Med-Surg Final (NURS 301-Liberty University)

General Adaptation Syndrome consists of what three stages?

Alarm

Resistance

Exhaustion (or recovery)

Hardiness

Individual has an internal center of locus

They have a sense of meaningfulness and personal goals and values

Sense of coherence

How the person sees the world and their place in it; more powerful than hardiness

Comprehensibility

Manageability

Meaningfulness

What does stress do to NKC's, inflammatory mediators, and immunity?

Suppresses all of the above

Name 4 ways to manage stress (List of 9)

Biofeedback

Relaxation

Imagery

Hypnosis

Therapeutic touch

4x4 breathing

Music

Prayer and encouragement

What are the three main functions of blood?

1. Transport O2, nutrients, hormones, and waste

2. Regulate fluid electrolyte balance, acid base balance, and temperature

3. Protect through clotting and immune function

What kind of tissue is blood?

Connective tissue

Where in the body is bone marrow abundant?

Sternum, scapulae, clavicle, pelvis, flat cranial bones, end of long bones

What are the two types of bone marrow?

Red (produces blood cells)

Yellow (adipose)

What is the stimulator for blood cell production?

Erythropoietin

What cells become blood cells?

Hematopoietic stem cells

Why is bone marrow aspiration performed?

To evaluate hematopoiesis or obtain a specimen for cytopathology/chromosomal abnormality testing

What are the three best places for bone marrow aspiration from ideal to less ideal?

1. Posterior iliac crest

2. Anterior iliac crest

3. Sternum

RBC lab value

4-6 million

Hgb lab value

12-18

Hct lab value

38-50

MCV lab value

80-95

MCH value

27-31

MCHC lab value

32-36

WBC lab value

5,000-10,000

Neutrophil lab value

2,500-8,000

Platelet lab value

150,000-400,000

How do blood counts change with age?

Stem cells drop after 30 and again at 65

Hgb drops after middle age

WBCs don't increase as much with infection

Shift to the right

Fewer and older WBCs

Chronic disease

Shift to the left

High numbers of immature WBCs

Acute disease

MAP equation

(SBP + 2DBP)/3

MAP equation

(SBP + 2DBP)/3

What is a good MAP?

>70

What is an MAP that needs to be watched?

<70

1 oz is how many mL?

30 mL

cc's are the same as what?

mL's

How many pounds are in a kilogram?

2.2 pounds

A undiagnosed chest pain patient comes in with a BNP level of 74. What do you do?

Assess other things for the cause because this is an okay BNP

An undiagnosed chest pain patient comes in with a BNP level of 126. What do you do?

Notify the doctor of possible heart failure diagnosis and assess the patient

What level of BNP is indicative for HF?

100+

What is the gold standard for the diagnosis of heart failure?

BNP

What is a reticulocyte?

An immature RBC

What does a high reticulocyte mean?

RBC's are being created and destroyed rapidly

What is a normal RBC level?

4-5 for women

4-6 for men

What system does the stress response activate?

Sympathetic nervous system

What is the goal of the resistance stage?

Adaptation

Stress leaves a patient at a higher risk for what?

Infection

What is the biggest question about cardiac?

ARE THEY PERFUSING??????

Blood flow through the heart from vena cava to the body

Vena cava

Right atrium

Tricuspid

Right ventricle

Pulmonic

Lungs

Left artium

Mitral (Bicuspid)

Left ventricle

Aortic

Body

Do all arteries carry oxygenated blood?

No, the pulmonary artery is the exception

Endocardium

Thin inner lining of the heart

Myocardium

Muscular layer of the heart

Epicardium

Outer fibrous membrane of heart

Pericardium

2 layered sac surrounding the heart that protects it from friction

Visceral definition

Inner

Parietal definition

Outer

AV valves

Tricuspid and mitral (bicuspid)

Semilunar valves

Pulmonic and aortic

What direction is blood flow supposed to be?

Unidirectional

What is it called when blood flow is not unidirectional?

Turbulent

What is the risk of turbulent blood flow?

Platelet aggregation causing a clot/ thrombus/ embolus

How does the heart stay oxygenated?

The sinuses of Valsalva, located above the aortic valve cusps, open to the right and left coronary arteries and perfuse the heart

When does the heart perfuse itself?

During diastole

What happens to the heart if the diastolic blood pressure is too low?

It is not perfused

Prolonged tachycardia can lead to what heart condition?

Myocardial ischemia

What is myocardial ischemia?

Tissue hypoxia

How long can myocardial ischemia last before it becomes infarction?

20 minutes

What causes ST depression?

Myocardial ischemia

What causes ST elevation?

Myocardial infarction

List the phases of conduction from beginning to contraction

SA node

AV node

Bundle of His

Bundle branches

Purkinje fibers

Contraction

What does the P wave represent?

Atrial depolarization

What does the QRS complex represent?

Ventricular depolarization

What does the ST segment represent?

Ventricular repolarization

What does atrial fibrillation look like?

-Irregularly, irregular

-Heart rate varies from slow to rapid

-No discernible P wave

What does atrial flutter look like?

"Sawtooth"

What does ventricular tachycardia look like?

Wide QRS with no P-wave

What does ventricular fibrillation look like?

TWITCHING VENTRICLES DON'T MOVE BLOOD. undefinable waves irregular in size, shape, frequency

Cardiac output equation

CO = HR x SV

What is a normal stroke volume?

60-70

What is a normal heart rate?

60-100

What is a normal cardiac output?

4-8

Little boxes on the EKG are equal to how much time?

0.04 seconds

Big boxes on the EKG are equal to how much time?

0.2 seconds

How long should the P wave be?

0.06-0.12 seconds

How long should the P-R interval be?

0.12-0.2 seconds

How long should the QRS complex be?

0.04-0.12 seconds

Preload is...

Volume

Afterload is...

Resistance

People with chronically increased preload have what condition?

CHF

List a few reasons why there would be an increased preload

Hypervolemia (Fluid overload

Aggressive fluid resuscitation

Cardiac valve regurgitation

Pump failure (CHF)

List a few reasons why there would be a decreased preload

Hypovolemia

Bleeding

Shock

Diabetes insipidus

What main medication decreases preload?

Lasix

What affects afterload?

Size of ventricle

Vascular wall tension

Arterial BP

What main medication decrease afterload?

Nitroglycerin

Starling's law

Fibers have a greater force of contraction the more they are stretched

Think of a rubber band being stretched

What three meds increase contractility?

Epi

NorEpi

Digoxin

What three things increase the workload of the heart?

Preload

Afterload

Contractility

When the workload of the heart increases what else increases?

O2 demand

Inotrope

Force of contraction

Chronotrope

Rate of contraction

Digoxin does what related to inotrope and chronotropes?

Positive inotrope and negative chronotrope

Pumps harder and slower so check HR and BP before giving

What is the most common anemia in the US?

Iron deficiency anemia

How do you treat iron deficiency anemia?

Iron pills

What is the most common anemia for alcoholics?

Folic acid deficiency anemia

How to treat folic acid deficiency anemia?

Replace folic acid

Possible blood transfusion if Hgb is really low