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HEHI Adult Exam 1
Left Heart Failure Assessment
Pulmonary Assessment
Pulmonary Congestion
Pink Frothy Sputum
Wheezing or Crackles
Dyspnea with Exertion
Cough
Systemic Assessment
Fatigue
Tachycardia
Weak Peripheral Pulse
S3, S4 Heart Sounds
1 min
Right Heart Failure Assessment
Jugular Venous Distention (JVD)
Peripheral Edema
Hepatosplenomegaly
Nocturia
Weight Gain
Ascites
Fatigue
1 min
Heart Failure Interventions
Diagnostic Tests
Echocardiogram
Invasive Hemodynamic Monitoring
Improve Gas Exchange
High Fowler's Position
Oxygen
Advanced Airway
Drugs and Devices
Diuretics
Beta Blockers
Angiotensin II Receptor Blockers (ARBs)
ACE Inhibitors
Digoxin (Lanoxin)
Pacemaker
2 mins
Endocarditis Assessment
Infection of Inner Layer and Valves
Assessment
Fever
Fatigue
New or Changed Murmurs
Roth's Spots
Splinter Hemorrhages
Janeway Lesions
Osler's Nodes
Considerations
Heart Failure
Embolization
2 mins
Endocarditis Interventions
Interventions
IV Antibiotics
4-6 Weeks
Anticoagulants
Good Hygiene
Considerations
Closely Monitor
Antibiotic Prophylaxis
Dental Procedures
Invasive Procedures
1 min
Bacterial Endocarditis
Signs and Symptoms
Fever
New murmur
Janeway Lesions
Splinter Hemorrhages
Roth spots/round white spots on retina
Osler nodes/tender lesions on finger or toe pads
Anemia
2 mins
Pneumothorax
Mechanism
Air Enters Pleural Space
Assessment
Sudden Dyspnea
Absent or Restricted Movement on Affected Side
Decreased or Absent Breath Sounds on Affected Side
Chest Pain
Tracheal Deviation
Vital Sign Changes
Crepitus
Considerations
High Fowler's Position With Oxygen
Prepare For Chest Tube Placement
Educate High Risk Patients
2 mins
Peripheral Artery Disease (PAD)
Mechanism
Atherosclerosis
Assessment
Intermittent Claudication
Pain with Exercise
Paresthesias
Arterial Ulcers
Critical Limb Ischemia
Amputation
Consideration
Ankle-Brachial Index (ABI)
2 mins
Abdominal Aortic Aneurysm
Screening
Screen Males 65-75 Who've Ever Smoked
Diagnosis
Ultrasound
Treatment
Observation
Asymptomatic and < 5 cm in Size
Surgical Repair
> 5.5 cm in Abdomen
Emergent Surgery
Ruptured or Symptomatic
2 mins
ECG: Atrial Flutter
Rate
Variable
Rhythm
Regular or Irregular
P Wave
Saw Tooth, Multiple Before Every QRS
PR Interval
Non-measurable
QRS Interval
< 0.12 seconds
2 mins
ECG: Atrial Fibrillation
Rate
Variable Rate
Rhythm
Irregular Rhythm
P Wave
No P Wave
PR Interval
No PR Interval
QRS Interval
QRS < 0.12 Seconds
1 min
Tension Pneumothorax
Mechanism
Air Enters Pleural Space, but Can't Exit
Trauma or Infection
Signs and Symptoms
Decreased Breath Sounds
Trachea Deviates Away from Affected Side
Chest Pain
Tachycardia
Tachypnea
Hypotension
Hypoxemia
Hyperresonance
Emergency
2 mins
premature ventricular complexes
Etiology
Idiopathic
CAD (Coronary Artery Disease)
Hypokalemia
Hypomagnesemia
Digoxin (Lanoxin)
Caffeine
Alcohol
compensatory pause
compensatory pause
> 2x normal sinus interval
longer pause > incr in filling > palpitation
non compensatory pause
non compensatory pause
< 2x normal sinus interval
Cor pulmonale
Peripheral Edema
Raised JVP
Right Ventricular Hypertrophy/Dilatation
Hepatomegaly
Tricuspid incompetence
Pulmonary hypertension
Basics:
Pulmonary Hypertension
>25 mm Hg
Pathophysiology
arteriolosclerosis
medial hypertrophy
pulmonary artery fibrosis
Causes:
BMPR2 gene
Drugs
Schistosoma
HIV
Portal Hypertension
Clinical
Respiratory Distress
Cyanosis
Right Ventricular Hypertrophy
cor pulmonale= death
Cardiac Tamponade
Mechanism
Fluid in the Pericardial Sac
Pericarditis
Decreased Cardiac Output
Signs/Symptoms
Beck's Triad
Hypotension
Jugular Venous Distention (JVD)
Distant Heart Sounds
Pulsus Paradoxus
Electrical Alternans
Treatment
Pericardiocentesis
1 min
Primary Open-Angle Glaucoma (POAG - Chronic)
Mechanism
Flow of Aqueous Humor Slowed
Signs and Symptoms
Slow Onset
No Pain
Tunnel Vision
IOP 22-32mm Hg
Considerations
Drug Therapy
1 min
Primary Angle-Closure Glaucoma (PACG - Acute)
Mechanism
Rapid Increase in IOP
Signs and Symptoms
Rapid Onset
Pain
Blurred Vision
Halos Around Lights
Nausea and Vomiting
IOP over 30 mm Hg
Considerations
Drug Therapy
Surgery
1 min
Age-Related Macular Degeneration (AMD)
Mechanism
Dry (nonexudative)
Wet (exudative)
Signs and Symptoms
Scotomas
Blurred, Darkened Vision
Loss of Central Vision
Distortion of Vision
Considerations
Drug Therapy
Surgery
Low-vision Assistive Devices
2 mins
Cataract
Mechanism
Age-related
Assessment
No Pain
Cloudy Opaque Lens
Decreased Visual Acuity
Occurs Gradually
Treatment
Surgery
1 min
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