CATHY PARKES ‘TeveldpRN.COM ©2018 Peers Dene tego Zs taties TEM Cerebral Anglogram Cerebral Angioaram | Wiha Presrocedure and poshproceduré nursing care on Electr ography (EEG) Wat ist? Pre procedure Nursing Te te «| ‘Cerebral Angiogrom: Alows for visualization of corral ‘lod vessels A catheters placed ito an artery (usualy the gr) and tweadad up ote boca vessos te bra, yells iectes, rays are aten + re-procedure: NPO 4-6 hs rata procedure, Assess foratergy fo odine or shells. Asses edney con (BUN, coatnine) to determine I Keneys can excrete ‘heya + Postprocedure: Check inserion ste for bleeding, Check exroriy distal o puncte ste (pulses capilary |b Foti temperature, cal). MERE Electroencephalography (EEG) EEG: Aratyzes elecreal acy nthe ran. tis used to ident seture acti seep disoraes, behaveal cnanges. ‘Small ecroges are laced on the sca Takes appro one ha Wash hak prior procedure. Brive deepens os hs nereases chance ol sire) 1 ole reded. Avetetmulae acaabve mescatons 12 nur botor recnr. + fom pao et ashing igh may be wes ing rare pater may bares Ryponanias Fereoe elect so Glasgow Coma Scale (GCS) ‘Scare between 3and 15. Less than = severe head lun) ‘andor coma Between ®12 = moderate Nand inhay, Add UP Eye opening: ()spontaneculy, (2) in esponse to woe {Ghin response te pan (1) nove opening (5) cherotoroned, (8) incohoron ‘lerentoa. @)nappropats words, (2) Sounds, ne werd, {no vocaaton (6 allows commands.) loca reaction {opain () gareral wihdrawal to pan, @) decacate posture (2) dacorebate postr, (1) ho met resporseIntracranial Prossuro (ICP) mot ‘What i? tnseatons ‘Symptoms of neeased ICP ‘oral ICP range = ge te #| PEs Ta Lumbar Puncture, Wrst si Indestons Pre procedure and set procecure nursing care 2F & tee] Magnetic Resonance Imagin Pre-proedure nursing ce TGP monitoring: Device inserted into cranial cavity the OR to measure proseue. Huge risk of infection, nications; Patent with @ GCS score of 8 or less (or ina coma) ‘Symptoms of incroasod ICP: Irritability (early sign), restessness, headache, decreasid LOC, pupt ‘abnormalities, aonormal breathing (ex: Cheyne Stokes), abnormal posturing Normal ICP range: 19-1SmmHa eT ge tee [Ee a! Lumbar Puncture [Lumbar Panetue: Cerebral pal Fe (GBF) song Token ‘rote canal fo ana. Indemon: Used agp msl oe, ‘erg, ecten CSF + "Prugrocedure: Hove pont voi Poston ptt nib pation on aie or ave pen sen over tale ni sein + Past procedure: Pate snouay tor aveainous. ff Trees postr ste done ol es OOF sy nk seg In neadoane (emer pam macs ord eneope ieeaned fagine} Epdra les path can be ted sol oe ro. Magnetic Resonance imaging (MRI) + Assess for allergy to shellsodine contrast wal be used. 1 Assess or histor of claustrophobia ‘+ Have patent remove al owlry ‘= Make sure patent does not have any metal Implants (pacemaker, orthopedic joints, attial fg heart valves, IUDS, aneurysm clips) + Earplugs can be proved 28 MRIs are loud Nociceptive vs. Neuropathic Pain Noziceptive pain: Darageiiammation of tssu65 (not Dartot CNS) Pan desosed ae: robbing, ching, and tsualy beatzed. 3 types: * Somatic: bones/oints, mete, conectve tase + Visceral: ineral organs 1 Cutaneous: skin, subestaneous tissue a ‘Meuropathic bn; Result of damaged nerves. Pan deserbec as: shooting, Bring. pins and needies". | ‘Asin meds oten aes atdepresans, sce resiants [>Components of Pain Assessment Non-opioid vs. opioid analgesics ‘nen to use? Key side effets ard concems fez TEM Meningitis, Wat i pes of mening Prevention ‘Symptoms =f a te | Meningitis Disgnoss using Cae Medications ate ‘Components of Pain Assessment Location of pain {Quaity of pain how it fooks o patnt, ox: “burning”, aching”) Intensity of pain (rate on scale from 1-10) “Timing (onset, duration, requency) Seting (now affects patent's ADL) ‘Associated sympioms (ex: nausea, fatigue) Aggravatingreeving factors 'Non-oplold vs. opioid analgesics ‘ooploid Use fr mild to moderate pain. Key concarsacotaminophan Iie should not ‘exceed 4g. + Monitor saleylsm wspiin (tits, vertigo). ‘Aminsier woes prevent Gl upset Longterm NSAID us caries fk o Bloc, Opioid: Use fr moderate to savers pain * Key sie eet incuce: cnstation, ypotenson, lunaryrlenon, nv sedavon,respratry depression “+ Naloxone is antidote. “Amini acund he eck (vs, PRN). Meningitis Moning: ifaraton of meninges (menbvanes around bain an spinal cara), Ve mening mest comroon (Cesoves wo Westnet). Bacterl mening s contagious, with high moray ate Prevention Inmnizations hap prevent ctr ‘menroits. Hib vaccrneis oven fe nln, NCVA vaccine {s piven fo students living in dorms. ‘Symptoms: Headache, ta (neck) rigiy, photophoba, nausea, vomiting, positive Kerig’s and Bruzins’s signs ‘over, ates LOC, acho Meningitis ‘Diagnosis: CSF analyss. Bacterial wil have cloudy CSF, ‘ecreased glucose content. Viral wil hve doar CSF Elevates WBC and elevated pote fox bot ype ot ‘meninais. Nareing care 1 Drops precautions util anes are administered for 24 nous. ‘+ Quiet rom, ew ght, HOS © 30 degrees, mritor for bereasod ICP, nec pabanto avs coughing! Sneezing. Implement sozur precautons bobs, aboonrulsans (ex: pennSeizures Wat re they? What is eplongy? Rik octore “ageing fectrs a oh te ‘Tunes of Seizures Tonic Cio, Absence, Nyowon Aon, Status epleptious =F a te @| 8 Nursing care (ring and post seizure) Madieaione ‘Suga intaventons ae & te “ Parkinson's Disease Cause ‘symptoms. Nursing Care eiations =P oe te | 6 Selzures: “Seizures: Uncontoled sleciical Gecharge of neurons nba ‘= Epilepsy = chronic seizures (2 oF more) Risk factors: Fever, cerebral edema, infection, foxin exposure, brain tumer, hypoxia, aleobalirag ‘thera, ud or elecvotte imbalances, Triggering factors: Stress, fatigue, cafeine, flashing lights. NERVOUS SYSTEM ‘Types of Seizures: “Tonle Gone; Maybe preseded by aura. 3 phases “Tonic episode: sei of musts, ssf coeciusess 1 Clone episode: 1-2 ran ot trac ting oxtemies + Postel phase-eousonsosposs Abasnoe: Love of consciousness fr afew eesoncs. Key feslures: blank staring, eye fering ip smacking, pcang at clos ‘Mvaclonie: bre storing of sererits. Alonic ss of sce fone, resis in aling Status epilepticus: Repoaiod saizur acy win 30, min, ora single seizure lasting more than 8 mi, Diagnosis: EEG lolenty eign of sola, Nursing care: + Dull ar: Tun pant oto side oan etre ‘tha, d not nao ia or recran paint, Sure + Pestainue eck vt! sone, nerlogeal chek, reorent tet sezare yocautrs ditine pss ager Meds: Ant-soizure tugs such ac phony, Surgeries: Vagal nerve sel, craniotomy to remove brain ussue causing seizures. rkinson's Diseas ‘Cause: Degeneration of substan ng, esha in 0 ie dopamine and oo mc acetychain ‘Symmptome: Tremor, musel rigidity, slow/shulfing gat bredsceca (stow movernent), muse sxpresian, ‘rooting ait swalouing Nursing cao: Monitor swalloniood inako, icken food, ‘ipa’ uright oeat, have suction equipment avalbe Encourage ROM and exercise, assist WADLS. Mods: tevotoparearbiopa increases dopamine levels) Denatosine (decreases aceychoine levels)‘Stages of Aleimers gern! components) =F o& te Alzheimer’s Disease Tsing coe Home safety measures Westone ‘Alzhelmer's Disease ‘Alaheimers: Nonversible ment, resuing in memory fear probiers wih judgment, and changes in personaly. Stags: ‘Sage 1: Ne impaiment. ‘Stage 2 Forgefilness, no manary robs. 1 Stage 5: ld copntve det, share memory loss ‘eteatia to family members I ‘lage ¢ Personally cuanges, obvious memory oss. ‘Stage Assistance WADLs necessary ‘Stage 6 tnoantnenco (fecal, unary), wandering {Stage 7: Impared swallowing, stana, no aby speak Alzheimer’s Disease Nursing cart Ninn ructured environment, Provide shor drectons, repauton, Avad overstimulation Use, Single-daycatar. Provide frequent recreation. Ninn Foutnettetingsehecie Home safety: Remove scatter rugs. neal door locks, ‘00¢ tong (particulary on stars} Mark step edgos w! colored tape, remave citer Mads: Donopeai (provertsbeakun of ACh, improves 0 to de ADL, eter mods to manage symptoms (an Psychotes,antcoprescants nt ana tes, Tg tee Multiple Sclerosis ‘iran vroaee syne sedestons ® Am rophic Lateral Sclerosis (ALS| ats? Symptoms ering care a& oe | = & tee Multiple Sclerosis ‘Mile Sarai: Aroinmure dsorce were plagus dovsors Frat rer fie CNS Agno onset ynly 2.40 ya t ‘pera cinon nwan Chaaceiea by prod oF ‘apsing ana remiing “Tigges: Tampere oxwunes, essay pepraey tatue ‘Sumptoms: Ey prblems (Oplonianytegrs), muscle spastaty Spd woaiece,bowoltinetrdytureto, crave ange, a prensa ines) yesh, toi ds: mmunosippessve ager (cyaosprn), prednisone {areinfereatery, muse rants (denlene, bere), NERVOUS SYSTEM, ‘Amytrophic Lateral Sclerosis (ALS) ‘ALS: Degenerative neurological disorder of upper and lower motor neurons, resutng in progressive parlysis Eventual causes respiratory paralysis win $5 years, Cognitive function not impacted. No cure Symptoms: Muscle weakness, atrophy ‘Nursing care: Maintain patent airway, suction! inlubate 2s needed, Montor fr pneumonia, respiratory failure, ds: Rluzole~ slows deterioration of moter neurons, extends patents ife 2-9 months.Myasthenia Gravis (MG) [HG:Actolmmane dserdor that causes severe mace ‘weakness Caused by antbodos that tat nleere vib Ach ‘st neuromuscular uncton (NU), Characterized by periods Iyperpiaei. ‘Symptoms: Musca weakness (nese wit), pop, ‘chase, moared espa, drooping yes Diagnosis: Administer edrophonium, whic inceeses Ach LNW. fsymptonsinprov, tis MG. rt, Risa crating rss iatrpine is antcot). [ESS ‘Myasthenia Gravis (MG) Myasthonia Gravis (MG) Nursing care edistions “Terepeute procetires end sug trenton ae, yng eo waren ope + Ree mente mae Soevaeaninn » Secret estan eecuraas j 7s ew oranonte eo raine headaches eco Nursing core Mesiations & tae Cluster headaches ‘Symptons adcatons 7 & Migraine headaches ls factortuagor: Alerges, bight ight, faiguo, soos sity ert econ ots MS, aie ‘Sumatoms: Photophobia,nauseaWomiting, unlatrs! Pain (usualy behind one eye or ear). Can hacen with ot ‘rinout aura (aul cstubances, nurnessfingrg) Pin persist for4.72 hours Nursing eave: Provide colarkquit environment. Teach Batert to avcis nggering foods, recuoe shes eves eds: NSAIDs (mie migraine) anerstcs (en). Suma pan o erotarine for more svere migraines ‘Cluster headaches ‘Sumptoms: ‘Sever, unlatra, nonthvobbing pain that asates to ‘eraneed, temple, chook 4 Gast sD main =2 ure Usualy secure daly a the ‘ame time for 4-12 ‘+ Mere troquontin ping ara fll Mere common in men between 20-50 years ot. + Facial sweating {Nasal congestion Medications: sumatrptn,eretamine (same.as migraine heaasehes)|ular iat jeneration smptons Cataracts ‘What ar they? Symptons Post sar tang TESS Glaucoma Whats 2 types of gaucoms Neral IOP how o measure IOP and drainage angle EP oh “a @] Glaucom: “Teseatons Patent teasing for aye crops Postsurgary teaching a a tae 2% Menk lisease “nat Symptoms Fisk fectors scopic sxainaton tee [ERIS Macular Degeneration and Cataracts Macular Degeneration. Cena lt of vin, Nur ove cme of tones over ag 0. Neer, 1 Eunplane: Bure vi, oss of ental vison, bine cataracts Opcty nine a ee, psng ven, “Eympone Oovensa wal aay progrsslopanlos ss Gvecr lon hao scum! igh, cont abet ‘edretes osu sec: Weat sunglasses, aot nceasing IG ctv sot aco ‘tang, eva hyporfezon heed an eorere cating, ‘00 Sg head Sacks wash fa int haem an ap |b fay movers Beet veer ora 0 woske errr __ Glaucoma Increase in |OP due to ssue with optic Derve. Glaucoma isa leading cause of blindness. * Open-angle: ost common Aquecus hurerouitow creased, resulting in gradual crease in OP. ‘SUMBIUME! mld oye pa, loss of peripheral vision. ‘Glosed-angle: Less common, Angle bebvesn Vi nd scora closes completly. resulting sucden Increase eF1OP Symtoms: severe pain haus ‘Normal range is 10-21 mmHg, Measure using tonometry. Measure dranage angle wigonioscopy ‘Poca (consti the pup) 1 Beta blockers moll feduces aqueous huner production) + Mannitol” osmotic duretic for lose ange glaucoma; uch reduces IOP. Patient teaching for eve drops: Adrnister 1 ero in each tye twice a day. Wal S10 mn Between eye Gps Do ot {buch tp of aplicater fo eye Place pressure at acomal duct stereo Same a eateract surgery (Le insane OP) Meniere's disease 's disease: Inner ear isorder, resulting inthe {olowang symptoms. tinnitus, unilateral sensorinoural hearing loss, vertigo, vomiting, balance issues, Risk factors: Vireectora infections, otto medications. Otoscopie examination: Pull euricie up and back for ‘adate, dow and back fr cldren. Tympanie ‘membrane should be pearly gray and intact. Light reflex should be at So'loc for ight ear, 7 o'lock for lft ear.Meniere's disease ‘eiestions patent aching Surperes Head Injury, Fist pony Sion ofneeased ICP Interventions to cece ICP =P a te «| 2 Tate Stroke/Cerebrovascular accident (CVA) Sips Risk ocors (veral symptoms a type of Stroke: Kay tisk factors: Smoking, hypertension, diabetes, ‘AFIB, nyparipisema ‘Overall Symptoms: Visual disturbances, dizziness, slurred spaecn, weak exremty. Meniere's disease Medications: Anthistemines, anticholinergic, antiemetics (examples: mecizin, éroperidol, tiphenydramine, scopolamine). Watch for signs of ‘nnary retention, sedation, Pationt teaching: Avoid caffeine and alcohol. Rest in {uiatiderk place when experioncing severe vertigo, Space intake of fluds throughout day, decrease intako ofealt Surgeries: Stapedectamy, coshlaar implant, iabrytoctomy. Hoad Injury Fits prorty: Stabiize ceva spine ‘Sans of increased (CP lrtablity(eorty sig) Feadache, decreased LOC, pup aberraiies, abnor ‘resting ex: Cheyne Stokes), anormal pork. ‘Cushing's tad (severe hypertension, widening pulse pressure, bradycardia) Interventions ta decrease ICP: Recuce nypereabla {hyperertate pavers), avo suctonng, aintan HOB fnote than 30 degreos Teach patent fo ala coughing, Bowng nse, exe neck lxionfoxtension, reatntve cletuog. Head Injury Seearrnare ace : ani eareme : xeric Stony ee emit see oars +" Bain wad a ra tk {rena (OC, sr expen an sorting, Fiera iar Pores Be ‘Stroke/Cerebrovascular accident (CVA) ‘+ Hemorthage: Ruptured artery/aneurysm + Thombote: Blood eat in ecebral artery {+ Embole: Blood elt from other part of Bec thet travels to cerebral arteryLeft cerebral hemisphere hata response Sypos e oke? Right cerebral hemisphere Wats trespensbie fo? Sympioms ef sok? DUO NG Stroke Narsing care Madiatons| Sure % ts 2 et a te | ‘Spinal Cord Injury (SCI What causes paraplegia ws. uaipleia? Neogene shock - symptoms, Upper vs. loner motor neon inj: muscle tonertader a "ae Spinal Cord injury (SCI Autonom yest: whats eymptams asin actions =P gh te @| ‘Stroke: Left and Right Cerebral Hemisphere. LEFT hemisphere: Language skis, math sls, analyical thinking Symptoms: Expressive aphasia (inabilty to speak anc inderstand language), reading and wring dficlly, ght Sided hersparesis (weakness) or hemiplegia (paralysic). RIGHT hemisphere: Vcual and spatial awareness | ‘Symptoms: Gveresimatin of abies, poor judgment (ignore lt sie of body), hemiplegia Ho pate’ 68> 180 e DBP>11 can deat en + Aster elon and gg roi bole alovingputeto Se Tern ys Tech et Sto whee 1 Tait pater toe scanning fchrag rf ern deci of snitsos seo Mectes de Gr Morenomous hme. Meas: aceaponts, atpaeets,tromboite meds (ge wth FStour ona sme) SME; Cais artery anaes sting ER a ‘Spinal Cord injury (SCI) ‘Paranieain nies below ',resuling nparalysiareae of ‘ower erent, Injuries in conical region, resuting paralysis patens of ala exrarites Naurosenie Shack; Occurs ster SC for several days tweets. Sympms: hypotension, cependent eden, temperate equation sues, ‘nner motor neuron injuls (above L1L.2) ssc muses ‘one, spaste neuegent nlscder faceei muscle tone, faced nouogens Bladder. a ‘Spinal Gord Injury (SCI) TWede, ucocrcods eauces fine cod econ). isn Sug neogene Stok mus vee (ice crrkiny st scat adder Dome” ‘Aono dvuleaa: For ists above Te: tenant ‘Spearman lnader response ory + Sunset hypertension. sewers hmaach, Rebate ine noracice meee, {are impute hore can) sonia ‘rtpoteasies‘Normal ranges of: pH, PaQ2, PaC02, HCO3, Sa02 Procedure: key points ef gh te RESPIRATORY SYSTE Bronchoscoy What iit for? Pre and post procodre ming cx =? a te EESuOnaS ‘Thoracentesis Whats tor? ‘Symptoms of pleural efsion rng cas sng procedure ‘Compaen =? go te ¢ RESPIRATORY Chest Tubes Winatare toy fr? “Toe shortens =F gh te @ RESPIRA =u ‘Arterial Blood Gas (ABG) + Eo setmcemce atte Smnctming |b + Fabeneeerssioe pas asrentoneas 1 SSS ‘Bronchoscopy =u Bronchoscopy: Alows for visualization of away (lary, trachea, bronchi}, biopsies, aspiration of deep sputum, or excision of esions.. Pre-procesure: Patient NPO 4-8 hours, administer Prescribed meds (atropine, antanxiety meds, viscous Idocaine). Post.proceduve: Enaure patient's LOG and presence (of gag reflex before allowing patient to eauldrink. Sore throat, dy throat, and smal amount of blood-tinged sputum expacted, Thoracontesis “Thoreau, Surg pation chet wa ar pla oace aia iin Satins, ec necabon o Spe pats: chs, esto, Ng oe pote at it er, ave aie Bart Sa roman Sa Arun Rid eure ul no enced to eve carioaes Ennion egos sn eee ase prauratwaropnplons ewsiad aces, ern Sareea mcmama, ESE Chest Tubes, ‘Chest bes: Drains nu, a,c bod tom pewal space, ‘Cheat te ip postaned Ue tr pneumatoray snd BOWN ‘orhemotharax pleura esi Drainage collection ember, Char aroun ad color of ‘tanage. Report drainage > 70 mir to provider. ‘Wat sal ember: Age strl fhd up 22cm na, onc ‘every Dh Charber must be ken! upight and bel chest tube oserion se. Tiling expected. Lack of aing = ung | [eaggmon ocbucton ntnuous Dubbing meats Suction contol chamber: 20 em H20 commen,Nrsing care (Chast tubo romeval proces & ‘se # RESSICnae Chest T Complications & ee Oxygen deliver Nasal cannula, Spl aco mask, Pare rebreather,Nonwobreather ESAs TEM Chest Tubes. ‘usin care for chest tubs: 1 Aisa ces be eon ier rhea pain Fostion patent n senkhigh Fowter poston ‘Obtain chest yay fo very tube placement Keep? hamoetate tans weer cobusive dressing at Daa. «Only clam when oer; do nt etiik tubing ‘chest tube removal patent to take a deep Ero, ‘Shale and Ben dono take a dap breath tn old) ‘tung remova Appi sone petoium ely gauze ressing ver ches tbe ste. Chest Tube Complications If drainage system becomes compromised, place end of tube ino stele water (to maintain water sea)) If chest tubo is accidontaly removed, place ‘celusive dressing over inserton site ~ taped only on THREE sides, + Tansion pneumothorax: can result from kink in Tubing or obstruction. Symptoms: rach doviation, absont breath sounds on affected sie, respiratory distress, asymimety of chest ‘Oxygen Delivery a: 1-6 Limin. Use humisifcaion for ‘Simple face mask: 6-8 Linn Paral rebroathor mask: 6-11 Limin. Adjust. ‘oxygen flow fo Keep reservar bag from defating + Nontebreather mask: 10-15 Lin. Keep reser bag 2/9 hi. Assess valve, Bap houty. + Vor masie 410 Limin. Most precise oxygen al very + Berosol masiface tent: Good for patients with a tee EEsannen asec ‘ions and Syploms (Ear and Late) of ryporeia ‘Signs and Shmpioms of oxygen toxy ‘aveting combustor eT & te é facial auma or bumns,prowdes high humdiicaton ‘Oxygen delivery SiS ofhvaoxemis ‘+ Enly: Restlessnessiiabily,tachyonea.‘achycacia, bales, typerenson nasal fanng, use of accessory ‘muscles, adverts lung sours. + LIE Confusion, cyanoss bradypnea, bradycardia, Fypotension, estima "hea welding eomtustion:Post"ne sekng” sgt, avold (Siu er woel fale, dono use tammabie maretale (Seotal, acetone) FEeM oe ‘era ams: Cans ow presi vs. ton rscian ms | | IAT lar Exons scene pan ag ute sng toe ort on vette ERS ing tr pinay Si naan ‘sng oe ar anton pe 1 Buon alan aces eertons ‘Bepoabon : Serta rt aranmncoe . ees a's || See ane tear ph clos toon “ EERIE a ‘SES: fever shorness of rest, chest pan, caugh, sane, ‘confusion (very common in older patents), racine! snheezes, ab esis: Obtain sputum sample BEFORE starting nibiotlcthrapy. Elevated WBC, decreased PaO? levels Diagnosis: Chest ay (shows consoksaon) Nursing eave: Posten patent in Rgh-Fowe', administer ‘O2as prescibec. Encourage coughing, deep breatng. use ‘ofan icant epromeier, rcroased fig ike. eds: antbioves,bronchadita (aeO, intammatores (ghcccortcosterads) ‘Signe and syrpoe,Lb s, Dlagoss, Metre oe, Nedeaens ‘sty Chien infantry aserder ofthe airway ia ie? intern and reverie Sions and sympiems, Diagnosis, Medes S28. Whoesng, coughing, prolonged exalation, ow $202, ‘Sloe thats Darel choot uso of accoscory muscios. Distnosis: Pulmonary functon tests (FVC, FEV!) eds: Bronchodlaors(shor-actng. buts, ngrectng gh be Sainetea) antehinerge macs revopm), rt = intammatory meds (cortcostoroits). | Setar samme: Any obcion vesporsve | typical testment Admister 02 bronchoatar, | sohnephine, Prepare or emergency rubaton, i =u Chronic Obstructive Pulmonary Disease COPD; Emphysema (ose ung east end Fearn in ass} eae ont {brunt bene) neersbe: Sahin rene tat eae SES Dyepne on oxron caine tare cee we of ecseny misc, casg Ppurevonence nop ay anced | S202 levels, rapid and shellow respirations. id | Gabe: nears! do tolow Ooh P02 < | ir PacO2 Stig osprey sone Signs and symptoms Lab este =? oh te =) aGESaRe as — ‘COPD ‘Muna crear COPD: Psion patent in oh Fower, OED Encarape cugtig, dee beeing ie their pioneer Nursing cane Emmure opr nition (teased ates an praan Tach ‘Meds roa cues, Congas damnation ke treats tom dtp, eon + Pumadio beams rene tough nose anda tough i 1 i 4 {Comet Rpt sided Nan ze, Symp dependent ‘iors. doiendesnece vers enlges her i Renae Tuberculosis (TB) "TB: Infocus dceaso in lungs caused by Mjeobactoriom fupereucs| SES: Cough iting > 3 weet, right sweats, purten” Slane and symptors ioody suri lethargy, weigh os, Degas Diagnosis: + Quanifron God oe et) || | Saeee ee 4 Ghestcisy: to veuaize act eso a args. F 1 Aaitas pat cute se Seay morning spun same. SES Tuberculosis (TB) ‘Tuberculosis (TB) ‘mast inroom, ae paserton NS ane fey Nun cre ‘elev room, eds ‘toon arly memos fo TE. 1 Teach pation! tat eptum earples wil be needed very i oeks Patere ae not fecsous ats Up to 4 antics are requtes fo 6-12 months of treatment, ncusing: eave, ramp, pyramid, ‘ham ESSEC Pulmonary Embolism (PE) ‘BE: Life tireatring blockage in pulmonary weecatre, most ‘commen caused by 8 DVT ‘isk Iaciors: immedi, al contraceptives, smokin, ‘besiege APE, lng-done acres, Sgsegmpas, ‘SES: amiay (bling impending doom) pon ‘rspraton, dyspnea, plural fiona, tachyearla, = oeeoe = PF gh tee] |/Bee {tromboie eraoy (alps, stepokinace). E 1Gesu Pulmonary Embolism (PE| ‘Surge interventions Nursing caro Patent teaching fr ancoagulants a Respiratory Emergencies Peurothorax Tension preurcthorax Homolhorax, Fist Chest ‘Trosimont of above conden EP o& ‘a @| Expected ranges, drain of elevated ievels on a Cholesterol levels Ditferent nds, Expectedrargos Hemodynamic monitoring Exped ranges for CV, PAVIP. CO Nursing ere cur atrial kine niserton =F gh te @| Pulmonary Embolism (PE) q Enbeocony fonoval er ot vo cova or lareeris new enact fom org pulrersy vaste) usa care: Pace pte Fone patna | ee cm csnmen + Radhee i of lod fo aso, use ec shavers, Sitccionshes vad bona nos SESE Respiratory Emergencies. Sai cm seem utenaee | epee ee oe cargo Seereraaseec crocs ioe a sama pop oot et swap men ote es Seite een ae en Eee ope beret mega {wh cut bo for preureoray sd Prvtra GREG Cardiac Enzymes ‘Cantae Enayines: Release n loodsveam in response io schema fn Hear musee. Troponin fs most specifi! + SKCMB: Nore speci to heat an CK. Shout be 0%. Etsy soe 2-2 cays + Troponin ; Shout be ese an 0.1 rp, Eovstd for iotreaye + Troponin: Shouts be less than 0.08 ng. Elevated for |p Tioaays IE + Myoglobin Can be elovst cus tohear damage OR fF Showtal mutcie damage. Shou be <0 meg. i lovato 24 hours i Hemodynamic monitoring OU Hs happy > 88 mgt (ween) >See) (Bienes a0 me {raeoées Beweor 36-138 mgt (women), bowen 4080 mai enh 1 Bains (Pumonany Ary WosgeProssre 6-1 ry 2 G0 (eseime Ouray sme Nain cave during Steal ie ineion Level aneducer ‘eth phlebosta as (ah itereoatal space, mex Hn), Sho Sjtam cunt acomartwecay oC (Canal Vancus Presse! 26 met I.Coronary Angiogy ‘ati? Presprocedure and posteroreduré nursing care =F gh te @| ‘Coronary Angiogram Cardiac Tamponade What i? ‘ions and symptoms, Diagnosis, Treatment COSC eripherally inser ‘Whats fer? Wher she ip? How long ean stayin? ‘Nursing care of PICC ne Implanted port: wnat ts use fe, ow to access? aT a tee Srapany Aaa ends ca, Tee PORE ‘St cterinefpateries corona stay Wockapee arouin. Catatarrsotad wt enor ar and add up 12 eo ‘bre arocadur: NPO 8 is par prow, Ase Slrgy dno atefiah Aas ey acon (BUN, ‘routin) 6 dle dra can ext the ye. + Postprozedura: Chak nsrian se eng, chock ‘emt dao pone ste ules, cpa ‘Spare clad) Take VS vey ein x4 omy SO7inx 2evany hui Pao esx ea 4 huts ter = a tee 1V complications Symptoms and Nursing ee for Pls, nation, A Embalsm =F oh te &| EM Cardiac Tamponade ‘Cardiac tamponade: Accumulation of fu n pericardial ‘SBS: Hypotension, muffled heart sounds, distondod jugular veins, paradoxical pulse (variance of 10 mmiig ‘or more in SBP between inspiration ané expiration). Diagnosis: Chest xray, echocardiogram ‘Treatment: Pencarciocentesis(comoval of uid rom pericardial sac), ICC line, Implanted port IGE; Used oon tar scriaton Ventas, TPN, erate feta nine cages itving cats of Ce + Asbes sevty 8M. Use Tomoye Syringe to hush ne 1 Rugn io of 9% Neel belo, boom, and ster ‘nodes + Bhd ats: weal or loo an aso, wa ‘ti a te sare nash tome Rac apt aay ROrEP on arn n Pics ine, Siisreriepy Rtas wih not zoring ber nei ESE 1V complications + Gare Discontinue 1 warm compress sntzaton: + SES" edems, coess, tut skin are: Dsconirue WV, col compress, elevaton Aicomb {+ Care: pace in Trendelerbur postin on nt sido, give oxygen, not powder.Medications ane Pacemakers Wiha do tey 307 Diferent moses Inelessone =F gi te a! Pacemakers Pstprocedure nursing care and patient aching =F gh te | Percutaneous Corona ntion (PCI) ‘Wratisi when 1 dof, 3 xnes of PCI Nursing cae Compicatons a a tee DEVS Dysrhythmias [aad WR <8 bom: oymoinate, wai avorie real rervrion-gacerate [AFIB, SV, Vermeer tachyeraa with ule: Amn ont [irvemte meses (ar erdsrns, aoa, wre ‘lect iteventon earoersen Nrsing caso esos ‘atest on oncogene «St omcs ars ear of art ten sos ceva 1 ter rood ses aiesy, mn VS oan EKG ter 8 af aaa (sek. clara tins puis, veri ation au ‘pnp eso iesenn:Oasaton ‘hen raul pacemaker n heat doesnt aitin proper hm. Programmed to pace aa (8), “ericular(V), or bath chambers (A). ‘+ Simehvonous; Fes only when heats inne rate fal bel cat rat Indlestions: Symptomatic bradycarca, hear block, sik sinus? Syren * Provide sling and instruct patente minimize ‘shoulder movement. + Assess for hiccups, which may india ‘pecemakeris pacing the ciaohregm + Instruct patient to: carry pacemaker iD card, tke puise cally, avoid contact sports and heswy ing for 2 months. ‘+ Pacemaker wil sot of ipo securty detectors + Me are contraindicated + OK to use garage door openers and microwave. Percutaneous Coronary Intervention (PCI) BEE Proesre to open caenary aes, Peiorod wah 3 hows ‘STehee oi eymotams Tee yoek etry er pas oss) + BTEX tang ato vn ane en) usreing ear: sare ss exensy spo inn ona than pair + Rls esa (manor for asta esnes ERG)Coronary Artery Bypass Graft (CABG) Wa ‘ey nursing care and patent teaching =F gh te @| Poripheral Bypass Graft ‘What sf? Nursing ere =F gy tee) Angi “Tne kinds of angina ‘angina vs. Myocarlal nario (Mt) a? ge te TE Myocardial Infarction (Ml isk aco, Sens and symptoms, Labs, EKG changes, Medications, Complcatons =F gh te @| ‘ne rest, Angina vs. Mi: Pain unelieved by resto nfrolyesnn anc fasts more than 30 mutes cea fan Hl = angina) Mls unk angina) ten have ober syrstoms, Such a: nausea, pigastic discomfort clphorass, ‘Coronary Artery Bypass Graft (CABG) “GABE: Surpary bypass ao oc mae cay snares. duo Etboxags to pate them. Sapiens wa otan ‘ion. Pasonts cor trperaiua wore dotease rtabalc {Grd ogo comand cue rods. key nursing car Monto BP Hypotension can cause beeing tem gras. Hypatnson can sis claps pt + ioren tine Over #60 mean Indes Femoerage = not provide tent teaching Test nga vin suing voter, ct ‘Sting, carmure hea heathy partner hb SEeeea pani, mee matic ete mt pct, a ca gen a eae | HE casero ou sae, + BESPEEPE sate me ante om By wart ots onsen in Ee asses ananramas, ‘Sabo angina; Gone with exercee,roieved by rat or niroayeet Unstable angina: Occurs with exercise or atest Increases in duration, occurrence, or severity over tine. Variant angina: Relste to coronal tery spas, occurs er restr, dowestod pipe pls, eet pal.Heart Failure ‘wnat 7 Lets at sed te oh te el Nursing Care Valvular Heart 2 ypes, Key isk factor, General smptoms,Diagncsis =e gt te | ; | Ms foci ar Disa: Hoart Disease | Mesesor ie 1 Aton ducng meds (ACE hits, angie surgeries eg cs ee poses ten Sa oa) Prasienttescing + eos ‘uric tebenions duet teachin! Prophylcte antics need 10 be taken Defoe dental work surgery, or ther invasive procedures. Heart Fallure He et reste aca ing ata: ove + Letteldeg HE Resutsnpumorary congestion pray SemarReysrmsons Stepan rachinomhopes + ERASE Rea yom sition pro dana, cn ate noted 100 amy q it t ic matting teased CVP, PAV: decreed CO| ecuch jocaan Fton (Nem Lok 1 Aten eds (ACE tors, fees bot calaum camel wacker) z= we goer) ess ENP) 1 anoagais Hi "Valvular Heart Disease ‘2 vnes of Valvular Heart Disease: ‘+ Steal: naawe opsning * nsufcencyregurataon of blood ey ek actors ‘Hypertension {1 Rhurti fevaroase streptococcal infections * lfecive endocarais rt streptococcal nections | Older age (causes cots texening) ‘Simptoms: Nurmurs, esta Neat sounds, arya, Syspnea winital stenoss cr insutkiony. ‘Diagnosis: Chest xray, EXG, echocardiogram ‘Valvular Heart Disease ests + Peers lon vaNops opens valves tat ave +e repair replace wipro waveInflammatory Heart Disorders Pencars Infact endocarcis| CARDIC Poriphoral Arterial Disoas “nat 7 Risk actors ‘Symptoms a ge tee! ripheral Arterial Disease (PAD) SCULAR SYSTEM Inflammatory Heart Disorders Faas tava scan * termini ches pan (elevedb ith ans iering ‘Sees ton, somes trea dora Guucsieaoratemontcans *tevsumgan: mcr ee Ses pr, pain 8 _Surmas oft, tonnes Ince encarta ce Srsieesn Scr: Conon ag see + Kevemetans oer ha omer mur, ptcie {edavois ude raltec (pm Pemartape) DIOVASCULAR SYSTEM Inflammatory Heart Diseases Positive bloed eure ‘+ Elevated ESR and CRP (cue 1 intammation) ‘+ Throat culture positive for streptococcal Infection. ‘Masi: Anibots (or infection), NSAIDs (fr fover, inflammation), prednisone (fr inflammation) Complications: Cardiac tamponade Peripheral Arterial Disease (PAD) AD: inadeqias Boos how o ower xFUrBDs coo Siiaoodeces, ‘Symtoms: ‘Pain legs during exreise rteve by plein egs in ‘Sepondon poston saging the) a up pan pan an wake mere. {tSnsin went amine, ew ena sks ‘sea reset, lesa = can ado tesoromton, Meda Antpetescatens (spi, copa reeves beet cat str ‘Besert Anta (ston, sor, pop bypas at (SEBS Eales Can cccunn foc rade paal pe, iereased pa aor, dh cometnet sya (x unbness Prin pssve meet eraVenous thromboembolism Risk actors ‘Symptoms Diagneat Nerang care Venous insufficiency Risk actos ‘symptoms iursing care Peripheral Venous Disorder Peripheral Venous Disorder: leeuo with adaquat lod retum fom he extvemvtes. 3 kinds: (1) Venous thromboombolism (VTE): Blood cit (2) Venous insuffiioney: Caused by incompetent vas inthe doopor veins. This can lead to swoling, venous ulcers, and callie (@) Varicose veins: Enlarged superficial veins Ba ae eee Le fae ree ener cea Somnae fees asec ese Ree acre nce eee inom ence 5 anicoaauiants,trombolies CIS 5 ‘Venous insufficiency Risk factors: Siting/standing in one place fore long) time, obesity, pregnancy ‘Symptoms: Aching pain and feeling of heaviness in igs, brown discoloration of legs (stasis dermatitis), BLE edema, venous stasis ulcers (usually around ankles) ‘Nursing care: Elevate legs, avoid crossing legs or restrictive clothing, compression stockings (apply in ‘morning when swelling is reducee), : Se ‘Varicose veins Varicose vein risk factors; Female, jobs that ‘equire prolonged standing, pregnancy, obestt, family history Symptoms: Distendeditortuous veins just below the skin surface, aching, puri, ‘Therapeutic procedures: Sclerotherapy (chemical “Solution is injected into varicose vein to close off the vein), vein-stripping, laser treatment, radio. ‘equency.Ee ‘Primary hypertension: No known causa Hypertension ‘Secondary hypertension: Caused by cisoaso or Pena. secondary hypransen mediation’. fk aoe rma an tena typatension) isk factors: ‘Symptoms. ‘= Primary: family history, excess sodium intake, inactivity, obesity, smoking, tess, hyparlpidemia sie face (arisan american. =] ‘+ Secondary: Kidney disease, Cushing's syndrome, pheochromocytoma sn faadiache,eizinass, visual esi alionts may not have ANY symptoms 7 Heperternton flere eee > of: re-ypatnin, Sige SacI, Hyparonche ice | | + Single zat DBP 0g a capes ‘Medis; Diuretics, calourn chanel biockars, ACE inhibitors, chia: Tae Breguet sah take, DASH dat {GatGH ruts veges, owt ely; LOW sa ae, oaice etre, once ess sop amoung hyprenaie its (mpons:avere headache, ana a ‘Types of Hemodynamic shock of Hemodynamic Shock (rcigeni: Cori pump aire ethos ir, ‘adogene, Hypoveleme, Obsbuctve, yoewolemie: Blood ls dye to trauma, suger, bursor Distibutve (Seps, Nourogeric,Anaphyacti) Reems ‘Giioese, curoe ‘Obstructive: Bloccage of great verses (2x PE, tnsion Saunas carduetrtponace) Distbutive: Exreme vasadiston, Thee kinds: dotouns in Boodsteam fom econ rast. |p ‘Stnmanly gram neguhve sae) E . oss of sympa tne cue to rauma or 5 Antigen antec acon duo 2 Stponure shorn ay ARDIOVASCULAR SYS Hemodynamic shock ans: Fypowe,tachypnes, pois wchyeara RIBPEIRE: Sreases rte sun uhesarg, ngouaar, | tanh wih araphylcte shox {Gite eratad sen at, tec A, Taicatons, Canpicaors (ities eae snares weatiogene ates tcreasea Ege wiyovolomc ek pote bos coe wh ‘sing sare: Admser 02 preparer ination ace patent fa wigs Seve ta ypeeraion Aiea: Dotwarine vasopressin, epi, colts or Nipovleme hace replace volme tat) sets or “| 8 3 = # Sapte anock _ ‘Semplications: MODS, DIC Hemodynamic shock Symptoms, Labs, Nusing care,