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by: Brenna Notetaker

cardiac Nurs 4020

Brenna Notetaker
GPA 3.4

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med surg cardiac
Mrs. Swift
Class Notes
med surg nursing, cardiac
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This 8 page Class Notes was uploaded by Brenna Notetaker on Monday February 8, 2016. The Class Notes belongs to Nurs 4020 at East Carolina University taught by Mrs. Swift in Fall 2015. Since its upload, it has received 20 views.

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Date Created: 02/08/16
Lecture 1- medsurg 08/28/2015 ▯ Anemia  Deficiency in the number of erythrocytes (RBC)  low volume (low hematocrit) can cause it o blood loss o impaired production o increased destruction  low quantity of hemoglobin  not a disease, it is a sign of a disease or a problem  Normally: erythropoiesis (production)= hemolysis (destruction) o life span is usually 120 days  kidneys make up erythropoietin which help regulate RBC production  Nursing assessment o depends on severity of anemia o Mild- could possibly have no symptoms, palpitations, fatigue, pale mucous membranes o moderate- patients will have increased fatigue, more palpitations, more dyspnea, diaphoretic o severe- pallor, jaundice, glossitis (inflammation of the tongue), tachycardia  oxygen is carried on HgB, so if you have low HgB then you have less oxygen, so heart pumps harder to get oxygen out  bad oxygen to brain= confusion  lethargic, decreased concentration, cold intolerance  fatigue, pallor, dizziness are top 3 signs of anemia  Nursing Care o diagnosis  fatigue (number one diagnosis) from adequate oxygenation  altered nutrition: less than body requirements  folic acid deficiency  ineffective self health management (lack of knowledge) o interventions  blood loss= blood transfusion  nutritional related= supplements with food to increase deficits  oxygen o gerontological considerations  may be recognized later  slightly slower hemoglobin as someone ages, so it could be seen as normal  most anemia in adults is nutritional  fatigue, confusion, heart failure signs, chest pain  Anemias from decreased production o Iron deficiency anemia (most common anemia-30%)  iron deficiency  can be from inadequate intake of iron or malabsorption  can be from blood loss  hemolysis  repeated blood draws  who gets it? very young people, poor diets, women in reproductive years  pallor, fatigue, glossitis, cheilitis (inflammation of the lips)  diagnostic studies- CBC, stool guaiac, colonoscopy, endoscopy (looking for blood loss, what the cause), serum iron levels  bone marrow biopsy if all other tests come back inconclusive  treat underlying cause  take iron supplements (ferrous sulfate-Fe)  iron is best absorbed in an acidic environment (take it with orange juice or Vt. C pill)  liquid iron stains teeth- drink through straw  side effect to iron- heartburn, constipation  sources of iron- green leafy vegetables, eggs, whole grains, potatoes, liver o megaloblastic anemias  cobalamin (vit. B12) deficiency  occurs in patients with GI disease (celiac disease, chrons, diverticulitis), GI surgery, bariatric patients, proton pump inhibitors, alcoholism  S/S- typical symptoms, sore, red tongue, anorexia, N/V  Parietal cells secrete intrinsic factor, which is needed to absorb Vit. B12. If gastric mucosa doesn’t secrete this (disease) or if gastric mucosa is removed (surgery)  Shillings test- need consent, pt will be NPO 8-12 hrs before, leading up to test pt can not have any B12 test (3 days before), day before test pt can not take any laxatives, day of test pt will start 24 hour urine (dump first one, then start and keep everything after, keep in on ice), take radioactive pill, 1-2 hrs after pill the nurse will give an IM B12 shot (1mg), after 24 hours send the urine to be tested for how much radioactive B12 was secreted in the urine over 24 hours (8-24% is normal, if its lower then it is a positive test which means it was not absorbed)  IM B12, intranasal B12  if they still have intact gut, they can take pill form of B12  folic acid deficiency  dietary deficiency  mal absorption (anti seizure meds, alcohol history)  S/S- smooth, beefy tongue, serum foliate level low  treatment is folic acid foods (green leafy veggies, liver, fish, whole grains) o anemia of chronic disease  anemia of inflammation  mild  follows chronic disease (lupus, DM, HIV, chemo and radiation, renal disease)  renal disease= decreased erythropoietin (made by kidneys)  EPO- erythropoietin injection subQ (keep in fridge, warm to room temp before giving)  IV iron  Anemia from increased destruction o hemolytic anemia  destruction  remember kidneys  Hgb can clog renal tubules (low renal output leads to renal failure) o sickle cell disease  genetic disorder, predominately affects African Americans  sickled cells= decreased oxygen  treat with hydration, pain management, and oxygen Thrombocytopenia  reduction of platelets (<150,000)  3 types o immune thrombocytopenia purpura (ITP)  most common  autoimmune  platelets get coated by antibodies and are destroyed by the spleen  autoimmune response from the spleen o thrombotic thrombocytopenia purpura (TTP) o heparin induced thrombocytopenia (HIT)  heparin drips (check dosage and double check)  antidote for heparin is protamine sulfate  low platelets  can form venous thrombosis (heparin immune response can cause endothelial injury)  petechia is a sign of bleeding  Nursing assessment o look for bleeding (petechial, purpura, bleeding gums) o use soft bristle tooth brush o GI bleeding (blood in stool or dark tarry stools, vomiting coffee ground looking stuff) o a lot of time pt is asymptomatic  collaborative care o ITP  Steroids (prednisone)  spleenectomy if prednisone doesn’t work  platelet transfusions (pack)- each pack should increase platelet count from 5-8 thousand o HIT  D/C heparin (first thing you should do)  give protamine sulfate  plasmapheresis  nursing management o monitor for bleeding o bleeding precautions (soft bristle toothbrush, electric razor, fall precautions, no IM injections (subQ is ok), no straining (stool softener), no aspirin, do not blow nose forcefully) o watch for headaches (sign of stroke) ▯ Disseminated intravascular coagulation (DIC)  Inappropriate thrombin response- causes diffuse clotting  clotting factors get used up quickly -> fibrolinic system gets activated to dissolve clots -> hemorrhage  not a disease, it is a result of something (ARDS, sepsis, shock, trauma)  Nursing assessment o Thrombotic- diffuse clotting (tissue necrosis, emboli’s, ARDS, kidney failure) o bleeding (petechial, bruising, hypotension) o vital sign changes o skin o urine output o check meds o pain management  diagnostics o low platelets o low clotting factors o prolonged PTT o D-Dimer used for the degree of fribrinolysis (how much of the clot is dissolving). Will be high in people with clots  collaborative care o treat underlying cause o may need blood products  nursing managements o depends on stage o blood thinner during thrombotic phase o during bleeding phase blood products will be given, platelets o cryoprecipitate- clotting factor 8 and fibrinogen ▯ Anatomy of the Heart  4 chambers  coronary arteries o outside heart o supply blood to the heart o MI- a coronary artery is occluded (partially or fully)  Blood flow through the cardiac valves o Tricuspid (tissue) o Pulmonic (paper) o Mitral (my) o Assets (ass)  cardiac assessment o health history  medications  smoke  exercise  family history  SOB  pillows to sleep  chronic cough  tried easily o head to toe  skin inspection (skin is normally pink, warm, dry. Skin should not be cyanotic or cold)  heart sounds (normal is S1S2, regular rate)  lung sounds (heart failure can cause crackles when its backed up to lungs)  extremities (color, pulse quality)  urine output (if heart’s not pumping effectively then kidneys don’t get blood which means no urine)  mental status (heart supplies blood to brain so if heart is not working the brain will lose oxygen and cause mental status changes) ▯ ▯ ▯


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