301 Test 3 Flashcards by Richard smith

In cardiac assessment always look for __ and __ problems

oxygenation and perfusion problems

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Atrioventricular valves

tricuspid

Mitral (bicuspid)

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Semilunar valvues

pulmonic

aortic

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First heart sound (s1)

closing of the AV valves

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Second heart sound (s2)

closing of semi lunar valves

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produces a rhythm classically compared to the cadence of the word “Kentucky”

3rd heart sound

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third heart sound

rare extra heart sound that occurs soon after the normal two “lub-dub” heart sounds (S1 and S2)

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S3 is associated with

heart failure

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in cardiac assessment diaphoresis, pallor, palpitations, dyspnea, nausea, tachycardia, or fatigue should be considered to be equivalent to

angina

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How many pillows do you use when sleeping or lying down?

Orthopnea

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S1 is louder than S2 at the

apex

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S1 coincides with

carotid artery pulse

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S1 coincides with _ wave on electrocardiogram

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second intercostal space (patient’s right of sternum)

aortic area

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second intercostal space (patient’s left of sternum)

pulmonic area

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third intercostal space (patient’s left of sternum)

erb’s point

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fifth intercostal space (patient’s left of sternum)

tricuspid area

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fifth intercostal space, mid-clavicular

mitral area (apex)

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Peripheral VascularSubjective Data—Health History Questions

Leg pain or cramps
Skin changes on arm or legs
Swelling
Lymph node enlargement
Medications

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test where you block the radial and ulnar arteries. When you release the ulnar, perfusion (color) should return to the hand within 7 seconds

allen test

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positive allen test is when

ulnar circulation does NOT return in 7 seconds

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Ankle systolic pressure divided by arm systolic pressure

ABI (Ankle-brachial index)

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Normal ABI (Ankle-brachial index)

1.06 or 106%

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ABI (Ankle-brachial index) is less reliable in patients with

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condition in which cramping pain in the leg is induced by exercise, typically caused by obstruction of the arteries

claudication

ABI for ischemia, with impending loss of tissue

less than 30%

Weak, “thready” pulse rating

Full, bounding pulse rating

two heartbeats close together followed by a longer pause. The second pulse is weaker than the first

Pulsus bigeminus

It is almost always indicative of left ventricular systolic impairment, and carries a poor prognosis

Pulsus alternans

peripheral pulses vary in intensity

A condition in which some areas of the body feel numb and cool in certain circumstances.

Raynaud’s syndrome

Swelling in an arm or leg caused by a lymphatic system blockage

Lymphedema

A vibration accompanying a cardiac or vascular murmur that can be palpated

thrill

Intracellular Fluids are what percent of total body weight

42%

Intracellular Fluids are what fraction of total body water

2/3

Extracellular Fluid includes 3 areas

Interstitial, intravascular, and transcellular

___ fluid is separated from other fluids by a cellular barrier and consists of cerebrospinal, pleural, gastrointestinal, intraocular, peritoneal, and synovial fluids. Loss of these fluids can produce fluid and electrolyte imbalances.

Transcellular

Interstitial fluids are the fluids between the cells and outside the blood vessels. These contain

lymphs

are triggered if hypovolemia (decreased BP due to dec CO, hemorrhage, dehydration), trigger thirst, and RAA

Baroreceptors

also triggered w decreased perfusion to the kidney

RAA

Produced in response to atrial stretch from FVE and cause as a diuretic that causes NA loss and inhibition of thirst

Atrial natriuretic Peptide

Insensible water loss is from the ___ and lungs

skin and lungs

Insensible water loss increases w temperature and increased RR. Also increases w

burns

The body’s thirst control center is in the

hypothalamus

normal sodium level

135-145

normal calcium level

8.5-10.5

normal potassium level

3.5-5

normal magnesium level

1.5-2.5

electrolyte responsible for serum osmolality, nerve conduction, regulation of acid-base

sodium

electrolyte responsible for glycogen deposits in liver and skeletal muscle, transmission, nerve conduction, normal cardiac function, muscle contraction

potassium

electrolyte needed for hormone secretion

calcium

electrolyte needed for enzyme activity

magnesium

normal chloride level

95 to 105

normal bicarbonate level

22 to 26

normal phosphorus level

2.8 to 4.5

H2CO3

Carbonic acid

PaCO2:

35 to 45 mm Hg

PaO2: should be higher than

60 mm Hg, normal 80 to 100 mm Hg

Extreme thirst, dry flushed skin, postural hypotension, fever, dizziness, agitation, seizures, restlessness

hypernatremia

apprehension, postural hypotension, abdominal cramping, n/v/d, tachycardia, dry mucous membranes, seizures, coma

hyponatremia

Weakness, fatigue, muscle weakness, n/v, intestinal distention, dec BS, decreased deep tendon reflexes, ventricular dysrhythmias, paresthesias, weak irregular pulse

hypokalemia

Anxiety, weakness and dizziness, muscle cramps, N/V, diarrhea, intestinal colic, ECG changes, cardiac arrest

Hyperkalemia

Anorexia, n/x, weakness, dec peristalsis, illeus, renal calculi, decreased level of consciousness, personality changes, cardiac arrest

Hypercalcemia

Hypocalcemia Nuero-musc

Tetny, Chevstek’s & Trousseau’s sign, hyperactive DTR, numbness/tingling, larnygospasm

Hypercalcemia Nuero-musc

Muscle weakness, increased fatigue, decreased DTR

Hypocalcemia GI

Hyperactive BS, cramps

Hypercalcemia GI

Hypoactive BS, N/V, constipation, anorexia

Hypocalcemia CNS

Irritability, depression, apprehension, confusion, convulsions, anxiety

Hypercalcemia CNS

Headache, personality changes, confusion, lethargy, memory impairment, coma, bizarre behavior

Hypocalcemia CV

Hypotension, prolonged qt, dec myocardial contractility

Hypercalcemia CV

Hypertension, heart block, short QT, cardiac arrest

Hypocalcemia renal

Oliguria, anuria

Hypercalcemia renal

Polyuria, polydipsia, renal colic-calculi

Hypocalcemia Heme

Increased bleeding & bruising

Hypocalcemia skin

Dry brittle nails, hair

`urine specific gravity results will fall between

1.002 and 1.030

The most commonly used ___ fluid is normal saline, a solution of sodium chloride at 0.9% concentration, which is close to the concentration in the blood (isotonic)

crystalloid

Peripherally inserted catheters are for

short therapy, such as fluid restoration postoperatively and antibiotic use

Long-term use would include

central lines, PICC catheter, or implanted ports

what do you escalate immediately in an abdominal assessment

Marked pulsations and widened pulse pressure: (HTN, aortic insufficiency, aortic aneurysm)

Auscultate the abdomin: begin in the

RLQ

Normal BS frequency

5-30 times per minute

Normal result of abdominal percussion

tympany

May be a sign of early bowel obstruction, gastroenteritis

Hyperactive BS

may be expected following abdominal surgery for a short time

hypoactive BS

may be a sign of inflammation, impending bowel obstruction

hypoactive BS

the accumulation of fluid in the peritoneal cavity, causing abdominal swelling

ascites

Splenic dullness: 9th to __th intercostal

11th

an opening in the belly (abdominal wall) that's made during surgery. The end of the ileum is brought through this opening to form a stoma

Ileostomy

a surgical procedure in which an opening (stoma) is formed by drawing the healthy end of the large intestine or colon through an incision in the anterior abdominal wall and suturing it into place

Colostomy

Not recommended for acute diarrhea

Antidiarrheal medications

Lomotil, immodium

Antidiarrheal medications

can be used for constipation when lifestyle changes are ineffective

Laxatives

the best treatment of fecal impaction is

prevention

presence of fecal impaction is determined by

digital examination

Oil retention enemas are to

soften

Tap water or Fleet enemas are to

remove and cleanse

Establishing a Bowel Training Program may include

stool softener

nitrogen comes from

proteins

Negative nitrogen balance:

sepsis, infection, burns, fever, starvation, draining wounds

BMR increases with

illness

Main source of energy

carbs

The body breaks down proteins when there are insufficient carbs to use for energy--- leads to

ketosis and metabolic acidosis.

the secret to long-term health reducing your risk of heart disease and diabetes and is the key to sustainable weight loss

Choosing low GI (glycemic index) carbs

the carbs that produce only small fluctuations in our blood glucose and insulin levels

low GI (glycemic index) carbs

nutrient essential for growth and repair

protein

complete or incomplete proteins, cereals, legumes, vegetables

incomplete

complete or incomplete proteins, fish, chicken, soybeans, turkey, cheese

complete

Water % of body weight is less in ___ people

obese

Water % of body weight is more in

infants

Antioxidants:

beta-carotene, A,C,E

water soluble vitamins

B and C

Digestion starts in mouth:

amylase

Gastric:

lipase, amylase, pepsinogen, gastrin promotes HCL (protein)

Duodenum:

secretin and cholecystekinin (CCK)

inhibits further gastrin secretion and promotes pancreas and GB to secrete enzymes

CCK

Elderly have slower

peristalsis

Colon: bacteria synthesize vitamins

K and B

Benefits of breast feeding include

reduced food allergies, fewer infant infections, easier digestion

vitamin and mineral requirements for older adults

remain the same

iron requirement for post menopausal women

decreases

First diet after surgery or if NPO for a while

Clear liquid

Clear liquid diet

broth, tea, carbonated beverages, clear fruit juices, gelatin, ice pops

Full liquid diet

clear liquid diet plus custards, cooked cerals, veg juice, pureed veg, all fruit juices

Mechanical soft diet

Finely diced meats, flaked fish, cottage cheese, rice, potatoes

Soft/low residue diet

low fiber

Diabetic diet usually __ cal

1800

parenteral feedings, if TPN, use

central line

parenteral feedings, if PPN, use

peripheral line

TPN __% or > glucose content

10%

xerostomia

dry mouth

increases potency of coumadin

grapefruit juice

An inflammation or infection in one or more small pouches in the digestive tract

Diverticulitis

Diverticulitis diet

low residue, then high fiber

DM diet

High glycemic index foods. Limit sat fat.

If someone has a nasal fracture, they could also have trauma

deeper in the skull

If someone gets hit in the head, what might leak out

CSF

to distinguish between CSF and blood check for

a halo (which surrounds CSF)

to distinguish between CSF and regular drainage, check for

glucose (which is in CSF)

You can't see swelling of the brain because the skull holds it in, except for in

infants

the brain could __ down the spinal cord to relieve pressure

herniate

At risk for salivary gland problems

radiation patients chemo patients head and neck injury patients

thyroid gland normally isn't

palpable

labored breathing includes the use of accessory muscles such as

sternocleidomastoid and intercostals

vertigo

an illusion of movement

increase in growth hormone

acromegaly

cushings syndrome is caused by

too much cortisone or an adrenal gland problem

bulging eyes

exophthalmos

when someone looks like they're dying

cachectic appearance

CSF leaking could indicate __ __ damage

basal skull damage

Head injury could cause drainage from the nose and

ears

fine crackles are heard during

inspiration

type of crackles that if heard in the lower back could indicate heart problem

bi-basilar inspiratory crackles

crackles heard in the anterior chest are probably a ___ problem

lung

Left heart failure causes

lung problems

The best indicator for PE

low SAO2

Which lung lobe can only be heard anteriorly

right middle

If you can hear someone's heart over the posterior axillary line, their heart is prob

enlarged

Sometimes in a person with HF you hear crackles in the

mid-clavicular line

The main driver of breathing in a normal person is increased CO2, but the driver in a COPD patient is

decrease O2

Patient gets air in, but can't push it out (a problem with expiration)

COPD

stridor indicates a problem with getting air

into the lungs

respiratory rate that indicates imminent danger

around 36

respiratory rate that indicates possible danger

around 26

If breathing is shallow, you auscultate sounds in the upper chest, but not the

lower back

a symptom of hyperventilation

cramping fingers

breathing heavily, then nothing, repeats over and over

cheyne-stokes

sometimes it is the breathing pattern right before death

cheyne-stokes

During Biots breathing you should record

how long the apnea lasts

packs per day x years of smoking

pack years

Increased tactile fremitis indicates

consolidation

how long do listen to each lung site

one in and and out

If a patient is wheezing and we give albuterol, the wheezing could stop. Does this mean there's an improvement?

Not necessarily. It could be that now there's not enough air moving

depression of the sternum that prevents lung growth

rectus excavation

tympany over the chest could indicate

pneumothorax

pink puffer

emphysema. No cyanosis. Thin and frail because they're using a lot of energy to expel CO2. Not a lot of secretion

blue bloater

bronchitis. Bloated because of right sided heart failure which causes edema. Lots of secretion

Sounds of someone with PE would be

diminished

the hallmark of acute respiratory distress syndrome is

hypoxemia

Do not take BP in the arm where the patient has had a

lymphadenectomy

What happens to the vitals of a COPD patient getting lots of oxygen

RR decreases

Ejection fraction

measurement of the percentage of blood leaving your heart each time it contracts

respiration

the actual exchange of gases at the alveoli (different from ventilation)

breathing rate of someone having an asthma attack

at first the rate is increased, but would slow after a while as they get tired

a few neuromuscular diseases that would effect oxygenation

ALS MS Parkinsons

decreased oxygen in blood

hypoxemia

decreased oxygen in tissues

hypoxia

respiratory Oh Shoot

``` nasal flaring retractions (muscles in between ribs sucking in) grunting PND Stridor ```

grunting indicates

they're getting tired from labored breathing

PND

paroxismal nocturnal dyspnea (wake up in middle of night and can't breath)

measures end expiratory pressure

peak flow monitoring

person takes a deep breath and blows. The breathing rating is Green, Yellow, or Red

peak flow monitoring

even if someone is a mouth breather they can probably still use a

nasal cannula

LDL levels

below 100 is best (100 to 129 is so-so)

instructions for patient using spacer/puffer

breath in and hold for 1 minute

patients at risk for aspiration include

GERD

One way to lower aspiration risk

thicken liquids

oxygen setting for nasal cannula

24 to 44

oxygen setting for venturi mask

24 to 50

oxygen setting for face mask

40 to 60

oxygen setting for non rebreather mask

70 to 100

best test for evidence for IGE

ABG

A late symptom of IGE

sweating

Polycethemia (over production of RBCs) increases risk for

DVT (it thickens the blood)

if you see an adult suddenly collapse

call 911 and do compressions

if you find an adult already already collapsed

- are you ok? - call 911 - get AED if possible - start traditional CPR (compressions and breaths)

traditional CPR (compressions and breaths) should be used for

- adults you didn't see collapse - children - drowning or breathing problems

murmurs are not

extra heart sounds, they're part of the lub dub

first intervention for patient having trouble breathing

elevate HOB

patient is having trouble breathing, after elevating HOB

suction

patient is having trouble breathing, after elevating HOB and suctioning

give 2L oxygen

patient is having trouble breathing, after giving oxygen

check meds

patient is having trouble breathing, after giving oxygen and checking meds

call provider

the earliest sign of heart failure that can be detected

S3 sound

bibasilar crackles indicate

impending heart failure

sound that is a sign of stiffened valve

murmur indicates a problem with the

valves

to check for JVD place patient in what position

semi fowler

what do you do if you find a bruit in the carotid

escalate

DM is a ___ cardiac risk factor

modifiable

what part of the stethoscope is used to hear abnormal heart sounds

bell

If you hear a loud murmur,

palpate with your palm

Total cholesterol level

less than 200

HDL level

greater than 50

LDL level

less than 130

triglyceride level

less than 150

what do you do before a cholesterol test

fast for 10 to 12 hours

During hypoxemia what happens to HR

initially goes up, then down

CVA tenderness is found while

percussing the kidneys

If someone has a strong pulsation in the stomach

do not palpate

to put someone on a thickened diet you need

an order

Most common cause of diarrhea in hospital patients is

C diff

Scar tissue in abdomen

adhesions

high intake of calcium and iron can cause

constipation

black stool can indicate

bleeding

painless GI bleeding

very abnormal, could signal something serious

occurs during palpation when you remove your hand and the patient feels pain

rebound tenderness

spleen could be enlarged for someone with

leukemia or car accident

older adults might not complain of GI pain despite

severe damage

Even in an obese person you should be able to auscultate

bowel sounds

soap sud

fleet

oil retention

gastroenteritis can cause

diarrhea

fluid balance is especially risky for

very young and very old

before colonoscopy

NPO for 24 hours | No beef

culture and sensitivity test needs ___ container

sterile

lomotil or immodium should NOT be used for

diarrhea related to infection (short term)

diarrhea can cause decreased (which electrolyte)

potassium

If someone has dehydration or fluid loss give them

NS (isotonic)

Is someone has blood loss or they're going to the OR give them

ringer lactate (isotonic)

burning fat causes

ketones

signs of fluid volume excess

crackles S3 JVD

creatinine indicates ___ damage

kidney damage

Be very careful with what kind of NS

3% NS (high risk of pulmonary edema)

If you suspect a sodium problem pay special attention to __ status

neuro status

symptoms of low calcium

tetany | muscle cramping

symptoms of high calcium

constipated

KCl 10 meq

should be given or 30 to 60 min. IF pushed, patient could die

symptoms of low calcium

Chvostek's and Trousseau's Signs

low calcium- face twitches when touched

Chvostek's

low calcium- arm flexes when taking BP

Trousseau's

best way measure to monitor fluid intake over a long period

weight

best way to measure short term fluid intake

I/O