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301 Test 3 Flashcards

1
Q

In cardiac assessment always look for __ and __ problems

A

oxygenation and perfusion problems

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2
Q

Atrioventricular valves

A

tricuspid

Mitral (bicuspid)

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3
Q

Semilunar valvues

A

pulmonic

aortic

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4
Q

First heart sound (s1)

A

closing of the AV valves

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5
Q

Second heart sound (s2)

A

closing of semi lunar valves

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6
Q

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

A

3rd heart sound

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7
Q

third heart sound

A

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

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8
Q

S3 is associated with

A

heart failure

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9
Q

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

A

angina

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10
Q

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

A

Orthopnea

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11
Q

S1 is louder than S2 at the

A

apex

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12
Q

S1 coincides with

A

carotid artery pulse

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13
Q

S1 coincides with _ wave on electrocardiogram

A

R

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14
Q

second intercostal space (patient’s right of sternum)

A

aortic area

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15
Q

second intercostal space (patient’s left of sternum)

A

pulmonic area

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16
Q

third intercostal space (patient’s left of sternum)

A

erb’s point

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17
Q

fifth intercostal space (patient’s left of sternum)

A

tricuspid area

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18
Q

fifth intercostal space, mid-clavicular

A

mitral area (apex)

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19
Q

Peripheral VascularSubjective Data—Health History Questions

A 
Leg pain or cramps
Skin changes on arm or legs
Swelling
Lymph node enlargement
Medications
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20
Q

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

A

allen test

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21
Q

positive allen test is when

A

ulnar circulation does NOT return in 7 seconds

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22
Q

Ankle systolic pressure divided by arm systolic pressure

A

ABI (Ankle-brachial index)

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23
Q

Normal ABI (Ankle-brachial index)

A

1.06 or 106%

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24
Q

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

A

DM

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25
Q

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

A

claudication

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26
Q

ABI for ischemia, with impending loss of tissue

A

less than 30%

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27
Q

Weak, “thready” pulse rating

A

+1

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28
Q

Full, bounding pulse rating

A

+3

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29
Q

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

A

Pulsus bigeminus

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30
Q

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

A

Pulsus alternans

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31
Q

Pulsus alternans

A

peripheral pulses vary in intensity

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32
Q

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

A

Raynaud’s syndrome

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33
Q

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

A

Lymphedema

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34
Q

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

A

thrill

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35
Q

Intracellular Fluids are what percent of total body weight

A

42%

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36
Q

Intracellular Fluids are what fraction of total body water

A

2/3

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37
Q

Extracellular Fluid includes 3 areas

A

Interstitial, intravascular, and transcellular

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38
Q

___ 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.

A

Transcellular

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39
Q

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

A

lymphs

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40
Q

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

A

Baroreceptors

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41
Q

also triggered w decreased perfusion to the kidney

A

RAA

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42
Q

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

A

Atrial natriuretic Peptide

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43
Q

Insensible water loss is from the ___ and lungs

A

skin and lungs

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44
Q

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

A

burns

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45
Q

The body’s thirst control center is in the

A

hypothalamus

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46
Q

normal sodium level

A

135-145

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47
Q

normal calcium level

A

8.5-10.5

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48
Q

normal potassium level

A

3.5-5

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49
Q

normal magnesium level

A

1.5-2.5

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50
Q

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

A

sodium

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51
Q

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

A

potassium

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52
Q

electrolyte needed for hormone secretion

A

calcium

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53
Q

electrolyte needed for enzyme activity

A

magnesium

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54
Q

normal chloride level

A

95 to 105

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55
Q

normal bicarbonate level

A

22 to 26

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56
Q

normal phosphorus level

A

2.8 to 4.5

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57
Q

H2CO3

A

Carbonic acid

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58
Q

PaCO2:

A

35 to 45 mm Hg

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59
Q

PaO2: should be higher than

A

60 mm Hg, normal 80 to 100 mm Hg

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60
Q

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

A

hypernatremia

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61
Q

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

A

hyponatremia

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62
Q

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

A

hypokalemia

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63
Q

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

A

Hyperkalemia

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64
Q

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

A

Hypercalcemia

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65
Q

Hypocalcemia Nuero-musc

A

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

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66
Q

Hypercalcemia Nuero-musc

A

Muscle weakness, increased fatigue, decreased DTR

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67
Q

Hypocalcemia GI

A

Hyperactive BS, cramps

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68
Q

Hypercalcemia GI

A

Hypoactive BS, N/V, constipation, anorexia

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69
Q

Hypocalcemia CNS

A

Irritability, depression, apprehension, confusion, convulsions, anxiety

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70
Q

Hypercalcemia CNS

A

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

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71
Q

Hypocalcemia CV

A

Hypotension, prolonged qt, dec myocardial contractility

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72
Q

Hypercalcemia CV

A

Hypertension, heart block, short QT, cardiac arrest

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73
Q

Hypocalcemia renal

A

Oliguria, anuria

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74
Q

Hypercalcemia renal

A

Polyuria, polydipsia, renal colic-calculi

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75
Q

Hypocalcemia Heme

A

Increased bleeding & bruising

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76
Q

Hypocalcemia skin

A

Dry brittle nails, hair

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77
Q

`urine specific gravity results will fall between

A

1.002 and 1.030

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78
Q

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)

A

crystalloid

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79
Q

Peripherally inserted catheters are for

A

short therapy, such as fluid restoration postoperatively and antibiotic use

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80
Q

Long-term use would include

A

central lines, PICC catheter, or implanted ports

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81
Q

what do you escalate immediately in an abdominal assessment

A

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

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82
Q

Auscultate the abdomin: begin in the

A

RLQ

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83
Q

Normal BS frequency

A

5-30 times per minute

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84
Q

Normal result of abdominal percussion

A

tympany

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85
Q

May be a sign of early bowel obstruction, gastroenteritis

A

Hyperactive BS

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86
Q

may be expected following abdominal surgery for a short time

A

hypoactive BS

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87
Q

may be a sign of inflammation, impending bowel obstruction

A

hypoactive BS

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88
Q

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

A

ascites

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89
Q

Splenic dullness: 9th to __th intercostal

A

11th

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90
Q

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

A

Ileostomy

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91
Q

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

A

Colostomy

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92
Q

Not recommended for acute diarrhea

A

Antidiarrheal medications

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93
Q

Lomotil, immodium

A

Antidiarrheal medications

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94
Q

can be used for constipation when lifestyle changes are ineffective

A

Laxatives

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95
Q

the best treatment of fecal impaction is

A

prevention

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96
Q

presence of fecal impaction is determined by

A

digital examination

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97
Q

Oil retention enemas are to

A

soften

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98
Q

Tap water or Fleet enemas are to

A

remove and cleanse

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99
Q

Establishing a Bowel Training Program may include

A

stool softener

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100
Q

nitrogen comes from

A

proteins

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101
Q

Negative nitrogen balance:

A

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

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102
Q

BMR increases with

A

illness

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103
Q

Main source of energy

A

carbs

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104
Q

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

A

ketosis and metabolic acidosis.

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105
Q

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

A

Choosing low GI (glycemic index) carbs

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106
Q

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

A

low GI (glycemic index) carbs

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107
Q

nutrient essential for growth and repair

A

protein

108
Q

complete or incomplete proteins, cereals, legumes, vegetables

A

incomplete

109
Q

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

A

complete

110
Q

Water % of body weight is less in ___ people

A

obese

111
Q

Water % of body weight is more in

A

infants

112
Q

Antioxidants:

A

beta-carotene, A,C,E

113
Q

water soluble vitamins

A

B and C

114
Q

Digestion starts in mouth:

A

amylase

115
Q

Gastric:

A

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

116
Q

Duodenum:

A

secretin and cholecystekinin (CCK)

117
Q

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

A

CCK

118
Q

Elderly have slower

A

peristalsis

119
Q

Colon: bacteria synthesize vitamins

A

K and B

120
Q

Benefits of breast feeding include

A

reduced food allergies, fewer infant infections, easier digestion

121
Q

vitamin and mineral requirements for older adults

A

remain the same

122
Q

iron requirement for post menopausal women

A

decreases

123
Q

First diet after surgery or if NPO for a while

A

Clear liquid

124
Q

Clear liquid diet

A

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

125
Q

Full liquid diet

A

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

126
Q

Mechanical soft diet

A

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

127
Q

Soft/low residue diet

A

low fiber

128
Q

Diabetic diet usually __ cal

A

1800

129
Q

parenteral feedings, if TPN, use

A

central line

130
Q

parenteral feedings, if PPN, use

A

peripheral line

131
Q

TPN __% or > glucose content

A

10%

132
Q

xerostomia

A

dry mouth

133
Q

increases potency of coumadin

A

grapefruit juice

134
Q

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

A

Diverticulitis

135
Q

Diverticulitis diet

A

low residue, then high fiber

136
Q

DM diet

A

High glycemic index foods. Limit sat fat.

137
Q

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

A

deeper in the skull

138
Q

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

A

CSF

139
Q

to distinguish between CSF and blood check for

A

a halo (which surrounds CSF)

140
Q

to distinguish between CSF and regular drainage, check for

A

glucose (which is in CSF)

141
Q

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

A

infants

142
Q

the brain could __ down the spinal cord to relieve pressure

A

herniate

143
Q

At risk for salivary gland problems

A

radiation patients
chemo patients
head and neck injury patients

144
Q

thyroid gland normally isn’t

A

palpable

145
Q

labored breathing includes the use of accessory muscles such as

A

sternocleidomastoid and intercostals

146
Q

vertigo

A

an illusion of movement

147
Q

increase in growth hormone

A

acromegaly

148
Q

cushings syndrome is caused by

A

too much cortisone or an adrenal gland problem

149
Q

bulging eyes

A

exophthalmos

150
Q

when someone looks like they’re dying

A

cachectic appearance

151
Q

CSF leaking could indicate __ __ damage

A

basal skull damage

152
Q

Head injury could cause drainage from the nose and

A

ears

153
Q

fine crackles are heard during

A

inspiration

154
Q

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

A

bi-basilar inspiratory crackles

155
Q

crackles heard in the anterior chest are probably a ___ problem

A

lung

156
Q

Left heart failure causes

A

lung problems

157
Q

The best indicator for PE

A

low SAO2

158
Q

Which lung lobe can only be heard anteriorly

A

right middle

159
Q

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

A

enlarged

160
Q

Sometimes in a person with HF you hear crackles in the

A

mid-clavicular line

161
Q

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

A

decrease O2

162
Q

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

A

COPD

163
Q

stridor indicates a problem with getting air

A

into the lungs

164
Q

respiratory rate that indicates imminent danger

A

around 36

165
Q

respiratory rate that indicates possible danger

A

around 26

166
Q

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

A

lower back

167
Q

a symptom of hyperventilation

A

cramping fingers

168
Q

breathing heavily, then nothing, repeats over and over

A

cheyne-stokes

169
Q

sometimes it is the breathing pattern right before death

A

cheyne-stokes

170
Q

During Biots breathing you should record

A

how long the apnea lasts

171
Q

packs per day x years of smoking

A

pack years

172
Q

Increased tactile fremitis indicates

A

consolidation

173
Q

how long do listen to each lung site

A

one in and and out

174
Q

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

A

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

175
Q

depression of the sternum that prevents lung growth

A

rectus excavation

176
Q

tympany over the chest could indicate

A

pneumothorax

177
Q

pink puffer

A

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

178
Q

blue bloater

A

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

179
Q

Sounds of someone with PE would be

A

diminished

180
Q

the hallmark of acute respiratory distress syndrome is

A

hypoxemia

181
Q

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

A

lymphadenectomy

182
Q

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

A

RR decreases

183
Q

Ejection fraction

A

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

184
Q

respiration

A

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

185
Q

breathing rate of someone having an asthma attack

A

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

186
Q

a few neuromuscular diseases that would effect oxygenation

A

ALS
MS
Parkinsons

187
Q

decreased oxygen in blood

A

hypoxemia

188
Q

decreased oxygen in tissues

A

hypoxia

189
Q

respiratory Oh Shoot

A 
nasal flaring 
retractions (muscles in between ribs sucking in)
grunting 
PND
Stridor
190
Q

grunting indicates

A

they’re getting tired from labored breathing

191
Q

PND

A

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

192
Q

measures end expiratory pressure

A

peak flow monitoring

193
Q

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

A

peak flow monitoring

194
Q

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

A

nasal cannula

195
Q

LDL levels

A

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

196
Q

instructions for patient using spacer/puffer

A

breath in and hold for 1 minute

197
Q

patients at risk for aspiration include

A

GERD

198
Q

One way to lower aspiration risk

A

thicken liquids

199
Q

oxygen setting for nasal cannula

A

24 to 44

200
Q

oxygen setting for venturi mask

A

24 to 50

201
Q

oxygen setting for face mask

A

40 to 60

202
Q

oxygen setting for non rebreather mask

A

70 to 100

203
Q

best test for evidence for IGE

A

ABG

204
Q

A late symptom of IGE

A

sweating

205
Q

Polycethemia (over production of RBCs) increases risk for

A

DVT (it thickens the blood)

206
Q

if you see an adult suddenly collapse

A

call 911 and do compressions

207
Q

if you find an adult already already collapsed

A
  • are you ok?
  • call 911
  • get AED if possible
  • start traditional CPR (compressions and breaths)
208
Q

traditional CPR (compressions and breaths) should be used for

A
  • adults you didn’t see collapse
  • children
  • drowning or breathing problems
209
Q

murmurs are not

A

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

210
Q

first intervention for patient having trouble breathing

A

elevate HOB

211
Q

patient is having trouble breathing, after elevating HOB

A

suction

212
Q

patient is having trouble breathing, after elevating HOB and suctioning

A

give 2L oxygen

213
Q

patient is having trouble breathing, after giving oxygen

A

check meds

214
Q

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

A

call provider

215
Q

the earliest sign of heart failure that can be detected

A

S3 sound

216
Q

bibasilar crackles indicate

A

impending heart failure

217
Q

sound that is a sign of stiffened valve

A

S4

218
Q

murmur indicates a problem with the

A

valves

219
Q

to check for JVD place patient in what position

A

semi fowler

220
Q

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

A

escalate

221
Q

DM is a ___ cardiac risk factor

A

modifiable

222
Q

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

A

bell

223
Q

If you hear a loud murmur,

A

palpate with your palm

224
Q

Total cholesterol level

A

less than 200

225
Q

HDL level

A

greater than 50

226
Q

LDL level

A

less than 130

227
Q

triglyceride level

A

less than 150

228
Q

what do you do before a cholesterol test

A

fast for 10 to 12 hours

229
Q

During hypoxemia what happens to HR

A

initially goes up, then down

230
Q

CVA tenderness is found while

A

percussing the kidneys

231
Q

If someone has a strong pulsation in the stomach

A

do not palpate

232
Q

to put someone on a thickened diet you need

A

an order

233
Q

Most common cause of diarrhea in hospital patients is

A

C diff

234
Q

Scar tissue in abdomen

A

adhesions

235
Q

high intake of calcium and iron can cause

A

constipation

236
Q

black stool can indicate

A

bleeding

237
Q

painless GI bleeding

A

very abnormal, could signal something serious

238
Q

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

A

rebound tenderness

239
Q

spleen could be enlarged for someone with

A

leukemia or car accident

240
Q

older adults might not complain of GI pain despite

A

severe damage

241
Q

Even in an obese person you should be able to auscultate

A

bowel sounds

242
Q

soap sud

A

?

243
Q

fleet

A

?

244
Q

oil retention

A

?

245
Q

gastroenteritis can cause

A

diarrhea

246
Q

fluid balance is especially risky for

A

very young and very old

247
Q

before colonoscopy

A

NPO for 24 hours

No beef

248
Q

culture and sensitivity test needs ___ container

A

sterile

249
Q

lomotil or immodium should NOT be used for

A

diarrhea related to infection (short term)

250
Q

diarrhea can cause decreased (which electrolyte)

A

potassium

251
Q

If someone has dehydration or fluid loss give them

A

NS (isotonic)

252
Q

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

A

ringer lactate (isotonic)

253
Q

burning fat causes

A

ketones

254
Q

signs of fluid volume excess

A

crackles
S3
JVD

255
Q

creatinine indicates ___ damage

A

kidney damage

256
Q

Be very careful with what kind of NS

A

3% NS (high risk of pulmonary edema)

257
Q

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

A

neuro status

258
Q

symptoms of low calcium

A

tetany

muscle cramping

259
Q

symptoms of high calcium

A

constipated

260
Q

KCl 10 meq

A

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

261
Q

symptoms of low calcium

A

Chvostek’s and Trousseau’s Signs

262
Q

low calcium- face twitches when touched

A

Chvostek’s

263
Q

low calcium- arm flexes when taking BP

A

Trousseau’s

264
Q

best way measure to monitor fluid intake over a long period

A

weight

265
Q

best way to measure short term fluid intake

A

I/O

aa Orgo (196 decks)

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