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ABSN > AH II Exam II > Flashcards

AH II Exam II Flashcards

1
Q

What are the clinical manifestations of cardiac dysrhythmias?

A 
palpitations
anxiety
fatigue 
pallor
SOB
HYPOtension
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2
Q

Which kind of cardiac patient is asymptomatic?

A

stable

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3
Q

How long is the average P wave? How many boxes?

A

0.12-0.20 seconds

3-5 boxes

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4
Q

How long is the average QRS complex?

A

less than 0.12 seconds

less than 3 little boxes

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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
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6
Q

Etiology of sinus bradycardia:

A 
valsalva 
gagging/vomitting
suctioning
conditioned athletes 
beta blockers
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7
Q

Etiology of sinus tachycardia

A

stimulants
exercise
stress
infection

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8
Q

What must be administered when “pacing a patient”?

A

pain meds

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9
Q

How many liters/min can a nasal cannula take?

A

6 L

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10
Q

When is “pacing” indicated?

A

When atropine doesn’t work

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11
Q

5 S&S of myocarditis:

A 
fever
chest pain
dyspnea
heart failure
dysrhythmias
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12
Q

Where do you read the O2 flow meter?

A

the middle of the ball

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13
Q

What is the #1 treatment for pericarditis? What if that doesn’t work?

A
  1. NSAIDs

2. colchicine for 3 months BID

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14
Q

S&S of Cardiac Tamponade

A 
Pulses paradoxes 
JVD
BRADYcardia
HYPOtension
Dyspnea
Fatigue
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15
Q

Max O2 flow for simple face mask?

A

5-8 L

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16
Q

Is hypertension a venous or arterial disorder?

A

venous

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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
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18
Q

Max O2 flow for partial non-rebreather mask?

A

6-11 L

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19
Q

What must be ensured with a partial non-rebreather mask?

A

bag must be 2/3 inflated

watch out for kinks

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20
Q

Max 02 flow for a non-rebreather?

A

10-15 L

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21
Q

Which type of high-flow O2 device is color coded?

A

Venturi Mask

24-54% FiO2

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22
Q

Hypertension masks the symptoms of what condition?

A

HYPOglycemia

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23
Q

Before treatment of hypertension, what should you ask the patient?

A

if they’ve had caffeine or exercised recently

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24
Q

What are 4 manifestations of advanced hypertension?

A

headache
blurred vision
nosebleed
depression

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25
Q

What is the normal creatinine clearance for men? women?

A

Men: 107-139
Women: 87-107

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26
Q

What is the usual treatment for hypertension?

A

thiazide diuretics

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27
Q

Which cardiac condition requires the use of soft toothbrushes?

A

infective endocarditis

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28
Q

Satan avoids

A

potassium

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29
Q

What class of drug for HYPERtension should you NOT have grapefruit juice with?

A

Calcium channel blockers

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30
Q

What masks the symptoms of HYPOglycemia?

A

beta blockers and HYPERtension

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31
Q

What drugs can worsten HYPOnatremia?

A

diuretics

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32
Q

You should look out for the worstening of Gout when taking which medication?

A

diuretics

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33
Q

Recommeneded exercise

A

3-4x/week

for 40 minutes

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34
Q

Sodium recommendations:

A

no more than 2.4 g

2400mg

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35
Q

DASH diet for HTN:

A

grains: 6-8
fruits/veggies: 4-5
dairy: 2-3
fats/oils: 2-3

Sugar: 5x/week

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36
Q

What up with low molecular weight heparin?

A

stop IV heparin 30 minutes before SQ injection (and don’t restart the IV)

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37
Q

Antidote for Coumadin (Wafarin)

A

Vitamin K

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38
Q

Antidote for Heparin:

A

protamine sulfate

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39
Q

Suffix for low molecular weight heparin

A

-parin (Enoxaparin)

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40
Q

If creatinine level is greater than 2, we expect

A

we expect to lower the dose of Heparin

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41
Q

What do you monitor for Warfarin adminstration?

A

PT/INR (1.5-2.0)

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42
Q

What precautions must be administered when giving Heparin?

A

no IM injections

soft toothbrushes

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43
Q

What do you monitor for Heparin admistration?

A

PTT

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44
Q

What is the alternative medication for DVT?

A

Bivalirudin (Angiomax)

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45
Q

When switching from IV to PO warfarin, you give the PO med _____ discontinuing IV.

A

BEFORE

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46
Q

What shouldn’t you eat when taking Coumadin?

A

green leafy veggies (potassium)

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47
Q

If INR is between ____ notify HCP.

A

4.5-6

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48
Q

Prescribed tx for varicose veins:

A

sclerotherapy
laser ablation therapy
ligation and stripping

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49
Q

Hallamrk characteristics for a venous ulcer:

A

irregularly shaped border

brown and brawny

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50
Q

Wound management for a venous ulcer:

A

Unna Boot

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51
Q

PVD diagnosis:

A

ABI of 0.5-0.9

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52
Q

Hallmark sign of PVD:

A

pale blanched appearance with extremity elevation

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53
Q

Describe the 4 stages of PVD:

A

I: asymptomatic
II: pain relieved with rest
III: rest pain that may wake the patient at night
IV: necrosis/gangrene

54
Q

PVD meds:

A 
aspirin 
tiCOPidine
CLOPidogrel
Pentoxifylline
NifediPINE
amlodiPINE
hydraliZINE
Minoxidil
55
Q

hallmark symptom of arterial ulcer

A

intermittent claudication

56
Q

S&S of Acute arterial occlusive disease:

A 
Pain
Pallor
Paralysis
Pulselessness
Paresthesia 
Poikilothermia
57
Q

What should you assess for with acute arterial occlusive disease?

A

CTP QHour for 24 hours
color
temp
pulse

58
Q

Meds for Buerger’s Disease (arterial AND venous inflammations):

A

CCBs (nephedpine)

59
Q

S&S of Beurger’s:

A

progressive claudication

rest pain

60
Q

Pain for abdominal vs thoracic aneurysms:

A

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
Q

Suspected rupture for abdominal vs thoracic aneurysms:

A

abdominal: sudden severe pain in back or lower abs
thoracic: sudden severe pain the chest or back

62
Q

What do you have to monitor after surgery on an aneurysm?

A

creatinine levels

63
Q

Patho of Alzheimer’s:

A

presence of plaques and near tangles in the brain

64
Q

Risk factors of Alzheimers:

A

women over 65

family hx

65
Q

Alzheimer’s Stages and nursing management:

A

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
Q

4 A’s for Alzheimers:

A

Anomia - can’t find words
Aphasia - can’t speak/understand
Agnosia - can’t recognize faces
Apraxia - can’t use words/objects correctly

67
Q

Cognition changes happen in which part of the brain?

A

Frontal

68
Q

What kind of questions should you ask Alzheimer’s patients?

A

Yes/No

69
Q

Parkinson’s patho:

A

atrophy of basal ganglia
loss of dopamine
secondary to brain injury

70
Q

Parkinson’s S&S:

A

TRAP

Tremors
Rigidity
Akinesia
Postural instabliity

71
Q

Multiple Sclerosis Patho:

A

demyelination and scarring of myelin sheaths (autoimmune)

women 2X more likely 20-50 years

72
Q

What does relapsing remitting MS turn into?

A

secondary progressive MS

73
Q

S&S of MS:

A

hypalgesia
dysmetria
everything goes to shit

74
Q

Which type of MS will NOT return the pt to baseline?

A

progressive-relapsing

75
Q

Which type of MS has no remission?

A

primary progressive

76
Q

Patho of myasthenia gravis:

A

weakness of voluntary mm r/t not enough acetylcholine and excess cholinesterase

77
Q

Dx for MG:

A

Tensilon test

30 second test tells us which kind of crisis the patient is in.

78
Q

Types of MG:

A 
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
Q

Management of MG:

A

Mestinon therapy - sit up for 1 hour after

80
Q

S&S of myastheic crisis vs. cholinergic crisis:

A 
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
Q

Priority intervention for a myasthenic crisis:

A

maintain respiratory function

82
Q

Priority intervention for a cholinergic crisis:

A

atropine to reverse OD

83
Q

Patient teaching for MG:

A

avoid temperature changes

avoid aspiration r/t overeating

84
Q

Gullian - Barre dx and tx:

A

dx: ascending paralysis with hx of infection (more males)
Tx: phoresis procedure

85
Q

What tests do you have to run for Guillain-Barre

A

cranial nerves (#7)

86
Q

Dx of seizures:

A

EEG - don’t drink caffeine, don’t sleep, make sure hair is clean before procedure

87
Q

Types of seizures (overview):

A

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
Q

Types of GENERAL seizures:

A

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
Q

What drugs do seizure pts go on?

A

the -pams

phenytoin (check dilantin levels should be 10-20)

90
Q

What do seizure precaution patients need to have?

A

suction/O2 available

IV access

91
Q

How long does Bell’s Palsy last?

A

2-5 days

92
Q

Care for Bell’s Palsy:

A

steroids
acyclovir (antiviral)
eye care

93
Q

What are the different types of TB?

A

Latent: they’re infected without symptoms but NOT infectious
Active: infected and showing symptoms AND infectious
Secondary: reactivation
XDR: resistant to drugs

94
Q

TB dx:

A

chest x ray
PPD (positive sign is induration of 5-10mm, NOT redness)
BCG will give a false positive

95
Q

How do you that TB tx has been effective?

A

pt will have 3 consecutive (-) AFB smears

96
Q

Hallmark sign of TB:

A

night sweats

97
Q

Management of TB:

A

family does NOT have to wear N-95

monitor phosphorous

98
Q

How long should you pinch your nose with a nosebleed?

A

10 minutes

learn forward, tip head down

99
Q

What do you have to ask a patient about sleep apnea?

A

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
Q

Tx for sleep apnea

A

NO alcohol

NO sleep meds

101
Q

What do you have to assess for with a tracheostomy?

A

subcutaneous emphysema (crackling under skin)

102
Q

What should you avoid with tracheotomy?

A

mouthwash that contains alcohol and glycerine

103
Q

Alkalosis puts you at risk for ______.

A

digoxin toxicity

104
Q

Metabolic ACIDosis breathing and skin:

A

breathing: Kussmaul
skin: warm, flushed, dry

105
Q

Respiratory ACIDosis breathing and skin

A

breathing: shallow rapid
skin: pale and dry

106
Q

Metabolic ALKYlosis breathing:

A

decreased respiratory effort b/c mm weakness

107
Q

Respiratory ALKYlosis breathing:

A

increased rate and depth of ventilation

108
Q

Steps for a spacer inhaler:

A
  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
Q

How often do you clean your inhaler with spacer?

A

inhaler- 1x/day

spacer- 1x/week

110
Q

Complications of chronic bronchitis:

A

CHF
dysrhythmia
cor pulmonale

111
Q

Risk factor of Pneumonia:

A 
age >65
coexisting illness
kidney px 
liver px 
NO vaccine within 5 years 
NO flu vaccine within previous year
112
Q

Where do fungal lung infections come from?

A

desert/soil fungus

113
Q

What is a empyema?

A

pleural effusion (pus/fluid)

114
Q

Dx of empyema?

A

reduced chest wall motion
reduced fremitus
decreased breath sounds

115
Q

Tx of empyema:

A

do not cough or move during thoracentisis THEN get a chest X-ray

116
Q

What do you monitor for with pneumonia?

A

HYPERnatremia

117
Q

Frequency of symptoms for mild intermittent asthma

A

2x/week or less

118
Q

Frequency of symptoms for mild persistent asthma

A

more than 2x/week

less than 1x/day

119
Q

Frequency of symptoms for moderate persistent asthma

A

daily

120
Q

Frequency of symptoms for severe persistent asthma:

A

continuous

121
Q

Which can trigger asthma?

A

NSAIDs, beta blockers- eyedrops, cholinergics, foods with sulfites (fruit juice, wine, beer)

122
Q

What up with the peak flow meter?

A

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
Q

What will you probably be prescribed for status asthmatics?

A

steroids
magnesium
O2

124
Q

What are the 2 organisms that cause acute bacterial sinusitis?

A

Strep

H. Influenzae

125
Q

What up with first generation antihistamines (Benadryl)?

A

Do NOT give to old people - dry mouth

126
Q

What’s the one thing you do NOT do with chest tubes?

A

do NOT strip

127
Q

What does too much bubbling mean? not enough?

A

too much: assess for sealed connection

too little: check for blockage

128
Q

Do you want tidaling?

A

yes - 5-10 cm with breath

129
Q

What do you do if a chest tube becomes dislodged.

A

tape with gauze on 3 sides - leave lower part untaped (notify HCP and prepare for chest X-ray)

130
Q

When do you have to call the HCP with a chest tube?

A

more than 70mL/hr

O2 sat < 90%

ABSN (18 decks)

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