Exam 1

chest pain

-Stable: predictable & constant
-Unstable: pain that doesn’t go away with rest; can lead to a heart attack

-nitroglycerin: vasodilator (side effect: hypotension)

Oxygen therapy

Obtain a detailed patient history

disease of the heart muscle

Dilated & Hypertrophic

(the most common) a significant dilation of ventricules without simultaneous hypertrophic and systolic dysfunction)

(common in athletes) it is genetic; leads to increase heart muscle size and mass

Sodium Levels & Fluid Overload

immobile people are the most at risk (bedridden, surgical pts, etc); can travel and cause a PE; treated with heparin & warfarin

INR (therapeutic levels on warfarin: 2.0-3.0; normal therapeutic range: 2-3.5)

doesn’t require hospitalization; rest, wear compression stockings

focus on EKG results

represents the electrical impulse of the upper chambers of the heart

represents the depolarization of the lower chambers of the heart

represents the depolarization of the ventricles (return to electrical rest)

the obstruction of the pulmonary artery or one of its branches by a thrombus (or thrombi) that originates somewhere in the venous system or in the right side of the heart

chest pain, shortness of breath (dyspnea)

Full assessment; administer O2

is an electronic device that detects and terminates life-threatening episodes of tachycardia or fibrillation, especially those that are ventricular in origin

acute coronary syndrome: is an emergent situation characterized by an acute onset of myocardial ischemia that results in myocardial death

EKG, ECG, Troponin, Creatine Kinase, Myoglobin

Bleeding

24-28 hours

-pH: 7.35-7.45
-PCO2: 35-45mm Hg
-PO2: >80mm Hg
-HCO3: 22-26 mEq/L
-SaO2 %: >94%

occurs when the parietal or visceral pleura is breached and the pleural space is exposed to positive atmospheric pressure

-Simple
-Traumatic
-Tension

spontaneous; occurs when air enters the pleural space through a breach of either the parietal or visceral pleura. Most commonly, this occurs as air enters the pleural space through the rupture of a bleb or a bronchopleural fistula. A spontaneous pneumothorax may occur in an apparently healthy person in the absence of trauma due to rupture of an air-filled bleb, or blister, on the surface of the lung, allowing air from the airways to enter the pleural cavity

occurs when air escapes from a laceration in the lung itself and enters the pleural space or from a wound in the chest wall

occurs when air is drawn into the pleural space from a lacerated lung or through a small opening or wound in the chest wall; causes the lungs to collapse and the heart, great vessels and trachea to shift towards the unaffected side of the chest(aka mediastinal shift)

pain is usually sudden; the trachea is midline, expansion of the chest is decreased, breath sounds may be diminished or absent, and percussion of the chest may reveal normal sounds or hyperresonance depending on the size of the pneumothorax. In a tension pneumothorax, the trachea is shifted away from the affected side, chest expansion may be decreased or fixed in a hyperexpansion state, breath sounds are diminished or absent, and percussion to the affected side is hyperresonant

non-productive cough, sore throat, fatigue, muscle aches, congestion, nausea

is a common clinical disturbance characterized by a low pH due to an increased H+ concentration and a low plasma bicarbonate concentration.

occurs when there is an excessive accumulation of acids. High anion gap occurs in lactic acidosis, salicylate poisoning (acetylsalicylic acid), renal failure, methanol, ethylene or propylene glycol toxicity, DKA, and ketoacidosis that occurs with starvation. The high amount of hydrogen ions due to the acids present are neutralized and buffered by HCO3− causing the bicarbonate concentration to fall and become exhausted

severe vomiting or gastric suctioning

correcting underlying acid-base disorder; restoring normal fluid volume by administering NaCl

caused by an absence or markedly inadequate amount of insulin; glucose levels: 250-800; signs/symptoms: fruity breath and Kussmaul respirations; major concern: POTASSIUM (affecting the heart); monitor blood sugar

-Hyperglycemia
-Dehydration & electrolyte loss
-Acidosis

is a metabolic disorder most often of type 2 diabetes resulting from a relative insulin deficiency initiated by an illness that raises the demand for insulin. This is a serious condition in which hyperosmolality and hyperglycemia predominate, with alterations of the sensorium (sense of awareness)

hypotension, profound dehydration (dry mucous membranes, poor skin turgor), tachycardia, and variable neurologic signs (e.g., alteration of consciousness, seizures, hemiparesis

fluid replacement; correction of electrolyte imbalances; insulin administration

-Hep A
-Hep B
-Hep C

transmitted primarily through blood, prevented by: safe sex, avoid high risk behaviors, hygiene

transmitted by blood transfusion and sexual contact

Protease Inhibitor Therapies for 8-12 weeks of oral therapy