221 Final Flashcards
Most common symptom in early bladder cancer
Gross, painless hematuria (chronic or intermittent). Confirmed by BIOPSY.
post op care for total laryngectomy
Monitor airway patency, VS, hemodynamic status, and comfrot level. Take VS hourly for first 24 hrs, and then every 2 hrs or according to agency policy until the patient is stable. Once off CCU monitor ever 4 hours.
The patient tells the nurse, “ I have lost weight since going on Digoxin. The nurse should reply which of the following?
- Hold your doses and see your doctor immediately
- That is expected and is an action of the drug
- This is a side effect and can have serious complications
It is expected that a patient will have weight loss from Digoxin. so 2.
Major side effect of INH (tb drug)
B6 depletion
When giving a diuretic what do you always check first?
BP!!!!!!!!!!!
ATN manifestations
Fluid overload (S3, JVD), decrease urine output or not at all, hyperkalemia, cardiac dysrythmias (life threatening)-abnormally wide QRS complex
K+ excess in oliguric phase
Cardiac muscle is inolerant or acute increase in K+, hyperkalemia creates an elevated T wave, hypokalemia creates and elevated U wave.
How does Verapamil work?
Verapamil relaxes the smooth muscle of the heart
Risk factors for pylenephritis
past medical Hx of chronic renal calculi (kidney stones)
Ted Hose (for DVT)
- Promotes venous return
- make sure elastic band isnt too tight
- Apply before getting OUT OF BED
ICD’s are used to prevent DVT not for active DVT!
Sickle Cell patho
When exposed to decreased O2 (being hig up in an airplane) – RBCs sickle, become rigid, fragile and sticky.
‘what will you see with hypocalemia and hyperphosphatemia ?
Trousseau’s sign, cardiac arrhythmias, prolonged clotthing time (uremia shortens lifespan of plts, Ca+ important for clottinh factor cascade), fractures.
AVF/AVG complications
Clotting/thrombosis, Steal syndrome: cold hands/fingers, numbness/tingling of giners, may resolve after 6 weeks.
What are some signs and symptoms of DIGOXIN TOXICITY?
Halo’s in vision, Color changes in vision, Headache, Lethargy, Nausea, Diarrhea, Bradycardia, Dysrhythmia, Irritable.
Lab values for ARF
K+ and phos increase, Ca+ and ph decrease Bun and creatinine increase
Normal Bleeding time?
1-6 minutes
Blood administration
Assess the clients lungs before and after, check for allergies, obtain a signed consent, 19 gauage or larger needle, isotonic solution(NS) in one and blood via the other spike, positively ID the donor blood and recipeient ( 2 RNs), check for storage lesions (old blood, temp of blood), takes 2-4 hours.
intermittent claudication
arterial insufficiency, due to lactic acid accumulation build up in muscle, usually can feel it upon activity and subsides after 10 min
Early s/s of diabetes
3 p’s polydipsia polyuria polyphagia. Classic sign is blurred vision, neuropathy also
The client with chronic peripheral artery disease and claudication tells the nurse that burning pain often awkens him from sleep. What is the nurse’s interpretation of this change.
A. The client has inflow disease
B. The client ahs Outflow Disease.
C. The client’s disease is worsening.
D. The client’s disease is stable.
C. This is the worsening sign and symptom.
(? from supplemental)
Beta blockers are ordered. The mechanism of action is
A. decrease heart rate, reduce myocardial oxygen demand
B. increased cardiac output, increased systemic vascular resistance
C.Stimulation of sympathetic nervous system
D. Alpha receptor stimulation producing vasoconstriction
A
What is responsible for Coagulation of the blood?
Platelets
Things that decrease preload
- Elevating HOB
- Nitrates (vasodialators)
- Morphine
Nursing Responsibility for a Bone Marrow Biopsy
Get consent, Pre-emptive medication (Conscious sedation) Versed, & Morphine, Pressure dressing after (hold for 15 min) do frequent site checks, Assess the site for bleeding (underneath them) Possible Complications: Infections and bleeding
EKG changes associated with coronary ischemia
T wave inversion and ST depression
What does this EKG show?
Normal sinus Rhythm with a large PVC
Acute interventions for ARF
I & O, daily weights, encourage cough and deep breathing, insentive spirometer
S/S of Peripheral Artery Disease (PAD)
-withered calf muscle -hair loss -thick toe nails -shiny, tight skin -painful ulcers in the toe that are black and do NOT bleed. -Blood clots can form in some cases (STARVATION)
List the following heart rhythms from most serious to least serious.
- Normal Sinus Rhythm
- PVC
- A fib
- V tach
- V Fib
Vfib, V tach, PVC, A-fib, Normal sinus rhythm.
accucheck coverage what type and why?
rapid or short acting b/c it’s easier to treat hypoglycemic rxn’s with these 2, go by sliding scale
post op care for client after radical prostatectomy?
remain on bed rest, and nothing per rectum.
What is this
V-Tach or Tombstone.
Ventricular Fibrillation
No cardiac output;; patient is technically dead
Treatment: D-fib (shock) to try to get some kind of rhthym to work with
Drug therapy for BPH
5a reductase inhibitors (Proscar) -decrease prostate size, decrease level of dihydrotestosterone, 6 months for relief of symptoms, supression of adrogens(hot flashes)
A-Adrenergic blockers = Tamsulosin (Flomax) - s/e: Hypotension, dizziness, fatigue (Priority nursing intervention is to assess for those s/e !
What is the normal pTT or APTT (Activated partial thromboplastin time)
Normal (CONTROL) 30-45 seconds
Someone on Heparin (2x the control) or 60-90 seconds
Intrarenal (ARF) results from conditions that cause direct damage to the renal tissue, some causes are:
Infection, Drugs (mutiple nephrotoxic antibotics: genotamcyin, all mycins), infiltrating tumors, IVP contrast, prolonged prerenal ischemia, nephrotoxic injury, acute glomerulonephritis, toxemia of pregnancy, malignant HTN, systemic lupus erthematosus, interstitial nephrtits, Acute Tubular Necrosis (ATN)
if you believe someone is hypoglycemic but you don’t have an accucheck???
treat as hypoglycemic until proven otherwise, give 6-8 oz of regular pop for hypoglycemia, give hard candy 6-10 pieces, give a complex carb or cheese or protein
Priority of care for hyperkalemia
Management! K+ (3.5-5.0), IV sodium bicarb to decrease blood ph, causing movement of K+ for the extracellular fluid into the cells in exchange for hydrogen ions.
CHF causes
Arthersclerosis, HTN, MI
Vascular Access sites for dialysis
Internal Arteriovenous Fistula (AVF)
-decreased complication rate, no dressing, allows freedom
Internal Arteriovenous Graft (AVG)
-decreased risk fo bleeding/clothing, no dressing, allows freedom
What is the normal platelet count?
150000 to 400000
c-reactive protein
shows up months before an MI, can possibly prevent an MI, lower # is better, measures the inflamm. Response
Why would having a streptococcal sore throat be detrimental to someone with a hx of heart failurel?
because it leads to rheumatic fever, which can cause a heart murmur and endocarditis
nutritonal therapy after stone removal
increase fluids to 3,000 ml/d
tPA
-Clot buster
IMMEDIATELY stop tPA if: hematuria, gingival bleeding, blood oozing from IV, decreased LOC, nosebleed
nephropathy is common in prolonged chronic diabetes, what is an early sign of nephropathy?
proteinuria
A recent MI patient has admitted with chest pain, and nausea. Which is the priority? Emesis basin? Oxygen by cannula? Beta blocker? X-ray?
Oxygen
What do Nitrates do?
Decrease pre and after load, which relieves chest pain.
Store in a cool area away from body and away from light,
sublingual, paste and spray are fast acting. Sublingual will cause tingling.
Nurse must wear gloves.
Infections common with immunsupressive therapy
Cytomegalovirus(most troublesome, may result in graft loss and client deth)
Herpes virus-treat with acyclovir (Zovirax)
(? from supplemental)
The pt with essential hypertension is started on procardia. The action of procardia includes:
A. Blocks stimulation of angiotension I to angiotension II
B. Inhibits beta 1 stimulation in the myocardium, decreasing heart rate
C. Produces vasodilation, decreasing afterload
D. Inhibits sympathetic nervous stimulation, decreasing cardiac output
C.
Treatment for new MI?
Morphine, Oxyge, Nitrates, Asperin (ASA), Beta Blockers
MONAB
If your urine sample comes back positive for streptococci, or is contaminated. What probably happened?
You touched the inside of the cup.
Peritoneal dialysis-procedure
1-2 L dialysis instilled (gravity fill) over 10-20 minutes, fluid dwells, drains.
Aseptic technigue at all times !
Patient on heparin in the hospital switching to coumadin
Patient cant go home on Heparin so placed on Coumadin
Coumadin takes a couple days to kick in
With both patient wont hemorrhage
Need to get INR regulated before taking off heparin
Coumadin is hard to regulate so always have vitamin K available
To decrease Preload……
Administer Nitroglycerin, Morphine, Elevate HOB 45 degrees
Post renal (outside of kidney)
sudden obstrution of urine flow due to enlarged prostate, kidney stones, bladder tumor or injury. BPH, STONES
Insulin is? Made in? And produced by? Funtion?
a protein that is produced by the pancreas in the Islets of Langerhans, it is released and stabilizes blood glucose (lowers it)
A client has had a recent MI. why is damage to the myocardium a problem for theis patient?
a. Damage to this area causes plaque to build up on the heart valves.
b. Damage to this layer can decrease the contractile force of the heart
c. Damage to this layer can lead to excessive cortisol and endorphin release.
d. Damage to this area causes striated heart muscle fibers to release damaging high defense lipoproteins.
b. Damage to this layer can decrease the contractile force of the heart
Renal diet
low potassium diet, APPLES low protein, llow sodium (Toast, Applesauce, Greenbeans ) TARG
Drugs contraindicated for someone of Coumadin
Aspirin, Nsaids, Motrin, Herbal Remedies or OTC (alot contain vitamin K which is antidote for coumadin)
Ex. of herbal remedies : Garlic, Ginger, Ginkgo, Ginseng &OMEGAS
pt taking OHA says he wants to exercise and increase his meds what do we tell him?
Do NOT increase meds but eat more to prevent hypoglycemia
The client becomes SOB and his lips are dusky. His ❤ rate is 120 and respiration are moist. The nurse administers O2 and places him in high fowlers mainly to: A. Increase BP B. prevent orthostatic hypotension C. Facilitate suctioning D. Decrease the preload
D. Decrease preload
Azotemia is?
High levels of Nitrogenous waste products in urine. Kidneys are not filtering correctly.
In order to diagnose HTN?
elevated BP readings must be present on at least 3 consequtive occasions during several weeks
Blood pressure increases with age due to?
ARTERIOSCLEROSIS (hardening of the arteries) and loss of elasticity
(? from supplemental)
Lasix 40mg is ordered for a pt in the ED. After administering lasix is important for the nurse to:
A. check the serum potassium level
B. Weigh the client
C. Measure the clients output
D. Take the clients BP
D (initially)
Complications of Sickle cell crisis
Prone to infection r/t spleen fails to phagocytize foregin substances (pneumonia), chronic leg ulcers.
proscar and flomax
given to BPH and kidney stones , vasodilator opens up allows stone to pass and also decreases prostate size, take at bedtime (flomax) causes erectile dysfunction
Risk factors of getting Bladder cancer
Cigarette smoking (ewwy), exposure to dyes used in some rubbber and cable industries, pt with a PMH of chronic renal lithiasis (recurrent stones), chronic UTIs and chronic cystitis.
Diabetes type 2 process and risk factors
Most prevalent type (90% of patients) pancreas can still secrete SOME insulin, this is called Peripheral Insulin Resistance Major risk factors: obesity and BMI >25.
Erythropoietin (procrit)
Used in pts not responding to hydroxyurea, can be self administer at home ( teach self injections)
someone with leukemia cant take this.
What blood chemistries should you check for in a urine sample?
BUN, Creatinine. These are expected in a client in suspected Cancer of pancreas. Run this test before chemo.
A new MI patient comes in, what needs to be done?
Give morphine, o2, get iv access established.
Nursing Diagnosis for HTN most common is?
Deficient knowledge related to management of disease process.
Med that can cause ATN
aminoglycosides (mycins), amphotericin B (antifungal), Cisplatin (chemo), radioisotopic contract media (IVP dye)
What is the action of Calcium channel blockers and what foods would you tell someone to avoid when on them,?
Cardizem (Diltiazem) relaxes smooth muscle, AVOID GRAPEFRUIT b/c your liver cant eliminate it and it builds up in the body
(? from supplemental)
56 year old female is seen in the ED with C/O crushing chest pain radiating to her neck and shoulders . The admitting dx is MI. The following orders are noted: o2 4L nc, chest xray, blood work including triponin and myoglobin levels, EKG, and morphine sulfate 2mg IVP. What shoud the nurse do first?
A. Give morphine
B. Obtain 12 lead EKG
C. Order the chest xray
D. Call the lab obtain specimen
A
Post-op for TURP
high potential for hemorrage, continous bladder irrigation (CBI) used to keep catheter from becoming occluded by blood clots, monitor Hgb and Hct, assess for hematuria in continous drainage bad, decrease irrigation rate of flow in clotting occurs, contact DR to udate any complications.
If stone is present should fluids be increased to dilute?
No when stones are present, just hydrate do once stone is gone you can super hydrate to help keep new stones from forming.
Hemodialysis complications
Hypotension (hold diuretics and antihypertensives), disequillbrium syndrome (causes nausea, confusion, restlessness, and headache, cerebral edema (confusions, alter LOC,jerking, headache), dialysis encephalopathy ( assess mental status and treat with aluminum-chelating agents)
The final event of an MI is usually what?
Thrombosis
Which of the following are true about brain natriuretic peptide (BNP) ? select all A. The test is useful in diagnosing CHF, B. The hormone has been shown to increase in response to ventricular volume expansion C. BNP is a marker of ventricular systolic and diastolic dysfunction D. The test is useful in diagnosing a MI
A, B, C
Nutritional threrapy for CRF
Restrict protein (40gm/day)
low protein det is deficient in vitamins- replace water soluble vitamins lost in dialysis, all but ADEK (fat soluble)
What is the T wave?
Ventricular relaxation or repolarization.
Nursing interventions for pulmonary Edema
Adminster O2, place in semi-fowlers position, DONT cough and deep breath
Someone is getting an IVP (Intravenous Pyelogram) what is of most concern before the procedure?
Check for iodine sensitivity (allergy) Shellfish, shrimp, seafood, etc.
Glucophage (metformin)
Decreases hepatic glucose production
drugs to give a pt with a PVC?
lidocaine or pronestyl
What are some side effects of atenolol? Select all that apply 1. Anxiety 2. Fatigue 3. Constipation 4. Dyspnea
Fatigue and dyspnea
Hematologic manifestions of CRF
Anemia r//t the decreased prodcution by the kidney of the hormone erythropoietin (decrease erythropoesis)
- teach self-injections of procrit (erythropoetin) SQ
- know ready to d/c when can properly give injection.
Nursing interventions for sickle cell
Manage pain (PRIORITY), bedrest during exacerbation, increase fluids, IV fluids, O2, teach to avoid: overexertion, high altitudes(moutains), dehydration (drink at least 8-10 glasses of water daily.
What does PVC stand for?
Premature Ventricular Contraction. The ventricle has cantracted before it can properly fill.
Someone taking nephrotoxic drugs to treat a previous condition develops ARF (Acute renal failure) what stage is this?
Intrarenal stage
What to do when pt has abdominal aortic aneuryms
- Report complaints of abdominal pain to Dr. immediatly!
- DO NOT PALPATE ABDOMEN!
Urinary diversion pre-op management
Body image distubrance r/t change in body function
Femoral Popliteal bypass for PAD
- improved blood flow beyond stenosis or occlusion
- monitor extremity q15min initially
*Assess pedal pulse q15min, complete neurovascular assessment
skin color changes (pallor) temp, cap refill, pp distal to operative site
avoid flextion of leg (no pillow)
A patient has an mi and edema, which meds should you give.
Morphine Diuretics
Anticoagulant therapy for treatment of DVT
-Pt placed on Heparin drip in the hospital -Patient cant go home on heparin so they’re placed on Coumadin or lovenox (LMWH) -Lovenox is given subQ, do not aspirate or massage, Leave air bubble! -Coumadin Therapy: administer same time each day, have blood drawn routinely to monitor serum electrolytes. -Pts on coumadin should wear a med-alert bracelet at all times, Report any bleeding -INR should be 2.0-3.0 on coumadin, if -Coumadin takes a couple days to have an affect so they need to be on Heparin IV for a couple days so theat the body can switch to coumadin.
Care of client post thoracentesis
Monitor VS, check breath sounds for absent or redcued sounds on the affected side. Check for bleeding around puncture site. Assess for reaccumlation of fluid in the pleural space, subQ emphysema, infection, and tension phenumothorax. encourage to breath deeply to promote expansion of lungs.
Management of pneumonia
Antibiotics, O2, analgesics, antipyretics, chest physiotherapy, rest, hydration, nutrition
Nutrition for Anemic patients
Foods high in iron: red meat, spinach, raisins, green-leafy veggies, dried fruits.
Eat small frequent meals with snacks.
Early signs of primary HTN (40% asymptomic ) A. End stage renal disease B. blindness C. Early morning headaches D. Loss of peripheral pulses and parathesias
C. Early morning headache. As well as unexplained fatigue and nocturia
The most common symptom of early bladder cancer is?
Gross painless hematuria. Either chronic or intermittent.
what to teach client when going for cystoscopy
They may experience burning and frequency for several hours after.
Pyridium may be used after to decrease bladder irritability.
What does the nurse hope to accomplish by administering Bumex?
- Reduce heart Arythmia
- Stop chest pain
- Reduce crackles and coughs in lung
- Cause expansion of avioli
- Reduce crackles and cough due to secretions in the lungs. Bumex or Bumetanide helps to reduce swelling and fluid retntion. Used to help in High BP.
Nursing intervention post-nephrectomy
meaure urinary output every 1-2 hours to ensure that the remaining KK is functional
tell pt w/ sickle cell to avoid ….
injury and high altitudes
Before using IVP what does the nurse need to asses for?
Seafood allergies. SHRIMP
someone with pernicious or iron def Anemia needs to take iron, how do they take it?
take iron on empty stomach so 1 hr b4 or 2 hours post meal can be taken with OJ , expect ur stools to be dark and tarry after not bright red
major complications of a prostatectomy
erectile dysfunction and incontinence
PAD Venous Symptoms (Gluttony)
Peripheral pulses- present but difficult to feel
Capillary Refill- less than 3 seconds
Edema- lower extremity edema
skin color- bronze, brown
texture- alligator, thick, hard
Temperature- warm
pruitis- frequently occurs
Nails will be thick for both arterial and venous
People prone to getting DVT (venous insufficiency)
-immobile, *abdominal surgeries*, someone who doesnt change positions alot (truck driver, CRAB BOAT CAPTAINS ON THE BEARING SEA! LOL)
For an acute MI with Pulmonary Edema what would you give?
diuretic and morphine
Chronic Pyelonephritis s/s
fever, chills, flank pain, and dysuria
The nurse initiated a teaching plan for Carol, Age 42, which is preparing for discharge following hospitalization for thrombophlebitis. She is to be discharged on Coumadin. Which statements indicate that teaching has been successful for discharge? (SATA) A. “I should increase my diet to include more salads to loose weight.” B. “I should wear a medic alert bracelet to indicate i am taking an Anticoagulant.” C. “I will need to have my blood draw regularly to monitor the effects of Coumadin.” D. “I will check with my physician before I begin or stop any medications” E. “I will begin an exercise program to facilitate circulation and decrease the chances of another DVT.”
B, C, D, E
how is pneumothorax treated?
chest tube to water seal drainage.
Points to remember for suctioning, when is not the easier kind that is already attached (like danielles pt)
Maintain surgial aspesis, mositen catheter, insert cath until patient coughs, dont suction while inserting, push in fast, pull out slow and hold suction down and let go while using a twist motion to pull out, do not suction for longer then 10 seconds, rinse cath between insertions. (am i referring to sex right now?!! moisten (lube), until they cough (she gags), go in fast, pull out slow, twist, clean off in between?? hahaahah im dirty)
diabetes is a ______ rather than a _______
syndrome rather than a disease, it’s altered lipid distribution
complications of diabetic neuropathy
delayed gastric emptying, infection, poor wound healing, hyperglycemia
Calcium Channel Blockers are? How do they work?
VND, Verapamil, Nifedipine (procardia), Diltiazem (Cardzem).
Relax the smooth muscle in the heart. Decrease contractility and conductivity of the heart which decreases the demand for O2
Side Effects are decreased BP, Bradycardia, Headache, Perpheral Edema, and abdominal discomfort.
Hypertensive Crisis
- BP 250/120 - Headache -Chest pain **STOPPING BETA BLOCKERS ABRUPTLY CAN CAUSE A HYPERTENSIVE CRISIS!
Surgical tx for bladder cancer
Radical cystectomy
-ileal conduit is created
Person has Bladder CA, theyve undergone a cystectomy,What is created, and what is expected for the first 2 days?
an Illeal Conduit is created, and mucous shreds in the Urine is expected for the first 2 days
Care of a client with HTN and
-Give Ace-Inhibitor because they do not cause CHF and they bring dowm the blood pressure.
Drugs for Bradycardia and decreased BP are?
IDEA. Isoproterenol, Dopamine, Epinephrine, Atropine.
PAD Arterial Symptoms (Starvation)
Peripheral Pulses- decreased or absent
Capillary Refill- more than 3 seconds
Edema- No edema present
Pain- rest pain in foot
Skin color- Rubor/pallor
Texture- thing, shiny, dry
temperature- cool to cooler
pruitis- rarely occurs (itching)
Name some Calcium Channel blockers and what they do ……
Very nice drugs verapamil, nifederone, diltiazem
if someone is bleeding, what will BP and
low BP high heart rate
Sodium balance of oliguric phase
Low Na+!! Avoid excessive intake of sodium, damaged tubules can conserve Na+
Which meds will prevent the extension of an mi? Select all thy apply 1. Nitro 2. Aspirin 3. Ace inhibitor 4. Beta blockers
Nitro and beta blockers
Hyper tensive crisis is?
BP 250/120, Headache, chest pain.
Stopping Beta Blockers suddenly can cause it.
early s/s of CKD
decrease urine output, uncontrolled diabetes, hypertension (???)
what type of isolation are TB patients in?
airborne
What are the signs of myocardial ischemia?
Chest pressure ( elephant on chest) Neck or jaw pain Shoulder pain (referred pain) Clammy skin. Sob Nausea and vomitting.
Too little insulin, undiagnosed DM, stress, low Na, Low Ca, hyperglycemia metabolic acidosis
DKA Diabetic Ketoacidosis
What needs to be done after a thoracentesis?
Chest x-ray: to rule out pneumothorax and mediastinal shift.
anemia
low 02 in blood, stimulated by hypoxia
HHS main complications, s/s & treatment
blood glucose above 500, dehydration, altered LOC, give .9 or .45 to replace fluids,
irreversible neuropathy is a complication of which type of anemia?
Pernicious
Preneal (ARF) before the kindey, causes consists of factors outside of kindey, some of them are:
Decreased renovascular blood flow = HTN, decreased urine output, BUN 70, creatinine >2.9, specific gravity >1.040
Hypovolemia
Decreased cardica output
Decreased peripheral vascular resistance
To assist someone with cultual needs pertaining to diet?
ASSESS what they normally eat, and offer some alternatives, help them list some foods lowest in Na+ and cholesterol from foods they normally consume
The nurse plans discharge teaching for a patient with chronic heart failure who has prescriptions for Digoxin, hydrochlorothiazide, and a potassium supplement. Appropriate instructions for the patient include?
a. avoid dietary sources of potassium because too much can cause digoxin toxicity
b. take the pulse rate daily and never take digoxin if the pulse is below 60 BPM
c. take the hydrochlorothiazide before bedtime to maximize activity level during the day.
d. notify the health care provider immediatelyif nausea or dificulty breathing occurs.
D. Digoxin toxicity is potentiated by HYPOkalemia.
What is Angina Pectoris?
Acute pain located in chest, usually an imbalance between oxygen supply and demand
What is most common with an MI? What is the final event of an MI?
Most common complication? pVC or dysrythmia Final event: Thrombus
What to teach a client on contiuous ambulatory peritoneal dialysis (CAPD)
To report fever & chills, report nausea and muscle meakness (s/s Na+ & K+ depletion from dialysis)
blood sugar of 100-126 mg/dl
prediabetes
What is this?
Ventricular Fibrillation
Prior to giving Digoxin,you monitor pt’s heart rate and it is 58
Hold the med recheck apical pulse in an hour and if it is 60 or higher administer the drug
Earliest signs of HTN
Nocturia, early morning headache, fatigue
When teaching a client when and how to take TB meds, tell them to:
they will take 4-5 meds for 6-9 months, and then 2-3 for another 3 months. stress importance of taking the medication for the whole time
What is a normal Digoxin Level?
Dig levels should be 0.8 - 2.0
Following an acute MI, a previously healthy 67 Y.O. patient develops clinical manifestations of heart failure. The nurse anticipates discharge teaching will include information about.
a. digitalis preperations, such as digoxin
b. Calcium channel blockers, such as diltiazem
c. B-Andrenergic agonists, such as dobutamine
d. Ace inhibitors, such as captopril
D. Ace inhibitors are recommended to prevent the development of heart failure in MI patients.
what to watch for when pt is on Tamsulosin (Flomax)
Hypotension, dizziness, and fatigue
What instructions should be given to a client who is about to begin treatment with an HMG-Coa reductase inhibitor such as simvastin?
A. This drug can cause constipation
B. Take this drug on an empty stomach
C. Report any muscle tenderness to your health care provider
D You may expierience flushing of the skin with this medication
C. This drug can cause myopathy.
How do ACE Inhibitors (Prils) work?
Stops the Conversion angiotensin I to Angiotensin II by causing sodium and water to leave body and retains Potassium. Patients will become dehydrated.
Side effects are dizziness, Cough, Headache, Dehydration, GI Distress, Orthostatic HTN.
(? from supplemental)
Which of the following statements are true concerning the administration of NTG paste per chest wall? (SATA)
A. Orthostatic Hypotension may occur
B. Withhold the drug for BP less than 100/60
C. Withhold the drug for the dx of stable angina or acute coronary syndrome
D. Place the NTG paste on the chest wall with each application
E. May be used in clients with acute chest pain especially with no IV access is available
A, B, D, E
Normal Serum Creatinine levels are?
0.5 - 1.5 mg/dl
early s/s of anemia:
fatigue pallor sob, tachycardia , CP, HgB decreased
A client with HTN should avoid which of following foods ? A. Turkey B. chicken. C. Green leafy veggies D. Frozen foods
D frozen foods
Clinical manifestations of BPH (benign prostatic hypertrophy)
Feeling of incomplete bladder emptying after urination, may not be noticed for a long while.
Multiple myeloma
Slow insidious nature, causes mental changes, series of involuntary muscular contractions, Ca+ is lost from bone, high levels of protein-acute tubular necrosis, bone pain (get help turning patient, give norco, vicodin, loritab, give two tabs if pain is 8, see what they usually take)
What to Assess when a patient has a chest tube?
Difficulty breathing, pulse ox, check trachea alignment (tension pneumothorax), assess pain, look for ‘eyelets’ visible on chest tube.
What is the mager diagnostic finding for an MI?
Troponin will increase 4-6 hours from event. CPK MB will also be positive or increase
Nursing diagnosis for Anemia
Ineffectivwe therapeutic regimen management r/t lack of knowledge of meds and nutrition AEB: asking about diet, meds and RX.
- Teach to take Fe+ before meals with Vit C
- inform client that Fe+ will cause dark stools and constipation
- avoid taking with hot coffee/tea
- take enteric coated
During the oliguric phase of ARF, neurological s/s result from?
A.Hypokalemia
B. hyponatremia
C. Decreased H+ ions in the blood
D.Urea and creatinine buildup in the blood
D. Urea and creatinine build up in the blood.
Unexcreated urea and creatinine build up in the blood = toxic effects on the CNS = neurological effects (lethargy/confusion)
A BP reading of 140/90 indicates:
Hypertension
sickle cell crisis care?
02, manage pain, bed rest, fluids, antibx
Assessment findings for sickle cell
Increased bilirubin (client scratches skin), DIB (SOB), pale mucous membranes, C/O painful swelling of hands and feet, CHF, hepatomegaly, pneumonia on x-ray
Your patient (admitted for hypertension) asks for help in ordering their dinner. Which would you select?
- Chicken Tenders.
- Hot Dogs.
- Chicken Stir fry.
- Baked Turkey Breast.
Baked Turkey Breast. The rest of those items are either fried or high in Sodium.
Hodgkin B symptoms
Worse prognonsis=fever, night sweats, weight loss
Stones are reccurent in..
50% of patients, and more common in summer.
*KNOW ST CHANGES ON EKG
ST depression- indicates ischemia
ST elevation- indicates injury
hemodialysis nursing interventions
Assess BP, lung and heart sounds before and after, weigh beofre and after, hold meds that effect BP, hold meds that be dialyzed off (anitbiotics, water soluble vitamins). Ausculate for bruit, palpate for fistula.
someone in DKA or HHS when to stop the insulin drip and hang d5w?
when BS drops below 250 from whatever it was at
in hemodialysis hold which meds?
antihtn’s dig, diuretics anything that lowers BP and diuretics bc they’re already losing enough electrolytes due to the dialysis
Coagulation cascade
Heparin acts on intrinsic factor. Coumadin acts on extrinsic factor
Action of ACE INHIBITORS
-Prevents conversion of angiotensin I to angiotensin II S/E: Hypotension Dry/persistent tickling Persistent dry cough -Does NOT effect
DKA
Lack of insulin, breakdown of ketones (ketonuria) fruity breath, Hypokalemia, BS ^300
Nursing interventions for a patient with AVG, what to not to on the arm it is in?
DONT measure BP, draw blood, place an IV or adminster injections, lift heavy objects or compress arm (carry with oppsosite arm) Palpate for thill, or ausculate for bruit (swooshing sound)
Most people in renal failure have what kind of HCO3 levels?
Low HCO3 because they are in metabolic acidosis. Normal levels are 20-30
Client with left side ❤ failure is Gavin difficulty breathing due to excessive fluid. What would ABGs look like ? A. Ph 7.47. Co2 30, Hco3 25 B. Ph 7.33, Co2 50, Hco3 26 C. Ph 7.20, Co2 35, Hco3 17 D. Ph 7.56, Co2 19, Hco3 24
B. resp acidosis
A patient with a non-ST segment elevation Myocardial infarction (NSTEMI) is recieving heparin. What is the purpose ofthe heparin?
a. Heparin wil dissolve the clot that is blocking flow to the heart.
b. Coronary artery plaque size and adherance are decreased with heparin
c. Heparin will prevent the development of clots in the coronary arteries.
d. Platelet aggregation is enhanced by IV heparin infusion
C
Post Op Teaching for Abdominal Aortic Aneuryms
-They will be in the ICU. -Prophylactic (prevents) antibiotics should be taken prior to dentist for those who recieved synthetic graft. -Teach to palpate peripheral pulses to make sure blood is getting down. -Teach that sexual dysfunction may occur if hypogastric AA is interrupted (decreased blood flow to penis) -May need refferal to a Urologist for impotence.
sickle cell anemia manifestations
SOB, pale mucous membranes, palpitations, swelling in extremities, jaundice
Bactrim is taken for how long?
3 - 5 days. Taken on an empty stomach
causes of pernicious anemia
gastric bypass which removes the parietal cells or aging due to atrophy of parietal cells (loss of parietal cell fx)
common clinical manifestations (s/s) or Lung CA
productive cough, blood tinged sputum, chest pain (pressure on nerve endings), dyspnea, wheezing, [anorexia, fatigue, weight loss] - (late sings), hoarseness, reoccurring resp infections that wont seem to go away.
The client with heart failure is prescribed to take enalapril, an ACE inhibitor. which of the following precautions should the nurse to teach this client regarding drug therapy?
- Avoid salt substitutes
- be sure to take this mediaction with food.
- Avoid aspirin while on this medication
- Do not take this mediaction if your pulse rate is below 74 BPM.
Ace inhibitors inhibit the excretion of potassium. so A
What is happening when the P wave is seen?
The P wave is the electrical impulse of the Atrium contracting or depolarizing.
Anaphylactic/severe allergic reactions to blood transfusions
Wheezing, cyanosis, cardiac arrest, initiate CPR if indicated, epinephrine SQ or IV as ordered, do not restart transfusion, Call Code !
To assist the patient with CAD to make the appropriate dietary changes, which of these nursing interventions will be most effective.
a. Assist the patient to modify favorite high-fat recipes by using monosaturated oils when possible.
b. Provide the patient with a list of low sodium, low cholesterol foods that should be included in the diet.
c. Instruct the patient that a diet containing no saturated fat and minimal sodium will be necessary.
d. Empahasize the increased risk for cardiac problems unless the patient makes dietary changes
A
A client with a diagnosed abdominal aortic aneurysm develops lower back pain radiating to the groin. what is the nurse’s interpretation of this information.
a. The aneurysm has become obstructed.
b. The aneurysm may be undergoing expansion.
c. The client is expieriencing inflammation of aneurysm
d. The client is expieriencing normal sensation associated with this condition.
B
Low potassium diet for CRF
APPLES, pasta, bread, spinachm, cucumber, coffee, peaches, eggs and chicken.
Long term complications of Uncontrolled Hypertension
Renal Failure( kidney) , Stroke ( brain), Vascular Disease,Blindness (eyes)
What is Stable Angina?
Predictable, reversible, pain on exertion as a form of chest pain.
Prerenal (Before kidney)
Factors Outside of kidneys Shock, or interruption of blood flow to the kidneys from severe injury or illness (hypotension) Decrease urinary output, BUN increase, creatinine increase, specific gravity increase
Ileal conduit care
meticulous skin care arpound stoma (cover stoma with gauze when changing appliance to keep dry), make sure there is drainage in bad post op (may be mucus shreds). Stoma should be red/pink moist, not flushed, not painful
Ejection fraction
Left ventricle - 45-65% Cardiac Cath decreases 20%
Mr. Tilly has a history of Buergers disease which is getting progressively worse. he is admitted with a gangrenous lesion of his right small toe. which goal does the nurse recognize is more important for mr. tilly? A. stop smoking B. perform meticukous foot care C. maintain normal weight D. control serum lipid levels
A!
the flow of urine output in a nephrostomy tube should be? What would we check for if decreased output ?
continuous check for kinks
the only insulin that can be given IV?
regular insulin
Treatment of sicke cell disease
Broad-spectrum antibotics, folic acid, exchance blood transfusions(in aplastic crisis), chelation therapy to decrease transfusion-induced iron overload, Oxygen.
Intrarenal (direct damage to the renal tissue)
infection, Drugs (mycins), IVP contrast, toxemia of pregnency, malignat htn, ATN (causd by ischemia, neprotoxins, or pigments)
What are the two main reasons to prescribe aspirin to a cardiac patient?
To reduce platelet aggregation, to decrease temp of inflamed tissues.
tx for hypoglycemia
fast acting CHO, check glucose, if normal give complex CHO, then 50% dextrose
Renal function can be checked with this? It is a better indictor than BUN.
Serum Creatinine. It is not influenced by protein and exercise.
Adminstration of blood
Remain with patient for first 15 minutes or 50 ml of blood (reactions occur at this time), infuse at rate of no more than 2 ml/min, take no more than 4 hours to administer, may use blood warmer to avoid chills.
When on coumadin what two tests should be monitored?
pT & INR
Normal pT is 12-15 seconds
Normal INR is 2-3 for someone on Coumadin; Target GOAL is 2.5; and 0.8-2.0 for normal people not receiving Coagulation
Patho of Hodgkin’s disease
Presence of Reed-Sternberg cells in the biopsy speciem ( GIANT, MALIGNANT, MULTINUCLEATED LYMPHOTCYTE)
AVF/AVG nursing interventions
Do not measure BP, draw blood, place an IV, or adminster injections in the extermity its in, do not life heavy objects or do anything that compresses extremity. Teach to carry stuff with opposite arm.
Most important assessment following a cardiac Cath is: A. Peripheral pulses B. resp rate C. Measurements for ascites D. Complaints of fatigue
A. Peripheral pulses
A patients dig levels is 1.2 and his k+ is at 4.2, do you give digoxin, LASIX or both? And why
Both. LASIX to reduce the potassium level, and digoxin to bring the dig level up.
If a patient with intermittent claudication says burning wakes him up from sleep what do you suspect?
the disease is worsening
Antibiotics used to treat pneumonia
Penicilin G, cephalosporins, (Keflin), aminoglycosides- garamycin, nebcin, vancomycin (nephrotoxic)
why does a patient who has undergone Gastric bypass surgery develop anemia?
because they cant absorb Vitamin B12 (Cobalamin)
Some chemotherapies are nephrotoxic. what needs to be monitored when patients are on chemo?
BUN, Creatanine, & Urine output
A chemo pt is at risk for?
bleeding, infection, & anemia
Nursing Diagnosis for PAD
1 Acute Pain
- Activity Intolerence
A 36 YO patient who has a history of thromboangiitis obliterans (Buerger;s disease) is admitted to the hospital with a gangrenous lesion of the right small toe. When the nurse is planning expected outcomes for the patient, which outcome has the highest priority for this patient?
a. Cessation of smoking
b. Maintenance of apropriate weight
c. Control of serum lipid levels
d. demonstration of meticulous foot care.
A. Smoking cessation. Only complete abstinance of nicotine will help reduce the risk of amputation in clients with Buergers disease.
Microangiopathy
specific to diabetes, complication involving the kidneys, eyes and loss of sensation
Anemia with CRF
r/t the decreased production by the kidney of the hormone erythopoietin Teach self-injections of procrit
Assessing the insertion site of chest tube
ensure dressing is tight and intact, check skin around insertion site for puffiness or crackling (could be subcutaneous emphysema) as well as for infection (redness, purulent drainage) or excessive bleeding.
Manifestations of CRF
Decrease urinary output with Azotemia(increase in bun and creatinine), arrythmias from hyperkalemia, drug toxicity, renal osteodystrophy (pidgeon chest)- as GFR decreased, phos and Ca+ are impaired, hypocalemia and hyperphosphatemia (trousseau’s, cardiac arrthymias, prolonged clotting time, fracures), pH decreases.
what do you want the pulse ox to be with a COPD pt and why?
around 90%, because they are CO2 retainers. only give O2 via NC, excessive 02 takes away their hypoxic drive to breathe
A client with case of fever, chills, and left costovertebral pain should have what kind of test started?
Clean catch urine test.
A patient with dilated cardiomyopathy has an atrial fibrillation that has been unresponsive to drug therapy for several days. The nurse anticipates that further treatment of the patient will require
a. Iv Adenosine
b. Electric cardioversion
c. Insertion of an implantable cardioverter-defirbrillator.
d. anticoagulant therapy with warfarin (Coumadin)
D Fib that has lasted more than 48 hours requires anticoagulation.
Schilling Test
Used to diagnosis Pernicious Anemia and malabosption syndromes, postitive for pernicious anemia when radioactive B12 is not found in the 1st 24 hr urine.
Ways to administer Heparin and reasons for it
Given IV or Subq
-Prevents extension of a clot:: does not dissolve a clot (steptokinase tPa)
Monitor PTT.
*if ptt is below 55; administer bolus of heparin or increase the rate.
If ptt is above 90, turn off hep drip for an hour, ptt should return normal because heparin has a short half life
Discharge teaching after a TURP (home care)
May need meds for ED, leg bag day, foley cath bag at night, avoid heavy lifting, oral fluids 2-3 quarts a day, refrain from intercourse and driving after surgery, contine annual rectal exams.
Streptokinase is prescribed for a client with myocardial injury. The therapy should be stopped when client experiences: A. Relief of pain B. oozing of blood from IV site C. Sudden decrease in LOC D. An increase in HR and myocardial contractility
C. Sudden decreases in LOC could be a sign of brain bleed
Patients taking Potassium Sparing diuretics such as Aldactone should be taugh what?
Teach paient to avoid k rich foods and monitor for hyper kalemia.
Anemia may be related to
Decreased intake of iron, cobalamin, folic acid, and green leafy vegetables
Who is prone for renal disorders?
Smokers, Textile workers, PAinters,
Which findings are indictive of flid volume overload?
A. palpitations, weakness. leg cramps
B. Pericardial friction rub
C. Pleural friction rub, fever, DIB(SOB)
D. S3
D. S3
palpitations, weakness, leg cramps = electrolyte imblance
Pericardial friction rub = pericarditis
Pleural friction rub, fever, and DIB = uremic toxins inflame the visceral and parietal pleura of the lung
What additional physical assesment parameter should be included in the examination of a client diagnoses with HTN?
A. Skin examination for telangiectasis.
B Otoscopic examinations of the inner ear
C. Fundusopic examination of the Retina
D. Neurologic of the cranial nerves.
Anser is C. HTN can effect the appearance of the retina
Treatment for DKA
treat the cause, give insulin, hydrate, give d5w KVO, prevent rebound hypoglycemia, stabilize the acidosis (priority)
Ventricular Tachycardia
TOMBSTONE
- Filling time is decreased b/c heart is beating so fast, oxygen demand is up while supply is down (supply oxygen to pt)
- Treatment: Check pulse, If there is a pulse cardiovert if not DFIB, lidocaine, pronestyl, amioderone
Can lead to VFIB which is BADDDDD!
Hemodialysis
Method of choice when rapid changes are requred in a short amount of time.
-pt complains of fatigue and is sleeping (azotemia) - emergency situation, SEE PT FIRST !
ISNT sterile
Types of stones
Calsium oxalate, calcium phosphate, struvite (acidify urine with cran juice), Uric acid (give allupurinol [prevents] ), crystine -genetic defect.
Make sure to maintain what with peritoneal dialysis?
aseptic, sterile technique, can cause peritonitis if connections are contaminated.
Client is admitted with acute CHF. Soon after client becomes restless and coughs up pink frothy sputum. The nurse would perform which of the following ?( select all ) A. Administer codeine as cough suppressant B. use corticosteroid inhaler C. Administer IV nitro and morphine sulphate D. Weigh client and measure abdominal girth E. Restrict fluids and administer lasix as order
C and E. as well as elevate HOB, give cardiac stimulate
The risk for developing prerenal failure is greatest in pts with?
A.
B. Acute pyelonephritis
C. Acute glomerulonephritis
D. SLE
A.
Disorders that decrease cardiac outout (
Renal infections ( pyelonephritits and glomerulonephritis) and SLE = intrarenal failure
When is a chest tube needed?
when air or fluid gets in the lungs. used to get lungs back to normal intrapleural pressure, allow lungs to reexpand
What is Unstable Angina?
New onset, increased frequency and may occur while at risk. If patient goes 6 months without any treatment there is a chance the arteries will close (Infarct)
A patient with Diabetes is admitted unresponsive to the ED. initial findings are Potassium 2.8, Sodium 138, Chloride 90, Glucose 628. Cardiac monitoring shows multifocal PVCs. The nurse understands that the patients PVCs are most likely caused by.
a. Hyperglycemia
b. Hypoxemia
c. Dehydration
d. Hypokalemia
D. Hypokalemia increases the risk for Ventricular dysrhythmias like PVCs. V tach, and V Fib. life threatening
Which instruction should be included in the teaching plan for a client with a permanant pacemaker?
- Baths are not permitted; Take only showers.
- Report pulse rate lower than your pacemaker setting.
- If you feel weak, apply pressure over your generator for 30 seconds.
- Have your pacemaker turned off before having magnetic resonance imaging testing.
B. Report pulse rates lower than pacemaker setting. should be normally 70-72 bpm
Peritoneal dialysis diet
Allowed more protein in the diet because urea and protein are lost in the peritoneal bath.
Ibritumomab tiuxetan (Zevalin)
A monoclonal antibody that tagets the CD20 antigen on the B cell and B cell tumor, allowing delivery of radiation directly to the malignany cells. (mouse urine)
Ileal conduit (urinary diversion)
Uretters are anastamosed to a segment of the ileum for urinary drainage.
Common to have mucous shreds in urine post op r/t attachment to bowel to maintain blood supply.
Make sure ther is drainage in thr bag post-op
insulin’s and peaks
rapid (lispro, aspart)( eat immediately) onset 5-15 min PEAK 30-90 minShort acting: (regular, Humilin R) onset 30-60 peak 2-4 hrIntermediate- ( Humilin N, NPH Lente) onset 1-2 hr peak 4-12 hrLong acting (Lantus, glargine, determir, Ultralente) onset 2-4 hr NO PEAK FOR LANTUS!!
Home care post op cystectomy (urinary diversion)
oral fluids 2-3 quarts a day, avoid heavy lifting ( >10lbs), refrain from driving or intercourse, continue annual rectal exams, use a leg bag during the day if sent home with catheter.
peritoneal dialysis
more simple, but carries the risk of peritonitis
Sterile
What is a side effect of Propranolol?
Bradycardia
What effect does Tachycardia have on the body and heart?
Increased Cardiac Ouput which in turn causes a higher demand for O2.
Client taking Lipitor, lopressor, and procardia is going home. What are some appropriate discharge instructions ?
Low sodium low CHO diet, orthostativ\c HTN,mild exrcise, Betas cant be stopped abruptly, monitor liver fx (light stool, light urine, skin color changes, RUQ tener, fatigue).
To reduce risk of complications associated with TPA
Following clot lysis, heparin and aspirin are prescribed
Renal osteodystrophy
realted to CRF, as the GFR decrease, phos and Ca+ balances are impaired – (hypocalemia)
Nursing diagnosis for UTI
Acute pain r/t inflammation of mucosal tissue of urinary tract AEB: pain on urination, flank pain, suprapubic pain, lower back pain or bladder spasms.
DKA type 1 or 2 ??HHS type 1 or 2??
DKA (diabetic ketoacidisis) type 1 HHS type 2
Preventions of Sickle cell
Flu and pneumonia vaccines since they are at risk for injection and to help prevent crisis, avoid hypoxia ( high altitudes, dehydration)
One of the clinical manifestations of Cystitis is?
Suprapubic pain. Relieved by voiding and frequency.
What is an angiogram?
- Shoots die in artery to look at blockages of artery
- Assess color, temp of affected leg post procedure if pedal pulses become weak.
- keep leg extended for 2 hours post procedure.
If the PQRST are all present and the beat is 60-100 BPM, What is it considered?
Normal Sinus Rhythm.
Shiny Skin with decreased hair growth is a symptom of ARTERIAL PVD OR VENOUS PVD?
ARTERIAL PVD
Antidote for Heparin
Protamine Sulfate
A client is to begin taking hydrochlorothiazide for contorl of HTN. what instructions should be given to this client before beginning therapy?
A. You may develop a sower pulse rate
B. You may notice some swelling in your feet.
C. You may develop shortness of breath.
Your diet should include foods high in potassium
D. Hydrochlorothiazide causes potassium loss.
Side effect of Atenolol?
Fatigue and Dyspnea
How do Beta Blockers (olol’s) work?
Block the beta receptors in the heart, causing decreased heart rate, decreased force of contraction, decrease BP.
Side effects are
- Bradycardia,
- lethargy
- CHF
During the assessment of Mr. Harvey, he tells the nurse that for years he has taken an evening walk but lately even a short walk causes leg pain and muscle cramping. if he stops for a while, the pain goes away. the nurse recognizes this condition as: A. thrombophlebitis due to a blood clot in a peripheral vessel with resulting obstruction B. DVT due to chronic inflammation of the peripheral veins C. varicose veins due to chronic venous insufficiency with resultant ischemia D. intermittent claudication due to perpheral ischemia nad accumuation of metabolites in the tissues
D
Strephtomycin (TB drug) is
nephrotoxic
What expected outcome would indicate effective management of a clients HTN?
a. The client has not developed pedal edema.
B. There is no evidence of sexual dysfunction
C.There is no indication of target organ damage
D. The client’s blood pressure reading is stable at 148/94
C. This is sign that the HTN is properly being managed.
Diagnostics for DVT are?
Blood Studies
Platelets, bleeding time, INR, PTT
If elevated this will mean underlying blood disease.
If decreased polycythemia which will increase heart workload and bllod pressure.
While you have a UTI, you should avoid what kind of food or juice?
Citrus. It irritates the bladder.
Right sided heart failure or Core pulmonale symptoms are?
- Fatigue
- Ascites
- increased Veinous pressure
- enlarged liver and spleen
- JVD
- Anorexia and complaints of GI Distress
- Weight gain and edema
- Oliguria
Why is ASA used as a prophylactic?
It reduces Platelet aggregation. It may also reduce temp secondary to MI.
Skin in an anemia patient will look like?
skin may be pale (decreased HGB), flushing (increased HGB), jaundice (excessive hemolysis) cyanosis (low HGB, High deoxyhemoglobin) Pruritis (hodgkins), leg ulcers (sickle cell), Petechia (low platelet or clotting factor), eccymosis, hematoma.
What are the major actions of Digoxin?
Increases Cardiac output, promotes mild diuresis. Must be held if Pulse is below 60 bpm.
Which statement made by a client would alert the nurse to the possibility of right sided heart failure?
- I sleep with four pilows every night
- My shoes fit really tight
- I wake up coughing every night
- I have trouble catching my breath
- My shoes fit really tight.
This is an early sign of Edema and heart failure.
What would someone with arterial insufficiency look like?
STARVATION: thin skin, dependent (redness/rubor) skin then it turns white, cool to touch, thick toenails, they do not bleed and do not have edema cap. refill is more than 3 seconds
Prostate-specific antigen (PSA)
normal is 0-4, variations can be utilized to determine between BPH and prostate CA, baseline can be utilized to determine cancer Tx, PSA may be normal in some men with prostate CA
S/S of Acute rejection of Kindey transplant
Swelling, tenderness at graft site
What is the normal platelet count?
150,000-400,000
Pain management for kindey stones
Load em up! opoid analgesics, tamsulosin (flomax) [vasodilates], keep adequately hydrated -overhydration=spams.
What is the most common complaint of a male with BPH (Benign Prostatic Hyperplasia)
Frequent urination due to a feeling of incomplete bladder emptying
How long do you have to stay on Antihypertensive meds? and what are common side effects?
Pt should know they will be on these meds for the rest of their life
Common s/e are fatigue and male sexual dysfunction
Erythropeietin (EPO), procrit, Epogen
increases RBCs
Fluid restriction for CRF
Restrict Na+ and fluids, includes all PO, IV
spread over 24 hrs, 550ml during the day, 300 afternoon, 200 at night.
A patient is scheduled for a cardiac cath before the test, nurse tells the patient …..
a feeling of warmth may be experienced as the contrast material is injected into the catheter
Which of thses items is high in Sodium, thus contraindicated for a HTN patient?
- Apple Juice
- Orange Juice
- Strawberry Banana Smoothie
- Tomato Juice
Tomato Juice is the highest in sodium of those listed.
Treatment of renal osteodystrophy
Calcium acetate (PhosLo) Lowers phosphate -to reat defective done development due to decreased serum Ca+
A client with a history of myocardial inarction calls the clinic to report the onset of a cough that is troublesome only at night. What action should the nurse take at this time?
- Instruct the client to come in to the clinic for evaluation
- Instruct the client to increase fluid intake during waking hours
- Instruct the client to use and over the counter cough suppressant before going to bed.
- instruct the client to use two pillows to facillitate drainage of postnasal secretions
A. Instruct the client to come to the clinic for evaluation
Nocturnal cough is an early indicator of Heart failure.
Signs and symptoms of a Hypertensive crisis
BP 250/120, Headache, Chest Pain
Nursing diagnosis for an acute renal failure client that is vomiting
fluid volume deficit?, fluid and electrolyte imbalance? not sure on this one couldnt find and answer.
The client is in atrial Fibrillation following cardiac surgery. Which of the following assesment parameters should the nurse monitor for complications associated with dysrhytmias.
a. measure urinary output
b. assess the shortness of breath
c. asses pulse oximetry every hour
d. Measure blood pressure in the lying and sitting positions
B. Assess for shortness of breath. Possible PE
Complications of Anemia
Erythrocyte (RBC) disorders lead to hypoxia
Hypoxia accounts for and is the underlying cause of the s/s of anemia:
-DIB
-palpitations
-confusion and tachycardia in severe cases
Calcium phosphate dietry suggestion
Diet high in Ca+ may actually lower the risk by decreasing urinary excretion of oxalate (a commone factor in many stones)
Tx for diabetic client
self monitor glucose, exercise, lose weight (type 2) stop smoking, control HTN No alcohol, ADA diet w/ even exchanges 1 carb=15 grams of fat, type 1’s decrease insulin have a snack b4 exercise. And have several small carb snacks to prev hypoglycemia during exercise, wear proper footwear, get eyes checked annually
New patient labs have revealed that the patient using heparin, has had his PTT time double. What will the nurse do? 1. Hold the next dose. 2. Notify the doctor. 3. Continue to observe and administer prescribed dose. 4. Adjust dose to profuse more quickly.
Continue to observe. Therapeutic doses of heparin will double PTT times.
Hemoglobin A1c (glycosilated hemoglobin test) & normal ranges
Tests BS for 90-120 daysin a non-diabetic 4-6%, in a diabetic 7%
What would help someone build collateral circulation for intermittent claudication?
walk/exercise
disorder of carbs, proteins and fats?
Diabetes Mellitus
Intermittent Claudication
- Pain with exercise/ walking
- goes away within 10-15 minutes
- due to peripheral ischemias and lactic acis (metabolite) accumulation tissues.
If patites states burning pain wakes him, the disease is worsening.
Control cholesterol, stop smoking (vasodialates)
Iron deficiency Anemia (malabsorption)
Gastric surgery may remove or bypass duodenum, Vit B12 isnt absorbed due to decreased intrinsic factor (cant take B12 oral, must be IM)
BNP (Brain Natriatic Peptide)
BNP is NOT an indicator of MI.
-BNP norm levels 0-100
less than 100 indicates repiratory problem or no problem
more than 100 indicates heart failure
Lifestyle factors related to kindey stones
prolonged bedrest, prolonged hospitalization, immobility, sedentary occupation.
(? from supplemental)
The client is a 55 yr old female, admitted with history of MI, valvular disorder, and CHF. The pt presents with weight gain, ascites, heart rate of 104, crackles, complaints of fatigue. The pt complains of chest pain that is radiating down the left arm and the triponin is elevated.What is developing? (SATA)
A. Pulmonary Embolism
B. Left sided heart failure
C. Right sided heart failure
D. Biventrical failure
E. MI
F.Unstable Angina
D, E
normal ppl get PVCs why? And is it dangerous to us?
taking stimulants: coffee, cocaine, hypoxia, fever heart failure, MI, CAD, smoking, it’s only dangerous to an ischemic heart
Drugs to give to someone in HTN crisis
Labetalol, Nadolol (Combined alpha a and B adrenergic blockers
Sever Anemia symptoms
HgB irritation of oral mucosa, impaired thought processess, tachycardia, chest pain, blurred vision, pallor, depression, theres more but only the bold ones were highlighted.
s/s of hyperglycemia
thirst, dry mucous membranes, poor skin turgor, polyuria fruity breath, fatigue tachycardia kussmauls
teach diabetic client to avoid what and why?
injury because of slow wound healing
AVG complications
Clotting/thrombosis, infections, steal sydrome= cold hand/fingers, numbness/tingling of fingers (my resolve after 6 weeks)
With TB drugs you should watch for jaundince, yellow skin because these drugs are
liver toxic
Common side effects of rifampin (TB drug)
turns saliva, tears and urine orange
Orange urine sample is usually?
Pyridium. given for urinary pain. burning and urgency.
What does this EKG show?
A-FIB
most common dysrhythmia!
Discharge Teaching with someone on Coumadin?
- Take med at the same time every day (usually 2pm-5pm)
- Use soft toothbrush, electric shaving
- Routine lab follow up
–Dont eat Vitamin K (antidote)
- Wear med alert bracelet
- Stop taking it prior to medical procedure
- Ask Dr. before taking any drugs including OTC
all diabetics get this for lunch…
1/2 turkey sandwich and glass of milk for a snack (not breast milk)
pt is HHS you can tell they’re getting better when ….
urine output returns to normal, ^LOC
Which intervention does the nurse plan for a client who is recieving a Continuous IV heparin infusion? A. have vitamin K available in case the client bleeds from the action of Heparin B. teach the client to give subcutaneou heparin injections for long term home therapy C. maintain strict bedrest to prevent accidental trauma D. notify the physician if PTT value is greater than 180 seconds.
D!!! Normal PTT 30-45, therapeautic is double…. 180 is wayyyy tooo highhhhhh
What client should be aware of post-transplant
They will be on immunosuppressants for the rest of their life!!
Client is to begin taking Bactrim for a UTI, how to tell him to take it?
With a full glass of H20, on an empty stomach which is an hour before or 2 hours after a meal. Oh and be sure to take the full prescription to get rid of the UTI ya nasty filthball
Hematologic disorders of oliguric phase of ARF
Anemia due to impaired erythropoietin production, WBC alteration- infection is the major cause of death with ARF, encourage cough and deep breathing to prevent pneumonia.
Acute blood transfusion reactions
Antibodies in the recipient’s serum react with anitgens on the donors RBCs
-casued by ABO-incompatible blood tye (adminstering to wrong patient)
INR values should be?
2-3 whiole on medication and target is 2.5.
Unmedicated target is 1
Most common EARLY complaint of Bladder Cancer?
Gross painless hematuria
Diabetes type one
insulin dependent diabetes occurs earlier in life, beta cells are destroyed, may follow exposure to a virus, need to take insulin not OHA’s only OHA they can take is Glucophage linked with genetics, autoimmune, results are metabolic acidosis
SE of antihypertensive medications
Beta Blockers- wheezing, bronchospasms, fatigue, hypotension, bradycardia, CHF
Ace Inhibitors- Hyperkalemia, hypotension, dry hacking cough, dehydration
Calcium Channel Blockers- hypotension, bradycardia
Sickle cell crisis
Severe. S/S= pain first ( aching and swelling in joints of hands and feet - priority nursing intervention is to adminster dilaudid IVP during crisis, get blood cultures for temp > 101.0 = infection!
If there is no fluccuations in a water seal chamber, what does this mean?
That the drainage system is blocked or the lung has reexpanded.
s/s of hypoglycemia
low blood glucose under 70, confusion, irritability, diaphorsis, tremors, hunger headache weakness , visual disturbances (can mimic alcohol intoxication)
Most critical assesment of a client with PVD
Pedal Pulses
Mr. Gatlin has recieved intravenous heparin therapy for six days for treatment of DVT. The physician now orders warfarin (coumadin) without discontinuing the heparin. Mr Gatlin questions the nurse about the use of both medications. The nurses best response is? A. I will check with your doctor about this. you could be at risk for bleeding. B because you are allowed more activity now, the heparin is metabolized faster and needs to be supplemented with coumadin C. because of the potential for pulmonary embolism, it is important for you to have additional anticoagulants D. it takes several days for the coumadin to take effect, so we need to keep you on the heparin for a few more days.
D!
What to do for blood transfusion reactions
Stop the infusion immediately (clamp everything off and get another IV), maintain NS IV line (seperate line), monitor vitals and urine output, recheck ID tags and numbers, notify blood bank immediately, send blood bag, tubing and UA to blood bank.
Neupogen
Increases WBCs
Renal diet for hemodiaylsis
low protein, low Na+ ( Toast, Applecause, Rice, Greenbeans ) TARG? lol
Etiology and patho of stones
Crystals, when in concentrated form, untie to form stones. Keeping urine dilute and free-flowing prevents this!
If patient does not want to go home on Coumadin.. an alternative would be..
Lovenox SubQ
Nurse would teach pt that shot is in abdomen, no aspirating, or massage. Keep air bubble
A patient admits to the ER with chest pain that radiates to the shoulder. What should the nurse do first?
- X-ray
- Call lab to take samples for analysis
- Hook up 12 lead
- Morphine, O2, Nitrates, ASA
- MONA
If you relieve the chest pain you relieve the ischemia.
Nutritional therapy ARF
Decrease protein intake 1.2 to 1.3 g/kg
Urinary tract calculi (nephrolithiasis)
Post-renal disease, Tx for UTI cause by pseudomonas predisposes client to renal calculi further down the road.
what to tell a pt before going to cystoscopy?
They may experience some buring on urination & urinary frequency for several hours post cystoscopy. Tx with pyridium
First thing people complain of with aortic aneurysm?
Excruciating Headache (cerebral)
pain (abdominal)
Thoracic Aneurysm- its high up so people mistake it as chest pain.
PROGNOSIS: DEATH
Diuretics are?
Given with morphine in situation of MI and Pulomanary Edma. Usually LAsix to reduce pulmonary crackles and coughs as well as BNP level.
if u have a pre-op NPO client that’s diabetic how to administer insulin therapy?
hold the long acting and dep. on BS give short acting
Polycythemia- manifestations and major problems.
Thick blood, enhanced blood viscosity and volume, congestion of organs and tissues and splenomegaly.
Manifestations- headache, dizziness, vertigo- all due to HTN secondary to hyperviscosity and hypervolemia (fluid volume overload)
Major problems- thrombosis(stroke), institute active or passive leg exercises and ambulate to prevent DVT.
Which is the appropriate question to as a 52 y/o male with post renal failure
A. Do you have and heart problems?
B. Do you have an enlarged prostate?
C. Do you have high blood pressure?
D. Have you recently had a diagnostic exam that utlized dye?
B. Do you have an enlarged prostate?
Post renal failure results from obstruction of urine from the kindey
Ask about disorders that can lead to obstruction (renal calculi, blood clots, tumors)
Heart problems = prerenal failure
HTN & dye reactions = intrarenal failure
What is a side effect a nurse should monitor for when administering Lipid Lowering Agents?
Hepatoxicity
Diuretic phase (big urine)
Gradual increase in urine output to 1-3 liters a day, may reach 3-5 liters (>400 ml/hr), nephrons are still not fully functional, monitor for Na+, K+ levelrs for dehyradtion.
What to report with a lithotripsy
WBCs >14,000
Diagnostics of a DVT
Platelet count, bleeding time, INR, APTT if these are elevated, the patient has an underlying blood disease, if they are decreased, the person has in increase in RBC or polycythemia, increased workload of the heart, increased BP,
What would someone with venous insufficiency look like?
Brawny(Brown) thick skin, warm to touch, normal OR thick toenails, these are the bleeders, these people are in glutany they feel a dull aching pain with heaviness and have lower extremity edema, cap refill less than 3 seconds
Coplications of hypertension?
Target organs are Heart, Brain, Eyes, Kidney, and veins.
You know treatment is successful when target organs show no indicators of damage.
What is the antidote for Coumadin?
What should be done after administration of antidote and why?
Vitamin K
Monitor the INR because coumadin has a long half life.
Moderate symptoms of Anemia
HgB 6-10, same symptoms as mild but at rest, dyspnea on exertion, pallor
Risk factors for primary hyper tension are?
Age (50% in people over 60), Alcohol, Smoking, Diabetes, elevated serum lipids (cholesterol) Excessive dietary sodium.
for oral anti diabetics check which labs? Specifically for glucophage check which labs?
liver fx tests for OA’s (OHA’s) they r metabolized by the liver, and renal fx (BUN & Creatinine) for GLUCOPHAGE it is rapidly excreted by the kidneys
When administering a blood tranfusion, person develops a blood transfusion rxn, what does the nurse do?
STOP the transfusion, get another line with normal saline, call doc!
How do you give lovenox
Abdomen shot, sub q with no aspiration.
Major complications of Abdominal Aortic Aneurysm
- if it ruptures patient probably will CROAK if they dont make it to the hospital stat. (within 2 min) -If pt is experiencing pain in abdomen DO NOT PALPATE! -Rupture is indicated buy shock symptoms and pains
What is the main difference between an MI and Ischemia?
Ishcemia can be reversed
What does the P wave on an EKG mean?
Depolarization of the atria.
(? from supplemental)
The pt is started on medication Verapimil. The action of the drug is to:
A. Decrease serum cholesterol level
B. Produce smooth muscle relaxation and decrease BP and Heart rate
C. Increase SA and AV node conduction
D. Decrease the preload and it adjunct to nitroglycerin
E. increase coronary artery circulation
B.
Drug Therapy for Antiplatelet Agents
- Aspirin
- Trental (most effective)
- Ticlopidine (Ticlid)
- Plavix- prevents platelet aggregation
Anemia questions for patients
Age of menarche, clotting, cramping, and amount of bleeding.
Elevated BP without an indentifiable cause (IDIOPATHIC)
Primary (Essential HTN)
If NPO in the hospital and has hyperglycemia?
give small amount of aspart, lispro, regular, cover w/ accucheck
What test is a better indicator of renal fx (BUN or CREATININE)? and why?
Creatinine, and because urea levels are influenced by infections and fluid intake. Normal levels are 0.5-1.5!
A patient on muliple pain meds, what would you watch for?
drug toxcity, hypotension, so do liver and nephro tests (bun creatinine), as well as montior BP and HR
What to watch for when patient is on hemodialysis?
disequillbrium syndrome = confusions, nasuea, restlessness, and headache, b/c hemodialysis is excreting too rapidly
Normal platelet life is?
9-10 days
What is atherosclerosis?
Plaque in the artery. Narrowing vessel. Altered lipid metabolism. Can lead to mi
In the diuretic phase of ARF, which of the following is true?
A.Urine output decreases
B. Glomerular filtration of blood stops
C. THe body retains K+ and Na+
D. The renal tubules cant concentrate urine
D. The renal tubules can’t concentrate urine.
During the diuretic phase, the urine output increases, the glomeruli filter the blood and the body excretes (rather then retains) K+ and Na+
Left sided heart failure Symptoms are?
- Restless and confusion
- Elevated Bp
- Orthopnia
- Dyspnea on exertion
- Hypoxia
- Pulmonary congestion, cough, wheezing
- Blood tinged sputum
- cyanosis and palor
- dysrhythmia
we never mix what insulin and why?
Lantus because its too alkaline (pH is too high)
The client with tachycardia is expieriencing all of the following clinical manifestations. Which one alertsthe nurse to the need for immediate intervention.
- Chest Pain
- Increased urine output
- Mild orthostatic pressure
- ECG tracing with P wave touching the T wave.
- Chest Pain
The chest pain is a sign the Tachy may be increasing the coronary workload.
Most threatening complication of ATN? and WHY
Hyperkalemia (K+ above 5) and because this causes Cardiac arrythmias and this is serious
Most common nsg diagnosis of renal calculi (Kidney stones)
Pain related to irritation of the stone
Femoral Popliteal BYpass Post op
-Monitor extremity q15 min initially, then hourly. -Assess pedal pulses q 15 min until stable. -Complete a neurovascular assessment… {Skin color changes (pallor), teemp, cap refill, pp distal to the operative site, sensation and movement} Avoid flexion of the leg NO PILLOW! -Monitor vitals IF CLIENT IS DIABETIC GOING FOR SURGERY DO YOU GIVE INSULIN? -give rapid acting insulin or get dr. order IF CLIENT HAS COPD GOING FOR SURGERY, LAY THEM FLAT BUT GIVE THEM OXYGEN,
Raynauds Disease
- Vasospasms of the arterioles and arteries of the upper and lower extremities -Vasospasms causes CONSTRICTION of the cutaneous vessels. -CARDIZEM (calcium channel blocker) is given to vasodilate. -Attacks are intermittent and occur with exposure to cold or stress, caffeine or smoking. -Affects fingers, toes, ears, and cheeks (color changes- white blue red) Primarily in women 15-40 yrs old. -associated with autoimmune disorder (rheumatoid arthritis, scleroderma, systemic lupus) -occupation related trauma (typists, pianists, those who use Hand held vibrating equipment) WINK WINK 8===================D - - -
Mild symptoms of Anemia
Hgb 10-14, palpitations, dyspnea, diaphoresis
An ounce contains how many mLs?
30 ml !
What does the QRS wave indicate?
This is the ventricular contraction or depolarization
BUN level is normally?
10-30 mg/dl
The nurse is performing an assessment with a client who has Chronic Arterial Insufficiency and she would expect to find? A. edema around the ankles and the feet B. ulceration aroung the inner aspect of the ankle C. scaling eczema of the lower extremities with stasis dermatitis D. Pallor on elevation of the limb, rubor when the limb is dependent
D.
In assesing the client with an aortic aneurysm before surgery, a nurse notes that the client’s systolic BP has increased by 30 mm Hg compared with the reading from 1 hour ago. What is the Nurse’s best first action?
a. Measure abdominal girth
B. Ausculatation of the abdomen
C. Increase the IV Rate.
D. Measure blood pressure in both arms
A. A sudden increase in BP or HTN can cause enlargement or rupture of the Aneurysm. Bleeding out into the trunk.
Megaloblastic (pernicious) Anemia
Chronic condition r/t impaired DNA synthesis, deficiency of folic acid and/or cobalamin (B12), may cause degenerative changes in the nervous system AEB: numbness and tingling in extermities.
(? from supplemental)
A client with CHF is hospitalized with severe dyspnea and a hacking cough. She has pitting edema in both ankles and her vital signs are 170/100, P 110, RR 28. The nurse recognizes that the clients symptoms indicate
A. Venous Return to the heart is impaired causing a decrease in cardiac output
B. There is impaired emptying of both right and left ventricles
C. the right side of the heart is failing to pump enough blood to the lungs to provide systemic oxygenation
D. the myocardium is ischemic
B.
What is the best condtion to guage JVD?
- Bed Flat
- Head of Bed at 90 degrees
- Head of bed at 45 degrees
- Head of Bed at 30 degrees
The best option is to have the head of bed at 45 degrees.
Heparin drip
- continuous IV monitor, watch for signs of bleeding (hematuria, bloody stools, increased HR, Acts on intrinsic pathway. -Antidote is protamine sulfate
Which statement made by a client would alert the nurse to the presence of edema?
- I seldom sleep soundly at night
- My shoes seem to be fitting tighter
- I seem to feel more anxious lately
- I drink at least two full glasses of water a day
- My shoes are fitting tired. This is a sign of EDEMA
Urinary diversion post op managment
Meticulous skin care around stoma.
APTT levels should be?
Normal 30-45 Heparing is 60 - 90 or 2x
A Nurse notes that the PR interval on a client’s ecg tracing is 0.14 seconds. What action should the nurse take?
a. Call the health care provider immediately.
b. Administer epinephrine immediately.
c. Apply Oxygen via nasal Cannula
d. Document the finding as the only action
Answer is D
PR interval normally ranges from 0.12 to 0.20
Delayed hemolytic reactions
Occurs 2-14 days after transfusion or as early as 3 days and as late as several months.
What symptoms are consistant with a Venous disease?
Edema, Aches, Heaviness. This is due to a lack of return of blood to the heart.
Assessment finding common with a long standing venous (gluttony) disorder?
- Peripheral Edema
- Bronze skin
- Warm skin
- Dilated varicose veins
- aching/heaviness
(? from supplemental)
Pt is admitted with chest pain and a positive triponin. Dr orders the following medications. Which meds should be given immediatly? (SATA)
A. Beta Blockers
B. NTG paste 1 inch to the chest wall
C. Digitalis
D. Hep lock and PRN nitroglycerin drip to control pain
E Verapimil
A, B, D
(? from supplemental)
Perry is digitalized with digoxin IVP. which of the following observations indicates effectiveness of digoxin?
A. increased ventricular rate
B. Decreased urine output
C. Serum potassium of 3
D. Weight Loss
D
What is this?
PVC
Nutrirional therapy before stone removal
Avoid forcing fluids ( Does Not facilitate stone passage, may exacerbate colic.
Nutritional Therapy diet for HTN?
Low sodium diets, No processed foods, restrict fats and cholesterol.
When should you suction a patient?
when respirations sounds moist, unable to expecctorate secretions, (remember how danielles pts sounded)
What do Vasodialators do?
Decrease preload and afterload
Someone with severe anemia will present with what?
confusion and tachycardia
The client is discharged on beta blocking agents following an MI. Which of the following instructions are correct for this collect ? (Select all) A. Report abnormal fatigue B. An early sing of CHF is unexplained cough C. Weigh daily D. The medicatiojn may be discontinued if wheezing develops
A, b, c, d
A client is SOB when he attempts to lie down at night to sleep. He has been sleeping in a recliner. The nurse should suspect: A. Lymphatic pneumonia B. MI C. R vent heart failure D. L side ❤ failure
D. L side ❤ failure
Care of client with renal calculi (kindey stones)
LOAD EM UP! opoid analgesics, Tamsulosin (Flomax)-vasodilates, keep adequately hydrated (overhydration -spams)
EKG changes for a heart attack are?
Deep Q waves mean damaged tissues for 4-6 weeks. ST segment will become elevated. T wave may become inverted, You will also see dysrhythmia, an increase temp and an increase in WBC
When you have chest pain at home what should you do?
Take nitro 1 time, if no relief call doctor. You can take up to 3 times every five minutes. No more than 3 doses.
How would you know that a loop diuretic is working in someone with CHF
decreased crackles in the lungs
PT Time should be what
Coumadin level should be 12-15.
cool and clammy what am I?Warm & dry what am I?
need some candy(low bs) Sugar high (hyperglycemia)
For which client would drug therapy with lovastatin be contraindicated?
- The client with Diabetes
- The client with peptic ulcer disease
- The client with rheumatoid arthritis
- The client with cirrhosis of the liver
D. Statins elevate LDL and cholesterol.
Someone has nephrolithiasis (Kidney stones) what stage is this in ARF?
postrenal
Postrenal (ARF) involve mechancial obstruction of urinary outflow, some causes are:
Benign prostatic hypertrophy (BPH), bladder cancer, calculi formation (nephrolithiasis), neurmuscular disorders, prostate cancer, spinal cord disease, trauma, adhesions from surgery.
care of pt on insulin pump
tight glucose control, continuous sub-q infusion of insulin, site infections can occur, wash hands and skin, rotate sites q 2-3 days , make sure pt. knows s/s of hyper/hypo glycemia
What is arteriosclerosis? And what are contributing factors that are non modifiable
Hardening of the artery a loss of elasticity. Non modifiable is age, genetics, gender, menopause, and race.
Why is resting good if a patient is having symptoms of a heart attack?
Because the coronary circulation can keep up with the demand of the body.
PVCS
PVCS will have wide and bizarre QRS!
-Give antirhymatic (Pronestyl, Lidocaine, Rhythmol, Amerodione (this drug is not used often because it causes Irreversible Pulmonary Fibrosis)
Biggest SE of Atenolol (Tenormin) BETA BLOCKER
Fatigue and Dyspnea
Pt comes to ER and is complaining of calf pain with rapid ambulation r/t a lactic acid accumulation in muscle tissue
Intermittent Claudication
If pt is admitted with a DVT and is complaining of shortness of breath..
- This patient is PRIORITY!
- Elevate HOB, give O2 and suspect a PE (Pulmonary Embolism)
What Would pitting edema be indicative of?
Right sided heart failure
A Cardiac Alarm has gone off. What should be done first?
- Check the leads on the machine.
- Administer morphine (MONAB)
- Check Patient vitals
- Administer O2
Check patient first.
diabetic footcare
test water, use mild soaps, pat dry, assess for breakdown, cut toenails straight, wear properly fitting shoes at all times NEVER go barefoot
Which of the folllowing drugs are used to prevent the extension of an MI? Slect all that apply
- NSAIDS
- Beta Blockers
- ASA
- Nitrates
2, 3, 4
Bactrim must be administered how?
On an empty stomach. 1 hour before or two hours after a meal. With a full glass of water.
Someone in DKA first you do what?
Correct the acidosis normal saline (.9) and 02
Cardiovascular assesment questions are?
Ask about chest pain, SOB, Alcohol use, anemia, Rheumatic fever, Streptococcyl sore throat (Fever) stroke, HTN, Thrmoboflabytis, Edema (pitting is a sign of Right sided Heart Failure) Assess Respiratory status.
If you stop a Beta Blocker abruptly
A Hypertensive Crisis can happen
Ppl at risk for DVT!
-Surgical patients -Obesity -Prolonged Bed Rest -Over the road truck drivers that dont take a break -Gynecologic -Gastric Surgery -History of estrogen use -Crab Boat Captains on the Bearing Sea !!!!!!!
Calf tenderness would be indicitive of?
DVT
In ARF - Kussmauls respirations occur due to the body trying to?
A. Decrease the blood pH
B. Exhale excess CO2
C. Increase H+ ion excretion
D. Increase the CO2 level
B. Exhale the excess CO2
This prcess beings when damged tubules prevent the syntheis of ammonia. The H+ accumulates in the blood since it can’t combine with ammonia. This decrease the blood pH. At first the body compensates by combing the H+ with bicarbs. This forms carbonic acis, which breaks down into water and CO2.
Oliguric phase of ARF
decrease production of urine ( remember 30 ml/hr is normal), Azotemia (increase accumulation or urea and creatinine), fluid retention (JVD, bounding pluse, pitting edema, S3)
What to teach a client with cystitis before discharge?
Avoid bath, wipe front to back, increase fluids 3L/day, empty bldder every 2-4 hours while awak.
Nursing interventions for ATN
diet: increase CHO, decrease protein, decrease Na+, decrease K+
Fluid restrictions, kayexalate to decrease K+ levels (hyperkalemia is life-threatening)
MI (Myocardial Infarction) sudden onset?
Crushing or squeezing of chest not relieved by nitro.
May radiate to jaw, neck, back, or shoulder.
Dyspnea, decreased BP, Extreme weakness, Increased HR
Dyaphoresis.
What are Streptokinase, and TPA?
These are clot busting agents. Do not give to patients who are pregnant, had cerebral anneurisms, or immunosuppressed. Asses for bleeding, bruising and oozing from IV site. If LOC changes withold med. Discontinue of decrease in HGB or dark stool which suggest GI Bleed. or if pt shows s/s of bleeding ex inc. HR dec. BP
A patient has admitted with a Bi-ventricular failure, what will the nurse notice?
Dyspnea, JVD, edema
A patient is scheduled for a cardiac catheterization with coronary angiopathy. Before the test, the nurse informs the patient that…
a. A catheter will be inserted into a vein in the arm or leg and advanced to the heart.
b. ECG monitoring will be required for 24 hours following the test to detect any dysrhythmia
c. a feeling of warmth may be expierienced as the contrast material is injected into the catheter.
d. it will be important to lie completely still during the coronary angiopathy procedure.
C. The iodine being inserted will be a warm feeling.
Dehydration can lead to?
UTI, Calculi, Renal failure.
Immunosuppressive therapy drugs used:
Cyclosporine, corticosteriods, antibodies.
Cardiac Cath
- Can be done many times
- It is an arterial stick, pt will have sandbag for 4-6 hours, lay flat for 4-6 hours
- DO NEUROVASCULAR ASSESSMENT (color, temp, movement, numbness & tingling)
check pedal pulses
Atrial Fibrillation
- Most common dysrhythmia
- Normal QRS, irregular P (quivering)
Cardiac Output is decreased and blood clots can form since blood is pooling in atrium.
Place on Heparin first then Coumadin
Pacemaker is not in SA mode so the AV node is selectively letting impulses through.
What to give a client underdoing hemodialysis that helps increase Ca+, and decrease Phosphorous?
PhosLO( Renegel)
What would be the most definitive method, or cardiac test
PTCA or Cardiac Catheterization
treatment for HHS
treat cause, hydrate, give insulin , requires MORE fluid replacement than DKA, no acidosis present
Pulmonary Embolism
-blockage of pulmonary artery by a thrombus
Manifestations: sudden change in mental status, appear drowsy
**WHEN PRIORITIZING SEE THIS PATIENT FIRST
What exercise should a nurse instruct a patient to do if pt c/o incontinence?
Kegel excercises (it’ll help their sex life too)
Nursing interventions when caring for pneumonia client, Tell client to:
cough and deep breath, encourage fluids, elevate head of bed, promote ROM, suction (if needed)
normal urine color for post op bladder surgery
Pink during 1st several days (should not be bright red)
Most critical Assessment finding in a client with Arterial PVD?
Absent pulses
Clinical manifestations of kindey stones
Abdominal flank** pain (severe) r/t stone irritation, **hematura & renal colic, nausea and vomiting, mild shock (when passing stone)
PTT findings R/T heparin drip
-PTT -Therapeutic level is 2 times the contol! Normal is 30-45 seconds Therapeutic level is 60-90. If the PTT is not within the therapeautic level, anticipate adjusting the flow rate of the Heparin per protocol.
What is an expected finding upon assessment of someone with interstitial cystitis?
Suprapubic pain relieved by voiding (PEEIN’ their little hearts out)
care of a client with a nephrostomy tube?
should have 30 mL /hr, never flush it, empty when it’s 1/3 full, give adequate fluids
A potassium level >6 can lead to what?
MM Weakness & cardiac arrythmias. Normal levels are 3.5-5.0
Diet for a client on peritoneal dialysis
More protein is allowed in diet because urea and protein are lots in the peritoneal bath.
Acute Tubular Necrosis (ATN)
Intrarenal, Results when tubular cells do not get enough oxygen (ischemic ATN). These tubules are very metabolically active, they are very dependent on the oxygen that supplies the tubular cells.
