Test 2 Gas Exchange, Perfusion
Gas Exchange
Sickle cell anemia: Inherited disorder that causes abnormal hemo
RF: Genetic, African american, northern mediterranean, hispanic, middle eastern
s/s: pain, fatigue, SOB, pallor, jaundice
Tx: Opiod analgesics on a schedule, antibiotics for infection
NC Administer IV fluids, blood products, o2 as ordered.
PT: Adequate fluid intake and rest. Prevent infection (hand hygiene, avoid crowds)
Diagnosits: RBC smear - look at the RBcs to see the shape. Gentic screening, newborn screening, gene mapping, hemoglobin electrophoreis test: Blood test that is a diagnostic for the presence of sickle cell trait or disease. CBC- H&H, RBC are decreased. Sixkle Dex Test- chemical solution add to pt blood sample, it changes the solution to cloudy if they have sickle cells
Vaso occlusive criss: RBC stick together in vessels and cause hypoxia - causing acute sever pain. Risks: Dehydration, infection, temperature changes, high altitude, smoking (vasoconstriction), stress, sugery, over physical exertion, pregancy.
Acute Chest syndrome: Red sickle cells block blood vessels in teh lungs, lung injury, tachypnea, SOB, lower 02 level, cough, chest pain
Medication-induced anemia
From like cancer wont stop the medication cuz cancer but will for others and corticosteroids, ibuprofen dark urine check kidney before,
Hemoalysis dark urin back pain
Cystic fibrosis: Mutated inherited CFTR gene which control movement of chloride and sodium in and out of the body cells. Too much salt not enough water in the cells.
S/S: Wheezing, coughing, dyspnea, msucus plugs, cyanosis, barrel-shaped chest, clubbing, chronic respiratory infections. Steatorrhea (fatty, malodorous stools), delayed growth, fat-soluble vitamin deficiency (A, D, E, K). High NaCl content in sweat, saliva, and tears
Labs: Sweat chloride test, DNA testing, PFTs, stool analysis
Tx: Medications: Bronchodilators, anticholinergis, dornase alfa antibiotics (pulomnary infections), pancreatic enzymes (take with meals and snacks). Procedures: chest physiotherapy uses percussion, virbration, postural drainge, and breathing exercises to loosen respiratory secretions. Schedule treatments before meals or 1-2 hrs after meals to avoid vomiting. Use bronchodilator 30-60 minutes before treatment.
Bronchodilator, hytonic saline/dornsase alfa,
NC: Administer oxygen. Encourage increase fluids, increase protein/calorie diet. Provide supplements (fat-soluble vitamins A, D, E, K)
RF: Genetically inherited - if both parents carry the gene 25% chance with every pregnancy. Genetic testing via saliva. Testing: Sweat testing - measures the amount of chloride in the sweat. Higher in CF clients due to salt wasting. Pilocarpine applied to the forearm or leg to induce wearing and chloride levels are measured externally.
RESPAITRY ACIDOSSIS PH LOW CO2 HIGH
Virtual support groups
Diet: high protein moderate carbs, fats, and ensure adequate salt
ABG
ph Low (7.35-7.45)-
pCO2 High(35-45)-
HCO3 High (22-26)-
PaO2 (80-100) cellular oxygen
Chest phsiotherapy
Postural drainge
Blood transfusions
STEM cell transplant
Medications
Pancreatic anzymes medicatitriple combination therapy of CFTRon is given b/c the mucus blocks bile ducts cauinsg pancreatitis and ultimately diabetes. Give WITH meals
CFTR FIXED PROTEIN
Fat soluble vitamins: A,D,E,K
Bronchodilators mucolytics
antibiotic
CFTR modulators
Hydroxyuera: Do not give to pregnat people, can pass through breast milk. N/V. lowers the WBC so if they have an infectiona dn
Crizanlizumab: Decreases the chance of a sickle cell crisis. Produces an antibody to preocue smoother blood flow. Pt have to be 16 and years and older. This an infusion. Joint pain, STOP if they have anaphalyxisis SOB, chest pain, sweating, chills, rash up to 24 hrs after getting the infustion. Do NOT give the pregant ppl.
Perfusion
Preload: Volume of blood going into the left ventricle before being pumped to the body. Amount of stretch/pressure on the cardiac muscle fibers
Afterload: Resistance the ventricle must overcome in the vessels to pump out 🇦
Contractility
Cardiac output: volume of blood the heart pumps out: HR x stroke volume (need echocardiogram to measure ejection fraction 55%-65%
Ischemia
Coronary Artery Disease: Narrowing/hardening/or buildup of plaque of the coronary arteries
RF
MONAB
M-orphine to decrease cardiac workload by vasodilating
O-xygen NRB
N-itroglycerin-vasodilator (nitrate) IV drip, paste/patch, sublingual
A-spirin - chewable 325mg
B-eta blcokers - lopressor, lower BP and HR
If a pt is going to a STEMI code need to assess allergies shellfish or contrast. Also if they take metoformin or glucophagel give mucomyst to protect kidneys.
Stress test to see if its a heart attack the excersie one or chemical one
EKG interpretation, sinus tachycardia (STEMI alert), Troponin 4.5 H,
Myocardial Infarction
Sudden blockage of blood flow to the heart due to plaque.
S/S: chest pain/discomfort (radiating to left arm), SOB, diaphoresis, dizziness, tachycardia, anxiey. Women n/v, fatigue, and pain the the back or jaw
Labs: Increase cardiac enzymes (troponin T, troponin 1)
Dx: EKG changes (ST elevation/depression, T wave inversion, abnormal Q wave), cardiac catheterization
Tx: Medications: Asprin, antiplatelet agent (clopidogrel), thrombolytics, anticoagulants, nitroglycerin, morphine, antihypertensives, (beta blocker, ACE inhibitors), statins Surger: Percutaneous coronary intervention, coronoary artery bypass graft, atherectomy (surgical removal of plaque)
NC: Administer o2 for less than 90%, moniotr for complications (HF, cardiogenic shock)
PT: Participate in cardiac rehabilitation program
Coronary Artery Bypass Grafting
Surgery to bypass one or more coronary artiers due to blockage or persistent ischemia, using the pt own blood vessels or synthetic grafts
NC: POST procedure: monitor BP d/t HTN can cause bleeding from graft, and hypotension can cause collapse of graft. Monitor temp, monitor for bleeding, LOC, fluid and electrolyte balance, cardiac rhythem, pain level
Things to do before the cardiac catherterization procedure
Vitals, allergies, IV access (2), groin shaves, assess pulses (femoral, popilteal, and pedal for femoral cath. Radia cath wanna assess radial and ulnar) Allens test hold both radial and ular test and pump hand then let go of radial . Mark the pulses. Vertify infromed consent, NPO, code status (advance directives), kidney function
ea
Going home after MI with blood thinner, antiplates, plavix, warfrain, ASA, beta blockers, ACE inhibitor “prin” HTN managment, lower afterload
CHF meds: Diuretics: remove excess fluids. Loop diuretic (-mide) monitor K+, Na+, BP, I&Os, BUN & Creatine) , potassium sparing (spironlactone), thiazide (HCTZ)
Congestive Heart Failure
Heart muscle does not pump enough blood due to being too stiff/weak to meet the bodys needs, which causes fluid to build up →decrease cardiac output
Left-sided: Pulmonary congestion the left ventricle, fluid back to lungs then right ventricle then body s/s:Dyspnea, crackles, fatigue, pinck/frothy sputum
Right sided: Systemic congestion fluids back to body s/s: Peripheral edema, ascites, JVD, hepatomegaly
Sytolic: Pumping issue, low ejection fraction, ventricle fails to contract adequately to eject a sufficent volume of blood
Diastolic: Filling issue, preserved ejection fraction heart cannot comsufficientpelty relax, disrupting normal filling
Dx: Echocardiogram: Ejection fraction 55-65 ), fluid in the heart, size, blood flow through the heart and the valves. Chest x-ray: Fluid in the lungs, seize of heart (cardiomegaly). EKG: Arrhythmias → past MI (ST depression) _> current MI (ST elevation),
Tx: Diuretic, digoxin, beta blockers, ACE inhibitors, antiotension II blockers, calcium channel blockers, vasodilators, anticoagulanted
Labs: BNP: B-type Natrciurtic Peptide: Normal <100 the higher the BNP the higher the fluid overload. CMP electrolytes: If in fluid overload, possilbe dilution
Patient educations: Heart healthy, DASH, come back is worsening chest pain, SOB, rapid weight gain 3-5 lbs in a weak. Monitor weight daily, I&O, sit pt upright (high-flowers), administer o2, restrict fluid and sodium intake as needed. Moniotor for complications (pulmonary edema)
Heart tones s1, s2, s3,s4
Cardiac catheterization
Echocardiogram
Electrocardiogram
Chest x-ray
Stress test: Trying to induce ischemia NPO before
LABS
Lipid panel: Total cholesterol, HDL, LDL, Triglycerides
C-reactive protein
Homocysteine: Higher risk factor for coronary artery disease if its a high level
Troponin
BNP Natriuretic peptides
LDH Lactate dehydrogenase
CK-MB Creatine kinase
Antiangianal: Nitroglycerine
Antilipemic Agents:
Bile acid sequestrants: Cholestyramine
HMG-CoA reductase Inhibitors: Atorvastatin
nicotinic acid: niacin
Indications: Hypercholesterolemia
MOA: decreases LDL and triglyceride synthesesis, Increases HDL levels
Contraindications: Cautionsly use with diabetics
SE: flushing of the face, GI upset, pruritus, hepatotoxicity, hyperglycemia
NC: moniotor liver function
My face dosent look very NICE because its FLUSHED after taking NIACin
Fibrates: Fenofibrate
Indications: Hypercholesterolemia
MOA: Decreases triglyceride production and transport. Increases HDL levels
Contraindications: Gallbladder disease
SE: GI upset, gallstones, hepatotoxicity, muscle pain
NC: monitor liver function
PT: take 30 minutes before breakfast and dinner
Just like eating a lot of FIBeR, fenoFIBRate will help decrease your cholesterol
Cholesterol absorption inhibitors: Ezetimibe
Indications: Hypercholesterolemia
MOA: Inhibits absorption of cholesterol in the SI
EZetimibe makes it EZ to bring down your cholesterol levels
SE: Runny nose, sore throat, joint pain, hepatotoxicity. Muscle pain if combined with a statine
NC: Monitor liver function. Check CK levels if pt develops muscle pain
Cardiac glycoside: Digoxin
Indications: HF, atrial fibrillation, atrial flutter
MOA: Positive inotropic effect (increase force and efficiency of heart contractions) and negative chronotropic effect (decrease HR)
When you DIG a hole, go SLOW and STRONG
SE: DIGOXIN TOXICITY (s/s: GI upset, dizzy/confusion, fatigue, weakness, HALOS OF LIGHT), arrhythmias, bradycardia
NC: Check APICIAL pulse for ONE minute before given DO NOT GIVE if less than 60. Monitor digoxin levels during therapy (0.5-2 ng/mL). Treat bradycardia with atropine.
Hypokalmeia increases risk of digoxin toxicity
Digoxin immune fab
Antidiote of digoxin
Aspirin (chewable)
Morphine sulfate
Thrombolytics
Spiralacton
Furosimide PUSH SLOW cuz otooxicity, BP drops 10mg per minute
Pt is taking digioxin d/t CHF what would the nurse notify the provider of immedtily of? Low BP, atril fibrillation with HR of 95 or pt states seeing halo lights? Halos around the lights in the room.
Echocardiogram which of the follows statments indicate that the students understands the the test? all of the following: The test will show structures and valves inside your heart, may be asked to hold your breath for short periods of time during the test, it will allow us to calculate your ejection fraction to see how effectively your heart muscle is contracting.
DO NOT need to be NPO at midnight prior to test.
Need to be NPO for stress, cardiac, and cabarge
What are priorty actions of the nurse be after a pt is immediately post cardiac catheterization: Urine output, 12-lead ECG, bedrest, bilateral pedal pulses, palpating procedure site
Fursomedie dont give is POTASSIUM is low
MAP: Mean atrial pressure want it over 65 to 100
Calculate MAP systolic BP+diastolic+disastolic/3
BP 168/60
168+60+60 then divide by 3 is 96
Pt with HF reports needing to rest between activies during the day what could be the reason? Decreased cardiac output
Let doc know when SOB when lying flat
Hanamushi's Doll Adventure
Pt with HF should NOT: Eat food with sodium,, excersie as much as possible even when feeling weak and SOB.
PT with CHF
Prolonged cap refill indicated atrial insufficiency