AH II Exam II Flashcards
What are the clinical manifestations of cardiac dysrhythmias?
palpitations anxiety fatigue pallor SOB HYPOtension
Which kind of cardiac patient is asymptomatic?
stable
How long is the average P wave? How many boxes?
0.12-0.20 seconds
3-5 boxes
How long is the average QRS complex?
less than 0.12 seconds
less than 3 little boxes
Patient teaching with a pacemaker:
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
Etiology of sinus bradycardia:
valsalva gagging/vomitting suctioning conditioned athletes beta blockers
Etiology of sinus tachycardia
stimulants
exercise
stress
infection
What must be administered when “pacing a patient”?
pain meds
How many liters/min can a nasal cannula take?
6 L
When is “pacing” indicated?
When atropine doesn’t work
5 S&S of myocarditis:
fever chest pain dyspnea heart failure dysrhythmias
Where do you read the O2 flow meter?
the middle of the ball
What is the #1 treatment for pericarditis? What if that doesn’t work?
- NSAIDs
2. colchicine for 3 months BID
S&S of Cardiac Tamponade
Pulses paradoxes JVD BRADYcardia HYPOtension Dyspnea Fatigue
Max O2 flow for simple face mask?
5-8 L
Is hypertension a venous or arterial disorder?
venous
Risk factors for HYPERtension
>55 for men >65 for women smoking obesity sedentary lifestyle diabetes dyslipidemia family history decreased GFR African American race
Max O2 flow for partial non-rebreather mask?
6-11 L
What must be ensured with a partial non-rebreather mask?
bag must be 2/3 inflated
watch out for kinks
Max 02 flow for a non-rebreather?
10-15 L
Which type of high-flow O2 device is color coded?
Venturi Mask
24-54% FiO2
Hypertension masks the symptoms of what condition?
HYPOglycemia
Before treatment of hypertension, what should you ask the patient?
if they’ve had caffeine or exercised recently
What are 4 manifestations of advanced hypertension?
headache
blurred vision
nosebleed
depression
What is the normal creatinine clearance for men? women?
Men: 107-139
Women: 87-107
What is the usual treatment for hypertension?
thiazide diuretics
Which cardiac condition requires the use of soft toothbrushes?
infective endocarditis
Satan avoids
potassium
What class of drug for HYPERtension should you NOT have grapefruit juice with?
Calcium channel blockers
What masks the symptoms of HYPOglycemia?
beta blockers and HYPERtension
What drugs can worsten HYPOnatremia?
diuretics
You should look out for the worstening of Gout when taking which medication?
diuretics
Recommeneded exercise
3-4x/week
for 40 minutes
Sodium recommendations:
no more than 2.4 g
2400mg
DASH diet for HTN:
grains: 6-8
fruits/veggies: 4-5
dairy: 2-3
fats/oils: 2-3
Sugar: 5x/week
What up with low molecular weight heparin?
stop IV heparin 30 minutes before SQ injection (and don’t restart the IV)
Antidote for Coumadin (Wafarin)
Vitamin K
Antidote for Heparin:
protamine sulfate
Suffix for low molecular weight heparin
-parin (Enoxaparin)
If creatinine level is greater than 2, we expect
we expect to lower the dose of Heparin
What do you monitor for Warfarin adminstration?
PT/INR (1.5-2.0)
What precautions must be administered when giving Heparin?
no IM injections
soft toothbrushes
What do you monitor for Heparin admistration?
PTT
What is the alternative medication for DVT?
Bivalirudin (Angiomax)
When switching from IV to PO warfarin, you give the PO med _____ discontinuing IV.
BEFORE
What shouldn’t you eat when taking Coumadin?
green leafy veggies (potassium)
If INR is between ____ notify HCP.
4.5-6
Prescribed tx for varicose veins:
sclerotherapy
laser ablation therapy
ligation and stripping
Hallamrk characteristics for a venous ulcer:
irregularly shaped border
brown and brawny
Wound management for a venous ulcer:
Unna Boot
PVD diagnosis:
ABI of 0.5-0.9
Hallmark sign of PVD:
pale blanched appearance with extremity elevation
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
PVD meds:
aspirin tiCOPidine CLOPidogrel Pentoxifylline NifediPINE amlodiPINE hydraliZINE Minoxidil
hallmark symptom of arterial ulcer
intermittent claudication
S&S of Acute arterial occlusive disease:
Pain Pallor Paralysis Pulselessness Paresthesia Poikilothermia
What should you assess for with acute arterial occlusive disease?
CTP QHour for 24 hours
color
temp
pulse
Meds for Buerger’s Disease (arterial AND venous inflammations):
CCBs (nephedpine)
S&S of Beurger’s:
progressive claudication
rest pain
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
Suspected rupture for abdominal vs thoracic aneurysms:
abdominal: sudden severe pain in back or lower abs
thoracic: sudden severe pain the chest or back
What do you have to monitor after surgery on an aneurysm?
creatinine levels
Patho of Alzheimer’s:
presence of plaques and near tangles in the brain
Risk factors of Alzheimers:
women over 65
family hx
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
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
Cognition changes happen in which part of the brain?
Frontal
What kind of questions should you ask Alzheimer’s patients?
Yes/No
Parkinson’s patho:
atrophy of basal ganglia
loss of dopamine
secondary to brain injury
Parkinson’s S&S:
TRAP
Tremors
Rigidity
Akinesia
Postural instabliity
Multiple Sclerosis Patho:
demyelination and scarring of myelin sheaths (autoimmune)
women 2X more likely 20-50 years
What does relapsing remitting MS turn into?
secondary progressive MS
S&S of MS:
hypalgesia
dysmetria
everything goes to shit
Which type of MS will NOT return the pt to baseline?
progressive-relapsing
Which type of MS has no remission?
primary progressive
Patho of myasthenia gravis:
weakness of voluntary mm r/t not enough acetylcholine and excess cholinesterase
Dx for MG:
Tensilon test
30 second test tells us which kind of crisis the patient is in.
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
Management of MG:
Mestinon therapy - sit up for 1 hour after
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
Priority intervention for a myasthenic crisis:
maintain respiratory function
Priority intervention for a cholinergic crisis:
atropine to reverse OD
Patient teaching for MG:
avoid temperature changes
avoid aspiration r/t overeating
Gullian - Barre dx and tx:
dx: ascending paralysis with hx of infection (more males)
Tx: phoresis procedure
What tests do you have to run for Guillain-Barre
cranial nerves (#7)
Dx of seizures:
EEG - don’t drink caffeine, don’t sleep, make sure hair is clean before procedure
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)
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
What drugs do seizure pts go on?
the -pams
phenytoin (check dilantin levels should be 10-20)
What do seizure precaution patients need to have?
suction/O2 available
IV access
How long does Bell’s Palsy last?
2-5 days
Care for Bell’s Palsy:
steroids
acyclovir (antiviral)
eye care
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
TB dx:
chest x ray
PPD (positive sign is induration of 5-10mm, NOT redness)
BCG will give a false positive
How do you that TB tx has been effective?
pt will have 3 consecutive (-) AFB smears
Hallmark sign of TB:
night sweats
Management of TB:
family does NOT have to wear N-95
monitor phosphorous
How long should you pinch your nose with a nosebleed?
10 minutes
learn forward, tip head down
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
Tx for sleep apnea
NO alcohol
NO sleep meds
What do you have to assess for with a tracheostomy?
subcutaneous emphysema (crackling under skin)
What should you avoid with tracheotomy?
mouthwash that contains alcohol and glycerine
Alkalosis puts you at risk for ______.
digoxin toxicity
Metabolic ACIDosis breathing and skin:
breathing: Kussmaul
skin: warm, flushed, dry
Respiratory ACIDosis breathing and skin
breathing: shallow rapid
skin: pale and dry
Metabolic ALKYlosis breathing:
decreased respiratory effort b/c mm weakness
Respiratory ALKYlosis breathing:
increased rate and depth of ventilation
Steps for a spacer inhaler:
- shake 3-4 times
- exhale
- release meds and breathe slowly
- if you hear whistling you’ve done it too fast
How often do you clean your inhaler with spacer?
inhaler- 1x/day
spacer- 1x/week
Complications of chronic bronchitis:
CHF
dysrhythmia
cor pulmonale
Risk factor of Pneumonia:
age >65 coexisting illness kidney px liver px NO vaccine within 5 years NO flu vaccine within previous year
Where do fungal lung infections come from?
desert/soil fungus
What is a empyema?
pleural effusion (pus/fluid)
Dx of empyema?
reduced chest wall motion
reduced fremitus
decreased breath sounds
Tx of empyema:
do not cough or move during thoracentisis THEN get a chest X-ray
What do you monitor for with pneumonia?
HYPERnatremia
Frequency of symptoms for mild intermittent asthma
2x/week or less
Frequency of symptoms for mild persistent asthma
more than 2x/week
less than 1x/day
Frequency of symptoms for moderate persistent asthma
daily
Frequency of symptoms for severe persistent asthma:
continuous
Which can trigger asthma?
NSAIDs, beta blockers- eyedrops, cholinergics, foods with sulfites (fruit juice, wine, beer)
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)
What will you probably be prescribed for status asthmatics?
steroids
magnesium
O2
What are the 2 organisms that cause acute bacterial sinusitis?
Strep
H. Influenzae
What up with first generation antihistamines (Benadryl)?
Do NOT give to old people - dry mouth
What’s the one thing you do NOT do with chest tubes?
do NOT strip
What does too much bubbling mean? not enough?
too much: assess for sealed connection
too little: check for blockage
Do you want tidaling?
yes - 5-10 cm with breath
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)
When do you have to call the HCP with a chest tube?
more than 70mL/hr
O2 sat < 90%
