301 Test 3 Flashcards
In cardiac assessment always look for __ and __ problems
oxygenation and perfusion problems
Atrioventricular valves
tricuspid
Mitral (bicuspid)
Semilunar valvues
pulmonic
aortic
First heart sound (s1)
closing of the AV valves
Second heart sound (s2)
closing of semi lunar valves
produces a rhythm classically compared to the cadence of the word “Kentucky”
3rd heart sound
third heart sound
rare extra heart sound that occurs soon after the normal two “lub-dub” heart sounds (S1 and S2)
S3 is associated with
heart failure
in cardiac assessment diaphoresis, pallor, palpitations, dyspnea, nausea, tachycardia, or fatigue should be considered to be equivalent to
angina
How many pillows do you use when sleeping or lying down?
Orthopnea
S1 is louder than S2 at the
apex
S1 coincides with
carotid artery pulse
S1 coincides with _ wave on electrocardiogram
R
second intercostal space (patient’s right of sternum)
aortic area
second intercostal space (patient’s left of sternum)
pulmonic area
third intercostal space (patient’s left of sternum)
erb’s point
fifth intercostal space (patient’s left of sternum)
tricuspid area
fifth intercostal space, mid-clavicular
mitral area (apex)
Peripheral VascularSubjective Data—Health History Questions
Leg pain or cramps Skin changes on arm or legs Swelling Lymph node enlargement Medications
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
positive allen test is when
ulnar circulation does NOT return in 7 seconds
Ankle systolic pressure divided by arm systolic pressure
ABI (Ankle-brachial index)
Normal ABI (Ankle-brachial index)
1.06 or 106%
ABI (Ankle-brachial index) is less reliable in patients with
DM
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
+1
Full, bounding pulse rating
+3
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
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
S4
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
