Adult Care 2: Exam 2 Flashcards
When should t-PA be given for a patient with a hemorrhagic stroke?
Never. t-PA should not be given to patients with hemorrhagic strokes
A patient reports stroke like symptoms that only lasted about a day, what diagnosis should you expect?
TIA
A patient presents to the unit with increasing fatigue, shortness of breath, cough, and orthopnea. They have CHF, what side do you suspect is affected?
Left side. These are all common symptoms r/t left sided heart failure.
A patient presents to the unit with known A-fib and reports a “funny feeling” in their chest, and fluttering/palpitations, would you classify this as stable or unstable?
Stable. These findings are consistent with stable A-fib.
A patient presents to the unit with know A-fib. The patient has a hx of heart failure and is hypotensive during assessment. The pt reports chest pain, and states that they have episodes of passing out. If cardioversion is needed, which type would be appropriate for this patient?
Electrical cardioversion would be appropriate for this patient because they have unstable A-fib.
If a patient has stable A-fib and cardioversion is required, what is the appropriate action?
Chemical cardioversion. Administer adenosine as ordered.
A patient has A-fib and is getting an EKG, what would you expect to see?
True P- wave is not identifiable.
What are some possible causes of CHF exacerbation?
FVO r/t overhydration, poor diet (too much Na), and non-adherence to medication regimen
A patient has CHF and says they have been weighing themself every Monday after breakfast, what should you teach them?
Patients with CHF should weigh themselves daily, in the morning, after first void/BM, before drinking/eating anything.
What diet recommendations should be made to a patient w/ CHF to prevent exacerbation?
Low sodium diet (<2g/day) and <2 quarts of water/day.
What are common s/s associated w/ right sided heart failure?
Ascites, reduced appetite, fatigue, JVD, and any/all L-sided symptoms bc L-sided HF usually causes R-sided HF.
If a pt has stroke symptoms w/rapid onset and they are hypertensive on assessment, which type of stroke do you suspect?
Hemorrhagic stroke.
What is unilateral neglect?
This can occur after having a stroke. The person ignores the affected side of their body/ does not recognize affected body parts as being their own.
What is important education to provide to someone with hemianopsia?
It is important to turn your head 180 degrees to make up for loss of FOV.
If a pt has hx of atherosclerosis and is now reporting stroke symptoms, what type of stroke might you suspect?
Ischemic stroke.
Why is dry weight important?
The patient should know their baseline dry weight and weigh themselves daily to look for deviations from their dry/discharge weight.
What interventions should take place if a pt has a confirmed DVT?
Have pt wear compression stockings, and encourage elevation of affected limb for 20 min 4-5x/day.
A patient on the unit suddenly reports unilateral leg pain. On assessment you find that the affected leg is edematous and warm. What do you suspect and what order would you expect next?
DVT. Would expect a D-dimer test.
A patient presents to the unit with leg pain. On assessment, the leg is cool, pale, and the skin is shiny. Pedal pulses are absent. What do you suspect?
Arterial disease
A patient with arterial disease states that they have been elevating their extremity since it is swollen, what should you do next?
Educate them by telling them that elevating an extremity with arterial disease decreases blood flow. They should dangle their extremity to increase blood flow.
The nurse should be able to identify that a patient with intermittent claudication has which form of PVD?
Arterial.
What does ankle brachial index (ABI), help diagnose? And what result indicates a positive diagnosis?
ABI is used to diagnose intermittent claudication. A result < 0.9 indicates arterial disease.
What medications are used for management of arterial insufficiency?
Oral vasodilators or topical nitroglycerin
If a patient is prescribed anticoags and clopidogrel, what type of PVD do you suspect they have?
Venous
What are the different types of antihypertensives?
- ACE inhibitors (-prils)
- ARBs (-sartan)
- Beta blockers (-lol)
Types of diuretics?
- Aldosterone antagonists (spirolactone)
- Loop diuretics (furosemide)
Types of anticoags?
- Platelet Aggregation Inhibitors (clopidogrel)
- NSAIDs (aspirin)
- Low Molecular Weight Heparin (Enoxaparin)
- Activated factor Xa inhibitor (Fondaparinux/ Rivaroxaban)
- Vitamin K inhibitors (Warfarin)
Types of antiarrythmics?
- Calcium channel blockers (diltiazem/ verapamil)
- Cardiac glycoside (Digoxin)
What are statins?
Meds that decrease cholesterol. (Atorvastatin)
What are common s/s of intermittent claudication?
Resting limb pain, paresthesia, ulcer formation, hair loss on LE, dry, scaly skin, thickened toenails, color changes of affected extremity.
What should be evaluated after ablation?
Assess VS for decomposition, monitor for thrombotic events, and monitor labs.
