply
o Position – avoid crossing legs
o Avoid stress, caffeine, smoking
o Warm environment
o Insulated socks
o Lower legs (not elevate!)
(Venous) Venous obstruction= edema (from an embolus or incompitent valves)
o DVT
Rest, Warm compress, Do not massage limb, Compression stockings
Meds – AC – IV Heparin – SQ Heparin/ Lovenox → bridge to PO (Coumadin,
Pradaxa) *assess bleeding
o Venous insufficiency
Elevate legs / feet
Avoid crossing legs
Elastic compression stockings
o Varicose veins
Elastic stockings
APAP for pain
Care plans
o Antiplatelet – reduce blood viscosity
ASA
clopidogrel Plavix
o Statins
Simvastatin Zocor
Atorvastatin Lipitor
Complications
o Compartment syndrome
Medical emergency!
Tissue pressure within a confined body space restricts blood flow and results in
ischemia – can lead to irreversible tissue death!
Loosen dressings/ clothes
HTN:
Risk factors → atherosclerosis, HF, stroke, kidney failure, obesity.
, Normal fasting blood glucose → 70-110
Wbc → 5-10
RBC → 4-6
HgB → 12-14 (F) 14-18 (M)
Hct → 3x HgB
Platelets → 150,000-400,000
Na → 135-145
K → 3.5-5
Ca → 9.1 -10.9
Creatinine → 0.5-1.2
BUN → 10-20
Dysrhythmia management:
Electrical therapies:
Cardioversion- usually synched on pts R wave or counter shocked to pts underlying rhythm
o During ventricular depolarization
o Used during a-fib, a-flutter, v-tach with pulse
o Use a lot less jules (energy used when de-fibing) more beneficial and efficient to the
heart
Defibrillation-
o Use higher jules (200-300)
o V-fib, v-tach with no pulse
o Not synched
Defibrillation safety → call “all clear: and check that no one is in contact with bed or pt, re-assess
rhythm- assess pulse, resume CPR in between shocks, inspect skin under paddles for burns
Implantable cardioverter defibrillator (ICD) (last resort)→ background and uses: brady, VT
(pulseless), V-fib, shocks or paced beats, failed drug therapy, surgery, or catheter ablation.
Cardiac arrest? initiate CPR & ACLS protocols, Can externally defibrillate a client with an ICD as
long as the paddles aren’t placed directly over the pulse generator
Pacemakers → check EKG for proper sensing and capture, monitor for dysrhythmias, assess for
signs of decreased CO, prevent infection-site assessment
o Patient/family education
The benefits of buying summaries with Stuvia:
Guaranteed quality through customer reviews
Stuvia customers have reviewed more than 700,000 summaries. This how you know that you are buying the best documents.
Quick and easy check-out
You can quickly pay through credit card or Stuvia-credit for the summaries. There is no membership needed.
Focus on what matters
Your fellow students write the study notes themselves, which is why the documents are always reliable and up-to-date. This ensures you quickly get to the core!
Frequently asked questions
What do I get when I buy this document?
You get a PDF, available immediately after your purchase. The purchased document is accessible anytime, anywhere and indefinitely through your profile.
Satisfaction guarantee: how does it work?
Our satisfaction guarantee ensures that you always find a study document that suits you well. You fill out a form, and our customer service team takes care of the rest.
Who am I buying these notes from?
Stuvia is a marketplace, so you are not buying this document from us, but from seller bestnurse. Stuvia facilitates payment to the seller.
Will I be stuck with a subscription?
No, you only buy these notes for $13.49. You're not tied to anything after your purchase.
Can Stuvia be trusted?
4.6 stars on Google & Trustpilot (+1000 reviews)
81113 documents were sold in the last 30 days
Founded in 2010, the go-to place to buy study notes for 14 years now
Recently viewed by you
