AH II Exam II Flashcards
1
Q
What are the clinical manifestations of cardiac dysrhythmias?
A
palpitations anxiety fatigue pallor SOB HYPOtension
2
Q
Which kind of cardiac patient is asymptomatic?
A
stable
3
Q
How long is the average P wave? How many boxes?
A
0.12-0.20 seconds
3-5 boxes
4
Q
How long is the average QRS complex?
A
less than 0.12 seconds
less than 3 little boxes
5
Q
Patient teaching with a pacemaker:
A
NO MRI's NO metal detectors Notify HCP with S&S move away from objects that may interfere with pacemaker and check pulse check pulse every day for 1 minute travel with a "pacemaker carrying card
6
Q
Etiology of sinus bradycardia:
A
valsalva gagging/vomitting suctioning conditioned athletes beta blockers
7
Q
Etiology of sinus tachycardia
A
stimulants
exercise
stress
infection
8
Q
What must be administered when “pacing a patient”?
A
pain meds
9
Q
How many liters/min can a nasal cannula take?
A
6 L
10
Q
When is “pacing” indicated?
A
When atropine doesn’t work
11
Q
5 S&S of myocarditis:
A
fever chest pain dyspnea heart failure dysrhythmias
12
Q
Where do you read the O2 flow meter?
A
the middle of the ball
13
Q
What is the #1 treatment for pericarditis? What if that doesn’t work?
A
- NSAIDs
2. colchicine for 3 months BID
14
Q
S&S of Cardiac Tamponade
A
Pulses paradoxes JVD BRADYcardia HYPOtension Dyspnea Fatigue
15
Q
Max O2 flow for simple face mask?
A
5-8 L
16
Q
Is hypertension a venous or arterial disorder?
A
venous
17
Q
Risk factors for HYPERtension
A
>55 for men >65 for women smoking obesity sedentary lifestyle diabetes dyslipidemia family history decreased GFR African American race
18
Q
Max O2 flow for partial non-rebreather mask?
A
6-11 L
19
Q
What must be ensured with a partial non-rebreather mask?
A
bag must be 2/3 inflated
watch out for kinks
20
Q
Max 02 flow for a non-rebreather?
A
10-15 L
21
Q
Which type of high-flow O2 device is color coded?
A
Venturi Mask
24-54% FiO2
22
Q
Hypertension masks the symptoms of what condition?
A
HYPOglycemia
23
Q
Before treatment of hypertension, what should you ask the patient?
A
if they’ve had caffeine or exercised recently
24
Q
What are 4 manifestations of advanced hypertension?
A
headache
blurred vision
nosebleed
depression
25
What is the normal creatinine clearance for men? women?
Men: 107-139
Women: 87-107
26
What is the usual treatment for hypertension?
thiazide diuretics
27
Which cardiac condition requires the use of soft toothbrushes?
infective endocarditis
28
Satan avoids
potassium
29
What class of drug for HYPERtension should you NOT have grapefruit juice with?
Calcium channel blockers
30
What masks the symptoms of HYPOglycemia?
beta blockers and HYPERtension
31
What drugs can worsten HYPOnatremia?
diuretics
32
You should look out for the worstening of Gout when taking which medication?
diuretics
33
Recommeneded exercise
3-4x/week
| for 40 minutes
34
Sodium recommendations:
no more than 2.4 g
| 2400mg
35
DASH diet for HTN:
grains: 6-8
fruits/veggies: 4-5
dairy: 2-3
fats/oils: 2-3
Sugar: 5x/week
36
What up with low molecular weight heparin?
stop IV heparin 30 minutes before SQ injection (and don't restart the IV)
37
Antidote for Coumadin (Wafarin)
Vitamin K
38
Antidote for Heparin:
protamine sulfate
39
Suffix for low molecular weight heparin
-parin (Enoxaparin)
40
If creatinine level is greater than 2, we expect
we expect to lower the dose of Heparin
41
What do you monitor for Warfarin adminstration?
PT/INR (1.5-2.0)
42
What precautions must be administered when giving Heparin?
no IM injections
| soft toothbrushes
43
What do you monitor for Heparin admistration?
PTT
44
What is the alternative medication for DVT?
Bivalirudin (Angiomax)
45
When switching from IV to PO warfarin, you give the PO med _____ discontinuing IV.
BEFORE
46
What shouldn't you eat when taking Coumadin?
green leafy veggies (potassium)
47
If INR is between ____ notify HCP.
4.5-6
48
Prescribed tx for varicose veins:
sclerotherapy
laser ablation therapy
ligation and stripping
49
Hallamrk characteristics for a venous ulcer:
irregularly shaped border
| brown and brawny
50
Wound management for a venous ulcer:
Unna Boot
51
PVD diagnosis:
ABI of 0.5-0.9
52
Hallmark sign of PVD:
pale blanched appearance with extremity elevation
53
Describe the 4 stages of PVD:
I: asymptomatic
II: pain relieved with rest
III: rest pain that may wake the patient at night
IV: necrosis/gangrene
54
PVD meds:
```
aspirin
tiCOPidine
CLOPidogrel
Pentoxifylline
NifediPINE
amlodiPINE
hydraliZINE
Minoxidil
```
55
hallmark symptom of arterial ulcer
intermittent claudication
56
S&S of Acute arterial occlusive disease:
```
Pain
Pallor
Paralysis
Pulselessness
Paresthesia
Poikilothermia
```
57
What should you assess for with acute arterial occlusive disease?
CTP QHour for 24 hours
color
temp
pulse
58
Meds for Buerger's Disease (arterial AND venous inflammations):
CCBs (nephedpine)
59
S&S of Beurger's:
progressive claudication
| rest pain
60
Pain for abdominal vs thoracic aneurysms:
abdominal: abdomen, steady and lasts hours or days and pushes left of midline, 5cm or larger
thoracic: diaphragm, SOB, hoarseness, visible mass at angle of louie
61
Suspected rupture for abdominal vs thoracic aneurysms:
abdominal: sudden severe pain in back or lower abs
thoracic: sudden severe pain the chest or back
62
What do you have to monitor after surgery on an aneurysm?
creatinine levels
63
Patho of Alzheimer's:
presence of plaques and near tangles in the brain
64
Risk factors of Alzheimers:
women over 65
| family hx
65
Alzheimer's Stages and nursing management:
Stage I: Early - independent ADLs, provide reality orientation
Stage II: Middle - wandering, money px, ADL px
Stage III: Late - bedridden, hallucinations, agnosia - use validation therapy
66
4 A's for Alzheimers:
Anomia - can't find words
Aphasia - can't speak/understand
Agnosia - can't recognize faces
Apraxia - can't use words/objects correctly
67
Cognition changes happen in which part of the brain?
Frontal
68
What kind of questions should you ask Alzheimer's patients?
Yes/No
69
Parkinson's patho:
atrophy of basal ganglia
loss of dopamine
secondary to brain injury
70
Parkinson's S&S:
TRAP
Tremors
Rigidity
Akinesia
Postural instabliity
71
Multiple Sclerosis Patho:
demyelination and scarring of myelin sheaths (autoimmune)
| women 2X more likely 20-50 years
72
What does relapsing remitting MS turn into?
secondary progressive MS
73
S&S of MS:
hypalgesia
dysmetria
everything goes to shit
74
Which type of MS will NOT return the pt to baseline?
progressive-relapsing
75
Which type of MS has no remission?
primary progressive
76
Patho of myasthenia gravis:
weakness of voluntary mm r/t not enough acetylcholine and excess cholinesterase
77
Dx for MG:
Tensilon test
| 30 second test tells us which kind of crisis the patient is in.
78
Types of MG:
```
I: ocular myasthenia
II: mild/generalized
IIB: moderate/bulbar paralysis (have to hold head with hands)
III: acute respiratory crisis
IV: chronic and progressive
```
79
Management of MG:
Mestinon therapy - sit up for 1 hour after
80
S&S of myastheic crisis vs. cholinergic crisis:
```
Myasthenic (speed up):
Increased HR
Increased RR
Increased BP
Bowel/bladder incontinence
Decreased urine output (hold it in, we're doing stuff)
Decreased swallowing/coughing
```
```
Cholinergic (slow down):
Decreased HR
Decreased RR (bronchospasm)
Flaccid paralysis
Hyper-secretion of saliva/sweat and tears
N/V/diarrhea
Ptosis
Myosis
```
81
Priority intervention for a myasthenic crisis:
maintain respiratory function
82
Priority intervention for a cholinergic crisis:
atropine to reverse OD
83
Patient teaching for MG:
avoid temperature changes
| avoid aspiration r/t overeating
84
Gullian - Barre dx and tx:
dx: ascending paralysis with hx of infection (more males)
Tx: phoresis procedure
85
What tests do you have to run for Guillain-Barre
cranial nerves (#7)
86
Dx of seizures:
EEG - don't drink caffeine, don't sleep, make sure hair is clean before procedure
87
Types of seizures (overview):
Partial Simple IA: conscious, aura, unilateral movement
Partial Complex IB: LossOC 1-3min, amnesia after, temporal lobe, commonly in new onset of diabetes, HTN, cardiac px, etc.)
General: sudden LossOC, symmetrical abnormal movements, cerebral hemispheres
Status Epilepticus: risk of death after 10 minutes, check dilantin levels (10-20)
88
Types of GENERAL seizures:
Absense: momentary LOC, sudden onset
Myoclonic: symmetrical or asymmetrical, lasts seconds
Atonic/Akinetic: sudden loss of mm tone, lasts seconds, resistant to drugs
Tonic-Clonic (Grand Mal): 2-5min, stiff arms/legs and jerking
89
What drugs do seizure pts go on?
the -pams
| phenytoin (check dilantin levels should be 10-20)
90
What do seizure precaution patients need to have?
suction/O2 available
| IV access
91
How long does Bell's Palsy last?
2-5 days
92
Care for Bell's Palsy:
steroids
acyclovir (antiviral)
eye care
93
What are the different types of TB?
Latent: they're infected without symptoms but NOT infectious
Active: infected and showing symptoms AND infectious
Secondary: reactivation
XDR: resistant to drugs
94
TB dx:
chest x ray
PPD (positive sign is induration of 5-10mm, NOT redness)
BCG will give a false positive
95
How do you that TB tx has been effective?
pt will have 3 consecutive (-) AFB smears
96
Hallmark sign of TB:
night sweats
97
Management of TB:
family does NOT have to wear N-95
| monitor phosphorous
98
How long should you pinch your nose with a nosebleed?
10 minutes
| learn forward, tip head down
99
What do you have to ask a patient about sleep apnea?
STOP BANG
Snoring
Tiredness
Observed cessation of breathing
Pressure(HTN meds?)
BMI >35
Age > 40
Neck circumference >40
Gender: male
answered yes for 3 or more Q's
100
Tx for sleep apnea
NO alcohol
| NO sleep meds
101
What do you have to assess for with a tracheostomy?
subcutaneous emphysema (crackling under skin)
102
What should you avoid with tracheotomy?
mouthwash that contains alcohol and glycerine
103
Alkalosis puts you at risk for ______.
digoxin toxicity
104
Metabolic ACIDosis breathing and skin:
breathing: Kussmaul
skin: warm, flushed, dry
105
Respiratory ACIDosis breathing and skin
breathing: shallow rapid
skin: pale and dry
106
Metabolic ALKYlosis breathing:
decreased respiratory effort b/c mm weakness
107
Respiratory ALKYlosis breathing:
increased rate and depth of ventilation
108
Steps for a spacer inhaler:
1. shake 3-4 times
2. exhale
3. release meds and breathe slowly
4. if you hear whistling you've done it too fast
109
How often do you clean your inhaler with spacer?
inhaler- 1x/day
| spacer- 1x/week
110
Complications of chronic bronchitis:
CHF
dysrhythmia
cor pulmonale
111
Risk factor of Pneumonia:
```
age >65
coexisting illness
kidney px
liver px
NO vaccine within 5 years
NO flu vaccine within previous year
```
112
Where do fungal lung infections come from?
desert/soil fungus
113
What is a empyema?
pleural effusion (pus/fluid)
114
Dx of empyema?
reduced chest wall motion
reduced fremitus
decreased breath sounds
115
Tx of empyema:
do not cough or move during thoracentisis THEN get a chest X-ray
116
What do you monitor for with pneumonia?
HYPERnatremia
117
Frequency of symptoms for mild intermittent asthma
2x/week or less
118
Frequency of symptoms for mild persistent asthma
more than 2x/week
| less than 1x/day
119
Frequency of symptoms for moderate persistent asthma
daily
120
Frequency of symptoms for severe persistent asthma:
continuous
121
Which can trigger asthma?
NSAIDs, beta blockers- eyedrops, cholinergics, foods with sulfites (fruit juice, wine, beer)
122
What up with the peak flow meter?
measures EXPIRATORY volume (pt breathes out)
Green zone: 80% above baseline (no S&S)
Yellow zone: 50-80% baseline (S&S appearing - if you're not back to green within an hour of med, go to hospital)
Red zone: 50% or less of baseline (use meds AND GO TO HOSPITAL)
123
What will you probably be prescribed for status asthmatics?
steroids
magnesium
O2
124
What are the 2 organisms that cause acute bacterial sinusitis?
Strep
| H. Influenzae
125
What up with first generation antihistamines (Benadryl)?
Do NOT give to old people - dry mouth
126
What's the one thing you do NOT do with chest tubes?
do NOT strip
127
What does too much bubbling mean? not enough?
too much: assess for sealed connection
| too little: check for blockage
128
Do you want tidaling?
yes - 5-10 cm with breath
129
What do you do if a chest tube becomes dislodged.
tape with gauze on 3 sides - leave lower part untaped (notify HCP and prepare for chest X-ray)
130
When do you have to call the HCP with a chest tube?
more than 70mL/hr
| O2 sat < 90%
